EVALUATION OF THE COMMUNITIES SUPPORTING
HEALTH, HIV/AIDS, GENDER EQUITY, AND EDUCATION
IN SCHOOLS (CHANGES) PROGRAM IN ZAMBIA
April 2005
This publication was produced for review by the United States Agency for
1nternational Development. It was prepared by Aguirre International under a
contract with Creative Associates International, Inc. Its authors are Richard
Kraft, Stephen McLaughlin, Catherine Mukuka, and Francis Sampa.
EVALUIATIONi OF THE, COMMUNITI,ES SUPPORTING
HEALTH" HIVJAIDS'" GEN.DER E.QUITY, AND, EDUCATION'
IN SCHOOLS (CH'ANiGES) PROGRAM INi ZAMBIA
A Report prepared for review by the United States Agency for International
Development (USAID) by Aguirre International under a subcontract with Creative Associates
International, Inc., and funded by the Basic Education, Policy and Support (BEPS) Activity
Contract # HNE-I-00-00-00038-00, Task Order #807.
The authors' views expressed in this publication do not necessarily reflect the views
of the United States Agency for International Development or the United States
Government.
CHANGES Program Evaluation
Women, Girls and HIVIAIDS
Written and Directed by Mrs. J. Jushoke
Performed for the Evaluation Team
Nalituwe Basic School
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CHANGES Program Evaluation
Table of Contents
Acronym Glossary
I. Executive Summary
II. Historical, Political and Social Issues: Education
III. Historical, Political and Social Issues: Health
IV. The CHANGES Programme
V. Ministry ofHealth Restructuring
VI. Ministry ofEducation Restructuring
VII. School Health and Nutrition
VIII. School Health and Nutrition (SHN) Programme
IX. Community Sensitisation and Mobilisation (CSMC) Programme
X. Small Grant Mechanism
XI. Ambassador Girls' Scholarship Programme
XII. Scaling Up
Bibliography
Annexes
Annex One: Persons Interviewed 75
Annex Two: School Health and Nutrition Competition Assessment Tool 84
Annex Three: SHN Continuous School Evaluation Questionnaire 87
Annex Four: Re-Structured Ministry of Education 88
Annex Five: The CHANGES Programme in the Context ofZambian Education 89
Annex Six: Service Learning and Community Service as an HIV/AIDS Prevention 96
Annex Seven: Ministry ofHealth Structure 98
Annex Eight: Excerpts from the National SHN Policy 99
Annex Nine: Options for Implementation of School Health and Nutrition Programmes 101
Annex Ten: CSMC Model 103
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CHANGES Program Evaluation
Acronym Glossary
AEI
AGSP
AIDS
ARV
BEPS
BESSIP
CARE
CBO
CBoH
CDA
CDC
CFPP
CHANGES
CHIF
CHW
CSMC
DC
DEBS
DEO
DHMT
DHS
ECZ
EFA
EMIS
EP
ESO
FAWEZA
FBO
FPP
FRESH
GDP
GRZ
HIPC
HIV
HW
IDA
IEC
JICA
LBT
MCDSS
MOE
MOH
MOU
NBTL
NFNC
NGO
NHC
African Education Initiative
Ambassador Girls' Scholarship Program
Acquired Immunodeficiency Syndrome
Anti-retroviral Drugs
Basic Education and Policy Support
Basic Education Sub-sector Investment Program
Co-operative for Relief Assistance Everywhere
Community based organisation
Central Board ofHealth
Community Development Assistants
Curriculum Development Centre
Community Focal Point Person:
Communities Supporting Health, HIV/AIDS, Gender Equity, and
Education in Schools
Community Health Innovation Fund
Community Health Worker
Community Sensitisation and Mobilisation Campaign
District Commissioner
District Education Board Secretary
District Education Officer
District Health Management Team
Demographic Health Survey
Examinations Council ofZambia
Education for All
Education Management Information System
Eastern Province
Education Standards Officer
Forum for African Women Educationalists ofZambia
Faith-based organization
Focal Point Person
Focusing Resources on Effective School Health
Gross domestic product
Government ofthe Republic ofZatnbia
Highly Indebted Poor Countries,
Human Immunodeficiency Virus
Health Worker
Iron Deficiency Anaemia
Information Education and Communication
Japan International Co-operation Agency
Let's Build Together
Ministry ofCommunity Development and Social Services
Ministry ofEducation
Ministry ofHealth
Memorandum ofUnderstanding
New Breakthrough to Literacy Prinlary Reading Program
National Food and Nutrition Commission
Non-governmental organisation
Neighbourhood Health Committee
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OVC
PAGE
PCD
PEO
PEPFAR
PRP
PTA
SACMEQ
SAFE
SCI
SESO
SFPP
SHN
SI
SIAPAC
SP
SPRINT
STI
TDRC
TED
TOT
TTC
UN
UNAIDS
UNDP
UNESCO
UNICEF
UNZA
USAID
USG
UTH
VIP
WFP
WHO
ZATEC
Z-CAI
ZCF
ZEST
CHANGES Program Evaluation
Orphans and Vulnerable Children
Program for the Advancement of Girls' Education
Partnership for Child Development
Provincial Education Officer
President's Emergency Plan for AIDS Relief
Zambia Primary Reading Program
Parent Teacher Association
Southern Africa Consortium forthe Measurement ofEducational Quality
Students' Alliance for Female Education
Schistosomiasis Control Initiative
Senior Education Standards Officer
School Focal Point Person
School Health and Nutrition
Successful Intelligence
Social Impact Assessment and Policy Analysis Corporation
Southern Province
School Program for In-Service for a Term
Sexually Transmitted Infections
Tropical Diseases Research Centre
Teacher Education Department
Training oftrainers
Teachers Training College
United Nations
Joint United Nations Programme on HIV/AIDS
United Nations Development Program
United Nations Educational Scientific and Cultural Organisation
United Nations Children's Fund
University ofZambia
United States Agency for International Development
United States Government
University Teaching Hospital
Ventilated Improved Pit Latrine
World Food Program
World Health Organisation
Zambia Teacher Education Course
Zambia Cognitive Assessment Instrument
Zonal Community Facilitator
Zonal Education Support Team
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CHANGES Program Evaluation
I. EXECUTIVE SUMMARY
This process evaluation ofthe CHANGES programme includes an analysis ofits three
major components: School Health and Nutrition (SHN), Community Sensitisation and
Mobilisation (CSMC), and Small Grants. It also examines the two cross-cutting issues of
HIV/AIDS and Gender Equity, within the context ofthe three major programme
components.
We conclude that the CHANGES programme has fulfilled its major goals of putting in
place excellent models for School Heath and Nutrition (SHN) and the Community
Sensitisation Mobilisation Campaign (CSMC), in addition to a well-functioning small
grants model. We recommend that the GRZ, with international assistance, scale up the
various aspects ofthe programme to reach beyond the two CHANGES provinces. The
Memoranda ofDnderstanding have broken new ground in inter-ministerial cooperation in
Zambia, by bringing together personnel and resources from the Ministries ofEducation,
Health, and more recently with an international agency, SCI. The Ministry of
Community Development and Social Services also has had an informal agreement to
participate in the programme. This cooperation has created, particularly at the zonal level,
a significant partnership to confront the educational, health and social needs of Zambian
school children and communities.
CHANGES concentrates on school health and nutrition needs in the Eastern Province and
3 districts in the Southern Province. There is solid evidence that the SHN has not only
had positive effects on the cognitive development ofstudents, but that teachers can be
trained to be full participants in the administration of drugs and in the improvement ofthe
health and nutrition in their schools. "Production units," involving school fields and
gardens, however, do not yet appear to be significant components of improving nutrition.
Community Sensitization and Mobilization (CSMC), which focuses on issues of gender
and HIVIAIDS, is now in all 11 districts ofthe Southern Province. Its effectiveness in
changing deeply rooted cultural beliefs and behaviours could serve as an international
model on confronting behaviours leading to HIVIAIDS and addressing the importance of
girls' education. The third major component ofthe CHANGES Programme is the Small
Grants Mechanism. Its goals have remained unchanged: increase the participation of girls
and other vulnerable children in basic education; integrate messages about HIVIAIDS,
life skills and appropriate behaviours into ongoing school-community and district-level
education activities; and improve learning, health, and nutrition of prinlary school
students through innovative SHN activities. Programmes in over 130 schools and
communities have led to infrastructure improvements, capacity-building, and community
sensitisation and mobilisation.
CHANGES
1. Finding: The MOD between the MOE and MOH, and more recently the MOD
between MOE, MOH and SCI are an important mechanism to promote cooperation on
issues affecting children and communities. The informal understanding, between the
MOE, MOH and the MCDSS at the provincial level has also served to bring that
Ministry into increasing cooperation with the programme.
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Recommendation: Any cross-cutting issues in the future should seek similar MODs
between relevant ministries, with an inter-ministerial Implementation Committee and
Chief of Programme housed in the MOE, and coordinators in MOH and MCDSS, to
assure that it is seen as an inter-ministerial activity. Given the importance of
production units and school nutrition, the Ministry ofAgriculture could be formally or
informally added.
2. Finding: A programme with two different focuses (SHN and CSMC) and two cross￾cutting issues (HIY/AIDS and Small Grant) can and does function well, despite very
different goals, objectives and outcomes.
Recommendation: It is critical to have a strong central office and provincial
coordinators and staff, particularly if any new programme seeks to scale up
nationwide.
3. Finding: While the Programme dealt with two important and even critical issues,
school health and community mobilization; it was not focused on the central roles of
teaching and learning in schools.
Recommendation: Any new programme should attempt to include one or more
educationally central components, to assure a "seat at the table:" e.g. multi-grade
materials and training; pre- and in-service teacher training; special needs; community
schools; clinical supervision; "Read-On" for grades 3-7; PTA and Community
Accountability; Out-of-School youth; or OYCs.
4. Finding: The restructuring ofthe MOE during the programme and ofthe MOH, prior
to its inception, made some aspects ofmanaging the programme more difficult.
Recommendation: It is critical for the functioning ofthis or future programmes, that
training and retraining occur, particularly in such critical areas as administration of
drugs and issues ofHIY/AIDS. Many personnel have been moved or replaced by
their respective ministries.
5. Finding: School enrolment, particularly for girls, and attendance increased and, to a
lesser extent, re-entry and retention of girls increased, as the result of children's
improved health from the drug and micro-nutrient treatment.
Recommendation: Parents, Community Members, Teachers and Head Teachers all
gave credit to CHANGES for the return of girls, who had left school due to
pregnancy, and the greater desire to enrol girls and have them remain in school for 7-9
years. Any new programme should maintain this focus.
Finding: CHANGES has developed a highly capable staff, with great capacity in all
aspects ofthe SHN and sensitization and mobilization model; research, training,
implementation, and action plans.
Recommendation: It is important that the skills ofthese highly qualified individuals
be utilized in any scale up ofthe current programme and in the development of new
directions.
6. Finding: Most Standards Officers still appear to utilize an inspectorial, generally
negative, approach to their monitoring and evaluation duties.
Recommendation: An important contribution of any new programme could be the
retraining of current Standards Officers or the formation of a new cadre ofHead
Teachers and Officers trained in new supervisory roles that assist teachers, rather than
in the traditional punitive, inspectorial role found in many countries.
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7. Finding: While CHANGES staff offer some workshops on HIVIAIDS and Gender
Equity for staff and students in the TTCs, it remains quite limited.
Recommendation: To have a broader impact on the overall educational system, any
future programme should seek to have a greater impact on the TTCs and the Teacher
Resource Centres, not just in HIV/AIDS and Gender Roles, but through a range of
workshops and/or courses that would assist future teachers in becoming genuine
"community" educators and developers. In addition, National Trainers could serve an
important in-service function in these and other topical areas.
School Health and Nutrition
1. Finding: Before beginning the SNH process, a detailed Situation Analysis was
conducted in the Eastern Province.
Recommendation: It will be critical in any scale-up or expansion ofthe model
beyond the Eastern Province and the three districts in the Southern Province, that a
Situation Analysis be conducted, so as to assure the appropriate health interventions.
2. Finding: The SHN programme has developed an excellent model to detail Inputs,
Outputs, Short-term outcomes and Long-term outcomes, in addition to listing
Antecedent and Mediating Variables. It has proven to be an exceptional model to
systematize school health in the whole Eastern Province and in three districts ofthe
Southern Province. .
Recommendation: In any scale-up of SHN, the many components ofthe model
should be carefully studied and used wherever appropriate.
3. Finding: The improvement of children's health, particularly as it involves de￾worming, schistosomiasis, and micro-nutrients, affects not only attendance and
enrolment, but has been shown through research to have positive effects on cognitive
development. The national SHN policy is being implemented in most schools. With
evidence of anaemia, a case for iron supplements can be made.
Recommendations: The SHN programme should be scaled up to eventually reach all
provinces, and carefully coordinated with all other MOE and MOH programmes
dealing with children's health. It also would be helpful to have EMIS disaggregate
grade 7 exam results to ascertain achievement effects on treated and non-treated
students.
4. Finding: Teachers are capable of being critically important persons in the health of
children, including the administration of drugs.
Recommendation: Teachers can be trained to assist the health sector in recognizing
symptoms, and sending children to clinics or hospitals for professional medical care.
School health should be a part ofthe pre-service teacher education programme.
5. Finding: While many schools had "production units," they did not function as
important sources offood or nutrition for students. They were more likely to serve as
a location for agricultural or vocational learning. They should not be seen as sources
of child labour.
Recommendation: School feeding programmes or even snacks were seen as critically
important for schools in particularly poor areas, for the many OVCs and to promote
girl's enrolment and retention. The name "production unit" should be changed to
"school feeding units" or "school food gardens" to assure their even limited use to
provide nutrients to children.
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6. Finding: The SHN programme ofCHANGES has not only gone well beyond its
original goals in de-worming and other interventions, but has provided exceptionally
good manuals, assessment tools, health cards, measuring poles, and charts that are now
in use throughout the country.
Recommendation: It is critical to utilise the lessons learned by CHANGES on
treating whole schools and communities, and assuring that all schools have SHN
manuals.
7. Finding: The School Health and Nutrition Competition Assessn1ent Tool and
Evaluation Questionnaire provides excellent means for evaluating and measuring a
wide range of School Health and Nutrition elements.
Reconlmendation: Similar instruments should be developed for use in measuring a
range of academic school issues.
Community Sensitization and Mobilization Campaign
1. Finding: The CSMC model has worked very well in effectively reaching deep into
rural communities, to a depth seldom attained by regular Ministry activities.
Recommendation: The CSMC model could be used for many additional
components ofschooling and health, not just those found under SHN, HIY/AIDS and
Gender Equity.
2. Finding: There is excellent cooperation and collaboration between the community
development workers, health professionals and education officers at the zonal level,
with apparently less effectiveness at higher levels.
Recommendation: Under any new programme, it will be important to continue
developing these linkages between the MCDSS, with their intimate community
knowledge, MOH with their health professionals who provide daily medical
assistance, and the MOE education officers, who work closely with the schools.
3. Finding: CSMC has strong credibility in rural communities confronting a range of
issues concerning HIY/AIDS and Gender Roles. Traditional drama, poetry, and
community meetings appear particularly effective, while English language posters and
instructional materials appear to have less effect among the many non-English reading
children and community members.
Recommendation: The model could be used to confront a broad array ofissues
facing rural Zambia, but must always be specially tailored to meet the cultural and
linguistic needs ofthe community. Since a full national expansion ofthe programme
is unlikely to be financially feasible, any new programme should carefully target
districts which appear to be suffering from low girl's enrolment, cultural practices
affecting early marriage and pregnancy, high HIY/AIDS rates, extreme poverty and
large numbers ofOYCs.
4. Finding: In a sense, the gender equity activity and the SHN activity are partially
victims oftheir own success, with so many returning girls and even more retained,
many schools no longer have sufficient space to meet demand.
Recommendation: The MOE must place priority on the creation of more school
spaces.
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5. Finding: Textbooks, library books, and other instructional materials are extremely
rare in most classrooms, and it is even rarer to find students reading or writing
original text.
Recommendation: It is critical that a wide variety of printed materials in both
Mother Tongue and English be available in every classroom. Children do not learn to
read and write unless they read and write. This is particularly important in the
CHANGES focus areas of School Health, HIV/AIDS, and Gender Roles.
6. Finding: Teachers, Head Teachers, or even Community Members who have been
trained as counsellors are very important in confronting issues of HIVIAIDS and
Gender Roles.
Reconlmendation: One ofthe most valuable contributions of any future programme
would be to have trained adult and peer counsellors available to assist young people
with critical issues ofsexuality, HIV/AIDS, and gender roles. The two chapters ofthis
report on HIVIAIDS and Youth and on Gender Equity provide numerous
recommendations.
7. Finding: While the many curricular and community activities appear to be well
accepted, there is not yet any data showing changes in sexual behaviour. International
research has found that service-learning, school and community involvenlent, and
mentoring have the greatest effect on adolescent sexual behaviour.
Recommendation: Any future programme should seriously consider adding these
components to any model being used to confront HIVIAIDS in schools and
communities. FAWEZA is already doing these things well, but with a limited nurnber
ofschools.
Small Grants and NGOs
1. Finding: For a comparatively small amount offunding, communities were mobilized
and capacity built to construct dormitories, latrines and bathing houses for girls, and
to conduct training sessions on HIVIAIDS and gender equality and other programmes
beneficial to schools and communities and to accomplishment of major CHANGES
goals.
Recommendation: Any follow-up programme of SHN and CSMC should also
incorporate a small grant component tied to programme goals.
2. Finding: The mid-level grants to Zambian NGOs like FAWEZA for girls' bursaries
and the Family Health Trust to train HIV/AIDS peer educators, contributed
significantly to the implementation ofthe CHANGES Programme goals.
Recommendation: Working through local NGOs and CBOs is particularly
important, as it builds capacity and is a comparatively inexpensive manner in which to
carry out programme goals.
3. Finding: The CARE small grant model effectively solicited, selected, monitored and
accounted for 130 small grants in two provinces and built capacity in securing and
managing small grant projects among community members.
Recommendation: Any follow-up programme that includes a small grants
component should adopt the CARE model of managing a small grant programme,
while simultaneously building capacity in local NGOs and CBOs.
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Ambassadors Girl's Scholarship Programme (AGSP)
Finding: FAWEZA appears to have met and surpassed all its AGSP goals. It is a
particularly effective programme, because it not only administers scholarships, but
also carries on a wide array of activities involving young women and men in
academics, HIV/AIDS prevention, and changing gender roles. The very real
problems listed in the AGSP section remain (housing, safety and security, pregnancies
and re-entry to school and transportation for monitoring), but are not insurmountable,
and do not directly relate to the excellent job being done by FAWEZA in
administering the programme.
Recommendations:
• FAWEZA, from all indications, is exceptionally well qualified to continue its
important work under any follow-up programme or even as a direct grantee from
USAID. It is already working in many provinces, so in a sense has been "scaled
up," another important reason for keeping it on as the administrator ofthe AGSP.
• FAWEZA's exceptional model of SAFE Clubs, HIV/AIDS work, service￾learning, community service, mentoring, counselling and other activities could
serve as a model for any organization seeking to deal with the serious problems
facing Zambian youth.
Scaling Up the SHN and CSMC
Finding: Scaling up the SHN will likely be considerably less costly, due to the more
limited sensitisation and training periods, than is true ofthe current CSMC. In
addition, with SCI paying for the cost ofmany ofthe drugs being administered, the
cost ofwhich is covered for at least the next three years. However, ifthe current
model is followed, CSMC is more expensive, with our estimates for the past two
years of approximately $1956 per school. Of course, this amount was spent on all
levels ofresearch, verification, community sensitisation, monitoring and evaluation at
all levels, not just the school, so this could no doubt be cut to a reasonable level.
Recommendations:
• Activate or re-activate the national secretariat and committees, before expanding
activities to other provinces, districts and zones.
• Utilizing the experience of the SHN and CSMC, decide which components ofeach
model are essential for a scale up, including research, sensitization and mobilization,
training, and monitoring.
II. HISTORICAL, CULTURAL, POLITICAL ISSlTES: EDUCATION
Since gaining its independence in 1964, the Zambian education system has been going
through several phases designed to improve quality. These changes have mainly been
influenced by political, economic and cultural factors, including changes in educational
policies in order to meet the Education for All goals, and to improve the quality ofthe
teaching and learning process.
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In 1977, a policy document, Education Reforms, emphasised that there should be a
continuous provision of education from Grades 1 to 9 with the curriculum organised on
the basis ofsix years ofprimary and three years ofsecondary education. According to the
National Policy of Education's, Educating Our Future (1996, p. 9), these first nine years
were referred to as 'Basic Education' and were to provide full-time education for all in
basic subjects, skills training and productive work. The 1992 Focus on Learning stressed
mobilisation ofresources for the development ofschool education. The third national
policy on education, Educating Our Future, reflects the government's emphasis on the
basic right of every Zambian to agood quality education, including access, equity and
quality maintenance at all delivery points in the system.
The Government ofZambia is implementing the present education plan through
decentralisation ofresponsibility and liberalisation of goals. While aiming to provide
education for all children, it places great emphasis on reforming the education.system,
making it more relevant for social as well as for individual educational needs.
Involvement ofteachers, parents, communities, educators, private and public sector and
cooperating partners can lead to the attainment ofthe goals. These goals are in line with
those set by the Dakar Forum (2000) Education for All, which stipulates that by 2015, all
children, particularly girls in difficult circumstances and those belonging to ethnic
minorities, have access to and complete a free and compulsory primary education of good
quality. Thus, on 22nd February 2002, Zambia declared the Free Education Policy for
grades 1-7.
However, cultural aspects, such as early marriages among girls, hamper some ofthe
efforts made in education. Some communities prefer educating boys rather than girls.
Girls are seen as a potential source offamily income through dowry, so instead ofsending
them to school to educate them, they are married offbetween the ages of 13 and 18 years.
In order to address this problem, the Ministry ofEducation has embarked on a community
sensitisation campaign in order to advocate for girls' enrolment and retention in schools.
In 2001 there were 1,783,213 children in grades 1-7; 861,200 were girls and 922,013
were boys. A total of 121,055 were enrolled in grades 10-12. Out ofthese, 69,804 were
boys and 51,251 were girls. Zatnbia has been designated as a Highly Indebted Poor
Country (HIPC). Therefore, in order to achieve its goals, it needs regional and
international cooperation and financial assistance. However, communities and other in￾country organisations have served as the key partners for directing this assistance to
targeted areas ofimprovement thus far.
In line with the education policy, Educating Our Future, the Ministry of Education has
developed a five-year Education Sector Strategic Plan (2003-2007) as a follow-up to the
implementation ofthe Basic Education Sub-Sector Investment Program (BESSIP). The
Strategic Plan covers Basic Education, Secondary Education and Tertiary Education.
Cross- cutting issues have been included in the plan, including School Health and
Nutrition, Equity and Gender, HIV/AIDS, Special Education Needs and Adult Literacy.
Since May 2001, School Health and Nutrition (SHN) and Equity and Gender have
received a lot ofsupport from the CHANGES programme. Now these programmes will
hopefully be institutionalised.in the Ministry through the Sector Plan, as a way of
sustaining them.
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III. HISTORICAL, CULTURAL AND POLITICAL ISSUES: HEALTH
During the colonial period, the first hospitals in the country were established by copper
mine owners to treat injuries and afflictions ofmine workers. In the late 1940s and 1950s,
missions and government programs expanded the number of hospitals, including health
centres around the countries' urban centres. These facilities, operating along railway
lines, were entirely staffed by expatriate personnel, who emphasized curative care, while
the need for training Africans was neglected. By the eve ofindependence in 1964, the
medical system in the country was uneven and inequitably distributed in favour ofthe
settler and urban populations. The rural areas, where the majority ofZambians lived, were
almost completely ignored. After independence was achieved, the new government
embarked on a radical programme to redress these imbalances by providing free medical
care to the entire population through a rapid expansion ofrural health centres and district
hospitals. However, between the 1970s and the late 1980s, rapid population growth of 3.2
percent, rural-urban migration and a collapsing economy led by the decline in copper
prices on world markets, compromised the government's ability to maintain health care at
a reasonable level.
By the early 1990s the health care system was near collapse; the government could
neither maintain nor replace the deteriorating infrastructure. Most health programmes
such as Primary Health Care were perfornling poorly. Health centres and hospitals were
left with chronic shortages of drugs and a significant number ofqualified medical
personnel trained by the government migrated overseas or to neighbouring countries. At
the same time, the epidemiological situation ofthe country was rapidly changing. The
onset ofHIV/AIDS compounded an already'desperate situation (WHO, UNICEF, WB
2000).
IV. THE CHANGES 'PROGRAMME
USAID began its support ofthe MOE/Gender and Equity Component Activities through a
1999 grant to UNICEF to assist the PAGE programme. Through this intervention and
through experiences in the Interactive Radio Instruction programme, a number oflessons
were learned. While communities were often sensitised to girls' education issues and
might be mobilised to help raise school fees or build structures, they were rarely asked to
assess their own situation as a community. It was also found that the MOE needed
strengthening in the monitoring and evaluation of programmes, as well as facing the
challenges inherent in mobilising communities to support basic education, especially with
the growing number of orphans. There was also evidence that school age children were
burdened with chronic micro-nutrient deficiencies, protein-energy malnutrition,
helminthes infection, and malaria, all ofwhich are associated with low academic
achievement.
With this background, the CHANGES programme was designed as a 3-year effort, with
the possibility of extensions and scaling up to include two basic tasks, including a School
Health and Nutrition (SHN) Programme concerned with the development of and
implementation ofschool-based health and nutrition interventions. The second basic task
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was that of community participation, which resulted in the Community Sensitisation and
Mobilisation Campaign (CSMC). In addition, two cross-cutting themes, HIV/AIDS and
gender equity were to be enhanced, along with the development of a small grants
mechanism. The SHN indicators from the Inception Report, listed in the table below,
gives an indication ofthe activities in this portion ofthe programme.
ugus
,,','Ii" :',. '" ',." "•.'..'.".':i, ...~E I
,
"'.'•• '.':'••• ·"··"':':.'r"r,.,',·~Llt..I·"'."'·'·.i! "." .. ,i.·.'i."".'·"'••• '·;:':':.:."'···'··'" ,I Y' ...'W'Y'W'I , "'."',' """ "'III ..," '","
1. Education Increase in cognitive assessment scores
2. Health Reduction in worm infection prevalence
3. Nutrition Increase in haemoglobin levels
4. Water % of schools with access to safe water on premises
5. Sanitation % increase of schools with latrines' available by gender
6. Community Action % increase of PTAs and communities supporting SHN
Plans interventions with specific action plans
7. Community-PTA % of PTA groups meeting regularly/at least X times a year Meetings
8. Teacher Training in # of teachers trained in school-based health and nutrition
SHN interventions
9. Teacher Training in # of teachers trained in HIV/AIDS life skills HIV/AIDS life skills
10. Children receiving # of children who have received the set number of health
health education lessons education lessons
11. Children receiving # of children who have received the set number of HIV/AIDS life HIV/AIDS life skills skills lessons lessons
Table 1:
CHANGES Indicators from Inception Report
A t 2001
The second task was that ofCommunity Participation, involving the development and
implementation of a programme to sensitise and mobilise the community to improve the
participation of girls and other vulnerable children in quality basic education. The priorities,
categories, and performance indicators from the Inception Report shown in the table below
give an indication ofthe goals and types of activities involved in this task.
Table 2:
CSMC Performance Indicators "
'... ,!~L~I~ ee, ii"·'i ..: i",." :}jbi±Y~<"'. I.·
,.",,',. '".". ··"··""·""}}'.i "
"ii .'."" ,rIIUI •••'W ..., ._-",,', .'W.IUIIIIClII\,t:: " ",.,.,,"',"" } ',.'.... .·"".,i}
1. Participation of girls
and other vulnerable Increase enrolment and retention rate of girls and other
children in basic vulnerable children in basic education.
education
2. Sensitization and Number of schools, communities, local leaders, PTAs and pupils
mobilization sensitized and mobilized concerning HIV/AIDS and
girlslvulnerable children's education
3. Gender and equity Number of provincial/district officials sensitized and trained in
gender and equity issues in education
4. Action Research Number of communities participating in action research
5. Participatory Training Number of national, provincial and district level officials (field
at all levels workers) training in participatory methodologies
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6. Research and a. Number of community members present to verify research
Verification b. Number of TED peiiormances for verification of research
7. Participatory a. Number of communities' activities monitored (as mentioned in
Monitoring action plan)
b. Number of communities monitoring their own progress
8. Life Skills Number of teachers (schools) using life skills modules in primary
qrades
At the completion ofthe initial three year contract in March, 2004, the Contractor,
Creative Associates, International," Inc. (CAlI) was given a sixteen month extension to
continue the tasks in School Health and Nutrition, Community Sensitisation and
Mobilisation, Sub-Grants, and the Ambassadors Girls' Scholarship Programme
(Bursaries). In addition, follow-up on an HIV/AIDS Impact Study and Fostering
Crosscutting, Collaborative and Multi-Sectoral Approaches and Alliances for Selected
Activities were included.
Table 3:
Deliverables by CHANGES in Extension Period
March 1, 2004-July, 2005
Task 1: School Health and Nutrition
1. Improved Health of Children
2. National, District MOE and SHN staff
trained
3. Provincial! district MOE staff and
SHN stakeholders oriented
4. Two training manuals
5. SHN Module for teachers
6. Community and school-based
organizations trained
7. Community-Based Action Plans
roduced
8. Cost/benefits Study and Report
produced
More children benefiting from the SHN
Programme
District and school level staff in all of Eastern
Province and in 3 districts of Southern Province
and national SHN coordinators able to manage
the implementation of the SHN programme at
their levels
Key personnel in at least five provinces able to
describe the SHN programme and how it is to be
mana ed
SHN Management and Technical aspects of SHN
One SHN module to train teachers on SHN
through the MOE's SPRINT programme
Community and school leaders develop capacity
to apply for and manage small grants for
communit actions to su ort SNN and Education
Communities plan and implement actions to
su ort SHN and Education
A study to.assess costs!benefits of this activity,
with finds and recommendations on resources,
ersonnel, and olic re uirements
1. District CSMC Training Teams in all
Southern Province Districts
2. Zonal Community Facilitators trained
in all Southern Province Districts
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Teams formed and functioning
Facilitators trained and functioning
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3. ZCF system for mobilizing and
monitoring community action, System is use, including HIV/AIDS mitigation
especially for girls
4. Community and school-based Community and school leaders with demonstrated
organizations trained capacity to apply for and manage small grants
5. Community-based action plans Action plans implemented to support SHN and
produced Education
6. Documentation with Document(s) produced and recommendations Recommendations and Findings of
National Consultative Stakeholders acted upon
7. Cost/benefits study and report Findings and recommendations on resources,
personnel and policy needed at close of produced CHANGES
Task 3: Sub-Grants Mechanisms
1. MOE District Education teams
trained
2. Small grant system that MOE and/or
its partners could use to provide
small grants to community-based
or anizations
3. Documentation that CHANGES￾funded activities comply with US
Government Environmental impact
rules and re ulations
4. Guidelines for making grants for
CHANGES related activities
5. Cost/benefits study
Six MOE District (3 Eastern, 3 Southern) trained
to teach community members proposal
develo ment and financial m 1. of small rants
Manual of procedures or gUidelines
Monitoring and evaluation reports on latrines,
boreholes, construction, agricultural inputs
Document listing approved activities and
regulations that apply. Checklists for monitoring
and actions for failure to adhere to re ulations.
Report produced with findings and
recommendations on resources, personnel and
olicies needed after close of CHANGES
While the task ofthe team was to evaluate the three main CHANGES components of
SHN, CSMC and Small Grants, we would compliment the programme on meeting a wide
range of goals set out in the original Task Order, its Inception Report, and in the
Extension Report. Working in two widely separated Provinces, concentrating on two
very different programmes, is a managerial challenge, but from all indications, and
despite the usual start-up difficulties, the programme has been well organized, structured
and managed. This is not to say that all school children are now healthy in the Eastern
and three districts ofthe Southern Province, or that all schools and communities have
successfully confronted the issues of Gender Equity and HIV/AIDS, but it is fair to say
that CHANGES has made a significant difference in the lives of hundreds ofteachers,
administrators, schools, and literally tens ofthousands of children and community
members in the two provinces. The program has developed very powerful models for
school health, community sensitisation and mobilisation, and the administration ofsmall
grants, and is thus worthy of careful expansion and scaling-up under future USAID
supported progranlmes.
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v. RESTRUCTURING THE MINISTRY OF HEALTH
AND ITS EFFECT ON THE CHANGES PROGRAMME
Since 1991, the Zambian government has been engaged in a process of health reform,
with the aim of providing equal access to quality health services, as close to the family as
possible. By the time the reform effort began in earnest in 1991, the health care system
was in shambles. In rural areas in particular, the:facilities were severely understaffed
and/or in disrepair, the staffwas demoralized and drug shortages were endemic.
The vision, objectives and targets ofthe reform were defined in the National Health
Policies and Strategies (1992). The strategy for achieving better health for all Zambians
was to introduce health sector reforms. A major objective ofthe reforms has been the
development of district health systems to provide basic health services in all parts ofthe
country. This requires decentralization of financial and administrative powers to district
and provincial level hospitals and district health boards, and actively involving
communities in the decision making process.
The reform process involved a redefinition ofthe Ministry of Health as the health policy
making body ofZambia; and the creation of a Central Board ofHealth as a technical unit
responsible for the delivery ofservices and for t~e implementation ofthe health reforms.
The CBoH was established in October, 1996.
The cooperating partners have played a major and continuously important role in the
Zambian Health Reforms. Their contribution has often been supportive of the need for
change, and expressed itself in the form offinancial, human and physical resource grants
and credit support. The Ministry's and cooperating partners' long term plan has been to
support broad-based programmes by financing aspects ofthe national health Strategic
Plan in general and activities in the respective Action Plans ofthe Ministry ofHealth and
the Central Board ofHealth in particular. In this regard, one ofthe major achievements
ofthe 1990s reform movement has been the pooling of government and donor funds to
support the running costs ofthe districts and their hospital management boards (the
district basket).
A lot of effort went into putting into place systems, and insufficient attention was paid to
service delivery. Subsequently, the need to focus on service delivery was recognized in
the National Health Strategic Plans (1998-2000, 2001-2005), which have proven difficult
to implement in a resource constrained environment, and with the impact of a
demographic transition, most affected by the HIV/AIDS epidemic. Affordability, as a
guiding principle ofthe reforms, has now become a central addition to the three guiding'
principles namely leadership, accountability and partnership.
In connection with the structural adjustment programs, the Zambian government first
introduced user fees in 1987, only to be forced to discontinue thenl due to public protest.
A watered down version of user fees was reinstated in 1988. Around 1992-3, the user
fee/prepayment scheme was introduced. Under this plan, certain categories of persons and
certain afflictions/diseases are exempted, and districts are generally tasked with
negotiating a rate that is acceptable to their communities. .
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A. An Historical Perspective on School Health and Nutrition
In Zarrlbia, at the time ofIndependence in 1964, the Ministry of Health (MOH) provided
comprehensive school health that included physical examinations, referrals and treatment
of ailments, provision ofimmunizations, environmental health and food supplements.
Moreover, the MOH had established the office ofthe School Health Specialist under
Maternal Child Health (MCH). Every hospital and health centre was providing school
health services in their respective catchment areas.
In 1985, the Ministry ofEducation (MOE) adopted the Child-to-Child program, as a tool
to provide health information to school and through them to the community. In addition,
activities such as regular sanitation checks by teachers and children's personal hygiene
were implemented.
In the last decades, however, School Health and Nutrition (SHN) services have declined
in terms of accessibility, availability and quality. School children are rarely examined,
treated or referred. Food supplementation ceased in the early 1970s, due in part to an
insufficient understanding and appreciation ofthe role that health and nutrition
contributes to learning achievement. This decline has been worsened by a misconception
that SHN is the prerogative ofthe MOH alone, rather than being regarded as a multi￾sectoral development issue. In general, the health and nutritional status ofschool children
has continued to deteriorate.
A child's ability to learn and obtain maximum benefit from a learning environment is
compromised by parasitic infections including intestinal worms, bilharzias and nutritional
deficiencies. Only rarely does infection have acute consequences for children. Instead, the
infection is long-term and chronic, negatively affecting all aspects of a child's
development: health, nutrition, cognitive development, learning and educational access,
and achievement (WHO 2003). Parasites consume nutrients from the children they infect
and bring about malnutrition and retard children's physical development. (CHANGES,
2004,7).
Vitamin A and nutritional anaemia are common in Zambian children. A survey conducted
(Luo et. aI., 1998) found that 66 percent ofthe 1,427 children surveyed were vitamin A
deficient, 22 percent were anaemic (14.5 percent had severe anaemia) and 22.2 percent
had malaria parasitaemia. Intestinal worm infestation and bilharzia were found to be
serious problems in a baseline survey conducted in October, 200 I by the Partnership for
Child Development (PCD) for the CHANGES programme in the Eastern province of
Zambia. In a sample of 1,392 pupils in grades I to 7, bilharzia infestation was found to be
over 45 percent in II out of 20 schools surveyed. Intestinal worm (mainly hookworm)
prevalence was 55 percent, bilharzias 48 percent and anaemia 33 percent (CHANGES,
2004).
In September, 2000, the Ministry ofEducation, in collaboration with the Ministry of
Health and the Ministry ofCommunity Development and Social Services authored a
concept paper for a programme to improve learning through school-based health and
nutritional interventions. The paper was written in the context ofthe Basic Education
Sub-Sector Investment Programme (BESSIP), which had eight key areas including school
health and nutrition. A BESSIP-SHN Focal Point Person was identified who was to direct
and manage all MOE activities related to SHN. As part of the SHN strategic plan, a SHN
Cross-sectoral Steering Committee was organized to represent, facilitate and mobilise
expertise, resources and synergy across key stakeholders, including government
ministries, NGOs and international donor organizations. An SHN Implementation
Committee, representing key government implementing agencies, was organized to
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coordinate and facilitate the planning and execution of SHN activities through appropriate
governmental programmes.
VI. RESTRUCTURING OF MINISTRY OF EDUCATION
AND ITS EFFECTS ON THE CHANGES PROGRAMME
':F!~'~t~qH!Vrirrg!9rqygat.·~9§m~q~!Mgo·cJJ~o~e~!:~Qf!i~t~o~fe,~~amgQgM~oi~YXig!SgH~~t{8~8ffjci~/~
fJQqr!~aH~.~r~,·Mqst••. q~(!,fJ~ ·••• B~8ple'··· fJ8(~~re,.\!rCJ/Q,~gr ••~~ i••·~8·~~!P.2!Qt .••·p~[~8Q~·/8~.:.~fJri8,~~ .•• fJc;{!\IJtie,~ ~Qg~rr~.~ ••.CFf~N(3F§iP.[89.~CJfI1fI1~CJH,~H!~eet.et~'!:.E!~~a!i~8!~~'.·'and.·new eo Ie•••• became Focal'.·Point
Persons. Therefore h re••.':s.•• Qq~.fJ.iQ~~q{q,~e,7J'?~n;P.~PP'!~j
:i"iRrovincial.Ministry.ofEducation
The Ministry ofEducation has been restructured in line with the Government policy on
the Public Service Reform Programme. The process ofrestructuring the Ministry of
Education was expected to be implemented from 2000 to 2002. The aim ofrestructuring
was to review the roles of units, sections and departments in the Ministry, in order to
clarify, streatnline and strengthen their functions. By restructuring, powers have been
decentralised to local levels and personnel have been redeployed at headquarters,
provincial and district levels. Therefore, most ofthe routine management tasks are now
expected to be dealt with at local levels. The restructuring system created five
directorates: Planning and Information, Standarqs and Curriculum Development, Distance
Education, Teacher Education and Specialised Services, and Human Resources and
Administration.
In view ofthe above, the Ministry headquarters is supposed to concentrate on policy
formulation, strategic planning,budgetary and financial management and quality
assurance. The Ministry has also to ensure that t~ere is an efficient communication
system with the provinces and districts. In orderto have reliable and up-to-date data on
schools, pupils and teachers, the EMIS department has been established in the Directorate
of planning.
Although the restructuring has brought about many positive changes that can improve the
Ministry's systems, it has also had negative effects on the success ofthe CHANGES
programme. The collaboration between CHANGES programme officials and Ministry of
Education officials has been weak, at times, because there has been less chance to plan
together than was the case during BESSIP, 19987"2003. During BESSIP, there were
component managers for HIV/AIDS, SHN, Equity and Gender; managing these
components was essentially their job. Since 2004, when BESSIP was phased out and the
Ministry was re-structured, the programme fell under the Directorate ofPlanning and
Information. The SHN-appointed focal point persons have their prescribed job
descriptions and thus may consider SHN secondary to other duties that they do. This has
had a negative impact on the programme at the n'ationallevel. However, it is good to note
that at provincial, district and zonal levels, there is very strong collaboration between the
three line ministries involved in the programme and CHANGES officials.
Another effect ofrestructuring on the CHANGES programme is that new people were
appointed to new positions. Some ofthese new officers have had no idea about the
programme. The restructuring came after capacity-building had been done at all levels of
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the ministry, and orienting the new officials to the program would require putting in
additional resources.
ThirdlY,restructuring came with the decentralisation ofresources. This means that
District Education Boards have to budget according to what they see as priority activities
in their districts. Ifthe CHANGES programme is to be sustained, it has to be
institutionalised and therefore, be part ofthe activities budgeted for in the districts.
However, if officials are not sensitised, then they may not see the activities in the
CHANGES programme as a priority for inclusion in their annual work plans and budget.
This was not a problem in the past, because work plans and budgets were centrally made.
It is important to note that only certain aspects of managing the system, such as planning
for activities·and procuring resources, have been decentralised. Other aspects such as
deciding the number ofteachers to be employed and disciplining ofteachers are still
made centrally. These are among the critical issues that need to be addressed ifthe
CHANGES programme is to be strengthened at a national level and institutionalised at all
levels ofthe Ministry.
VII. SCHOOL HEALTH AND NUTRITION
USAID provided the technical and financial support to MOE in order to develop the SHN
component of BESSIP. Included in this support was the pilot activity in Eastern Province.
CHANGES designed a multi-sectoral pilot School Health Program, which involved
among other things, the development ofsystenls and capacity-building at all levels. The
SHN program was first piloted in the Eastern Province and then expanded to the Southern
Province. The goal was to achieve improved learning through School Health and
Nutrition interventions as measured by education indicators, retention rates, increased
enrolments and decreased absenteeism. Initial implementation ofthe program was in the
Chadiza, Chama and Chipata districts with subsequent expansion into Mambwe, Lundazi
and other districts in the province.
Prior to the pilot activities in the Eastern Province, the CHANGES SHN advisor worked
in the MOE to assist the ministry with the development ofthe Memoranda of
Understanding between MOE and MOH and MCDSS, drafting the national SHN policy,
writing the SHN strategy guidelines, contacting all relevant NGOs and stakeholders to
determine their level ofinterest and current activities within SHN, and other activities
related to the SHN programme start up. All these activities were necessary background
work to ensure smooth and rapid implementation ofthe pilot.
Since programme implementation, CHANGES has continued to work on the SHN policy,
revise the MOUs and SHN strategy with the placement of a SHN regional advisor in
Lusaka, and to develop the school health card, present the research proposal to the human
ethics board (UNZA) for approval ofthe pilot research, test the tablet pole, and design the
bilharzia prevalence questionnaire.
The main activities of SHN included:
• Conducting baseline-biomedical, anthropometric and cognitive surveys;
• providing micro-nutrients to primary school pupils (Vitamin A and iron
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supplements) and de-worming pills (Praziquantel and Albendazole) administered by
trained teachers;
• training teachers in school health and nutrition, and life skills;
• community sensitization and mobilization through popular theatre, district field
teams, and public gatherings;
• strengthening linkages between health centres and schools; and
• providing small grants to schools and communities to support SHN and HIV/AIDS
interventions (CHANGES leaflet, 2003).
In order to provide convincing evidence of SHN's effectiveness as an intervention, a
biomedical research component was carefully designed using a selected sample of 80
schools and a phased intervention/control approach over a three year period. In this way,
the pilot was able to show the impact of de-worming treatment as compared to those who
had not received treatment. This has been done only in a few countries (CHANGES,
2005). The biomedical research included urine testing for schistosomiasis, blood testing
to estimate serum levels of: retinol, transferritin/ferritin and haemoglobin and stool
microscopy for intestinal nenlatodes. The results revealed low levels of vitamin A in
children 9 years and below (below the 20mg/dl). In the Eastern Province, 33 percent of
the pupils were anaemic, with haemoglobin below 120g/l, with 0.5 percent being severely
anaemic (haemoglobin below 85g/1). 19 percent ofthe boys and 16.1 percent ofthe girls
were severely iron deficient. Also in the Eastern Province, the prevalence of hookworm
and urinary bilharzia infestation were 55 percent and 48 percent respectively. In the first
year the biomedical survey involved the testing of 1,140 pupils.
In addition to biomedical research, anthropometric data was also obtained: height for age
(stunting levels were 36 percent), weight for age (22 percent were underweight), body
mass index (21 percent ofthe children were thin) (CHANGES, 2002).
In addition, cognitive testing was done, using a test developed by Yale University in
collaboration with the University ofZambia and the Zambia Examination council. The
test involved eight sub-tests, including pattern recognition, connect the dots, manipulation
ofblocks, and maze activities, all of which were designed to gauge the pupil's
understanding, pattern recognition and ability to follow directions. These tests were used
to measure the change in a pupil's intelligence performance after de-worming.
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Finding: Before going into specific findings and recommendations, it is helpful to view
the SHN Process Model, which carefully lists the Inputs, Outputs, Short and Long-term
Outcomes, in addition to the Antecedent and Mediating Variables. It is a very carefully
thought out and successful model for School Health Interventions. While not all the
outcomes can yet be demonstrated, the SHN team is to be commended for completion of
all the outputs. The evaluation team found strong support among teachers, students, and
comnlunity nlembers for the interventions, and much "word of nlouth" evidence that, at
least in the short-term, the SHN interventions had positively affected not only the health,
but the classroom participation, performance and cognitive abilities oftreated students. It
is too soon to document long-term outcomes, particularly in light ofthe fact that the -
GRZ/MOE has not yet fully taken over the programme without specific international
technical assistance.
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VIII. THE SCHOOL HEALTH AND NUTRITION PROGRAMME
Table 4:
SHN Process Model
L()l"Ig~·!~~:m
Outcomes
-Training Module for -Numbers of -Immediate -Extent to which
SHN student health teachers, health changes, if any, in higher attendance,
intervehtion by teachers workers, principals incidence of better school
and health officers. trained in Shisto/worms performance, and
-CHANGES interventions administration of infection. cognitive ability
to facilitate ongoing de-worming -Imd. changes, if continue after initial
medicine and gains and funding collaboration between micro-nutrients. any, on attendance withdrawal. Zambia MOE and MOH. rates of medically
-Training of popular -Number of health treated students. -Extent to which
focal point teachers imd. lower levels of theatre troupes and trained. -Imd. changes, if Shisto worm scripts for nutrition and any, in cognitive incidence continue health dramas. -NUn1bers of ability of students after programme
-CHANGES staff work to affected students medically treated interventions end.
facilitate collaborative given de-worming with de-worming,
relationships between medicine and nutritional -Extent to which
MOE and MOH district supplements. interventions. girls are enrolled
staff. -Development of -Imd. changes, if and/or retained at
same or higher
-Development of health charts for any, in the school rates after
protocols for recording data. performance of
programme ends. treated students, .measurement of Shisto -Number of including scores on -Extent to which and worm presence, students tested on classroom tests, HIV infection rates cognitive ability, and post-treatment verbal responses, change, if at all, in stunting levels. cognitive ability. and standard treated
-Baseline testing of a -Number of popular achievement tests communities.
sample of students for theatre AND opinions of -Extent of the Shisto/worms performances held teachers, admin. teacher/health prevalence, stunting, and to raise and parents. worker cognitive ability. consciousness -Imd. Changes, if collaboration. about HIV/AIDS. -Training and any, in numbers and -Extent to which development of health -Number of percentages of girls model and social focal leaders. HIV/AIDS info enrolled and mobilization can be
-Small grants program
stations set up. retained. effectively
conceptualized and -Number of radio -Imd. changes, if replicated
announced. programs on AIDS any, on the level of elsewhere in
-USAID, MOE, MOH created and knowledge about, Zambia.
broadcast. and attitudes bUdgets committed to toward, HIV/AIDS -Extent to which the
SHN activity in EP. -Number of parents and infection routes. MOE continues
-Contributions of other or community funding and
donors. groups sensitized. -Imd. changes in the operation of
-Number of small attitudes of parents programme
grants made. and community interventions in
groups on effects of project
interventions, communities.
including grants.
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Income level of target communities.
Literacy and education levels of project
communities.
Respective infection rates of Shisto, worms
and HIV/AIDS in project communities.
Respective knowledge levels of HIV/AIDS
and its prevention among community
members in project areas.
Cultural traditional beliefs that either impede
or support health interventions.
Policies of MOE, MOH or USAID that have
unintended consequences on effectiveness
of health and social awareness interventions.
A. Goals and Rationale
As part ofthe MOEs strategic plan for a national school health and nutrition program, the
CHANGES programme has been focusing on the basic nutrition and health status of
primary school-aged children, to improve their school performance. It emphasises multi￾sectoral, school-based, cost-effective, health interventions that address three ofthe main
health issues in Zambia: parasitic infections, malnutrition and HIV/AIDS.
The overall objective ofthe SHN component is to improve learning and equity among
children attending basic education through integrated health and nutrition interventions in
collaboration with community and inter-sectoral partners. The specific objectives ofthe
intervention are:
a. promote a healthy environment conducive to learning, supported by a SHN policy;
b. provide health and nutrition services for school children to improve their holistic
development;
c. provide health and nutrition education, including psycho-social life skills,
guidance and counselling to affect behaviour change and modification;
d. improve water, sanitation and hygiene practices ofschool children;
e. strengthen community-based health and nutrition activities by linking schools to
other government ministries and organisations like PTAs, health neighbourhood
committees and others;
f. integrate HIV/AIDS strategies into SHN interventions;
g. develop a SHN school-based information system to be integrated in the main
education information system; and
h. develop an information, education and communication strategy to create social
awareness for SHN issues (CHANGES leaflet, 2004).
B. Design of SHN.
The design ofthe Joint SHN intervention is based on four research-supported theories:
Teachers, school administrators and health workers trained together to treat
students is an effective and economical way to improve the health ofthe
student population;
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• Teachers, school administrators and health workers trained to treat students
should lead to measurable improvements in student's health;
Teachers, school administrators and health workers trained to treat students
should lead to measurable improvements in pupil attendance and performance;
and
Providing health interventions through schools will promote and encourage
healthy behaviours. The teaching oflife skills within the curriculum is
particularly relevant in combating the transmission ofHIV/AIDS.
Initially, 80 schools in two EP districts were selected to participate in the SHN
component. Eastern Province was the pilot province because both health and education
indicators were poor. Participating schools performed biomedical and cognitive testing
and additional interventions over a period offour years.
As the component progressed, additional schools were added. As part ofthe SHN
component design, schools that initially acted as control schools became intervention
schools the following year. This design facilitated the partial achievement of
government's long-term goal of eventually having all schools in a school health and
nutrition programme.
The signing ofMemoranda ofUnderstanding between the Ministry ofEducation and the
Ministry ofHealth and the "understanding" with the Ministry ofCommunity
Development and Social Services respectively made it possible for the three line
ministries to work together in this intervention. This has been a rare undertaking. The
SHN intervention also put in place systems which ensured the efficient inlplenlentation of
various activities. A drug delivery system involved the ordering ofde-worming medicine
by the MOE and their shipment to Zambia. Thereafter, the MOE had the drugs cleared,
custom duties paid, quality checked by Medical Stores and transferred to district health
board pharmacies, which in tum ensured delivery to rural and urban health centres located
within the school catchment area.
At the district level, inter-sectoral monitoring teams make use ofmonitoring forms
designed by the program intervention to look into the process ofimplementation at the
zonal level.
1. Impact Regarding the Resources, Personnel and Policy Requirements
for the Ministry of Education to Continue the SHN Interventions
SHN has made available to the pilot schools medication for worms and micro-nutrient
supplementation over and above what would routinely be stocked by the MOH district
health pharmacies. This is evidenced by the fact that, in non SHN schools, not all children
found to be infested with bilharzia or worms were able to receive treatment due to
inadequate stocks of anti-worm drugs at the health centre. This strongly suggests that the
CHANGES/SHN intervention far exceeds the performance of health centres in the
programme areas with respect to ensuring adequate de-worming drugs and micro￾nutrients. Similarly, the health care system provides adequately for under-5 children as far
as vitamin A supplementation is concerned, but, again, extra stocks for school-going
children would have to be sourced ifthe health sector were to perform this function.
Clearly the SHN pilot program has been able to provide the appropriate drugs for de￾worming and micro-nutrient supplementation.
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The manuals that were designed by CHANGES and the MOE were made available to all
who had passed through the SHN training. Teachers and health workers were trained
together and district and provincial staffin the three line ministries received instruction
on the program. The manuals were said by several teachers to be a valuable tool as a
reference text and also for the purpose of orienting colleagues who had not been part of
the training. The manuals have been officially adopted by the MOE and will be used by
the zonal training centres established by the MOE to train an average of 4-5 schools in
their catchment areas. SCI has an abbreviated version ofthe SHN training manual which
incorporates much ofthe CHANGES manual and this too will be used by Zonal Training
Centres.
The SHN data derives from forms already used in schools as well as forms initiated by
the SHN programme. The SHN forms adopted by the MOE include the school health card
and drug request form. A treatment record and bilharzia prevalence questionnaires are
being used in SHN schools and will be adopted by the MOE for use in all SHN schools in
the expansion phase (CHANGES, 2005). Monitoring tools such as the SHN monitoring
form, TCA Performance Evaluation form and the SHN Continuous Evaluation
questionnaire are other materials that have been developed by CHANGES to be used by
any scale-up intervention. Flip charts have been used by teachers as a good trigger for
health talks in the classroom.
In partnership with a nationally renowned musician, the CHANGES programme
produced an audio tape with ten songs that promote SHN activities. Ofthese, four focus
on HIV/AIDS prevention messages. A total of300 copies of the tapes have been
produced for distribution to SHN schools, in both Eastern and Southern Provinces. Thus
far, 208 copies ofthe tapes have been distributed. The songs are both in English and a
widely spoken colloquial language, Chinyanja.
Recommendations
• The provision of de-worming medications and micro-nutrient supplementation
should be scaled up to other schools.
• The manuals used for training should be part of every teacher's collection of aids.
2. Personnel
The teachers in the SHN districts received training on the skills required to use the
instruments and tools. The training included review of diseases, overview of SHN issues,
drugs, use ofthe bilharzia questionnaire, the dosage tablet pole, record keeping,
monitoring forms, malaria, HIV/AIDS, health promoting schools, and co-ordination and
action plan development.
The Head Teachers, teachers and personnel from the MoH and MCDSS, who were
trained in SHN intervention activities, generally felt that the training was informative and
useful. Teachers were glad to be able to have insight into their pupils' health problems
and to be able t9 do something about them. Also, Head Teachers and teachers who had
received the four and day training in SI-ThJ activities conducted orientation'sessions for
the rest ofthe staffin their respective schools and made the SHN manuals available to
them. The methodology used in the pilots for training Head Teachers and one other
teacher, with a view that the rest ofthe staff would be oriented, is thus a good one. The
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"non-trained" teachers at the schools which were visited exhibited full participation in
SHN activities and were able to accurately describe these activities.
During training, the teachers and health workers were encouraged to conduct activities
such as sponsoring drama groups, SHN and anti-AIDS clubs. They were also encouraged
to host community meetings about SHN; an open day for parents to visit the school to see
for themselves the various SHN activities; to ask parents to give their children breakfast
before sending them offto school; to ask parents to provide a mid-day snack; to establish
SHN committees whose members comprise persons from the community, school and
health centre; and to work with PTAs and initiate other activities that will engage parents
in the SHN component.
The MOE has service structures on the ground at three levels: Zonal Education Support
Teams (ZESTs) are responsible for in-service education at the zonal level, District
Resource Centre Co-ordinators (DRCCs) at the.district level and Provincial Resource
Centre Coordinators (PRCCs) at the provincial level. The CHANGES SHN programme
undertook the training of all provincial and district resource centre coordinators who were
also trained as SHN trainers oftrainers. At the time ofthe evaluation, the training of zonal
coordinators was underway.
CHANGES has supported the provincial HIV/AIDS strategy, including the sensitisation
ofteachers and patrons of anti-AIDS clubs and the development oflocally designed
materials (readers and teachers guides) for pupils and teachers. Also the programme
encourages the SHN focal point teacher to establish anti-AIDS clubs and student drama
groups to perform in the school and surrounding communities to increase awareness
about HIVIAIDS and prevention strategies.
At the time ofthis evaluation, the pilot intervention in the Eastern Province had trained
1,082 people in SHN activities: 640 males and 442 females. The programme had targeted
the training of950 teachers by 2005: 510 and 440 males and females respectively. Also,
113 community members have received instruction in SHN and information
dissemination techniques (61 male and 52 female). Among the pupils, 236 have been
trained in HIV peer education: ofthese, 119 were male and 117 female.
At the community level, health workers (a community-based worker trained by the MOH
and its partners to promote healthy behaviours and deliver preventive and curative care)
and community development assistants (community-based officials ofthe MCDSS who
have received formal training in community mobilisation and sensitisation) were also
trained. .
Recommendations
• Any scale-up program should employ the same methodology oftraining Head
Teachers together with one other teacher, so as to disseminate SHN knowledge and
skills to all members ofthe school staff. Trained staff would be given a time frame
in which to do this with close monitoring by the district SHN inter-sectoral team.
• The training of provincial and district resource coordinators should be part of any
scale- up, with the provincial training teams playing critical supervisory and
supportive roles alongside their national counterparts.
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3. Policy Requirements for MOE to Continue Implementing SHN
The pilot SHN progranlme has allowed the MOE to learn lessons and derive thoughts on
a nationwide scale-up ofthe program. As the program has been implemented, non-SHN
schools and communities, District Education Offices, Provincial Education Offices, and
their counterparts in other line ministries have learned lessons concerning the initiation,
implementation and monitoring of SHN activities. The district team which comprises the
three line ministries, for instance, has seen the value of close monitoring of SHN
activities; the Community Development Assistants (from the Ministry ofCommunity
Development and Social Services) have strengthened their role as community mobilisers
within the context ofthe SHN intervention; and health centre workers have observed the
need to liaise with schools to confirm drug administration dates, and to then remind the
district health office to promptly deliver the drugs.
Teachers founq the iron regimen difficult to adhere to because the iron tablet was to be
given once a week for 10 weeks; teachers ran into difficulty when pupils were absent
during the 10 week period or ifthe drug administration began near the end ofthe school
term. They did, however, manage to give all the children the iron tablets and to document
all 10 doses. With the bulk ofthe worms in children surveyed in the baseline study being
attributed to hookworm, and nutritional anaemia being the common cause of anaemia in
Zambia (Luo et. aI., 1998) and in pubertal girls,body iron loss during menstruation being
a reality, there is a case for continuing the supplementation ofiron in school children.
Moreover, in Zanzibari school children, Ascaris lumbricoides and hookworm infestations
were associated with worse iron status; the association with hookworms was the strongest
by far. Multivariate analyses indicated that hookworms were responsible for 75 percent of
the children's severe anaemia (Stoltzfus, R.J. et aI, 1997).
Future SHN policies can thus be derived from the experience ofthe pilot programme.
Examples ofsuch policy requirements might entail:
• Redefining the roles of health workers at health centres in view ofsevere staff
shortages in some areas by excludingsuch activities as their presence at the school
during drug administration,. unless the drug administration day coincides with the
health centre school health outreach activities (an activity which is in the annual
health centre plan and which therefore has a lunch allowance attached to it for out￾of-station work);
• Iron supplenlentation; and
• Ensuring inter-ministerial monitoring.
Recommendation
• The supplementation ofiron would be done under the supervision of
parents/guardians after appropriate levels of consensus have been reached, as in the
pilot programme. The decision for this intervention would be reached after further
dialogue/consultation on the matter.
4. Opportunities for Future Support
The pilot programme has presented opportunities for future support at every level. At
MOE headquarters, the restructuring process has brought about a shifting of personnel
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and the SHN National Focal Point Person now has others duties. The persons to whom
SHN has been assigned must also perfoml SHN activities in addition to their core
business. The Ministry has submitted to the Cabinet office the need to establish an officer
whose core functions would be SHN duties. This process may be protracted.
The finalisation ofthe SHN policy, which is still in draft form, is another opportunity for
support at national leveL Generally, the government procedure for adapting policies is
lengthy and the longer the SHN policy is in draft form, the longer the adaptation process
will be delayed.
At provincial and district levels, support for training and monitoring ofintervention
implementation is necessary. Also, further strengthening ofsystems will be imperative,
especially since the drug provision will be administered primarily through another
programme- the Schistosomiasis Control Initiative (SCI). A shorter training has been
proposed (1-2 days) as opposed to the 3-day CHANGES training. CHANGES, together
with the SCI, will be testing a method oftraining trainers for Zonal Resource Centre
Coordinators, who in tum will train the teachers in their respective catchment areas.
Recomnlel1dations
• In the interim, as the re-structuring process is evolving and the cabinet office still
has to sanction a senior person for the supervision ofthe SHN program (Principle
Education Officer), a partner will be needed to give support to the MOE in this
officer's function. .
• At provincial and district levels, monitoring support will be vitaL The frequency of
the monitoring visits need not be as often as in the pilot programme, but there
certainly has to be logistical and financial support for the inter-ministerial
monitoring team, especially since the MCDSS is severely constrained by a lack of
logistical and financial resources.
• At the school level, ensuring the following in the scale-up will be critical for
success:
· Community sensitisation and mobilisation;
· Training ofstaff at non-SHN schools and refresher training ofstaff at SHN
Schools;
· Ensuring drug availability; and
· Strengthening the nutrition, water and sanitation components ofSHN.
5. SHN's Cross-cutting Collaborative and Multi-sectoral Approach
The CHANGES program provides an opportunity for nlulti-sectoral collaboration
between the Ministry ofEducation, Ministry ofHealth and Ministry ofCommunity
Development and Social Services. This collaboration is at its strongest at community and
district levels. Although the Ministry ofEducation has made great strides in establishing
and maintaining this collaboration at the national·level, further strengthening ofties is
needed. There is also a need for MOE advocacy at national level for further involvement
ofthe MOH in the SHN program. Already, CHANGES has supported the MOE in re￾establishing the SHN Intersectoral National Steering Committee. This committee would
work together with relevant ministries, NGOs, and appropriate officials in the MOE for
HIV/gender issues, to discuss SHN activities including school feeding. This would ensure
that SHN does not fragment, especially as new components such as malaria are added to
the programme.
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Lower level officials in the health care delivery system feel reluctant to make certain
decisions in the area ofschool health, because of a lack of d~finite national policy
guidance. A good example ofthis is the issue ofpre-payment schemes for school
children: Head Teachers at basic schools have been willing to pay a lump sum to health
centres in their catchment area, in order to facilitate pupils' referral to these facilities.
They have entered into negotiations with the health centre regarding these charges, and
have reached a consensus about the amount ofmoney to be paid out from their sector
funding allocation. Even though health centre staffhave recognized the need for such a
prepayment arrangement, they have not been altogether comfortable with it because
neither the MOH policies, nor the Memorandum ofUnderstanding with MOE, give them
the authority to do so.
The tripartite relationship between schools, communities and health centres can be
illustrated by what occurs when a teacher recognises symptoms ofillness in a child. The
following diagram exemplifies this relationship.
Child taken
to health
centre for
treatment
Child receives
treatment; health
worker writes child's
problem and treatment
given on health card
which goes back to the
SHN FP/class teacher
Child taken
to parents or
parent called
to school
Teacher refers
pupil to SHN
FP/class
teacher who
obtains pupil's
health card
Teacher
identifies
symptoms
ofillness in
a pupil
In some districts, there has been an incessantly low turnout at quarterly district, inter￾sectoral SHN meetings by representatives ofline ministries. It was observed that
meetings, which are called by the District Commissioner (the overall government
supervisor ofthe district), are usually well attended. This is possibly because these
meetings have a sitting allowance attached to them. Potentially, therefore, there is no
reason for poor attendance of SHN meetings since the inter-sectoral District Development
CoordinatingCommittee which is chaired by the District Commissioner is usually well
attended.
The CHANGES SHN programme is a member orihe NGO forum and networks with
several NGOs, programmes and governmental systems. Among these are the PHASE
project-hygiene education, Tooth Savers International (for basic oral hygiene), Family
Health Trust Anti-AIDS clubs, Care International sub-grants, World Food Programme
and Medical Stores Limited. A sub-forum ofthe NGO forum addresses HIV/AIDS
prevention/control.
Recomntendations
• The fact that the MOH is in another phase ofthe Zambian Health Refonns means
that the MOE will have to use forums in which child health issues are tackled to
gamer further participation by MOR at the national level. Such forums are:
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• The Child Health Coordinating Committee chaired by the Minister of
Health;
• The cooperating partners in the child health subcommittee; and
• The child health meeting chaired by the Child Health Specialist of
CBOHIMOH.
• There is need to collaborate with the Ministry ofHealth at a national level
concerning which drug will be used for de-worming school children, because ofthe
implications this has in the long term for integration ofthe de-worming program
into the public health sector, as far as drug provision is concerned. SCI will
purchase drugs for the MOE and will cover four provinces by the end of 2007.
There are initial plans for a three-year phased implementation of a de-worming
programme, which will entail the treatment of 2,500,000 persons, using an
implementation model similar to the CHANGES SHN programme. The total cost
will be US$2 million. The SHN programme for MOE will continue concurrently
and will reach the additional provinces during planned expansion.
• The District Commissioner (DC) may be requested to call meetings for district
committees. Giving the DC minutes ofmeetings might spur members to attend. This
has its own difficulties as the DCs office is often very busy.
6. Cost Data of Classroom-based Components
The following table is an excerpt ofthe estimates ofdrug quantities for national school
health and nutrition drug requirements for 2005 as tabulated by CHANGES:
2,013,336
4,872,351*
2,436,176*
2,436,176*
Table 6:
SHN District Packa e Estimated Costs
schools
169,038
409,063*
204,536*
204,536*
De-worming*/Micro-nutrients*(Vit Allron)
Trainin teachers/health workers
IEC/media/materials/HE/health cards, etc.
Water/sanitation/h iene activities
Production units/school feedin
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$.65/pupil;
For communities: $.40
Total dru cost = $200,000
500x1.2MK=600m
100x1MK=100m
4MK
6MK
6MK
4MK
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Monitoring/shared costs/MOE/MOH/MCDSS 2MK
(
Total $225,000
Total all districts $16,200,000
* This assumes only once per year treatment as a minimum
** This includes all pupils and out of school/communities-- communities only receive
bilharzia treatment depending on the prevalence in school. If the prevalence is 40% or
above, surrounding communities in the school catchment are treated.
Total of 72 Zambian districts; average population per district= 200,000
7. Integration at All Levels Including MOE Directorates
At the MOE level, the SHN intervention falls under the Directorate of Standards and
Curriculum. The directorate is responsible for the formulation ofthe SHN policy and for
the direction ofSHN activities as well as collaboration with other directorates within the
ministry, line ministries and cooperating partners. The Directorate also monitors and
evaluates SHN activities at provincial and district levels. Under "Special Issues," SHN
has been included in the MOE national strategy, action plan and has a budget line. Last
year, at a planning workshop to mainstream Special Issues, SHN was designated as a
national priority. The national level has also accepted the use ofthe materials developed
by CHANGES to train persons who will be involved in the scale-up component ofSHN.
At the provincial level, in the area ofteacher training, it was not clearly apparent that
SHN had been included in the pre-serVice training. The college principal had received
instruction in SHN intervention and teacher trainers were all trained on SHN, an activity
which was envisaged by the concept paper of 2000, as a way of building sustainability
into the program. What remains is for the speeding up ofthe process to include SHN in
the teacher training curriculum at the national level. Further, at provincial level, even
though the provinces were tasked by theMOU to translate policy into implementation,
the concept ofthe School-based Health Policy (one ofthe four cornerstones ofthe
FRESH Start approach - Focusing Resources on Effective School Health) was not well
known. The same applies to some districts as well. This may be due to recent transfers
and promotions ofstaff, in line with the restructuring process, which subsequently has led
to the placement ofpersons not previously trained in the SHN intervention.
At the district level, integration of SHN activities is more apparent than at higher levels,
with the monthly monitoring visits to SHN schools providing a powerful catalyst for this
process. At the community level, integration is even stronger with community groups
being involved with all three components ofthe program. SHN has provided for the
creation of closer links between the health centre and the teachers in the following ways:
• Through the Memorandunl ofUnderstanding, which spells out roles and
responsibilities ofteachers and health workers;
• Collective training;
• The school health card which serves as a referral/feedback tool;
• Encouraging teachers to sit on Neighbourhood Health Committees
(committees whose membership derives from the community and who
have representation on the Health Centre Committee - a component which
plans and monitors the activities ofthe health centre).
In addition, community sensitisation initially took place through four popular theatre
groups which were contracted by CHANGES to work for 10-day periods in each ofthe
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20 pilot intervention school catchment areas, collecting information and holding theatre
performances on SHN, based on the data they had collected. The major theme ofthe
drama was the importance ofSHN, the teachers' new role in providing de-worming drugs
and the relationship between health and learning. Later, community members, teachers
and school children performed the dran1a as part ofthe Theatre for Community Action
approach, and carried on the sensitisation, an aspect which allowed the programme to
save resources and avoid the logistical problems that had been part ofthe first
arrangement.
Community involvement was evidenced by participation in SHN committees; members
were able to elaborate the various SHN related activities that were taking place. Parents
were found at the school either holding meetings, or cooking food to serve to the children.
Several children had chiwaya (roasted maize) to eat as mid-morning snack, indicating
parent compliance to teachers' requests for them to supply a snack. Drama performances
by community members and school children on the importance of SHN were informative
and entertaining.
Recommendations
• It will be important to ensure that pre-service training for teachers will include SHN
activities.
• Orientation of new provincial and district staff on SHN will be imperative in order
to maintain gains in SHN.
8. Capacity-building to Support Sustainable Positive Change
Workshops were conducted for provincial, district administrative and managerial level
staff. Whereas the training covered several broad subjects (including roles of various
levels, letters of understanding between MOE and line ministries, what should happen at
the school level among other topics) the subject area most talked about by provincial and
district administrators was that ofmonitoring the SHN intervention. At community levels,
teachers have been given the capacity to administer de-worming drugs and micro￾nutrients, and also to recognize common childhood ailments. Health centre workers have
learned how to ensure smooth delivery of drugs mid to strengthen relationships between
the health facility and the school. Additionally, they have recognized the importance of
being present at the school during drug administration days. Local partner organizations,
linked with the SHN program, were conversant with the particular SHN component in
which the program was collaborating. Community leaders were knowledgeable on the
SHN activities that should take place at the school level.
Recommendations
• In order to support sustainable positive change at national and provincial levels, the
MOE could utilize forums in the other line ministries for" an orientation on the MOD
and the pertinent aspects ofthe program. At provincial and district levels,
orientation of new or transferred staffwill be important to provide much needed
continuity.
• At provincial and district levels, orientation of new/transferred staffwill be
important to provide the much needed continuity.
• Community sensitization and mobilization must be sustained through the
Community Development Assistants.
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• In any scale up, training ofteachers and health workers must be conducted close to
the time of SHN activities' implementation in schools in order to avoid situations
where trained persons must wait before drug administration is actually
implemented.
9. Strategies to Maintain Capacity After the Close of CHANGES
Local SHN staff have built capacities to initiate, implement and closely monitor school
interventions. These activities have required coordination with national, provincial and
district management/administrative personnel in the line ministries and a good rapport
with schools and the communities in their catchments. Local staff have been able to
generate significant numbers of activity reports on at various levels, including
community sensitisation, training, selection of pilot sites, process monitoring and
documentation of achievements, best practices and lessons learned.
Recomnlendatiol1s
• At the national level, an SHN Technical Assistant would be valuable in aiding MOE
officials to whom SHN is assigned as an additional function.
• At provincial and district levels, local SHN staff would be valuable in assisting the
MOE with the training component ofthe intervention and also with the critical
monitoring aspect ofthe programme. This assistance would come in the form of a three
to four person team, which would also strengthen the coordination aspect ofthe
intervention and ensure that important paperwork is generated.
10. Assessing Effects of SHN on Educational Access and Achievement
The SHN intervention's effects on children's learning ability are manifested in both
individual cognitive capacity and in aggregate changes on common measures ofthe
education system. Both are needed to give a complete picture ofthe SHN intervention's
value as an educational innovation.
In terms of cognitive effects, the pilot-phase experimental testing ofthe main CHANGES
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nutrients) by an independent research organization demonstrated significantly improved
cognitive ability among student recipients, in comparison to non-recipient control-group
students (CHANGES report, 2004, p. xi and 23). This was measured through a pilot pre￾test of cognitive ability, followed by an experimental comparison ofschools receiving
treatment at different stages with schools that were untreated (during the pilot phase). The
primary measurement tool consisted of a specially designed cognitive instrument known
as Z-CAI, along with assessments of vocabulary, and school-related math, English and a
Zambian language for older students (Successful Intelligence, no date, p. 5).
In terms of effects on the larger education process, this evaluation found that the
CHANGES SHN intervention has been accompanied by higher - often substantially
higher - enrolments and attendance ofstudents in the treated schools. This outcome, and
its attribution to the drug/micro-nutrient intervention, was supported by a large majority
of educators from schools, district education offices, the Eastern Province principal
education office staff and the MOE headquarters. Because SHN is a package of
interventions undertaken in close succession, the effect ofthe drug and micro-nutrient
administration itselfwas difficult to disentangle from that ofthe other intervention
activities, including community sensitization on general health and nutrition themes,
school gardens or feeding programs, and school'facilities improvements (e.g. toilets and
dorms for girl students). However, educators and health officers at district and
school/community levels unanimously agreed that the removal of disease symptoms from
treated children was immediate and visible and that the parental attraction to the free
medical treatment oftheir children's worms and Bilharzia infestation was strong. This
suggests that the drug intervention, along with its targeted sensitization, was at least
partially, and probably significantly, responsible for these enrolment and attendance
increases.
To a far less documented extent, drug and micro-nutrient treatment was also accompanied
by slightly better retention rate in treated primary schools. Effects relating to retention
must, for the time being, remain tentative, due to the complex interplay of economic,
cultural, personal, as well as health factors on school retention decisions. Beyond these,
retention can depend on whether there is available space or teachers for expanded
numbers of upper-primary students. But, a majority of educators from SHN-treated
schools did partly credit improved student health for enhanced retention among their
students.
Drug/micro-nutrient administration and sensitization ofstudents' parents on health issues,
in both the immediate school community and the surrounding catchment area, have been
accompanied by a modest re-entry ofschool drop-outs. Included among the drop-outs are
female children who had earlier been required to drop out due to pregnancy, but later
wanted to continue their schooling. Attribution ofthese phenomena to the SHN drug
intervention and sensitization is confounded by several competing influences. One
possible contributor is the school infrastructure improvements that have been made
possible by CARE-funded small grant projects in some SHN schools. New or renovated
facilities, such as dorms, latrines, and bathing houses reserved for girls, were reported by
staff ofseveral schools to have nlotivated many out-of-school girls to enrol in or re-enter
primary school (see later section on small grant component). Periodic-but, usually, very
occasional--school feeding, also account for som,e ofthese re-entries. But, in the opinions
of a majority of educators at the school, zonal, district and provincial levels, the SHN
drug intervention has been at least partially responsible for attracting these out-of-school
children-often girls-back to school.
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The educational effects ofthe SHN drug/micro-nutrient treatment were less identifiable
and less measurable within the classroom. A majority of administrators and teachers in
the visited SHN schools did report nl0re alertness and energy among their students. As is
pointed out elsewhere in this report, Zambian government schools have been adversely
affected by the central government's freeze on new hiring of government civil·servants,
which, with the added effect ofretirements and AIDS-related deaths, has left most
schools severely under-staffed. Therefore, any significantly higher exam scores in a
particular school might well reflect nothing more than the fortunate presence of an
experienced grade 7 teacher, rather than an untrained, or no, teacher, as is often the case.
The CHANGES/SHN activity has been accompanied by an apparent increase in demand
for higher levels of basic education. Several ofthe visited schools have added grades 8
and 9 instruction to accommodate students who passed the grade 7 exam and wanted to
continue their schooling. This was done even with space at a premium and, often, an
insufficient numbers ofteachers. The study could not determine precisely which factors
have created this demand, other than to say that it could reflect slightly higher pass rates
into grade 8, a higher overall value attached to education by students and their parents,
and/or improved health (with regard to worms and Bilharzia) and the attraction of
(occasional) food provided by the school.
The impact of interventions on children's infestations with parasitic worms was marked:
amongst children who had received de-worming for one year (2002) or two years (2001
and 2002), the prevalence ofinfection (number of children infected) with parasitic worms
was approximately one quarter ofthe baseline rate and was much lower than that of
children in the control group (p<0.001). Treatnlent also resulted in large reductions in
intensity ofinfection (numbers of worms in a child - p<O.OO1). Treatment was most
effective when delivery was sustained; children who received two rounds oftreatment
(2001 and 2002) were less heavily and less commonly infected than those who had
received treatment only once (2002). Thus, the impact assessment demonstrated that
teacher delivery of interventions was highly effective; an example ofthis impact is shown
in Figure One below (PCD Report, as quoted by Freund, 2005).
Figure 1: The impact of SHN intervention on prevalence of Schistosoma. haematobium
during the study 2001-2004
Prevalence ofS. haematobium
60.00%
50.00%
......., 40.00%
e
30.00%
c;
>
P:: 20.00%
10.00%
0.00% -t-------.----------,-----------,
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Recommendations
1. USAID/Zambia should provide resources for the training and ongoing support of
trainers who will train and monitor school and community focal point persons in
health education and drug administration at the zonal level.
2. Despite wider awareness ofthe SHN drug/micro-nutrient benefits, the MOE and the
Schistosomiasis Control Initiative (SCI), which are planning to undertake a wide scale
administration of anti-Bilharzia and de-worming drugs, should continue a modest pre￾treatment sensitization oftargeted parent and community populations to optimize
inclusion of out-of-school children, who might otherwise not enrol in or re-enter
school and thus receive treatment. This may: be particularly necessary as the treatment
penetrates into more remote and scattered communities and to those with community
schools rather than government basic schools.
3. The MOE's EMIS unit should disaggregate grade 7 exam results according to
exposure to SHN drug/micro-nutrient intervention in order to allow wider comparison
oftreated and non-treated students and schools over several years.
11. Water and Sanitation
Water and sanitation improvement, together with the improvement ofthe hygiene
practices ofschool children; was another objective ofthe CHANGES/SHN pilot
intervention. In every SHN school, there was evidence ofpit latrines, hand washing
facilities and safe drinking water.
There is a general need to increase the number of Ventilated Improved Pit latrines (VIP)
on school premises in most basic schools, particularly since enrolments have increased in
such an unprecedented manner. The MOE'srecommended pit latrine ratios of 1 latrine to
every 20 girls and 1 latrine to every 25 boys may need to be reviewed, since some
premises are not large enough to accommodate the necessary number of buildings to fulfil
this requirement. Moreover, recommended distances oflatrines from water points must be
adhered to.
The VIPs that were inspected, for the most part, did not meet the national standard, in that
odours and flies were present. There was no gauze on top ofthe ventilation pipes, and
most latrine holes were uncovered. Schools had protected wells or bore holes for their
water requirements, and in some schools, drinking water was placed in a bucket and
chlorinated using locally available chlorine solution. In some schools, hand washing
facilities were complete with soap and an adequate supply ofwater, whilst in others, soap
was missing and water ran out quickly with no one paying heed to its replenishment.
Recommendations
1. Schools should adhere strictly to instructions for the construction of VIPs. The
Environmental Health Technicians and Technologists at the health centre can be
consulted in this regard.
2. Drinking water must be chlorinated or boiled in order to make it safe to drink.
3. There is a need to emphasize the necessity of a continuous supply ofwater for hand￾washing.
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12. Nutrition
Most, if not all, CHANGES schools have begun, expanded or improved school gardens
(i.e., "school production units"), thereby supplying cash from sales of crop yields to fund
school needs, and/or contributing to the food availability ofstudents through school
feedings. Crops that are grown include maize, sweet potatoes, groundnuts, vegetables,
cassava and fruits such as bananas, paw paws and oranges (cassava cuttings and fruit
trees were provided by the MOE and officers from the Ministry of Agriculture provided
technical assistance on how to handle certain crops). This study could not determine the
reason that some schools had extensive "school production units" and school gardens,
while others had made little progress. Both the CHANGES/SHN programme and the
GRZ/SHN Initiative contained messages encouraging supplementation ofstudent diets
through school production units, but we were unable to ascertain the effects of either
programme on successful or unsuccessful implementation of production units or gardens.
In some schools, women's groups are actually coming into the school to provide a hot
meal for selected grades.
Students perform the bulk ofthe labour in many school production units, with community
members participating in others. Reliance on student labour may develop potentially
valuable agricultural knowledge and skills for rural children, as well as giving the
students a stake in producing the food they will later consume. Conversely, students'
labour may also assume negative connotations, should the output ofthe production units
be used primarily or exclusively to raise cash for the school, in which case students may
not perceive the benefits oftheir labour.
Given the very infrequent school-sponsored feedings given to students in almost all
schools, there is sufficient reason to doubt that student labour on the school production
units are either supplementing their diets or instilling in them a healthy respect for
agriculture and the work required for its yields. It is no doubt true that many schools use
the proceeds ofthe school gardens and farms to purchase supplies, such as chalk, pencils,
and notepads that benefit students. However, these are supplies that should be provided
by the MOE. Given the appearance that students might be working on the school farm for
the benefit ofthe teachers or a school manager, it would probably be in the interest of
schools to move away from the concept of using production units solely as a fund-raising
venture. With prevailing high levels of poverty and pupils attending schools hungry and
malnourished, maize raised on the school production unit could be ground into meal and
used for porridge to feed them. In schools where groundnuts, soy beans, pigeon peas and
sunflowers are grown, the addition ofthese foods would supply the required protein and
caloric requirements to the porridge for improved nutrition.
"T~e objective is to move towards SHN gardens, so that schools can r~n towards sustainable
dingprogrammes.So,!,e crops are not recommended in producti()n units, (schools) should
sweet otatoes roundnuts and even soya beans - those (crops that have a·direct benefit
to children. "
- District Education Officer
Recommendation
• The MOE should consider discouraging the impression that production units
produce crops for commercial exploitation or school cash resources only.
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• The MOE should strengthen links with the nutrition staff at a national level in the
MOH/CBOH, seeing the National Nutrition Strategy (2004-5) has school feeding
as one ofits concerns. Moreover, the strategy advocates for the involvement of
communities in developing and refining "region specific" options for nutrition
improvement to be promoted (National Nutrition strategy, 2004-5, p. 6,14)
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IX: COMMlTNITY SENSITISATION AND
MOBILISATION CAMPAIGN
A. Rationale and Goals
The Community Sensitisation and Mobilisation Campaign (CSMC) is the second major
component ofthe CHANGES programme. It was piloted in the Southern province and
can now be found in all its Districts. It focused on five major campaign goals, which
were to ensure that:
• Parents, community members, teachers and children understand the importance of
education for girls and other vulnerable children, as well as for boys;
• Communities and schools actively advocate and implement activities to support the
enrolment and retention of girls in primary school;
• More girls and other vulnerable children attend school and complete a primary cycle
• Community members, teachers and school children aware ofthe causes and
transmission ofHIVIAIDS; and
• Community members, teachers and children engaged in activities to halt the
proliferation ofHIVIAIDS.
The CHANGES programme planned to invest in a vigorous publicity campaign that
targeted communities and schools in the Southern province in order to create a conducive
atmosphere for the education of girls and vulnerable children and for the prevention ofthe
spread of HIVIAIDS and care of patients. This was aimed at empowering the
underprivileged communities: women, elderly, youth, religious and cultural minorities, to
identify their needs and make decisions. Therefore, a suitable strategy was to be used that
would help communities reflect on cultural practices that hinder girls from attending
school, health issues and the need for interventions to prevent HIV/AIDS and care for
affected people,. This strategy was called the Community Sensitisation and Mobilisation
Campaign model. The model was also to be used to stimulate demand for access to
programme funds that would assist in achieving the campaign goals ofthe CSMC.
According to the World Declaration on Education/or All and Framework/or Action to
Meet Basic Learning Needs (p. 9 1990), partnerships at community, intermediate and
national levels should be encouraged; they can help to harmonise activities, utilise
resources more effectively, and mobilise additional financial and human resources where
necessary. The CHANGES programme identified an active participatory process,
involving groups, schools and the community to address basic learning needs. A wide
range of partners were involved in implementing the programme. Families, teachers,
communities and NGOs were all involved in activities aimed at improving access to
education for girls, removing obstacles that hamper their active participation, and fighting
HIV by removing the factors that promote its proliferation.
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B. Design of the Model
A four-step model was designed for the Southern Province pilot phase. We have included
it in the Annex to provide the reader with a visual concept ofthe process. The first step
was to conduct research and to verify the findings. Five schools were to be sampled in
each ofthe eleven districts. Research was also to be conducted in six communities in the
catchment area of each ofthe fifty-five schools. This meant a total offifty-five schools
and 330 villages were targeted. Participatory Research Teams then went into communities
and stayed there for 10 days. During this period, they studied the behaviour ofthe local
people and picked up on key themes. Then, through drama and dance they made people to
react and confirm, reject or modify the behavioural patterns shown, that related to the
spread ofRIV/AIDS, constraints on girls' education and health issues.
The second step was the training ofZonal-level Community Facilitators. The ZCF teams
are three-person teams, comprised of one person each from the MOE (a teacher), MaR
(an Environmental Health Technician), and MCDSS (a Community Development
Assistant). Government employees from the three line ministries (MOE, MaR, MCDSS)
were trained in mobilisation -and sensitisation ofschools and communities. The
participants were from the zonal level ofthe three line ministries; provincial and district
officers also joined in this training.
In the third step ofimplementation, the Zonal-level Community Facilitators conducted
Community and School-based Sensitisation and Mobilisation. The head teacher, two
classroom teachers and four community members were trained to be Focal Point Persons
to guide their schools and comnlunities as they deliberated and developed actions. This
was done by holding community wide meetingsand school staffmeetings. The
community meetings were normally held at the zonal centre schools.
The fourth step in the model was the Community and School-based Interventions.
Communities and schools were to implement activities based on their action plans. The
activities were very diverse and depended on the needs ofindividual schools and
communities. Most ofthese activities were to be community and small grant supported.
The model was meant to be cyclical, so that once activities were planned, communities
and schools would meet again to review successes and challenges and draw fresh action
plans. This model was to achieve preset campaign goals ofimproving the enrolment and
retention of girls and addressing the fight against RIV/AIDS.
c. Outputs
The CSMC was intended to pass through developmental stages, beginning with research
and verification. There was to be training of zonal level community facilitators,
community and school-based sensitisation and mobilisation, community and school based
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interventions, and outreach and impact. It was expected that at least 9 ofthe 11 districts in
the Southern province would be actively involved in the CSMC.
Training was a component of CSMC, as a way of creating awareness, capacity and action.
Different strategies and methods were to be used in the training in order to acquire
knowledge and skills and change in behaviour ofthe people. The training was planned to
be in the fonn of workshops, mentoring, coaching, meetings and focus groups. Training
was to be conducted at all levels and cater to officials in the three line ministries, MOE,
MOH and MCDSS. 110 district officials from MOE, MOH and MCDSS (10 per district)
were to be trained in community participation methodologies and mobilisation strategies.
It was planned that the Creative Associates' staff at the CSMC office would train the
provincial, district and the zonal level staff (zonal level community facilitators -ZCFs) in
a joint six day workshop, called the zonal level community facilitators workshop. Eleven
workshops were held. The ZCFs were to train one head teacher, two teachers, and four
community members at the zonal centres (SFPPs and CFPPs). The school focal point
persons and the community focal point persons, with the zonal level community
facilitators then developed action plans on how to promote girl child education and fight
HIV/AIDS.
Community and school-based sensitisation and mobilisation targeted parents, guardians,
teachers, local leaders and all members ofthe community. In the first phase ofthe CSMC
the target was five schools per zone in each ofthe nine programme districts (2 districts
were excluded from CSMC). Since there are 82 zones in the nine districts, 410 schools
were targeted in the first phase and there were six communities involved in each school
catchment area. Therefore, there were 2460 communities for all school catchment areas.
This was to ensure that there was commitment and support from everyone in the
community. After the extension, all basic schools, plus 67 community schools were
brought on board.
Since there were different experiences that influenced girls' education and contributed to
the spread ofHIVIAIDS, each community was supposed to conduct its own interventions,
based on their experiences. This would be expressed by such actions as sending girls to
school instead ofselling food, and assisting in construction of pit latrines and girls'
donnitory at school. This would also be achieved by strong links between the PTAs and
schools. According to the plans, 90 (10 per district) district level plans of actions would
be developed as a framework for community sensitisation and mobilisation.
CSMC was meant to have a positive impact on the girls' education and vulnerable
children, to learn about HIVIAIDS and take measures to stop it. CSMC was planned to
reach out to all children, and in the process, include both schools and communities.
Increased girls' enrolment and a reduction in drop out rates, an increase in retention rates,
and improvement in perfonnance would measure the result. It was expected that a total of
728 primary school catchment areas would produce plans of action and snlall programme
based plans (proposals).
D. Outcomes
Phase One ofthe model, research and verification, was successfully conducted as planned
and in each district resulted in the production of 5 school profiles and 30 community
(village) profiles, which were translated into one comprehensive district profile and were
used for advocacy. However, sending researchers to live in communities for 10 days
proved to be expensive, in addition to the training that they had received. The ZCFs
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trained one head teacher and two teachers from each school and four community
members from each catchment area. 728 schools were involved, with 5096 people
trained.
The evaluation team found evidence of community wide meetings and community and
development ofschool based action plans. Committees had been formed consisting of I
head teacher, 2 teachers and 4 community members.
In most ofthe schools, there was evidence that community and school-based.
interventions had been conducted. At the school level, teachers sensitised other teachers,
while community members sensitised members oftheir communities. School action plans
were visible in the head teachers' offices that included community activities. At the
community level, no action plans were evident beyond the development ofsmall grants
proposals. There were many grant-supported activities in both EP and SP.
The CHANGES/CSMC component has successfully implemented a complex array of
community education and development activities that require in-depth understanding of
local cultures and economies, conceptualization of potentially amorphous content into
readily accessible and actionable messages, inter-generational and cross-class
communication techniques, regular and effective monitoring, and concrete involvement
and support from representatives and officials at various levels ofthe MOE, MOH, and
MCDSS in the Southern Province.
E. Activities of the CSMC
The CHANGES programme has successfully mobilised and sensitised schools and
communities, zones and officials at district and provincial levels. The sensitisation has
focused on Equity and Gender and HIV/AIDS. This has been achieved by conducting the
following activities:
• Initial research in five schools and six communities surrounding each ofthe five
schools in each district, in order to establish the lifestyle ofthe people. This was
followed by dramatisation, song and dance that carried themes on the identified
needs;
• Holding training workshops for school focal point persons, zonal focal point persons
and officials at district and provincial levels; These persons in turn trained others in
their institutions and communities;
• Sensitising college lecturers and training ZATEC students in Primary Teacher
Training Colleges, Chipata TTC and DALICE;
• Producing and distributing materials and posters in English to all schools,
communities, districts and provinces that carry information on gender and HIVIAIDS
• Strengthening leadership and collaboration among three ministries (MOE, MOH,
MCDSS), schools and communities;
• PTAs working hand in hand with schools to.draw Action Plans for mobilising and
sensitising members ofthe community;
• As a result ofCSMC, schools and communities are producing infrastructures such as
bathrooms and dormitories for girls, introducing school feeding programmes,
administering drugs for children and changing attitudes and behaviour ofpeople on
children's education and HIV/AIDS; and
• Conducting advocacy workshops with opinion leaders and influential people (such as
traditional leaders, religious leaders, elected community representatives and local
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authorities etc.) in all eleven districts to sensitise them about CSMC, apd to challenge
them to contribute to CSMC objectives in their constituencies ofinfluence. Producing
activity resolutions.
The above have led to increased enrolment in schools, especially for girls, improved
health ofthe children, and reduction in cases ofHIV/AIDS. Communities have realised
that learning becomes effective when a child is fed at least something at home and at
school. As a result, both schools and communities have embarked on food production in
their gardens and animal farming.
F. General Perspectives on CSMC
The outcomes, as distinguished from the outputs, ofthe research-verification in the first
stage CSMC are notoriously resistant to quantification and categorization, due to the
unpredictable and one-off nature ofschool/community initiatives. For example, a
community that is concerned about improving gender equity may seek to stop early
marriages of girls by keeping them in school, while another community that is
impoverished may be more interested in introducing life skills and/or vocational skill
training to give youth another means of earning a living. Despite the lack of easy
categories for outcomes, the depth of consciousness gained by communities through an
intensive approach may be likelier to produce community actions on more substantive
and complicated issues, than are possible with targeted sensitisation campaigns.
The community sensitization and mobilization appears to be particularly well-suited to
the challenges of addressing intractable problems such as high-risk sexual behaviour and
barriers to fuller realization of gender equity in schools and society, which have their
roots in long-held and deeply embedded cultural norms and practices, such as lobola
(bride payment), polygamous marriage, rites ofpassage ceremonies, sexual cleansing, and
marriage to the spouse ofthe deceased. CSMC has, for example, contributed to the
advancement of gender equity in the form ofhigher initial enrolnlent of age-appropriate
girls in school, re-entries of girls formerly removed for pregnancy, and improved
retention of girls in school, including, in some cases, progression to grade 10. Where
there has been strong collaboration between schools and communities and the local
leadership had been sensitised, it was reported that cultural practices that had impinged on
girls' education and put people at risk of contracting HIV/AIDS had been reduced.
The CSMC has pioneered a means ofmotivating de-centralized MOEstaffto conduct
sensitisation, training and monitoring activities in the field, by providing meals or lodging
allowances for travel to other locations. Zonal community facilitators and school focal
point persons, in particular, have shown a willingness to be involved in these activities.
CHANGES has "pooled" the funds for small allowances to provincial and district MOE
offices, where they are disbursed through the district MOE's financial systems.
Statements by CSMC staff, however, indicate that some teachers have noticed these
allowances and began to express a desire to receive them before doing any CHANGES
work.
According to many respondents, HIV infection rates are much lower in rural areas than in
urban areas. But the traditional attitudes, norms and practices to which youth are
acculturated-such as early marriage for girls and submissive female behaviour towards
men - in rural areas predispose them to sexual behaviours and HIV risk factors if, and
when, they visit or migrate to urban areas. Likewise, urban dwellers infected with HIV
also can, and do, spread the virus locally to students and other rural youth.
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Despite their differences, the SHN and CSMC sensitization and mobilization "packages"
have used many ofthe same techniques and nl0dalities, such as training offacilitators,
involvement oftraditional leaders, and diffusion of consciousness-raising content through
community meetings, popular theatre, music, dance, and poetry performed by troupes or
community groups, in addition to posters and radio broadcasts. These techniques were
even more effective in locations where the school and the community formed a joint
drama club, thus bridging generations and education levels. While professional troupes
were effective for SHN, they are more expensive and generally do not know the
communities as well as local residents, which makes a difference in sensitising on more
conlplex issues.
General Recommendations
• USAID should continue to build upon the intensive sensitisation and mobilisation
process, or elements ofit, with a modest expansion into carefully selected districts,
along with continuation offollow-on activities in S P to establish communities' ability
to progress further in HIV/AIDS prevention/amelioration and/or gender equity.
• USAID should, in any follow-up programme, attempt to obtain MOE, MOH and
MCDSS, buy-in for any further sensitisation and mobilisation initiative.
• Tpe follow-up programme should investigate ways to deal with "expectations creep"
among teachers and other line ministry staffto receive allowances as "compensation"
for their participation in sensitisation and mobilisation activities, unless their
contributions involve a planned activity that requires travel to another site.
• Restructuring has resulted in a lot ofmovement and position changes. It was noted
that many officers in the Ministry of Education were new as focal point persons for
the CHANGES programme (SHN, HIV/AIDS, Equity and Gender, CSMC). There is
a need to train or retrain officials at the district, provincial and national levels. The
training should include all Standards Officers at these levels, which will ensure that
teaching and learning processes link up well with all these cross-cutting issues.
• Any follow-up programme should seek ways to continue the collaborative use of
sensitisation and mobilisation techniques, especially at local levels. The use ofschool
clubs and improvised drama troupes to sensitise their peers and communities and vice
versa, the use of communities to sensitise their fellow members and pupils should be
strengthened in the expansion ofthe programme.
• The training offocal point persons for CSMC was an impetus for the success that the
CHANGES programme had scored in orderto reach the schools and the community
and ensure sustainability ofthe activities. However, at schools where there are many
teachers, focal point persons should not be the same person for HIVIAIDS, for SHN .
(in the 3 Southern Districts), for CSMC and for Equity and Gender. In schools where
a teacher had many roles to playas a focal point person, activities were not very
effective, because the teacher had to move from one workshop to another. Future
training should ensure that valious people from the same school are being trained in
all activities ofthe CHANGES or a follow-up programme.
• The training ofFPPs should focus on strengthening the link between PTAs and
schools, and the need to ensure that information reaches the people and that both male
and female merrlbers ofthe community are involved in decision making process.
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• There were some schools where the CHANGES programme was very successful, but
the classroom work was very poor. For example, Musokotwane Basic School in
Livingstone had constructed a girls' dormitory and skills training centre and the
school had been electrified. But when one entered the classrooms and looked at both
pupils' and teachers' work, there was very little evidence ofteaching and learning.
There must be a link between acaden1ic performance and the cross-cutting issues, in
order to ensure that teachers do not spend more time at the skills centre at the expense
ofteaching.
1. MOE Resources and Requirements to Continue CSMC
While the CSMC is characterized by its inter-ministerial nature, it is understandable that
many personnel continue to see the programme as primarily that ofthe MOE. The
CHANGES models have shown that capacity can be built in personnel at the school,
zonal, district, provincial and national levels, but not without cost in time and finances.
CHANGES has trained thousands offocal point personnel and formed CSMC committees
at all levels ofthe educational system to be full participants in health (Eastern Province
and beginning in Southern Province) and community development (Southern Province).
There is near unanimous agreement, however, that the programmes should continue to
receive outside support and not be abandoned in their infancy. The CSMC sensitisation
and mobilisation models developed by CHANGES are without cost in time and resources.
With careful planning, short workshops can be expanded to other provinces at
comparatively small cost, as can interventions such as hand washing, disposal ofrefuse,
'and school cleanliness. Bore holes and the building of latrines, however, do involve
extensive expense, and are critically important to the long term health of children. The
CSMC model involves a high commitment oftime to penetrate each community, in order
,to ascertain local problems and achieve "buy-in." It also involves extensive costs oftime,
personnel and funding to train personnel and monitor their action plans.
Recommendations
• Utilize the fall of 2005 to prepare for scaling up ofthe programme to all Provinces,
with training for provincial teams to begin in January, 2006, followed by District
teams in April, 2006, fol~owed by Zonal training during the next school break period.
• Expand the CSMC model to other provinces utilizing "shortened" versions ofthe
intensive sensitization, and only in carefully selected districts where, for reasons of
language and culture, among others, it is thought that unique components might
necessitate adaptations ofthe SP model.
• It is important that future activities are in line with those ofthe MOE, in order to
continue with CSMC, which has worked very effectively in the pilot phase in SP,
implemented by the CHANGES programme. This should be done by linking up the
activities on HIV/AIDS, as outlined in the HIV/AIDS Strategic Plan 2001-2005, and
the activities in Sector Plan under the Directorate of Planning and Information on
SHN and Gender and Equity. The following are some ofthese activities: develop a
participatory monitoring tool and conduct monitoring ofHIVIAIDS and Equity and
Gender activities, and continuous training and upgrading offocal point persons to
spear-head planning and implementation of HIVIAIDS and Gender and Equity work
at the provincial and district level. Although these FPPs seem to be in place, during
the evaluation, it was found that most ofthem changed places and positions during
restructuring and those who were trained are playing new roles.
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• In order to strengthen collaboration and to effectively build activities, there is need to
have an Implementation Committee within the Ministry ofEducation. The
Implementation Committee should be comprised·ofmembers from the key
Directorates: Standards and Curriculum, Teacher Education and Specialised Services
and Planning and Infonnation. The committee should be served by the secretariat
from the new programme. The committee should plan and implement the activities
supported by the new programme and those ofthe MOE, so that they can ensure that
there is integration at all levels. This committee should also incorporate members
from MOH and MCDSS.
• A leadership office of any follow-up programme should be located within the
Ministry ofEducation, to assure close coordination with the various Directorates,
although the size ofthe programme will make it likely that there will need to be
separate offices for staff of any new programme.
• There should be a national Zambian project manager, employed by the programme
and possibly an international Technical Adviser housed within the MOE, to serve as
secretariat and plan the implementation to facilitate support in line with MOE
activities. These two would then be sitting at most ofthe MOE meetings and plan and
implement programme expansion.
• Training manuals have been developed for FPPs by the CHANGES programme.
However, there was little evidence of classroom participatory methodologies for
teaching HIV/AIDS and Gender Equity. There is a need to look at the classroom
based interactive methodologies and develop teachers' guides to assist teachers on
what to do in the classrooms. This is an important area that will require support.
• HIVIAIDS comers in schools, where pupils could share infonnation with peer
educators, exist in almost all the schools visited. However, there is a need for
guidelines for teachers on the definition ofthese comers and how they should be used.
The roles ofteachers and peer educators should be clearly explained through
counselling training. Many schools visited were asking for funds to construct offices
for peer educators. Yet the activity can take place in an existing classroom ifthere are
no other people present, or even under a tree.
• A lot ofinfonnation on HIVIAIDS, Gender and Equity has reached the schools and
the communities in the EP and SP. The infonnation is meant to sensitise both pupils
and communities on health issues, girls' access to education, HIVIAIDS prevention,
and caring for the sick. However, most ofthis infonnation is written in the English
language. In line with MOE policy that initial literacy should be in local languages,
and in order to encourage adult literacy and allow more people to glean messages
from posters, leaflets and local radio programmes, some ofthe infonnation should be
translated into the 7 local languages used in schools for teaching. Given funds for
workshops, this is where the Directorate of Standards and Curriculum could come in
and use the language specialists to translate appropriately for Grade 1 and even up to
grade 7, and for most members ofthe community. This will provide many chances
for parents and children to share infonnation.
• Training ofin-service teachers and pre-service students in MOE activities is done by
the Directorate ofTeacher Education and Specialised Services through the teacher
training colleges. The directorates have established structures and a system has been
put in place by the use ofthe Teachers Resource Centres and Provincial, District and
Zone Education Support Teams. These groups are nonnally brought on board at the
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beginning of any programme; however, during this evaluation, it was discovered that
some ofthese teams were not involved in the CHANGES programme. At the zonal
level, the ZEST (Zone Education Support Team) is comprised ofthe Head Teacher,
the Zone Resource Centre Co-ordinator and the Subject In-service Provider. The role
ofthis team is to train teachers and head teachers in MOE activities and to monitor the
progress ofthese activities. These are the appropriate people to train the FPPs at
school and in communities. The use ofthese teams has proved to work very well, was
used by the Primary Reading Programme and has produced very good trainers. It is
very effective, especially when rolling out a programme countrywide. The new
programme should explore ways of using these teams.
There is need for a team of national trainers who could train the FPPs in districts and
also train the School and Community FPPs in their districts. It would take 6 days to
train 70 National Trainers and 18 days to train 360 District trainers (FPPs) who would
train 12,000 Zonal FPPs in their districts. The pool of national trainers should be
comprised of Senior Standards Officers, Curriculum Specialists, Officers from
Planning and Information, Teacher Education Department (In-service training),
College lecturers and teachers from the pilot schools in EP and SP who have done
well in CSMC.
2. CSMC's Crosscutting, Collaborative Nature 'and Sustainability
The Memoranda of Understanding and informal understandings between the three
Ministries (MOE, MOH, and MCDSS) appear to be functioning well and having an
impact at the zonal level, with varying levels of commitment and understanding at the
district, provincial and national levels. The MOE and MOH resources (personnel, budget,
transportation etc.) are significantly greater than that ofthe MCDSS. Since the SNH and
CSMC are primarily efforts ofthe MOE, it is not surprising that the level of effort and
commitment are greater there than in the other three ministries. Provincial, District and
Zonal Committees are in place, but the regularity oftheir meetings, attendance of
members, and commitment to CSMC goals appears to differ by setting. The MCDSS
zonal community development workers appear to know their communities well and
collaborate with the MOE in providing information for bursaries for girls and OVCs.
Community health centres do not appearto be deeply involved in the drug administration,
but the MOH does assist in the storage and distribution of drugs to the schools. If
MCDSS is to become a full partner in a fully functioning multi-sectoral CSMC, it will
need strengthening.
Recommendations
The zonal community development officers (MCDSS) are generally without any
forms oftransportation, and thus seldom are able to visit all villages in their zone.
Bicycles or motorcycles would assist them in their efforts.
Any follow-up to CHANGES by USAID should involve all three Ministries on a
regular basis at alllevels, and the programme leaders should be regular participants in
those meetings at the national, provincial and district levels.
Integrate community, zonal, district, and provincial development officers into all
training, monitoring and on-going committees.
Strengthen the implementation ofteacher trainings for life-skills at grades 1-9.
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Educational Standards Officers from the MOE need to monitor all activities, including
health, nutrition, care of OVCs, and other factors, in addition to the teaching and
learning process.
Quarterly reports ofthe new programme need to be circulated to all MOE directorates
and to appropriate officials in the MOH and MCDSS.
Most ofthe information on HIV/AIDS and SHN can be integrated into support
material for literacy, which has already been successfully implemented nation-wide
from grades 1 to 7. It could be included as reading materials for class libraries, or as
part ofre-training ofteachers in Read On literacy courses from grades 3 to 7, where
literacy has not made a big impact.
After sensitisation and training on the CHANGES programme, schools and
communities became aware ofthe need for girls' education, the impact and
prevention of HIV/AIDS, and how to promote SHN. However, there is need for
follow up with all stakeholders who had conducted sensitisation and training, to check
on what people have done and how behaviours have changed. One example is David
Livingstone College of Education, where lecturers were involved in the extension
phase and look forward to seeing progress made in the field by being involved in
monitoring.
The initial stage ofthe programme: sending researchers to 55 schools and 330 -
communities for 10 days to identify and verify problems, has worked very well and
has led to the writing ofschool profiles. However, in the nationwide scale-up ofthe
programme, this is not a viable exercise, since it would be very expensive to send
researchers into every community. Zonal FPPs could be trained in this aspect of
research so the problems identified by these Zonal FPPs could be compiled at the
district level for planning purposes. Or, sampling research in some ofthe communities
in each province could be done.
In order to improve on the MOE's EMIS system, there is need to train head teachers
through ZEST on how to maintain data on enrolment rates and progression rates, so
that correct records are kept in schools and correct figures are given to districts for
compilation by Planning Officers. It was observed during this visit thatmany head
teachers lacked skills for maintaining such records.
3. Gender Equity
The CSMC conducted participatory research in each ofthe 11 districts ofthe Southern
Province to document the reality lived, experienced and described by the local people. It
then published District Profiles on its findings, which were meant to lead to action on the
part ofthe local population. The Zambian Government produced a document entitled
"Education Our Future," (1996) which details the role of education in personal and
national developn1ent. This document states that "Where access, participation, and
achievement in education are impeded by gender.....the government will seek to
eliminate the sources of educational disadvantage in order to enhance equity." To this
end, the PAGE programme, conducted by UNICEF with USAID support, and the current
CHANGES programme have sought to assist the GRZ in bringing about greater gender
equity through schools.
The results ofthe CHANGES/CSMC study, Gender andEquity in Basic Education in
Zambia: BeyondAdvocacy to Action (2005), found that in the Southern Province, for both
the under 7 and at age 7 categories, girls outnumber boys in grade one, but that at each
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level above that, boys outnu1l1ber girls. However, the total nU1l1ber of girls, of any age, is
still greater in grade one than that of boys (25,762 to 25,484). This is an indication that
the longer girls delay initial enrolment in school, the greater the disparity. The same
study found that at every grade above grade one, boys outnumber girls,·with the total
enrolments of 160,794 boys to 153,112 girls in grades 1-7. It also found that female
dropouts, for all reasons, numbered 4,833, as opposed to 3,459 for the boys, with
marriage and pregnancy counting for the largest disparities in gender enrolment. While
girls repeated grade one at a slightly higher level, in every succeeding grade, male
repeaters outnu1l1bered females, so that by grade seven, 57 percent ofthe repeaters were
boys. These figures point to the importance of cultural factors in the female drop-out
rate, and suggest that if girls stay in school, they are likely to do better than the boys.
International research has made similar findings on girls' academic achievement in a
curriculum involving literacy, something that is important in the Zambian system, where
children learn both Mother Tongue and English.
CSMC reports the following basic factors leading to gender disparities in Southern
Province.
Socio~CUlti.tral•• Factors:
~'F:~mjlyDySfuric;UOn
~·.• :,~r~~~I~~J,§,~xua 1..·.Custdrrls··.·and
School Factors:
S;!.$,Qq981::ln!r~strUQt9r.~an ~.~',~i9D • 'School Furniture·and,Educational.Malerials
•••••!;·.rv1i.str~~Jm~;bt~bd .. ~~R;!§ilafic>nofPupii~ •."Relevance ofEducation ~")ln'siimiionaj'Managemenl
Family Dysfunction
In general, the CSMC findings report that family dysfunction is closely related to poverty,
hunger, parental mortality, orphanhood, socialisation of boys and girls, household chores;
all affect enrolment and attendance.
• The study emphasises the importance ofstrategies to alleviate poverty and hunger,
although this would appear to be a long-term strategy, along with family planning for
smaller families, reducing parental mortality through HIV/AIDS prevention
programnles, assistance to orphans, and encouraging parents to reduce the burden of
household chores, particularly for girls on school days.
Sexual Customs and Mores
Among the sexual customs and mores that affect school involvement and attendance are:
peer love relationships, teacher-student sexual liaisons, social gatherings held by churches
or traditional ceremonies, concert parties, children sleeping in their own huts, peer
pressure for sexual activity, traditional initiation rites for girls (Nkolola) which includes
the seclusion ofgirls, content ofinitiation lessons, and the ceremony day in which girls
are advertised as virgins, are all seen as affecting enrolment and attendance ofgirls.
Recontmendation
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• Sex by pupils should be discouraged through education on sexual and reproductive
health, including HIV/AIDS; guidance and counselling services in schools; clarity of
regulations and professional ethics ofteachers with enforcement of penalties; and
changes in the traditional practices of girls' initiation rites (Nkolola).
School Factors
Among the school factors that affect enrolnlent and attendance by girls are:
dilapidated buildings and furniture; class size; lack of desks; lack ofstaffrooms; lack of
teachers' houses; lack ofteachers or multi-grade teaching; lack oftoilets (particularly for
girls); lack ofprivacy; lack ofbathing facilities; school uniforms; distance to walk to
school; corporal punishment; teachers' negative behaviours and attitudes; child labour in
school and production units; lack oftextbooks; safety in walking to school; irrelevant
curriculum; lack ofpositive female or other role models; shortage ofmiddle and upper
basic schools; utility and fairness of examination system; lack ofsupervision; teacher
absenteeism; non-teaching duties; lack ofteacher commitment; teaching "extra" lessons
for pay; teacher alcoholism; high staffturnover; untrained teachers; conflicts and power
struggles among and between teachers and head teachers; and lack ofpower in the PTA.
Recommendations
Improved infrastructure; schools located within five kilometres; preventive
maintenance; teachers' offices and homes; appropriate ratio oftoilets; progranlme for
sanitation and hygiene; equity in the number of desks and textbooks; teacher .training
on classroom management and teaching; controls on child labour in school and
production units; provision of uniforms forOVCs; discipline guidelines; curriculum
on children's rights; clarity on government policy on the non-requirement ofschool
uniforms; construction and staffing ofmiddle and upper basic schools; greater
fairness in national examinations system; improved inspection system; control of
extra duties for teachers so they can concentrate on teaching; better remuneration of
teachers; controls to reduce teacher absenteeism, alcoholism, and conflicts; replace
untrained with trained teachers; clarification ofroles and responsibilities ofPTAs to
empower them; and training in school management.
Guidelines on Gender Equity
While the findings and recommendations ofthe CSMC on gender equity are research
based, and we are in strong agreement with each ofthem, gender equity goes much
deeper into what it means culturally to be female or male. We offer the following
recommendations for consideration.
Recommendations
Equitable access to schooling is not enough, ifthe education offered is limited by
cultural definitions ofwhat it means to be female and male in the society.
• Both boys and girls must be targeted in any policies and practice, to assure that all
Zambian children are prepared for an equitable society, including work, civic
involvement and domestic life. Schools should be places in which both girls and boys
feel safe, are safe, and where they are respected and valued.
• Schools should acknowledge their active role in the construction ofgender, and their
responsibility to ensure that all organisational and management practices reflect
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commitment to gender equity. This includes, but is not limited to, female and male
role models in all school positions, gender equity in textbooks and all instructional
materials, equal treatment ofgirls and boys in class, seating arrangements, types of
classroom questioning and many other factors that help to "construct" gender roles in
the schools.
• Understanding of gender construction should include knowledge about the
relationship of gender to other factors, including socio-economic status, cultural
background, rural/urban location, disability and sexuality. These factors need to be
brought to the forefront in each school setting, ifZambia is to reach beyond surface
gender equity.
• Acceptance of changing gender roles is a long and difficult task, but understanding
and accepting that there are many ways ofbeing masculine and feminine will assist all
students to reach their full potential. The narrow boxes into which boys and girls
throughout the world are confined prevent both genders from fulfilling their potential.
• Strengthening and empowering PTAs, ensuring survival and vocational skills through
schooling, and regular involvement with the broader community are all critical to the
improvement and change in educational outcomes for girls and boys.
• Any interventions should be targeted towards increasing options, levels of
participation and outcomes ofschooling for girls and boys. While the issues facing
girls are, without question, a high priority, it will do little good ifthere are not
simultaneously interventions which target gender construction in boys.
• Anti-discrimination and other relevant legislation at the national, provincial, district
and even zonal levels should inform all educational programmes and services.
• Many countries which have attempted to achieve greater gender equity forget that the
process needs continuous monitoring of educational outcomes and programme review
to prevent a return to old cultural patterns and norms in the home, school and broader
society.
4. Girls' Enrolment and Progression Rates, and Community
Sensitization
It is not possible to attribute, with any exactitude, the percentage of girls' enrolment that
can be attributed to community sensitization, but all school, zonal, and provincial
officials, as well as parent and community informants, point to greater enrolment of girls
in recent years. This is particularly true in the early primary grades and less so in grades
5-9, particularly upon girls reaching puberty. The rise in girls' enrolment has been
attributed to CHANGES interventions, the PAGE programme (a predecessor of
CHANGES), MOE emphasis on gender and equity, free primary education, and school
feeding programmes, among others. Many informants attribute the return of young
mothers to school to the sensitization ofthe CHANGES programme. The CSMC is given
strong credit for achieving the support ofChiefs and Village Leaders in changing or
modifying traditional cultural practices such as initiation ceremonies, early marriage and
pregnancy, and protective measures for the girl child in the home.
Recommendations
• Continued support to the MOE's gender and equity offices and campaigns.
• The expansion of gender and equity to a much larger and significant concept
including issues such as masculinity and femininity, gender based violence,
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•
•
•
•
•
•
•
•
•
•
curriculum, adult gender roles, teachers' attitudes and behaviours, parental and
community education, popular culture and gender roles and many other topics dealt
with in more detail in the Evaluation Report section on gender roles.
Expansion ofthe CSMC model to provinces and districts throughout the country,
particularly with in-depth research and verification in new cultural and linguistic
settings, different than those found in the Eastern and Southern Provinces.
Continued training and support for NGOs, such as FAWEZA and other programmes,
to provide bursaries for girls and other vulnerable children to complete their schooling
up through grade nine. Procedures on identification by MCDSS and names taken to
the DEBS Office for bursaries, must be carefully followed to prevent nepotism and
fraud.
Continued support for building latrines, bathhouses and dormitories for girls.
Build on the successes ofPAGE that are currently in the Office of Gender Equity in
the MOE.
Continuation ofthe Family Pack Programme and other quality materials on gender
equity.
Monitoring ofgirls' enrolment from the school to the national level, with numerical
goals on equity at each level.
Study the reasons for success and failure of boys, and deal with issues of gender￾based violence, respect for girls and women, and develop materials to assist boys in
growing into productive citizens.
Continued support in working with publishers to assure gender sensitive textbooks
and instructional materials.
Promotion ofmore women in rural areas to strengthen positive role models for girls.
PTAs need women in positions ofleadership, not just men, and gender balance in
discussions and actions should be sought.
5. Cost Data for CSMC Classroom-based Components
The Original Contract and Extension Period for CHANGES contract included the sum of
$1,424,222 for the delivery ofCSMC activities. This was the total for trainings,
workshops, small grants, information education and communication, pre- and in-service
training ofteachers, sensitization and mobilization for SHN and CSMC, advocacy, and
the development of action plans. While it is not mentioned in the CSMC performance
indicators, monitoring was mentioned as being a "high cost" part ofthe process, but
monitoring by CHANGES stafflikely comes under the salaries, benefits and others costs
associated with the programme. It is difficult to extrapolate costs per classroom, as
figures from CSMC appear to be a nlixture of "total costs" from the whole period ofthe
programme, and only costs expended during the Extension period.
Recommendations
• Based on the assumption that the $1,424,222 CHANGES expenditures (2001-2005)
on activities covered 728 school catchment areas, the per-school costs would appear
to be approximately $1956 per school. Ifthe national total of6,786 Basic Schools,
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minus the 728 already "sensitized," were to be covered, then the total cost for scaling
up to cover all ofthem would be approximately $11,849,448.
• This figure covers all levels oftraining and other activities, not just for individual
schools, but can give one an approximation of costs ifthe programme were to be
expanded nationwide, utilizing the same model used in the Southern Province. It does
not, however, cover headquarters, salaries, benefits, and other administrative costs of
the programme.
• It is unlikely that such a sum offunds will become available, and thus it is
recommended that CSMC could be carefully targeted at certain districts, which have
cultural factors that affect school attendance, girls' enrolment, HIV/AIDS, gender
roles and other issues of concern. Neighbouring districts could then learn from the
sensitised districts and hopefully put many ofthe "best practices" into their on-going
in-service training programmes.
6. Integration of CSMC
The restructuring ofthe MOE appears to have slowed the process ofintegrating the
CSMC in some districts, as many key personnel have been moved to new positions and
locations in the past two years. Despite one or more persons being charged with being .
the focal point person(s) at each level (school, zone, district and province), with the move
towards having Standards Officers in charge ofseveral areas ofresponsibility, there was
evidence that activities on girls' education and HIVIAIDS were not always the highest
priority of many ofthe officers so designated, due to multiple roles and work plans.
There also appeared to be much variability between districts and zones. The support of
the DEBS is a critical factor, along with the district focal point persons, having been
. through the various training components.
Recomnlendations
• The reader is referred to many ofthe CSMC recommendations in #1 above, where
resources, personnel and policy requirements are given in detail.
• Persons who are trained as focal point persons at the school level should continue
training other teachers in the school through the SPRINT system.
Any future programme should ensure that committees on HIV/AIDS and Gender
Equity are strengthened and supported.
• Work plans should capture HIVIAIDS and Gender Issues at the provincial and district
levels, with provisions made for monitoring both ofthese.
A continuous process for reviewing work plans should be put in place.
7. Line Ministries and Zambian Partner Organizations' Capacity-building
Findings and Conclusions: Capacity-building has been a major component ofthe CSMC
program. Extensive training has been held for literally hundreds ofindividuals, and
reports on the quality ofthe workshops has generally been positive. The following totals
ofindividuals trained at each level, as ofDecember 31, 2004, with significant female
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participation of approximately 1/3 of all officials and focal point persons. Provincial
Officials-15, District Officials-125, Zonal Officials (ZCFs)-327, School-Based Focal
Point Persons (SFPPs)-2184, Community-Based Focal Point Persons (CFPPs)-2912. In
addition, a provincial multi-sectoral team has been formed, 11 district multi-sectoral
teams, and 103 zonal level multi-sectoral teams. Five NGOs have been given capacity￾building assistance. Small grant proposals were received from 288 communities and 529
schools, with over half ofthe 728 communities and schools being expected to submit
proposals, based on community or school-based action plans. Some 950 pre-service
teachers have been trained in HIVIAIDS, life skills, and gender equity issues, along with
76 TTC staff, and 158 head teachers and teachers. 445 teachers and head teachers have
been oriented on the use ofthe manuals on the topics above, along with 2 Teacher
Resource Centres (TRCs). 360 HIVIAIDS and life-skills modules have been
implemented, along with 130 gender modules.
Recommendations
• While capacity-building workshops are important, it should be ensured in the future
that the on-going schooling of children not suffer from the trainings, which are held
by the many programmes ofthe MOE.
• Capacity-building in grant writing is important for communities seeking external
funds to improve their schools, but mechanisms must be found to educate schools and
communities on the limited nature of grant funds, in order not to discourage or even
anger communities not receiving assistance.
Monitoring and follow-up ofAction Plans resulting from the capacity-building is an
expensive and time-consuming task. Without them, it is likely that any future
programme will be but another ofthe many programmes which have been carried out,
with little long term impact.
• School health, gender equity, and HIV/AIDS have been handled by the Planning and
Information Office ofthe MOE, so officers in Standards, Curriculum, Teacher
Education and Specialized Services have been generally left out. They are key
players in the monitoring and training and must be included, especially at the national
level.
• MOH has signed the MOD and MCDSS has an informal understanding on
CHANGES, but neither have played an important role in the planning and
implementation ofservices. Representatives ofthese two ministries must serve on
any future Implementation Committee and their staffincluded at the provincial and
district levels in all trainings.
8. Effect of CHANGES on Girls' Enrolment
It is difficult to factor out the effects ofCHANGES on girls' enrolment, as the
programme followed on the heels ofthe well accepted and positive PAGE programme, in
addition to coinciding with the policy offree primary education and feeding programmes
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by the World Food Programme. Testinlonials by focal point persons at each level and by
community members, however, give credit to the CSMC for strongly promoting girls'
education, receiving the support of many Chiefs and Village Heads, bringing numbers of
young women back to school following the birth oftheir children, changing the timing of
initiation rites to vacation periods, improving latrine and bathing facilities for pubescent
girls, and providing greater protection for girls on their way to and fronl school or through
building girls' dormitories. In the 20 schools in the Siavonga and Sinazongwe Districts
of Southern Province, the percentages of boys is only slightly higher than that of girls (5.4
percent more boys than girls in Siavonga and 3 percent more boys than girls in
Sinazongwe), but in the drought ridden, poorer district of Gwembe, the difference is 22.2
percent more boys than girls enrolled. Informants from Gwembe indicate that enrolments
rise and fall with feeding at school or sufficient food at home, and that the balance of
genders is generally better in the larger villages in the District. As might be expected, the
percentage of girls enrolled tends to fall, the higher the grade in school, despite growing
evidence that girls are achieving as well or better than the boys in many subject areas.
This would indicate that traditional gender roles, early marriage, chores at home,
initiation ceremonies, and other "traditional" factors continue to make it more difficult for
the girl child to remain in school, despite CHANGES and other GRZ initiatives.
Recommendations
• Targeted assistance should continue in the Southern Province to particularly poor
districts and those with significant numbers ofOVCs.
Districts with continuing significant differences between boys and girls' enrolment,
attendance and graduation rates should be targeted.
• Working with the World Food Progranlme, NGOs and others, school feeding
programmes should continue to be targeted at drought ridden and particularly poor
areas, as these factors appear to affect girls' enrolment figures.
• Continued sensitisation of community members on the importance ofgirls' education
is of great importance.
• Small grants should be continued to construct VIPs, bathing facilities and dormitories
for girls.
• Teachers need training in counselling and guidance for both girls and boys on
HIV/AIDS and gender issues.
9. HIV/AIDS
Another major cross-cutting issue ofthe CHANGES Programme is that of HIV/AIDS.
Although the SlAPAC study was basically a stand-alone activity ofthe CHANGES
programme rather than being directly tied to either SHN or CSMC, the impact of
HIV/AIDS on the educational environment warrants closer examination. Therefore, this
study seeks to detail the nature ofthe epidemic among young people and what appear to
be the most powerful change agents of adolescent sexual behaviour: namely service
learning (Community Service) and mentoring.
Before going into greater detail on the issues surrounding HIV/AIDS and youth
throughout Africa and the world, and promising approaches to confronting the issues, we
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will review the findings ofthe SIAPAC study, financed and supported by CHANGES,
published in January, 2004.
• Zambia is among the world's most affectedcountries by HIV/AIDS, with a
prevalence rate at 16 percent. The rates for women are even higher, estimated at 18
percent versus 13 percent for men. In addition, women are being infected and dying at
a younger age than men. Urban rates are estimated at 2.5 times that ofthe rural rate,
and HIV rates appear higher for the employed, as compared to those who stay at home
or who work as farmers. The report also estimates that the risk of a 15 year old dying
from AIDS at some point in his/her life is one in two.
• In 2001, 60 percent of all orphans in Zambia were AIDS orphans, and for the 7-14
year old age group, 27-33 percent ofthe children will have lost one or both parents to
the disease, while for 0-6 year olds the estimate was between 17-21 percent. By 2003,
there were an estimated 800,000 children who had lost one or both parents, and is
projected to increase to 1.2 million by 2010.
• Zambia has responded more substantively to the epidemic than most other countries,
with a range ofpolicy initiatives across the various sectors. According to SIAPAC,
however, a key gap in the response has been insufficient attention to the role of
attitudinal and behavioural change, particularly the role ofwomen in sexual decision￾making. Along with this, there has been a shortage of voluntary counselling and
testing services, a lack of behavioural change communication approaches to learning
and action, inconsistent access to and use of condoms, and extremely limited
provision of anti-retroviral drugs. Some ofthese issues are dealt with in the extensive
section which follows on successful interventions in other countries, utilizing service￾learning and community involvement to promote attitudinal and behavioural change.
• The study predicts a weakening of demand for education as fewer children are born,
and families are unable to keep their children in school. Educational shortfalls have
undermined the provision offree education; HIV has already affected attendance and
is undermining the quality of education received by children.
• The number of educators who are HIV positive is estinlated at one-in-four, higher
than for the population at large. The study suggests that at least half ofthe deaths in
the system are from AIDS. It predicts that a sufficient number ofteachers will be
trained until 2010, after which there will need to be an increase in production of
teachers. A more imnlediate impact is that ofteacher absenteeism due to illness, both
short and long-term.
• Educational quality is suffering greatly, partially due to HIV/AIDS, but also due to a
wide range of other factors. In addition to absenteeism, there are numerous doubled￾up classes, untended classes, and many schools that offer a shortened school day. The
results are born out by low scores on national assessment tests.
• AIDS could cost the MOE as much as US$375 million between 2003-2015, with
some costs offset by ARVs.
Recommendations
• The government has already planned to increase the supply of ARVs for teachers and
their families, with a predicted 700 being offered in 2005 to 5,000 by 2015.
Community-based initiatives are recommended, again something the government has
already responded to, with the large number of community schools now in existence.
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The study recomnlends a "mainstream" approach to HIVIAIDS, rather than special
programmes. While CHANGES is a "special" programme, its CSMC approach is a
holistic one that involves not just schools, but whole communities in the process. The
danger of mainstreaming HIVIAIDS responses is that it is quite likely that when
everyone is responsible, no one is-responsible.
The CHANGES/CSMC approach oflearning from, scaling up and providing support
for local interventions is already being acted upon. Regrettably, the repertoire of
interventions is still limited, both in the community and in the school. The following
section attempts to provide insight into what has worked in other countries.
The study calls for greater resources for the MOE to deal with HIV/AIDS, and also
for working with NGOs and private service providers to assist at the school and
district levels. Some ofthis is already being done by CHANGES/CSMC through
small grants for training and materials.
The Workplace Programme must be broadened to affect mainstreaming and the
development of diagnostic skills, and response development among MOE personnel.
These personnel need to focus on how HIVIAIDS is affecting their work, their pupils,
their schools and their communities.
Among the many specific recommendations made by the study are the following:
Being aware that not all teachers are well informed or good role models;
Reaching out to pupils through non-testable curricula, special programmes,
booklets and brochures;
· Schools need to be protective environments, not part ofthe problem;
Children need to know how to protect themselves;
Detailed information on the effect ofHIV/AIDS on personnel in the sector;
An MOE directive on mainstreaming, and a high profile by the MOE on the
issue;
Combat stigmatisation, secrecy and denial;
Inter-sectoral approaches and alternative funding sources sought;
Consider expanding free education to higher grades;
Clarity ofpolicies on OVCs, with programmatic responses;
· Expand pre-service and in-service training on HIV/AIDS;
· Move beyond knowledge into attitudinal and behavioural change;
· Greater use ofradio and distance education;
Enforce zero tolerance for sexual misconduct by MOE personnel;
Improve security at hostels and dormitories;
Make condoms available to those who choose to be sexually active;
Develop circles ofsupport;
Incentive schemes for communities to respond to AIDS;
Respond to the full range of orphans' needs;
Special attention to schools in "high risk" environments; and
· Concentrate more on local initiatives, rather than centrally mandated solutions.
Many ofthese are already being done in schools and communities, particularly those
tied to CHANGES/CSMC. Many others are also found in the detailed literature on
youth and HIVIAIDS found in Annex 6 and in the following section.
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10. Special Vulnerability of Youth
The demographic reality ofmost developing nations, but particularly those of Sub￾Saharan African including Zambia, in which a majority ofthe population is under the age
of 18, makes prevention much more problematic and important. The Population
Information Centre (2004) summarizes well the particular vulnerability of youth.
"Physical, psychological and social attributes of adolescence make young
people particularly vulnerable to HIV and other sexually transmitted
infections (STIs). Adolescents often are not·able to comprehend fully the
extent oftheir exposure to risk. Societies often compound young people's
risk by making it difficult for them to learn about HIVIAIDS and
reproductive health. Moreover, many youth are socially inexperienced and
dependent on others. Peer pressures easily influence them - often in ways
that can increase their risk."
Most HIVIAIDS experts point to a number offactors which make children and
adolescents particularly vulnerable.
Findings:
1. While educational campaigns are underway throughout the world, a large
percentage of young people (as high as 90 percent in some countries) are still
unaware of how to protect themselves or have misconceptions about the
disease (Population Reference Bureau, 2000).
2. Information and education has proven to be insufficient. Risk avoidance
skills, delay ofsexual debut, negotiation with sex partners, and early
education, long before children become sexually active are all needed.
3. Many young people living with HIV/AIDS do not know they are infected, and
sexually active young people, regardless of country, do not perceive
themselves as being at risk (UNAIDS, 2001).
4. Youth tend not to have a strong political voice and thus are not given a high
priority for funding or action.
5. HIV/AIDS tends to infect the most vulnerable of children and youth, those
living in the poorest countries and regions ofthe world, and those who suffer
fronl lack of education, economic opportunity and health services available in
the wealthier nations (Henry J. Kaiser Foundation Fact Sheet, May, 2002).
6. Condoms are not readily accessible or available to Zambian youth.
7. Young people, particularly young women for physiological reasons, are at
greater risk for STDs and HIV/AIDS than are adults.
8. Few services are currently "youth friendly," offering insufficient counselling
and health care, or referral.
9. Many cultural norms and practices place young people, particularly women, at
greater risk.
10. Too few programmes involve youth in planning and running prevention
activities, and more effective rrieans are needed to reach parents, teachers and
other adults who can interact with and influence youth (Population
Information Programme, 2004).
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11. Strategies to Maintain and Capitalize on the Capacity of the CSMC
Staff after the Close of CHANGES
The CSMC had a positive effect at the Provincial, District and Zonal levels; officials have
expressed their strong belief ofthe need for continued assistance in order to sustain the
gains that have been made to date. In the Eastern Province, the Sensitisation and
Mobilisation was primarily focused on the development of SHN activities and put into
work plans.
Recommendations:
• A "skeleton" staff ofthe CSMC should be maintained in Chipata to assure
sustainability ofthe efforts in Southern Provinces.
• Other staff could take leadership roles in support ofthe MOE's expansion ofthe
CSMC programme to other Provinces and Districts around the country, once again
concentrating on those that are most needy as evidenced by lower girls' enrolment
and higher HIV/AIDS rates.
• The CHANGES staff could be linked up to the National Implementation Committee
at the national level, in order to plan, train, implement and monitor the expansion to
other provinces, in alliance with the National Coordinator.
• The CSMC staff could be assigned to the head office of Pre-Service in Teacher
Education, to work with all TTCs in the country.
x. SMALL GRANT MECHANISM
A. Rationale and Goals of the Small Grant Mechanism
The third major component ofthe CHANGES Programme is the Small Grants
Mechanism or component. Its three goals have remained unchanged over the last three
years: (1) increase the participation of girls and other vulnerable children in basic
education; (2) integrate messages about HIV/AIDS, life skills and appropriate behaviours
into ongoing school-community and district-level education activities; and (3) improve
learning, health, and nutrition of primary school students through innovative SHN
activities (CARE, CHANGES Impact Summary, Jan. 2005, p. 3). Thus, small grants were
intended to advance CHANGES' overall goals for gender equity, HIV/AIDS prevention,
and primary school health and nutrition improvement, rather than serve as stand-alone
economic development programmes.
From the outset ofthe CHANGES programme, a small grants component was viewed as
a necessary counterweight to the economic basis of gender inequity in formal education.
As documented by studies in many countries, the economic benefits of not enrolling
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daughters in, or withdrawing them from, school-either for the purpose of adding labour
to the family or generating wealth as young brides-have interrupted or foreclosed
completion offormal education for millions ofpoor Zambian girls. Likewise, the lack of
any financial support for and/or the high cost of educating other vulnerable children such
as AIDS orphans and children with special needs have largely resulted in the exclusion of
these groups from formal schooling. The enormity ofthis population in Zambia-an
estimated 800,000 children including non-enrolled girls-has presented an additional
challenge to educational institutions that are ill-prepared for such- needs.
Zambia has made progress in closing the gender gap in primary school enrolment.
USAID/Zambia has already been active in this area with its support ofthe MOE's
Programme for the Advancement ofGirls' Education (PAGE), the MOE's Basic
Education Subsector Investment Programme (BESSIP), and its pilot testing ofradio
instruction for vulnerable children. But school retention figures from USAID's
Demographic Education Survey (Zambia DHS, p. 90) still showed a greater likelihood of
rural girls dropping out before completing grade one than rural boys (44 percent vs. 37
percent). And, girls were significantly less likely to regularly attend school (DHS, p. 54)
compared to boys, as attested by the strong male bias in the rural gender parity index
(0.83). Scholarships for girls and other vulnerable children from poor circumstances
would directly reduce or remove this economic cause ofschool withdrawal. And, sn1all
grants could also fund innovative alternatives to educating other vulnerable children
within formal schools.
While youth sexual behaviour has often been considered impervious to change,
sensitisation approaches that engage children in an interactive process have shown
promise. HIVIAIDS-prevention campaigns, like many initiatives that go beyond core
government functions, have often consisted ofmodest add-ons that do not interrupt
essential curricular goals or divert programmed funds. The Zambia MOE has, for
example, limited its HIV/AIDS campaign to distribution ofa life skills training manual
without any specific training or curriculum changes. Small grants projects could
conceivably buttress the MOE's efforts to counter widespread misinformation about
HIVIAIDS and reduce high-risk sexual behaviour (Impact Summary for CHANGES,
CARE, Jan. 2005, p. 6; CHANGES Proposal~ Creative Associates, SOW Appendix A,
Sctn. 3.3). There is also the possibility that small grant projects could mitigate the
isolation and neglect experienced by individuals living with AIDS-related complications.
These two applications were expected, of course, to require outside inputs for materials,
training and adult guidance that exceeded the resources oflocal communities or their
local government entities.
The health and nutritional deficiencies ofrural, school-aged children offered a third area
of opportunity to complement a CHANGES programme goal. Although the CHANGES
interventions directly addressed the causes ofworm and Schistosomiasis infestation,
improvement of other aspects of children's health beyond the SHN vitamin and iron
supplementation would require a more varied and higher quality diet than might be
available to most children locally. CHANGES regarded the small grant mechanism as an
appropriate vehicle for supporting school/community projects in health education or in
school production units and feeding programmes.
Finally, the process of conceiving, preparing and executing a programme supported by
outside financial resources was assumed to produce a sense of empowerment and a skill￾set that could be applied to other community needs. Small grant projects might even be
planned so as to nurture such effects in future community endeavours. As the Statement
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ofWork for Creative Associates November, 2000 Proposal stated, "Capacity will be built
within local leaders, community members and community groups as problems are tackled
and responsive projects implemented. This will, in tum, build confidence, empowerment
and forward nlomentum as other related, and perhaps more complex problems are
confronted" (Proposal for a SHN Project, Appendix A, SOW, Section 3.1.2).
In addition to these goals, the CHANGES small grant component directly addressed the
financial barriers to girls' enrolment and retention in school through a scholarship (or
bursary) programme directed to girls and vulnerable children. While GRZ's establishment
offree basic education resulted in increased enrolment ofmany poor children, the costs of
school uniforms (or decent general clothing), supplies, and exam fees have discouraged
many children from attending school. Bursaries seek to overcome the reluctance ofthe
families of girls, AIDS orphans, and other vulnerable children to enrol them in school,
provided that they all agree to remain in school until completion.
B. Design of the Grant Mechanism
This component differed from the other two components in that responsibility rested with
Creative Associates' partner, CARE International. The small grant program was funded at
about $1.3 million, more than was spent on all the SHN interventions, and thus can be
viewed as a crucial element to the overall programme and in assisting communities to
consolidate, sustain and expand upon any accomplishments made by the other two
components. It was anticipated that small grant activity might lag behind progress in the
other two components due to the need to concentrate first on these more complex
activities.
Grants were to fall into either oftwo categories: (1) relatively snlall "rapid-response"
grants below $10,000 in total cost, and (2) larger "mid-level" grants ranging from
$10,000 to $100,000 (Inception Report, Aug. 2000, p. 30). The original CHANGES
Proposal envisioned approximately 10-20 ofsmaller and 2-3 ofmid-level grants being
made per year (SOW, Section 3.3). The March, 2004 Programme Extension Proposal
called for continuation ofthe same funding regime, but with greater involvement ofthe
MOE in proposal preparation and programme selection (pp. 20-23). The latter addition
was seen as a means ofbuilding the Ministry's skills in eventually "integrating the
management of a small grants mechanism into the overall MOE programme" (Inception
Report, p. 22).
The range of permissible grant activity was made purposely wide to accommodate both
the multiple programme components and the particular community needs, human and
physical resources, and level at which community organizations felt they could operate
most effectively. This allowed everything from training, rehabilitation of buildings,
materials development, and vocational skill training, to infrastructure development.
C. Outputs of the Small Grant Component
It is important to note that no official monitoring indicators and targets were established
for this component. This was because ofthe desire, first, to fund only well-conceived
programmes-however long that took to establish-and, second, due to the sometimes
unpredictable outcomes of a community sensitisation and mobilisation process itself.
CARE/Zambia did, however, document its output milestones in detail, so it is possible to
track small grant activity in both provinces at various.stages of evolution.
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After a June, 2001 national launch ofthe programme followed by training ofprospective
applicants in proposal-writing and preparation of hand-out documents for the grants
programme, the CARE team began to receive and review proposals fronl communities.
Only 20 grants, however, had been funded and begun by the end of2002. From this
modest initial output, the pace of grant awards quickly accelerated, and, by mid-2003,
awareness ofthe programme had grown to the extent that 211 proposals had been
submitted. More than half ofthem communities in which a CHANGES activity occurred
had submitted a small grant proposal--more proposals, in fact, than could be funded with
the available budget. Although estimates vary, one CARE staffmember said that the final
number of grants funded would be about 130 nationwide. Only 4 programmes in the EP
could not be completed, with a similarly small number in the SP.
Table 7: Small Grants Outputs
Proposals
Submitted
Small Grants
Funded
Cumulative No.
Funded
Over 1,000
49
112
?
130
*According to the Oct.-Dec. 2004 Quarterly Report
The following description of a local CBO, Let's Build Together, provides insight to one
ofthe powerful ways that CHANGES has built capacity and had a powerful effect at the
community level.
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D. Outcomes in Relation to Goals
Data collected in the visited schools and communities suggest that small grant projects
have, indeed, helped advance the SHN and CSMC programmes rather than serve only as
stand-alone projects. CARE's own documentation ofthe funded projects also reveals
consistent congruence with major programme goals. Despite some concern early in the
CHANGES programme that the small grant programme had been "hampered by a lack of
genuine synergy with the other dimensions" (Quarterly Report Oct.-Dec. 2002, p.5), the
evaluation found no instances offunded grants being unrelated to, or unsupportive of,
gender equity, HIV/AIDS prevention, or improved health and nutrition ofschool children.
These programmes have improved the quality ofrecipient schools or community life with
a very modest cash investment.
A few examples illustrate the close connection that was observed between funded grants
and CHANGES programme goals. Many schools in the Eastern Province applied for
funds to construct additional ventilated improved pit (VIP) latrines, dormitory blocks or
bathing shelters reserved for female students. Lack ofsuch facilities has kept many
families from enrolling or retaining their daughters in school. Similarly, programmes such
as training of peer educators, psycho-social counselling, creation of girls' clubs in
schools, and gardening skills training were no less relevant to HIV/AIDS, gender equity,
and school health and nutrition, despite being less tangible.
Some programmes were innovative in design or strategic in their purpose. One
particularly inventive activity is a conlbined poultry and fish farm, which uses droppings
from the growing chickens as feed for the fish. Another project type that reportedly has a
desirable payoff is construction of a teachers' house. According to Lusaka CARE staff,
the shortage ofteacher housing is frequently a reason why young teachers leave rural
communities after their first year, and for female teachers not accepting posts there in the
first place-thus, losing a crucial element for "girl friendly" schools.
In most cases, the evaluation found that small grant projects were not just congruent with
CHANGES goals but were essential to their success in individual communities. As told in
the LBT story above, one community-based organization in the Southern Province
district, for example, had sought to provide assistance to "AIDS orphans" but had no
means of delivering food, clothing and other items to the distant villages in which they
lived. A CHANGES small grant provided money to purchase 20 bicycles for members to
reach 22 children regularly as well as help the organization to sensitize approximately
4,000 individuals on HIVIAIDS.
One other effect ofthe rapid-response small grant projects deserves mention. Projects that
involve construction, infrastructure improvement, vocational skill training, or farm
production all result in local purchase of materials, equipment and sale of commodities.
Even grant-supported trainings may boost local food or beverage sales. These commercial
transactions stimulate the rural and adjoining town economies and foster a realization that
rural dwellers can also create added value (e.g. by raising and selling a pig).
With regard to mid-level grants, limited evaluative data indicate that the NGOs receiving
mid-level grants--for example, (1) the Forum for African Women Educationalists of
Zambia (FAWEZA) that administers to girls' scholarships (bursaries), starts SAFE clubs,
and trains peer leaders and (2) Family Health Trust in Monze that trains HIVIAIDS peer
educators-have also contributed significantly to the implementation ofthe CHANGES
Programme goals. Family Health Trust, for example, which has been operating in the
AIDS field since 1987, has trained many young peer educators. These are among the few
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individuals who are well educated, trained in HIV/AIDS issues, live at zonal level
communities and, unlike teachers and clergymen, can connect with young people at a
deeply personal level on uncomfortable topics like HIV and sexual behaviour.
As for "Safe Clubs," none were actually observed during the site visits, due in part to the
fact that the programme's launching in later 2004 has probably limited its scale to a
relatively snlall number of clubs to date. Yet, the concept ofthe clubs merits a much
closer examination both by USAID and the MOE. Their potential value as an alternative
way to engage youth on HIV/AIDS is particularly noteworthy. While the anti-AIDS clubs
that are promoted by the MOE play on fear ofthe retro-virus as the motivating tool-a
tactic with questionable effectiveness - SAFE clubs draw on a message of nlutual respect,
human rights and friendship as motivators for forswearing aggressive and unwanted
sexual advances on girls.
1. Scholarships (Bursaries) to Girls and Vulnerable Children
FAWEZA staffreported that most ofthe AGSPrecipients in Zambia are repeatedly
supported to maximize the likelihood ofschool completion. Unlike the rest ofthe small
grants mechanisms, the AGSP bursaries target girls and vulnerable children in six of nine
provinces (Eastern, Southern, Lusaka, Central, Copperbelt, and Northwestern). Thus, this
programme has already been "scaled up," at least in having a broader geographic
presence. This programme is dealt with in more detail in the next section ofthe evaluation
report.
2. Resources, Personnel, Policy and Future Support
Few resources exist locally for funding the kind ofsnlall grant programme implemented
by CHANGES through CARE. Interviews with MOE headquarters officials indicate that
the current debt-reduction strictures on ministry,expenditures allow no funding for
activities considered outside ofits core mission. Likewise, MOE personnel at every level
of government have little incentive to assume additional roles of coordinating a small
grant programme, although many officials and s~aff at the provincial and district levels, to
their credit, volunteer to serve on the steering committee and other review bodies for
selecting grant recipients.
The small grant model, developed in large part by the CHANGES staff and passed on to
CARE/Zambia staff, appears to meet, if not exceed, recommended practices in the
management ofsmall grant programmes. For example, money is, correctly, awarded in
the form of grants rather than loans, since their required purpose is community betterment
rather than individual profit. Only community groups can receive funds, not individuals,
thereby creating peer expectations and pressure for full financial accountability.
Community consensus on each proposed project and a thorough, multi-step vetting
process are required to ensure the need, feasibility and sustainability ofthe project.
Training in proposal writing, project management and financial accounting prepares
community grantees for their responsibilities. Although not originating with CARE, USG
requirements for an environmental assessment of proposed projects affords protection
against the possibility of harm to the environment, in the absence of a well-developed
Zambia government regulatory system. Once funded, small grant recipients must make
monthly written reports on the status oftheir projects.
Policy implications came more from the USAID and the USG side than from the Zambian
government side. CARE headquarters staff reported that different federal guidelines for
small grants, depending on the funding source (i.e., PEPFAR or AEI), had the effect of
delaying grant disbursements in the early stage ofthe activity. GRZ regulations pertaining
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to small grant programmes appear not to have had any hindering effect on creation or
distribution ofsmall grant funds from an external source.
The most salient constraint for small grant programmes is the lack offinanchil resources
from inside Zambia and the absence of highly effective home grown models (see next
sub-section). Other donor sources ofsmall developmental funds, such as the u.s. African
Developn1ent Foundation, UNICEF, and some European international assistance agencies
do, of course, exist. But, from the infonnation available to this evaluation, none ofthese
grant funds operate with the same shared and hannonized goals as CHANGES'
sensitization on gender equity, HIV/AIDS, and its SHN drug delivery mechanism. CARE
staff does often refer grant applicants to other donors where the funding priorities might
be a better fit.
Indeed, the fallout from insufficient funds to meet all qualified small grant proposals was
clearly evident as an unintended consequence in both provinces. Perhaps three ofthe
schools that were visited had submitted proposals for a grant and had, fairly or unfairly,
expected it to be funded. Disappointment ran high in these, and numerous other
communities, upon being infonned that funds were insufficient to award grants to them.
Despite having been infonned ofthe rigorous application process, the inexperience of
many rural residents with competitive proposal selection, no doubt, raised expectations in
unforeseen ways.
Recommendations
• Given the improvements made possible by small grant projects, their congruence with
major country and agency goals, the integrity with which this activity has been
managed, and the absence of comparable funding from other sources, USAID/Zambia
should continue its financial support of a small grants programme in the country,
using much or all ofthe model developed and employed by CHANGES and CARE
International.
• Ideally, a small grant programme would be deployed in conjunction with any future
sensitisation and mobilisation effort on gender equity, HIV/AIDS, school health and
nutrition or some other compelling national priority.
• USAID/Zambia should continue its participation in the Ambassador Girls Scholarship
Programme, regardless of whether any connection to a CHANGES-type follow-up
activity exists in the future.
E. Capacity Built at the Provincial, District, and Zonal Levels, the National
MOE, MOH, and MCDSS, Zambian Partner Organizations, and Comrnunity
Leaders
The study made no direct assessment ofthe capacity of district, provincial, and national
level MOE staffto administer a similar small grants programme. However, data gathered
in relation to the government's role in implementing the SHN and CSMC components
strongly suggest that officers and staff ofline ministries such as the MOE, MOH and
MCDSS would have little or no available time, resources--or, for that matter, desire - to
operate a small grants programme without external support.
The MOH's small grant programme, the Community Health Innovation Fund (or CHIF),
illustrates GRZ's difficulty in deploying such programmes. CHIF provides small grants
for health-related projects in rural areas. Monitoring ofsuch projects is not a core
function ofMOH staff, and most workers see no advantage in taking on additional
responsibilities for which their perfonnance will not be assessed. The experience ofthe
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MOH is instructive in predicting how MOE staffmight react to an imposition ofsimilar
responsibilities on them-with or without training. Nonetheless, CARE's inclusion of
provincial and district ministry staff in the review and vetting of proposals does, perhaps,
signify one way to create a stake, if not a niche" for government officials in a small grants
operation.
The active role ofthe provincial Ministry of Community Development and Social Service
(MCDSS) in the small grant programme ofthe Southern Province is noteworthy in that
MCDSS is well-suited by its mission to assist a community-based project scheme.
MCDSS staff participation was confined to review of project proposals. But, this ministry
would make a very useful partner iftheir staffs chronic lack oftransportation could ever
be solved.
In contrast to the line ministries, several Zambian NGOs did acquire (or already
possessed) experience in managing relatively large ($10,000 to $100,000) grants from
CHANGES and/or other donors. As the sub-grantee for the AGSP, FAWEZA, in
particular, might well possess the kind and level of organizational skills suitable for
administering a provincial and, perhaps, a countrywide small grant fund, in partnership
with an international NGO. FAWEZA's considerable national-level capacity, however,
might not be matched by a sufficient field staff to monitor a geographically dispersed set
of grant projects.
There is another area that is easily ignored in establishing a small grant programme:
community inexperience in writing proposals, purchasing materials incost-effective
ways, and properly accounting for funds. Many community members, rural or urban,
have never undertaken a project that affects more than their family units, and there may
only be one individual on the project committee who is literate and can keep records.
CARE staff have done remarkably well in improving the capacity of communities to fulfil
these responsibilities through its training before and during the grant period. There were
numerous examples ofsmall grant recipients who were planning new projects and already
writing proposals, even while completing their CARE-funded projects. Indeed, some had
secured funding for new projects from other donors.
As was noted in the outputs section, a small percentage ofsmall project committees were
quite slow in reconciling their expenditures, and a few grants had to be suspended due to
accounting problems. The evaluation viewed the small nunlber offailures as a favourable
commentary on CARE's model, but any failures are still a reminder ofthe scarcity of
organizational skills in some rural communities and the need to nurture project
development and management skills to assure successful project completion.
Recommendations
• Any follow-up programme should continue and expand active involvement ofline
ministry staffin those functions ofthe small grant operation-including, but not
limited to, screening and selection ofqualified proposals-to which they are willing
to devote time. .
• Any follow-up programme should explore ways to "loan" particularly competent
managers to other communities that are experiencing difficulty in organizing and
managing a small grant activity.
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F. Maintain and Capitalize on Capacity Built Among CARE/Zambia Staff
The CHANGES Small Grant component has built significant capacity within
CARE/Zambia and among other CHANGES provincial staff, who have interfaced with
CARE for their sensitization work. CARE coordinators are, in fact, the staff who
regularly travel to the widely dispersed sites to monitor the progress offunded projects.
Both CARE coordinators in their respective two provinces were very knowledgeable
about all aspects oftheir operation, provided written documentation ofthe grant activity
and could discuss the details ofgrantees and the status oftheir grants. CARE staff, both at
the provincial and national level, represent highly experienced individuals who could
manage a small grant scheme in any future follow-up programme.
Recommendation
• Any future continuation of a small grant mechanism should strongly consider
continued partnership with CARE International administration or a new
entity/contractor involving small grant stafffrom CARE/Zambia, possibly, linked
with NGOs that have effectively managed mid-level grants.
XI. AMBASSADOR GIRLS' SCHOLARSHIP PROGRAMME
Through the CHANGES grants mechanism, USAID has supported the U.S.
Ambassador's Girls Scholarship Programme (AGSP) in partnership with the Forum for
African Women Educationists in Zambia (FAWEZA). This programme has provided the
following assistance:
• The provision offinancial aid for girls who need financial support for education at the
upper basic and secondary levels;
• Monitoring and reporting data on indicators for AGSP; and
• The provision oftechnical assistance to FAWEZA to ensure the organization has in
place the necessary institutional capacity to receive and manage direct grants from
USAID/Zambia, should USAID decide to do so.
The CHANGES programme decided to fold the cross-cutting HIV/AIDS issue into
FAWEZA's mission, believing that the organization's close contact with scholarship
recipients would give it a receptive audience for facilitating discussion on this topic. And
with its extensive experience in Zambia and elsewhere in Africa assisting girls and
women in education and workplace settings, FAWEZA was considered well suited for the
role of advocating for girls education as well as reviewing applicants and selecting and
monitoring qualified recipients for bursaries.
In 2003, FAWEZA also instituted a new programme ofso-called Student Alliance for
Female Education or "SAFE clubs," using funds from USAID's PEPFAR and African
Education Initiative (AEI) mechanisms. The purpose of "Safe Clubs" is to instil a sense
ofrespect, privacy, and right to safety and health for girls and young women, both among
male and female students. FAWEZA trains qualified students as peer educators who can
lead these clubs, assisted in mentoring by a designated teacher. The organization's hope is
that these clubs can counter the kind ofmale aggressiveness and lack offemale
assertiveness that often result in the sexual predation of girls and women.
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During 2003, USAID support for girls' scholarships was provided to FAWEZA through a
mid-level grant from CARE International, which is managing CHANGES' small grants
mechanism. During the Extension Period ofthe CHANGES Programme, support has
been continued through the direct transfer offunds from CHANGES to FAWEZA. In
2003, FAWEZA, through CARE International, supported 341 girls initially, with the total
grant expected to assist 538 girls in total.
Funds during the Extension Period ofthe CHANGES Programmes were not received
until June, so the programme of orienting the School Selection Committees distribution of
cheques was done in July.. Each school formed a Selection Committee to select girls and
to validate that they fulfilled the OVC criteria. The committees were also tasked with
monitoring procurement ofpersonal effects and ensuring that all pupils had uniforms.
Some ofthe issues pointed out in the CHANGES Programme Quarterly Report #14,
(July-September, 2004) were the following.
Due to the lateness ofthe cheques, some children had to take up work in order to pay
for the first term. This left some children unable to enrol and led to the selection of
alternate OVCs who were already in school.
A majority ofthe recipients complained of poor housing, as girls living far from home
or guardians had to rent lodgings in shanty compounds, paying rent and taking up
additional work to pay expenses. This led to real concerns for the safety and security
ofthe girls.
• Several girls were removed from the bursary programme due to pregnancies and most
schools had not made arrangements to readmit them. SAFE clubs are important for
both bursary-funded and other girls to provide adolescent reproductive health
information and to sensitise communities on, government re-entry policies, and to
track pregnant girls so that they re-enter school.
• The lack of administrative support in the schools, particularly as it related to
facilitating transport into town to purchase uniforms or seek medical assistance, was
pointed to as a problem for those schools located away from town centres.
• Monitoring also was mentioned as an issue in 2004, due to the distance ofthe
National Secretariat, and the necessity that Provincial Focal Point Persons be
employed to supervise the timely submission ofreports.
• Finally, in 2004, FAWEZA had only one reliable vehicle to use in effectively
monitoring and coordinating the programme.
On visits to ASGP schools, the team was pleased to learn that all cheques had been
received at the beginning ofthe 2005 school year, so that the schools could fund their
programmes and the girls could receive their small allowances immediately.
In the final report of 2004, the latest available, FAWEZA had awarded a total of 772
scholarships, well past its target population of635. An additional 332 girls had already
been selected for 2005, for a total nurnber ofscholarships awarded being 967. There is
not yet any available information on the exact number who have actually enrolled in
2005. It was reported that all or almost all the girls receiving scholarships remained
enrolled, with the AGSP being listed as the probable reason for their remaining enrolled.
Finally, 229 scholarship girls graduated from grade 12 in 2004, some 50 more than the
target of 179. With 255 lih graders in 2005, it is likely that the programme will continue
to show continued growth in numbers. .
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A. The Selection Process
On visits to several schools which had the AGSP, administered by FAWEZA, the teanl
was impressed with the selection process, which in every case involved a Selection
Committee made up ofthe Head or Deputy Head, guidance counsellor, one or two
teachers, a PTA and/or a community member, often the Head Girl, and where other
scholarship programs such as the Christian Children's Fund were present, there was often
a representative from a Faith Based Organization (FBO). Students were generally
referred to the Selection Committee by teachers or occasionally by a social worker. After
the social worker or other staff member checked on the genuine need ofthe child, they
were put forward for a FAWEZA or other scholarship program. The criteria consisted of
vulnerability, due to the death of one or both parents, extreme poverty or disability. In one
school with an attached school for deaf and blind children, 17 of 231 disabled students
were on scholarship, but only 2 of 1700 girls in the regular school. The regular school
had an estimated 100 double orphans and over 600 single orphans, many or most of
whom would likely have been eligible for a scholarship. Given the limited nature ofthe
funds, some schools also attempted to provide scholarships to those students with better
academic records and greater likelihood to complete High School and move on to tertiary
education.
Among the continuing difficulties faced by the girls, as mentioned by Heads, teachers,
counsellors and some ofthe young people themselves were: having to rent rooms alone
or with friends and having little or no funds to pay rent; no food to eat (particularly true
for double orphans living alone and raising brothers and sisters); transportation costs to
get to school and the problem of "sugar daddies" preying on the girls; no food for grade
12 students who are in school from 8:00 a.m. to 4:00 p.m. each day; only Kl,500,000 or
$312 to buy food for 213 disabled secondary students per month, - an impossible amount
to feed them all; a small number of known pregnancies in the general student population -
none among AGSP recipients were mentioned; students who are active sexually, but do
not have easy access to prevention; and the poverty of a majority ofthose with parents,
due to their being laid off from factories, no rain for crops, or other causes.
B. General Findings
FAWEZA appears to have met and surpassed almost all its goals as far as the AGSP
programme is concerned. We believe that this is due to a variety of factors: FAWEZA
does not just administer scholarships, but provides additional assistance to the girls
through its Reading Circles Programme, Remedial-Learning programme, regional
Teachers' Science, Mathematics and Technology Expositions, the Girls' SMT Camp for
99 Grade 8 and 10 girls, Writing Tents for children aged 10-15, and a Public Speaking
contest to mark the Day ofthe African Child. These activities, when supplemented with
the girls' empowerment through SAFE, provide a chance for peer support and peer
mentoring. With Youth Media, FAWEZA has worked on four television shows. Its staff
is involved in TOT (Training ofTrainers) in Adolescent Reproductive Health. FAWEZA
is also involved in influencing policy reforms and the replication ofsuccessful
interventions and in a range of advocacy activities. In other words, FAWEZA is a well .
administered, multi-service NGO that sees girls' education not only as a priority, but as a
"calling."
Recommendations
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• FAWEZA, from all indications is exceptionally well qualified to continue its
important work under any follow-on programme or even as a direct grantee from
USAID. We strongly recommend its being scaled up by the United States and other
donors. While 972 girls on scholarship is a wonderful accomplishment, and while
FBOs, NGOs, the MOE and other donors also provide scholarships, only a small
percentage ofthe needy girls are being served.
It is important for FAWEZA to move towards greater equity between schools. Some
schools had as many as forty or more scholarships for a smaller student body, while
one Lusaka school, as mentioned above, had only two scholarships for more than
1700 girls.
• The frequency ofmonitoring ofthe girls and the grants appears to differ from school
to school. One school mentioned only a visit when the funds were distributed, while
another, some 40 kilometres from Lusaka said that FAWEZA staff visited as often as
3 times a term.
• In one school, there were two boys on AGSP scholarships. It is not clear to the
committee whether it is permissible for them to be on scholarships, although we are in
strong agreement that boys need to be involved in SAFE clubs and other FAWEZA
activities.
FAWEZA's many approaches to working with young people is perhaps the most
effective HIV/AIDS prevention we have observed in the country. As mentioned in
the CSMCsection, Service-Learning, Community Service and Mentorships have the
greatest impact in changing adolescent sexual behaviour and FAWEZA is, to our
knowledge, the only programme in the country which utilizes these. All schools and
progranlmes would do well to follow their lead.
• Given the tremendous need for girls to be safe and secure, we believe FAWEZA
could be tasked to provide dormitories or "rescue homes," as one Head put it, so that
girls don't have to rent rooms in dangerous sections or towns, live with abusive
relatives, or suffer sexual abuse at the hands ofsugar daddies or others.
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XII. SCALING UP
Throughout this evaluation, we have consistently pointed out the many exceptional
components ofthe SHN and CSMC. They have developed excellent models for
improving the health ofZambian children and sensitizing and mobilizing communities to
take action on issues ofHIVIAIDS and gender equity. Our offering a range of
recommendations to improve each ofthem is an affirmation that both are worthy of being
scaled up by the Government ofZambia. As was pointed out in the Executive Summary,
they have provided an example of what can be accomplished when two or more
Ministries work together on an issue. Through their Memoranda ofUnderstanding and
informal agreements, they have inlproved the lives ofstudents, community members, and
government personnel. The challenges facing both health and education in Zambia are
daunting, but the CHANGES Programme has shown the way for the country to make
significant progress in the coming years. The two following sections provide a guide for
the scaling-up of activities to other provinces and eventually the whole nation.
A. School Health and Nutrition (SHN)
The MOEs ultimate goal for SHN is that every school has a SHN school action plan,
deliver de-worming, and engages in other SHN activities using MOE records. The MOE
began expanding SHN even during the pilot to schools in the Central and Lusaka
provinces and plans to reach all provinces by early 2005. Parallel activities under SCI will
reinforce the MOE's efforts by providing sufficient drugs and training ofteachers and
health workers in a shortened one-day course (CHANGES, 2005).
The CHANGES program has generated interest in SHN from several donors, among
whom are UNICEF, WHO, JICA and World Vision; any scale-up might include these
partners. Also, the programme suggests that many ofits components do not require large
financial resources and thus, stresses the importance of not streamlining the model to
compromise vital components ofthe intervention.
B. Model for Scale-up Using a Phased Approach
There is increasing evidence ofintegration ofthe SHN programme with National Food
and Nutrition Commission (NFNC) activities. The NFNC is committed to reducing
micro-nutrient deficiencies among school going children~ Also, the Roll Back Malaria
programme of the MOH is to be part of SHN interventions.
The institutionalisation of SHN within MOHIMOE will occur only ifthe focus on
strengthening systems, building capacity and supporting existing organizational structures
at provincial and district levels, as started by the CHANGES program, will continue. It is
also important to finalise national SHN policy guidelines, as they will provide the
necessary support for continuing a strong SHN programme.
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Table 8:
Model for Scale-u Usin' a Phased A roach
Aguirre International
• Develop more effective ways of incorporating SHN into teachers
training (team to be derived from Principles of Chipata TT and
David Livingstone TT, teachers from good SHN schools in pilot
project, Standard officers MOE, COD, CHANGES program staff
to work on this aspect)
• Conduct TOTs for selected lecturers at the TTs
• Orientation of remaining lecturers on SHN at TTs to be done
within college context by principles and lecturers trained
• Inclusion of the SHN programme in the curriculum for teacher
trainin
• Revitalise national steering committee for SHN implementation
comprising MOE/MOH/MCSS/SCI to meet quarterly
• Orientation meetings for line ministries at national, provincial,
district levels
• Advocacy with MOH Child Health Coordinating Committee,
Cooperating Partners health committee, Child health inter￾sectoral committee at EP secretariat
• Advocacy for inclusion of SHN in MOH/CBOH plans
• Develop phased scale up plan with SCI to include MOE interest
Le. poor indicators for education and health
• Reduce teacher training to 2 days with appropriate adaptation of
manual. Integrate teacher training into zonal resource centres
• Scale to remaining schools in EP and SP (ensure that school
action plans include SHN)
• Thereafter select the next province(s) with poor education and
health indicators and begin implementation with schools which
meet certain criteria e.g. minimum of 4 permanent members of
staff, accessibility from district office, presence of CDA, presence
of zonal resource centre, distance of school from health centre -
within 15 to 20 km. Using best practices and lessons learned roll
out to next lot of schools in the province. MOE to work in close
collaboration with SCI
• Coordination with WFP scale up programme for school feeding
and simultaneously ,strengthening use of local foods and building
on gains from CHANGES SHN programme and MOE
• Utilising CHANGES SHN model for community sensitization
using Theatre for Community Action and other methods, e.g.
meetin s
• Maintain drug flow system, SCI drugs to follow same system as
was used in pilot
• Micro-nutrients to come from UNICEF/MOH
• Monitoring system: Reduce number of visits from monthly to
quarterly. Support required for MDCSS, Ministry of Agric. Ensure
monitoring is planned and budgeted for especially at district and
provincial level. Ensure prioritization on monitoring SHN in district
health plans
• Collect information i'n pilot schools on SHN for input into EMIS
also discuss with MOH on inclusion of SHN data into Health
Mana ement Information S stem HMIS
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CHANGES Program Evaluation
Table 9:
Communit Sensitization and Mobilization Cam
Date Activity
New office established, officers appointed:
• Linking up activities with MOE work plan
• Orientation of MOE officials to CSMC
• Identifying the zone centres in 3 other
provinces
• Verification meetings with Chiefs or village
head men, CDAs, opinion leaders
• Verification meetings with members of the
community
• Training materials reviewed
• Formation of TOTs
• Training of District trainers in CSMC
• Training of teachers, head teachers, 1
community member, 1 health worker and 1
MCDSS by district trainers
• CSMC implemented
• Monitoring and evaluation
• CSMC to all communities
• Monitoring and evaluation
Level of
1m lementation
MOE HQ: Planning
, Standards and
Curriculum and
TESS.
DEBS office:
DESO,DRCC,
lecturer, CDA,
health worker in
presence of PESO,
PRCC and
New programme,
MOE: zone,
district, provincial,
college officials
Communities
around every
school in the three
provinces
New programme,
MOE: zone,
district, provincial,
college officials
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Annex 1:
Persons Interviewed
CHANGES Program Evaluation
Appendices
LUSAKA PROVINCE
" .",.. ..,.>" .. /....;.. .·:i:)j).:·:·,;:,\.····;'.::'.:....·•.·•.•..·;,··'·'···:··,··;,,···.··i,·..·.·,';) }j ."...... ;.)[);.)./), NO. ,..·DATE .,.,..•'.;. " ;,,;- ·········,·,·\t·" ,..,.l),.,NAME:';::,,,.,,;. /,,,,/"t"U~IIIUN) .•.••. ORGANIZATION
1. 28/01/05 Dr. Edward Graybill Chief Party, Creative
CHANGES Programme Associates, Lusaka
2. 31/01/05 Dr. Rick Henning S06 USAID, Lusaka
3. 31/01/05 Ms. Winnie Chilala S05 USAID, Lusaka
4. 31/01/05 Dr. Cornelius Chipoma S06 USAID, Lusaka
Focal Point Person: Ministry of Education
5. 31/01/05 Sr. Audrey Mwansa Equity and Gender Headquarters,
Lusaka
6. 31/01/05 Mrs. Daphne Chimuka National Co-ordinator FAWEZA, Lusaka
7. 31/01/05 Mrs. Dorothy Kasanda Programmes Officer FAWEZA, Lusaka
Focal Point Person: Ministry of Education
8. 01/02/05 Ms. Irene Malambo HIV/AIOS Headquarters,
Lusaka
9. 01/02/05 Dr. James Mwansa SHN/SCI University Teaching
Hospital , Lusaka
10. 01/02/05 Dr. Faith Nchito SHN / SCI University Teaching
Hospital, Lusaka
Ministry of Education
11. 01/02/05 Mr. Drake Warrick EMIS Headquarters,
Lusaka
12. 02/02/05 Ms. Rose Chibbonta Small Grants CARE, Lusaka
13. 02/02/05 Ms. Catherine Munene Small Grants CARE, Lusaka
14. 02/02/05 Mr. Mark Vander Vort Small Grants CARE, Lusaka
15. 03/02/05 Mrs. Catherine Phiri CSO (Former SHN) Standards, MOEHQ,
Lusaka
16. 03/02/05 Dr. Paul J. Freund SHN Regional Advisor CHANGES, Lusaka
17. 03/02/05 Mr. Delphin Kinkese SHN technical officer CHANGES, Lusaka
18. 04/02/05 Ms. Tezah Sinyinza National Assessment Examinations Council
of Zambia, Lusaka
19. 04/02/05 Mr. Joe Kanyika National Assessment Examinations Council
of Zambia, Lusaka
Grade 4 Competency Examinations Council 20. 04/02/05 Mr. William Kapambwe Testing and Continuous of Zambia, Lusaka Assessment
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EASTERN PROVINCE
ili~II~~iliiiil!ilI:::::i~\~~f:~iiil~lli:I!:II!liilt ITi ·.ttti.i·iii·.·:.l:·tt
··O~%ii~i~:'4.TION
21. 07/02/05 Mr. Josias Enos Zulu Provincial CHANGES
Co-ordinator program, Chipata
07/02/05 SESO (NS): SHN Provincial
22. Mrs. Catherine Chirwa Education Office, Focal Point Person Chipata
23. CHANGES
07/02/05 Mrs. Margaret Chabinga SHN Training Officer program, Provincial
Lungu Education Office,
Chipata
CHANGES
24. 07/02/05 Mr. Benidicto Phiri SHN Training Officer program, Provincial
Education Office,
Chipata
CHANGES
25. 07/02/05 Ms. Gertrude Zulu Technical Officer program, Provincial
Education Office,
Chipata
CHANGES
26. 07/02/05 Ms. Rodah Sinda Clerical Officer program, Provincial
Education Office,
Chipata
CHANGES program Provincial
27. 07/02/05 Mr. Colin Zulu Sub-grant Education Office,
Co-ordinator Chipata
Provincial Education Provincial
28. 07/02/05 Mr. Selesial Chanda Officer Education Office,
Chipata
Principal Education Provincial
29. 07/02/05 Mrs. P. Jere Education Office, Standards Officer Chipata
District Education
30. 07/02/05 Mr. Mathew Chirwa District Education Board Secretary's
Standards Officer Office (DEBS),
Chipata
District Education
31. 07/02/05 Mr. Alec Jere Statistician Board Secretary's
Office (DEBS),
Chipata
Provincial Resource Provincial
32. 07/02/05 Mr. Alex Mutale Centre Co-ordinator Resource Centre,
(Basic Schools) Chipata
33. 07/02/05 Mrs. Mdglene Zimba District Resource District Resource
Centre Co-ordinator Centre, Chipata
34. 07/02/05· Mr. Simon B. Mpundu Principal Chipata Teachers'
Training College
District Health
35. 07/02/05 Mr. Patrick Mbewe Director Management
Team, Chipata
Provincial Health
36. 07/02/05 Dr. Kabulubulu Director Management
Team, Chipata
SHN Focal Point Provincial Health
37. 07/02/05 Mrs. Josephine Mwale Person Management
Team, Chipata
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38. 08/02/05 Mr. Adamson Sakala Head Teacher Dzoole Middle
Basic School
39. 08/02/05 Mr. Kennedy Mbambara D/ Head Teacher Dzoole Middle
Basic School
40. 08/02/05 Mr. Moses Sakala Assistant Teacher Dzoole Middle
Basic School
41. 08/02/05 Mr. Emmanuel Vuttah Teacher - Sports Dzoole Middle
Basic School
42. 08/02/05 Ms. Kwanji Phiri Teacher: SHN Focal Dzoole Middle
Point Person Basic School
43. 08/02/05 Mr. Salatiel Banda PTA Chairperson Dzoole Middle
Basic School
44. 08/02/05 Mr. Ostern Tembo Works Committee Dzoole Middle
Member Basic School
45. 08/02/05 Ms. Lebetina Mbewe SHN Committee Dzoole Middle
Member Basic School
46. 08/02/05 Ms. Bester Mcheta SHN Committee Dzoole Middle
Member Basic School
47. 08/02/05 Mr. Hunock Banda Induna: Chindimbe Dzoole Middle
Villaqe Basic School
48. 08/02/05 Mr. Maxwell Banda Headman: Chindimbe Dzoole Middle
Villaqe Basic School
49. 08/02/05 Mr. Chrispin Ngulube Head Teacher Kasonjela Middle
Basic School
50. 08/02/05 Mr. Moffat Phiri D/Head Teacher Kasonjela Middle
Basic School
51. 08/02/05 Mr. Mulala Mwape Health Centre Kasonjela Middle
Basic School
52. 08/02/05 Mr. Joseph Mbewe PTA Vice Kasonjela Middle
Chairperson Basic School
53. 08/02/05 Mr. Macmillan Kwenda PTA Treasurer Kasonjela Middle
Basic School
54. 08/02/05 Ms. Una Phiri Nduna: Chiefs Kasonjela Middle
representative Basic School
55. 08/02/05 Mr. Nelson Mwale Headman: Kasonjela Middle
Mqamptuula villaqe Basic School
56. 08/02/05 Mrs. Dorothy Phiri Head Teacher Magwero Standard
School (Dutch)
57. 08/02/05 Mr. Shadrick Zulu D/Head Teacher Magwero Standard
School (Dutch)
58. 08/02/05 Mr. Reselian Sinazongwe Teacher: SHN Focal Magwero Standard
Point Person School (Dutch)
59. 08/02/05 Mrs. Susan Shawa PTA Vice Magwero Standard
Chairperson School (Dutch)
60. 08/02/05 Mr. Isaac Soko Representing Magwero Standard
Community School (Dutch)
61. 09/02/05 Mrs. Ruth M.N. Moyo Education Standards' DEBS: Lundazi Officer
62. 09/02/05 Mr. Munyumbwe Hawala Planning and DEBS: Lundazi Information Officer
63. 09/02/05 Mr. Clement Chilembo District Resource DEBS: Lundazi Centre Co-ordinator
64. 09/02/05 Ms. Hellen Zulu School In-service Emusa Middle
Provider Basic School
65. 09/02/05 Ms. Febby Msimuko Nutritionist Kanyanga Zone
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66. 09/02/05 Mr. John S. Nguni Zone Resource Phikamalaza Basic
Centre Co-ordinator School
67. 09/02/05 Mr. Gidson Zimba Zone Resource Emusa Middle
'. Centre Co-ordinator Basic School
68. 09/02/05 Mrs Caleb Miti Ophthalmic Nurse Lundazi District
Hospital
69. 09/02/05 Mr. Evaristo Zulu Head Teacher Phikamalaza Basic
School
70. 09/02/05 Mr. Paul Nkhoma Head Teacher Amusa Middle
Basic School
71. 09/02/05 Mr. Julius Banda Physiotherapist Lundazi District
Hospital
72. 09/02/05 Mrs. Mwerwa M.B. Phiri Clinical Officer In- LundaziUrban
chan::Je Health Clinic
73. 09/02/05 Ms. Mary Tembo Head Teacher Lundazi Middle
Basic School
74. 09/02/05 Mrs. Eunice Daka Teacher: School In- Lundazi Middle
service Provider Basic School
75. 09/02/05 Mr. Alexander Kapikanya Teacher: INSPRO Kanyanga Basic
trainer School
76. 09/02/05 Sr. Euphrasia Banda Teacher: Special Lundazi Middle
Education trainer Basic School
77. 09/02/05 Mrs. Jennipher L. Chanda Teacher: Special Lundazi Middle
Education trainer Basic School
78. 09/02/05 Mr. Innocent Ziba Teacher: INSPRO Thunkhu Middle
trainer Basic School
79. 09/02/05 Ms. Luwina Tembo Midwife In-charge Phikamalaza Basic
School
80. 09/02/050 Mr. Winfrred Phiri Teacher: INSPRO Lundazi Middle
9/02/05 trainer Basic School
81. 09/02/05 Mr. Mbewe D/Head Teacher Phikamalaza Basic
School, Lundazi
82. 09/02/05 Mr. Prince B. Thole PTA Chairperson Phikamalaza Basic
School, Lundazi
83. 09/02/05 Mr. Foreman Mtonga PTA Treasurer Phikamalaza Basic
School, Lundazi
84. 09/02/05 Mr. J.B. Ziba Headman Phikamalaza Basic
School, Lundazi
85. 09/02/05 Ms. F.A. Lusala PTA Vice Phikamalaza Basic
Chairperson School, Lundazi
86. 09/02/05 Mrs. R. Mchizi Community Member Phikamalaza Basic
School, Lundazi
87. 09/02/05 Mrs. J. Nyirongo Community Member Phikamalaza Basic
School, Lundazi
88. 09/02/05 Mr. K. Mtonga Community Member Phikamalaza Basic
School, Lundazi
89. 09/02/05 Mr. A. Phiri Community Member Ptlikamalaza Basic
School, Lundazi
90. 09/02/05 Mr. Save Nyasilu Senior Community Phikamalaza Basic
Health Worker School, Lundazi
91. 09/02/05 Mr. Mukuka Shokela C.E.O: Phikamalaza Phikamalaza Basic .
Aariculture Camp School, Lundazi
92. 10/02/05 Mr. Westone Siwale District Education Katete District
Board Secretary Education Office
93. 10/02/05 Mr. L. M. Mwanachingwal District Education Katete District
Standards Officer Education Office
94. 10/02/05 Mrs. T.J.V. Ngoma Education Standards Katete District
Officer Education Office
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.95. 10/02/05 Mr. Patrick Phiri Community Katete District
Development Officer Education Office
96. 10/02/05 Mr. Philimon Phiri Head Teacher Kafumbwe Basic
School, Katete
97. 10/02/05 Mrs. Mary Bwalya Banda Deputy Head Kafurnbwe Basic
Teacher School, Katete
98. 10/02/05 Mrs. Mada Mshanga Teacher: SHN focal Kafumbwe Basic
point person School, Katete
99. 10/02/05 Mr. Felix Tembo PTA Chairperson Kafumbwe Basic
School, Katete
100. 10/02/05 Mr. Lawrence M. Banda PTA Vice Kafumbwe Basic
Chairperson School, Katete
101. 10/02/05 Mr. Tenford A. Zulu Head man: Mgulula Kafumbwe Basic
Villaae School, Katete
102. 10/02/05 Mrs. Albertina Phiri CBO Kafumbwe Basic
School, Katete
103. 10/02/05 Mrs. Eness Banda CBO Kafumbwe Basic
School, Katete
104. 10/02/05 Mr. Chrempino Banda PTA Treasurer Kafurnbwe Basic
School, Katete
105. 10/02/05 Mrs. Olida Phiri PTA Vice Treasurer Kafumbwe Basic
School, Katete
106. 10/02/05 Mr. James L. Lungu Senior Teacher: SHN Kafurnbwe Basic
treasurer School, Katete
107. 10/02/05 Mr. Pius UU. Zulu Teacher: SHN Kafumbwe Basic
Secretary School, Katete
108. 10/02/05 Mrs. Bwalya M. Banda Deputy Head Kafumbwe Basic
10/02/05
School, Katete
109. Mr. Kapandila Phiri Head Teacher Kagoro Basic
School, Katete
110. 10/02/05 Mr. Shawa San Teacher: SHN Focal Kagoro Basic
point person School, Katete
111. 10/02/05 Mrs. Gloria Phiri Community Dev. MCDSS, Katete Assistant
112. 10/02/05 Mrs. Florence Lungu PTA Chairperson Kagoro Basic
School
113. 10/02/05 Mr. Wilson Phiri PTA Vice Kagoro Basic
Chairperson School, Katete
114. 10/02/05 Mr. Zembeni Phiri Village Head Man: Kagoro Basic
Chimbuna villaae School, Katete
115. 10/02/05 Mr. B.A. Kawengele District Education District Education
Board SecretarY Office, Nvimba
116. 10/02/05 Mr. Fuli Tembo District Education District Education
Standards Officer Office, Nvimba
117. 10/02/05 Mr. Lamano J. Phiri Community Dev. MCDSS, Nyimba Assistant
118. 10/02/05 Mrs. Ruth Phiri Deputy Head Mfumbizi Middle
Teacher Basic School
119. 10/02/05 Mr. Dennis Mkonda Head Teacher Mchimazi Middle
Basic School
120. 10/02/05 Mr. George Kaoma Deputy Head Mchimazi Middle
Teacher Basic School
121. 10/02/05 Ms. Elidah Phiri Teacher: SHN Focal Mchimazi Middle
Point Person Basic School
122. 10/02/05 Mr. Elias Banda Teacher: HIV/AIDS Mchimazi Middle
Focal point person Basic School
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SOUTHERN PROVINCE
•••• !'~O., .• ; 1:!{iFDA·f~ii'}i·!: I;!i!;ili.i··ril:i:!,r!i\'ii!:;.i;
I, "i>'""IAllll~,,. i",'
t"U~IIIUN
i""",..",:,:,.~,,;'~·"·r,i!.:.!i;i.i iii:·.:'··!·::a·~'~~ M17~TIO~'·"!·!iii·!i CHANGES CHANGES 123. 14/02/05 Mr. Sitwala Mungunda Programme Co- Livingstone ordinator
Field Co-ordinator: CHANGES 124. 14/02/05 Mr. Muyunda Lindunda Monitoring and Livingstone Evaluation
125. 14/02/05 Mr. Mweelwa Muleya Advocacy Field CHANGES
Co-ordinator Livingstone
126. 14/02/05 Mr. Rodewell Mbewe Program Assistant: CHANGES
Documentation Livingstone
127. 14/02/05 Mr. Obed Phiri Program Assistant: CHANGES
Data livingstone
128. 14/02/05 Ms. Saboi Simasiku Grants Co-ordinator CHANGES
Livingstone
Head Teacher: Musokotwane
129. 15/02/05 Mrs. Delphine Mweemba CSMC FPP Basic School,
Livingstone
Deputy Head Musokotwane
130. 15/02/05 Mr. Peter Mwalunyunje Teacher: SFPP Basic School,
. Livingstone
Musokotwane
131. 15/02/05 Mr. Noel Katanekwa Teacher: SFPP Basic School,
Livingstone
Musokotwane
132. 15/02/05 Ms. Immaculate Sigande Teacher Basic School,
Livingstone
Teacher: Guidance Musokotwane
133. 15/02/05 Mr. Clement Sikulova and Counselling Basic School,
Livingstone
Teacher: Guidance Musokotwane
134. 15/02/05 Mr. Greywell Chizyuka and Counselling Basic School,
Livingstone
Teacher Guidance Musokotwane
135. 15/02/05 Mr. Fine Halwiindi and Counselling Basic School,
Livingstone
Provincial Education Provincial
136. 15/02/05 Mrs. Isabel Nanja Officer Education Office,
LivinQstone
SHN Focal Point Provincial
137. 15/02/05 Mrs. Rosey Chulu Person Education Office,
Livingstone
Senior Planning Provincial
138. 15/02/05 Mr. Muchele Education Office, Officer Livingstone
HIV/AIDS Focal Point Provincial
139. 15/02/05 Mr. Bornwell MUbanga Person Education Office,
Livingstone
140. 15/02/05 Mr. Mwape E. C.Walimba Provincial Social MCDSS,
Welfare Officer Livingstone
141. 15/02/05 Mr. Fanwell Muyunda Provincial Community MCDSS,
Development Officer Livingstone
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Ministry Of Health,
142. 15/02/05 Mr. Kennedy Siame Office Administrator Provincial Office,
Livinqstone
Head Teacher Mukuni Basic 143. 16/02/05 Mr. P. MlJlenga School, Livingstone
Vice Chairperson: Mukuni Basic 144. 16/02/05 Mrs. Rose Siloka PTA School, Livinqstone
MOH: Zonal Health Mukuni Basic 145. 16/02/05 Mr. Halubona Simweeba Worker School, Livingstone
MCDSS: Zonal Mukuni Basic 146. 16/02/05 Mrs. Karen Shamusemuna Community Focal School, Livingstone Point Person
Teacher: Zonal Mukuni Basic 147. 16/02/05 Mrs. Melvin Muhau Education Focal School, Livingstone Point Person
Head Teacher Nalituwe Basic 148. 16/02/05 Mr. Y. Hakayobe School, Livinastone
Deputy Head Nalituwe Basic 149. 16/02/05 Mrs. P. Daka Teacher School, Livinqstone
Teacher: Home Nalituwe Basic 150. 16/02/05 Mrs. Malambo Economics School, Livinqstone
Community Focal Nalituwe Basic 151. 16/02/05 Mr. Jeremiah Chuulu Point Person School, Livinqstone
Teacher: SHN Focal Nalituwe Basic 152. 16/02/05 Mrs. Molly H. Sibajene Point Person School, Livinqstone
PTA Treasurer Nalituwe Basic 153. 16/02/05 Mr. D. L. Kelo School, Livinqstone
Teacher: Committee Nalituwe Basic 154. 16/02/05 Mr. S. Bwainga Member School, Livinqstone
Community Focal Nalituwe Basic 155. 16/02/05 Mr. W. Siampisani Point Person School, Livinastone
PTA Chairperson Nalituwe Basic 156. 16/02/05 Mr. E. Matele School, Livinqstone
David Livingstone
157. 16/02/05 Rev. Howard J. Sikwela Principal College of
Education
Head of Section: David Livingstone
158. 16/02/05 Mr. Alfred B. Sikazwe Mathematics and College of
Science Education
David Livingstone
159. 16/02/05 Mr. Mike R. Kanini Senior Lecturer College of
Education
District Education District Education 160. 17/02/05 Mr. Darius Kaluba Board Secretary Office, Kalomo
District Resource District Education 161. 17/02/05 Mr. Sebastian Hambokoma Centre Co-ordinator Office, Kalomo (DRCC)
Planning Officer District Education 162. 17/02/05 Ms. Febby Michelo Office, Kalomo
Education Standards District Education 163. 17/02/05 Mr. John Sitali Officer (ESO) Office, Kalomo
District Education District Education 164. 17/02/05 Mr. Steven K. Hamilemba Standards Officer Office, Kalomo (DESO)
Manager District Health 165. 17/02/05 Ms. Margret M. Hazemba Administration Office, Kalomo
Mr. Kingsley Ngalande District Community 166. 17/02/05 MCDSS,Kalomo Development Officer
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CHANGES Program E.valuation
Lets Build
167. 17/02/05 Ms. Mwiiga C. Malumo Chairperson Together,
Choonqa, Kalomo
Lets Build
168. 17/02/05 Mrs. Dimba Vice Chairperson Together,
Choonga, Kalomo
Lets Build
169. 17/02/05 Mr. Alex Lilanda Secretary Together,
Choonga, Kalomo
Lets Build
170. 17/02/05 Mr. Elnot Sikatumba Vice Secretary Together,
Choonga, Kalomo
Lets Build
171. 17/02/05 Ms. Choombe Mutinta Treasurer Together,
Choonqa, Kalomo
17/02/05 Lets Build
172. Mr. Charles Mweernba Committee member Together,
Choonga, Kalomo
Lets Build
173. 17/02/05 Mrs. Walenda Committee member Together,
Choonga, Kalomo
Lets Build
174. 17/02/05 Mrs. Namukanda Committee member Together,
Choonqa, Kalomo
Lets Build
175. 17/02/05 Mr. Evans'Simulele Committee member Together,
ChoonQa, Kalomo
Lets Build
176. 17/02/05 Ms. Bertha Nosiku Committee member Together,
Choonga, Kalomo
177. 17/02/05 Mrs. Mary H. Bukowa Gwembe Basic District Education
School Office, Gwembe
178. 17/02/05 Mr. Venter Ngandu District Resource District Education
Centre Co-ordinator Office, Gwembe
179. 17/02/05 Mr. Charcks Nzala Planning Officer District Education
Office, Gwembe
180. 17/02/05 Ms. Joyce Musambila District Education District Education
Board Secretary Office, Gwembe
181. 17/02/05 Mrs. Beatrice Kapikwa MCH Co-ordinator District Health
Office, Gwembe
182. 17/02/05 Mr. Joseph Maninga Education Standards District Education
Officer Office, Gwembe
183. 17/02/05 Mrs. Florence C. Mongazi Head Teacher District Education
Office, Gwembe
184. 17/02/05 Mr. J. Moomba Community MCDSS, Gwernbe Development Officer
185. 18/02/05 Mr. Borniface Mafwela Family Health Officer Family Health
Trust, Monze
186. 18/02/05 Mrs. M.M. Sikasanga District Education District Education
Standards Officer Office, Monze
187. 18/02/05 Mrs...l.N. Mweetwa Acting Assistant District Education
Statistics Officer Office, Monze
188. 18/02/05 Mr. L.K. Siampazanga Planning Officer District Education
Office, Monze
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189. 18/02/05 Mrs. B.B. B. Murray Deputy Head teacher District Education
Monze Basic School Office, Monze
190. 18/02/05 Mr. Z. Munthali Acting Accountant· District Education
Office, Monze
191. 01/03/05 Mr. R.S. Chenda Head Teacher Kafue Day High
School, Kafue
192. 01/03/05 Mrs. M.S. Mulendema Teacher: Guidance Kafue Day High
and Counselling School, Kafue
193. 01/03/05 Mrs. G.M.C. Simutowe Teacher Kafue Day High
School, Kafue
194. 01/03/05 Mr. C.L. Chikanta AI Head Teacher Naboye High
School, Kafue
195. 01/03/05 Mrs. E.M. Chilekwa Teacher: Guidance Naboye High
and Counselling School, Kafue
196. 01/03/05 Debora Mutune Pupil Naboye High
School, Kafue
197. 01/03/05 Vincent Kalenga Pupil Naboye High
School, Kafue
198. 01/03/05 Sarah Chipoya Pupil Naboye High
School, Kafue
199. 01/03/05 Mrs. Agnes M. Imonda Head Teacher Munali Girls' High
School, Lusaka.
200. 01/03/05 Mr. E. Silwimba Bursar Munali Girls' High
School, Lusaka.
201. 01/03/05 Mrs. Agnes T. Chanda Teacher: Guidance Munali Girls' High
and Counselling School, Lusaka.
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Annex Two:
School Health and Nutrition Competition Assessment Tool
Eastern Province
1. School Health and Allot 2 points ifthere is a School 2
Nutrition Health and Nutrition Promoting
Promoting Team? Team (SHNPT) with at least
membership from local health
centre, agricultural department,
PTA, NHC, Community
Develo ment etc.
2. Is the School Allot 2 points if evidence of 2
Health and meeting in the last two months.
Promoting Team
active?
3. Are resolutions Allot 2 points if evidence of 2
from SHNPT implementing any ofthe resolution
meetings made in the last two months.
im lemented?
4. Is there a School Allot 2 points ifthe school health 2
Health Polic ? olic is available and dis la ed.
5. Are pupils and Randomly select two pupils and one 4
teachers aware of teacher. Allot a point for each pupil
the school health if aware ofthe policy and another 2
policy? points ifthe teacher is'aware ofthe
olic .
6. Is there a school Allot 1 point ifthe school has a 2
garden or field? garden or production unit and allot
another 1 if evident that produce are
used for the benefit of u ils.
7. Are pupils fed on Allot 4 points if pupils are 4
produce from the periodically fed on food from the
arden or field? school ardens and field.
8. Is there a school Allot 4 point ifthe orchard had 4
orchard? more than 30 tree and/or suckers.
9. Are there waste Allot 2 points if all classrooms and 2
paper baskets or offices have waste paper baskets or
boxes in each any approved provision for
classroom and throwing litter.
office?
10. Are there pit Allot 2 points for present of girls, 2
latrines/toilets for boys and staff latrines or closets.
teachers and
u ils?
11. Maintenance ofthe Allot 3 marks if evidence of repairs 3
school. of broken glass panes, desks, chairs,
aintin of classes etc.
12. Are the toilets One latrine or close for every 25 2
ade uate? u ils.
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13. Maintenance of All 5 points if all toilets are clean 5
latrines. and well maintained.
14. Is there a provision Allow 2 points for evidence of 2
for washing hands provision of hand washing facility
by use ofrunning by use ofrunning water.
water after use of
toilet?
15. Local resource Allot 5 points for evidence oflocal 5
mobilization. resource mobilisation to support
SHN Activities.
16. Is the school Allot 2 points ifthe school is clean 2
surrounding well- and free from animal droppings.
kept and free from
animal droppings
and litter?
17. Are pupils and Allot 2 points if both teachers and 2
teachers drinking pupils are drawing their drinking
water from a safe water from a protected well,
source? borehole, pipe or any approved
source of drinking water.
18. Is the water source Allot 2 points ifthe well is fended 2
protected from and has a cover. The borehole area
animals and dirty? is fenced and clean.
19. Is the water Allot 5 points ifthere is evidence of 5
periodically water being taken for analysis.
checked for quality
control?
20. Are periodic public Allot 5 points ifthere is evidence of 5
health inspections a public health inspection
conducted at conducted in the last 6 months.
school?
21. Is there an SHN Allot 2 points if there is an SHN 2
comer? resource centre.
22. Is the SHN Allot 5 points if evidence of 5
resource comer teachers, pupils, and surrounding
utilized? communities using the facility.
23. Do pupils carry Allot 4 points ifthere is evidence of 4
food with them to at least more then 60% of pupils
school? bring snacks to eat at school.
24. Is there a Allot 4 points ifthere is evidence of 4
Community Based such an organization.
Organization in the
surrounding
community
supporting the SHN
programme?
25. Are pupils Randomly select 5 pupils. Allot 5 5
inspected for points if pupils are inspected for
personal hygiene personal hygiene every day before
every day? starting classes.
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26. Pupils knowledge Randomly select 5 pupils, one from 5
on prevention of each grade (grades 3-7). Detennine
intestinal wonns knowledge level by asking basic
and Bilharzia. facts about prevention of worm,
bilharzias and communicable
diseases. Allot a point for each
pupil who gives a correct answer.
27. Pupils knowledge Randomly select 5 pupils, one from 5
on prevention of each grade (grades 3-7). Detennine
Vit A and iron knowledge level by asking basic
deficiency. facts about prevention ofiron
deficiency anaemia (IDA). Allot a
point for each pupil who gives a
correct answer?
28. Are there at least 3 Allot 2 points for each club that 4
health promoting show evidence of meeting in the
clubs in the school? last month.
29. Has the SHN team Allot 2 points if action plan is 2
got an action plan? available.
30. Is the action plan Allot 2 points if action plan is being 2
being followed? followed.
31. Does the school Inspect the treatment fonns. Allot 3 3
administer SHN points if SHN treatment protocol
Drugs according to and schedule are followed.
protocol/schedule?
TOTAL 100
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Annex Three:
SHN Continuous School Evaluation Questionnaire
1. Name of School?
2. Head teacher's name?
3. Is he/she trained?
4. SHN focal point person?
5. Is he/she trained?
6. School Enrolment: girls 1-7 boys 1-7
7. Villages in the Catchment area
}#:i}•.••.•. }·.·····••••• N: >If I;"....,:,;,.}.i· \\............
. .........•... .•... }.} ................... .... ,. •• '.'... -0.·••/>. bc ..... -I.(t:I-~· • . •... .••.•• \., •• }}}}i·}}/<) .. ..
8. Has the Community SHN Committee been formed?
9. What is their plan (community managed action plan)?
10. District level information?
11. District SHN Education Focal Point Person?
12. Has the school ever used the District SHN Resource Centre?
13. What materials were relevant from the Resource Centre?
14. Feedback from the District Coordinating Committees?
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Annex Four:
Restructured Ministry Of Education
Permanent
Secretary
I I
Planning
and
Information
Accounts
Unit
Aguirre International
Standards
and
Curriculum
Development
Audit
Distance
Education Teacher
Education
and
Specialised
Services
Purchasing and
Supplies Unit
Human
Resource and
Administration
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CHANGES Program Evaluation
Annex Five:
The Changes Programme in the Context of Zambian Education
The CHANGES programme serves critically important needs for the overall educational
system ofthe Zambian government. It does not stand alone, however, and thus we offer
the following short comments about other components ofthe system and how they
impinge on its effectiveness. Each topic is followed by a recommendation, which refers
to what any new follow-up programme and the continuing USAID funded education
programmes could consider, particularly as they relate to lessons learned under the
CHANGES programme.
1. Multiple Programnles in the Schools:
Findings and Conclusions: The following separate acronyms were listed by the
MOE in 2002, and although not all ofthem still exist, parents, head teachers and
classroom teachers expressed their concern that teachers were "always going to
workshops," and unable to be about the business ofteaching children to read and
write: INSPRO, PAGE, ANTI-AIDS, GRACE, GEMS, TGM, INSET
WORKSHOPS, SITE, CHANGES TED, DISTRICT WASHE, FAMILY PACK,
QUIZ, SPORT DRAMA CULTURE, AND MIEP. In addition to these formal GRZ,
NGO or Internationally funded programmes, many schools have a multiplicity of
after-school clubs and sports activities, some of which occur during the school day. It
was reported in one zone that the whole second trimester was taken up with sports,
with little or no formal education occurring at all.
Reconlnlendations:
• It has proven difficult, particularly in small, 1-7 teacher rural schools, to have
CHANGES interventions receive the necessary level of attention. Each activity
requiring "training" takes teachers out ofthe classroom, limiting the instructional
time for students. When one teacher or head teacher serves as the "focal point"
for multiple programmes, there is little question that most, if not all, ofthe special
programmes will suffer from neglect, regardless oftheir importance.
2. Educational Quality in Primary Education:
"The Zambia NationaIU(7i0(70fTfJachers (ZNUT) .. .says' toorr1iJchemphasis has bee(7 put on
upils passing subjects otherthan mastering survival skills. ;The curriculum must be reviewed. -
because it was a majorcause of faili(79 educ~tiopal§tandards ...The grade eight andnine syllabus
was equally 'useless' because it didnot allow pupils. to ma§ter survival skills that woulqh(3lp them
even when they failed to find white-collar ·obs~ ..the recent results were a disaster. "
- The ,2005
Findings and Conclusions: The team was not able to observe large numbers of
classes in session, as many heads and teachers dismissed their students from class
before our arrival at the school to hold dran1a, dances and other community events.
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Others had their teachers meet with the teanl, instead of our being able to observe
them teaching. Visits, however, were made to many classrooms, and other than the
NBTL, Primary Reading Programme classrooms in grade one and SITE in grade 2,
the rooms were almost completely devoid of books, learning materials, mathematics
manipulatives, or other evidence ofteaching and learning. Student workbooks were
examined, and again, other than in grade one and somewhat less in grade two NBTL
classrooms, there was no evidence of original student writing, but much evidence of
copying offthe blackboard. Books, again with the exception ofsmall libraries in
NBTL/SITE classrooms, were not in evidence in any classroonls observed, but could
be found, sometimes hundreds ofthem, in the office ofthe Head Teachers. In other
cases, books were still at the Resource Centres or District Offices, and not in the
hands ofteachers and children. At no time were children observed reading even a
textbook. The National Assessment Survey of 200 I under the Basic Education Sub￾Sector Investment Programme concluded in a somewhat understated fashion that
"learning achievement levels in Grade 5 were somewhat low," with the mean
percentage scores in English and Mathematics at 33.42 and 35.74 respectively. It
went on to say that "Pupils stayed for a considerable long period without learning."
Recommendation:
• While neither CHANGES nor any follow-up programme deals directly with the
low quality of primary schooling, they are and will be affected by the nature ofthe
teaching-learning process in the classroom, the lack ofreading and numeracy
skills on the part of children, and other indicators oflow quality. Students who
cannot read, cannot read materials on HIVIAIDS or gender roles.
3. Lack of Trained Teachers in the Classroom:
Findings and Conclusions: The IMF/WB controls on the employment of additional
teachers have placed a tremendous burden on the schools ofZambia. It is hoped that
when the controls are lifted, the 3 year backlog ofteacher graduates from the TTCs
can be employed. An obvious partial cause oflow achievement in Zambian primary
schools is the lack oftrained teachers in almost every school visited. Often only 2 to
4 "certified" teachers were responsible for up to 7 classes in a given school. The
other classroonls occasionally had an untrained adult from the community, often paid
only K60,000 per month to be a community teacher. Far too often, however, no adult
was present in the room, and thus, children could be found playing on the school
grounds, orjust returning their homes.
Recommendation:
• As described in the following section on multi-grade teaching, highly successful
multi-grade classrooms with up to 75 students are now functioning throughout
several Latin American countries, and are being experimented with in Uganda.It
involves a major reform ofschooling, not a piece-meal approach, but can be done
for approximately a 10 percent added cost factor, with under-trained teachers, and
often leads to children in multi-grade, rural classrooms achieving at or above
students in regular, graded, urban settings. Any new programme could work with
the materials preparation, multi-grade teacher training and a scaling-up ofthe
current experimental programme.
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4. Language of Instruction, Activities, Posters and Instructional Materials:
Findings and Conclusions: While there is great hope in the research results of
PRPISITE in teaching children to read and write in their mother tongue and in
English, English does not yet appear to be a strong medium ofinstruction in rural
primary scho·ols. Children do not appear to have a solid grasp ofthe English language
until grades 8 and 9, and by that time, a significant percentage ofstudents have left
the system.
Recommendation:
• While a few posters could be found in mother tongue languages, the vast majority
ofmaterials on girls' education and HIVIAIDS are in English. While a case could
be made that these reach the older students who have "mastered" English, there is
informal evidence that even these older students do not fully understand much of
the more conceptual information about HIVIAIDS, to say nothing ofprofound
cultural issues involving gender roles within their respective cultural and linguistic
groups. There is a great need to retrain teachers for the "Read-On Programme" for
grades 3-7.
5. Pre- and In-Service Teacher Education:
Findings and Conclusions: The CHANGES Programme, while primarily
concentrating on in-service education through the training offocal point head teachers
and regular classroom teachers, has also offered workshops in Teacher Training
Colleges on HIV/AIDS and Girls' Education. Regrettably, the new graduates have not
yet been able to obtain positions due to IMF/WB controls, as stated above. In
addition, with HIV/AIDS taking its toll on the teaching profession, despite ARVs for
teachers and their spouses, it will remain important that new teachers receive the pre￾service training and that those out in the schools are not only provided with "cascade"
training by focal point persons in their schools, but regular monitoring and updating.
The reader is referred to the Annexes for infornlation on More and Less Successful
Interventions in Teacher Education.
Recommendations:
• Any follow-up programme to CHANGES must continue to consider the needs of
both pre- and in-service teachers. It will be critical for any new effort to work
closely with the TTCs in each Province, while continuing to upgrade in-service
teachers.
6. Training:
Findings and Conclusions: As indicated in nunlber one above, head teachers and
teachers are involved in considerable training for one or more ofthe many
progranlffies in the Zambian schools. In many small rural schools, teachers nliss nlany
days each month attending training sessions. While the evaluation team was unable to
visit any ofthe CHANGES training sessions, the training documents themselves
appear to be well designed, but rather "didactic" in nature. Whether the trainers
actively involve the participants in the training itself, we could not ascertain, but if
trainees remain passive participants, then the trainings themselves reinforce the
copying methodology which appears to dominate most Zambian classrooms. An
additional concern has to do with the "cascade" model oftraining. It is utilized
throughout the world as a mechanism to train large numbers ofteachers at
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CHANGES Program Evaluation
comparatively low cost, but there is strong evidence that the learning tapers off
significantly on the 2nd, 3rd or 4th iterations.
Recommendation:
• It is critical that monitoring and evaluation occur in at least a sample group of
schools, to assure that critically important information is actually passed on to
other teachers, parents and communities involved in either SNH or CSMC, who
are not focal point persons. On such critically important topics as HIV/AIDS,
Gender Equity, and Life Skills, information is never enough. All trainings must
also involve attitudes and behaviours, and thus the type oftraining itself~ecomes
critical.
7. Primary Reading Programme (NBLT/SITE):
Findings and Conclusions: The most important innovation in the Zambian schools is
the Primary Reading Programme. On a classroom level, it is immediately apparent
when one enters an NBLT classroom, as it contains children working in groups, age
appropriate reading materials in Zambian and English languages, children working
individually and in groups, teachers working with groups of children rather than a full
class, little copying offthe board, etc. Its success has been exceptional, with gains in
literacy between 1999 and 2002 of up to 2000 percent in Zambian reading scores in
grade 1, and gains of over 700 percent in English reading scores in grades 2-5.
Zambia has become THE international leader in literacy, and its successes are now
being copied throughout the continent.
Recommendation:
• The MOE has already produced a mathematics text called Mathematics Rainbow
Kit (MARK), based on the model, and plans to produce similar texts across the
curriculum for all primary grades. Any follow-on programme should seriously
consider working closely with and supporting this expansion ofthe reading
programme to other grades and subject areas.
8. Multi-grade Teaching Methods:
Findings and Conclusions: A large percentage ofrural teachers are forced to teach
more than one grade, due to the lack of employment of new teachers and teachers
being gone for reasons ofworkshops, illness, or death. While workshops on multi￾grade teaching have been held in Zambia, the only design that has proven itselfin
poverty-stricken rural areas is that ofthe New School Movement (Escuela Nueva) of
Latin America. Suffice it to say, that Ministers of Education from throughout Eastern
and Southern Africa have visited Colombia and Guatemala to observe it inaction and
have been positively impressed, but to date, only Uganda is experimenting with an
African version. The model is now expanding nationwide in Nicaragua and is starting
in Peru. It has proven particularly powerful in poor, rural settings, where children
perform at equal levels in literacy and numeracy to their urban counterparts in graded
schools. Cost estimates from Latin America have shown it to be approximately 10
percent more costly than other systems, but that the benefits significantly outweigh
the costs.
Recommendation:
• Regardless ofwhether Zambia gets out from under the controls ofthe IMFIWB,
significant numbers ofrural teachers will continue to find themselves teaching or
having responsibility for more than one grade. Unless, and until, Zambian rural
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teachers are provided with the training, workbook materials, flexible promotion,
books, student government, and the other proven components ofthe system, rural
students will continue to significantly lag behind their urban counterparts. Any
follow-up programme should seriously consider assisting a pilot programme in the
New Zambian Primary School.
9. Production Units, School Feeding and Nutrition:
Findings and Conclusions: There were several very impressive Production Units
seen at particularly rural schools. Large, healthy fields of maize, ground nuts,
sunflowers, and other crops were observed, as were several vegetable gardens. These
Production Units, however, appeared to have little to do with school nutrition and
feeding, as products in most cases were only served to the children once a week at
most, and often only two times during a term. We were unable to determine if
students gained any real vocational skills by tending the fields and gardens, or
whether they already had most ofthe skills and were merely being used as unpaid
labour.
Recommendation:
• Whether primary school children should be working in the fields rather than
mastering other basic skills is a fundamental question which needs to be addressed
by the MOE. The nutritional and feeding value ofthe fields and gardens is not
apparent. .
10. Clinical Supervision, Guidance and Counselling:
Findings and Conclusions: The traditional role ofschool inspectors or monitors has
been replaced by "Standards" officers, but it is our perception that most playa similar
role to their old inspectorial role. Uganda has trained a whole cadre of "clinical
supervisors," who have gained the skills necessary to assist head teachers and teachers
in their roles, rather than inspect and monitor student records and finances and pass'.
judgment on lesson plans and teaching techniques. While we met one excellent
guidance counsellor in a large urban school, who had clinical supervision and
guidance skills, this appeared to be the exception rather than the norm.
Reconlnlendation:
• In the deeply profound areas ofHIVIAIDS and Gender Equity, to say nothing of
the all the other things facing school heads, teachers, and pupils, any new follow￾up programme needs to consider the development of a cadre of professionals
trained in facilitation and counselling skills.
11. Decentralization, Local Boards, Parent and Community Control:
Findings and Conclusions: Parents and community members with whom we met are
increasingly frustrated by teachers who miss class for workshops, illness, to collect
their monthly paycheques, supervise sports and other activities, or have other
legitimate or illegitimate reasons for not teaching their children. Most felt that they
had little input into the decision-making processes oftheir children's schools.
Recommendation:
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• It will be critical for any follow-up progranlme to confront the sense of
powerlessness that many parents and communities feel about the schools which
their children attend.
12. Life Skills, Vocational Skills:
Findings and Conclusions: A large majority ofZambian children will finish their
schooling at or before grade 7 or grade 9. It is thus absolutely critical that they gain
the life-skills necessary to survive in a world of poverty, HIV/AIDS, and gender
discrimination. It is also necessary th.at the skills they learn in school are of worth
when it comes to being able to supporting their future or present families. The life￾skills taught through the DFID/UNICEF Guide for Out-of-School youth deal with
such individual skills as self-awareness, empathy, decision-making, problem-solving,
and effective communication; and specialized life-skills such as drug and substance
abuse, reproductive health and entrepreneurship. It is an excellent manual on
introducing these skills.
Recommendation:
• It is critical that many ofthese life-skills become part ofthe regular school
curriculum, as it is much more difficult to contact out-of-school youth, than it is
while they are still in the school. Some schools have given over half a day each
week to "practical" skills, but too often this is just working on the school
production unit, or even in the fields and gardens of head teachers and teachers.
Any follow-up programme could work with the MOE to see that many ofthese
skills become part ofthe regular curriculum.
Findings and Conclusions: Regrettably, the Evaluation team had no chance to visit
the Community Schools that have become a critical component ofthe Zambian
educational system. They do, however, educate an increasingly large number and
percentage ofZambian children, with even less resources, infrastructure, salaries and
trained staff than is found in the regular school system.
Recommendations:
• Any follow-up programme needs to be involved in training teachers, providing
support for HIV/AIDS, SHN, and Gender Equity efforts in these schools.
14. Orphans and other Vulnerable Children:
tl here a~~ more vf.Jlni/ri1ble childreii in school
inistry orEducation VUJnerable. Schem
Equity and Gender Officer, MOE
Findings and Conclusions: Most schools are counting and/or monitoring the number
of orphans in their schools, often with the support and assistance ofthe Community
Development workers from the MCDSS. The numbers of children falling into the
category ofsingle or double orphans is truly staggering, with some schools reporting
25-50 percent orphans. In a limited number of cases, teenagers are raising their
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brothers and sisters with limited assistance from the schools and community
development workers.
Recommendation:
• A case could be made that a large majority ofZambian youth are vulnerable, even
those with both parents still living. Malnutrition, lack of adult supervision, a wide
variety of health risks including HIVIAIDS and poverty, make it imperative that
any new efforts by USAID reach these children, who are among the most
vulnerable in the world.
15. Time: In School and On-Task:
Findings and Conclusions: Not only are the Zambian primary schools suffering from
a lack of books and other instructional materials, generally poor instructional
techniques, and many untrained teachers or no teachers at all in the classrooms,
because ofthe large number ofstudents attracted by free education, school feeding
programmes and other interventions, many schools have multiple shifts, with children
coming and going all day. 'Many children appear to be in class little more than 3
hours daily, while many teachers are overworked, teaching two or more shifts. If
every minute ofschool time was used for actual learning, it might be possible for
children to master the curriculum, but regrettably, we observed classes with no
instruction occurring due to lack ofteachers, and reports were given to the team of
large blocks of instructional time being taken up with sports and other extra-curricular
activities.
Reconlnlendation:
• NBLT/PRP has made exceptional strides in confronting this problem at grades
one and two, but books, instructional materials and sufficient time in school and
on-task are needed at all grade levels. Without this fundamental reform, all other
interventions of curriculum, subject-matter standards, pre- and in-service teacher
training, teachers' guides, learning comers, etc., are almost certainly doomed to
failure. National policies, with monitoring, on the nurnber of days in school,
starting and finishing on time, length of recess and lunch breaks, and other factors
concerning time
16. Out-or-School Youth:
Findings and Conclusions: With a large majority ofyoung people completing their
schooling at or before grades 7 or 9 and often without mastering basic skills of
literacy and numeracy, and with few vocational skills, programmes geared primarily
at school children are not meeting the needs ofthese out-of-school children and youth.
Radio or television programmes and posters might meet some of the needs of
particularly urban young people, but millions ofrural children receive little formal or
non-formal education. Community schools and adult education programmes are
beginning to confront some ofthese issues, but unless and until this group receives
nluch more attention, issues of health, HIVIAIDS, gender equity, life-skills and
vocational skills will continue to grow in importance.
Recommendation:
• USAID should give serious consideration under any follow-up programnle to a
much greater emphasis on meeting the needs of out-of-school youth, as these are
among the most vulnerable members of Zambian society in life-skills, academic
and vocational skills, and at risk for HIV/AIDS.
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Annex 6:
Service Learning and Community Service as
an HIVIAIDS Prevention Method
Service-learning is a teaching method that enriches learning by engaging students in
meaningful service to their schools and their communities. Through careful integration
with established curricula, lessons gained from perfonning hands-on service activities
heighten interest and enhance academic achievement, citizenship, and character
development. Service-learning is a proven key to educational refonn that also makes
significant contributions to community development. (NYLC, 1994) Service-learning is
a philosophy, a community development model and a teaching and learning method. As a
philosophy, service-learning embraces young people as a community resource and asset.
It views all people in a democratic society as citizens with a capacity to contribute - no
matter their age.
Service Learning, Community Involvement and Lessons for HIV/AIDS
Interventions
Youth are a community asset and a resource
Real-life community issues are part of the
school curriculum and communit life
Active learning using critical thinking and
roblem solvin skills
Citizenship and character gains result
A feeling of ownership results when youth are
involved at all stages of the process
Service learning must meet a genuine
community need
A clear connection to curricular learning
objectives, often interdisciplinary in nature
Reflection on the action and learning is critical,
with lessons learned leading to change
Direct contact with people in need
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Young people, not just "experts," need to be
involved in all HIV/AIDS interventions
HIV/AIDS must be part of every formal and
informal educational settin
Passive acquisition of knowledge has not
roven a successful intervention
Limited participation in programmes by young
people leads to few citizenship or character
ains
When information is done "to" students or when
they are not involved in planning,
im lementation or evaluation, ains are limited
Particularly in the African context, there can be
no greater community need than HIV/AIDS
intervention
Rather than a short unit in science or health, an
in~depth, interdisciplinary programme is more
Iikel to have a reater im act
Rather than memorization of theoretical
information, reflection on HIV knOWledge and
service can change the individual and the
communit
In many African communities, nearly every
person is directly affected by HIV/AIDS. The
t es of direct assistance are unlimited
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Indirect channelling of resources to areas of With over 10 million orphans worldwide, and
need hundreds of thousands of youth infected
annually, there is no shortage of areas of need
Advocacy to eliminate sources of problems Advocacy against social stigma and
discriminatory laws. Behaviours in favour of
effective interventions are critically important
Project-based learning with student Too many HIV/AIDS programmes are adult
identification of need, programme planning and designed, managed and evaluated with little or
implementation, and evaluation no youth planning, implementation or
evaluation
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Annex 7:
Ministry of Health Structure
Central Board of
Health Provincial
Health Offices (8)
District Health Boards
District Hospitals
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Health Centres
Health Posts
Voluntary Providers
e.g. NHCs, CHWs
HC
Private providers
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Annex 8:
Excerpts from the National SHN Policy
Guiding Principles
The management ofthis policy and its implementation will be guided by the following principles:
a) Creating an enabling environment for the professional delivery of SHN services
through effective planning, institutional management, resource mobilization,
monitoring and evaluation
b) Guaranteeing that quality SHN is instituted in all learning institutions to benefit
learners and to sustain their health living
c) Ensuring that equity of access to SHN services is accorded to every learner without
discrimination in terms of gender, religious beliefs, HIV and AIDS and social status
or race
d) Empowering Education Boards and Parent Teacher Associations to take an active role
in decision-making on issues related to the SHN programme
e) Strengthening partnerships and community alliances required in the provision of
quality the SHN programme
t) Take into consideration the existing legal provisions in education health and nutrition,
and that no activity under SHN shall contravene the provisions in these pieces
legislation
Vision
To promote and provide quality and cost-effective health and nutrition services to all school
children in order to improve learning
Policy Objectives
a) Promote and improve the nutrition status ofschool children in order to enhance and
sustain their physical, social and mental well-being
b) Promote and maintain the health status ofschool children through the initiation of
effective health promoting activities
c) Improve collaboration among line ministries in planning and implementing SHN
interventions
d) Strengthen school and community based health and nutrition activities
e) Provide health and nutrition education and promotion of activities at all levels ofthe
education system
t) Promote and sustain a safe and healthy learning environment
. g) Ensure capacity-building among stakeholders
Resource Mobilization
a) The government shall create a budget line to finance the SHN programme
b) The government shall ensure that line ministries commit resources towards the
implementation ofthe SHN interventions
c) The government and other implementing agencies shall mobilize resources for SHN
activities
d) The government shall train human resource for the implementation of SHN
programme
Monitoring·and Evaluation
a) The government shall ensure that monitoring and evaluation of SHN is integrated into
education programmes
b) Line ministries and other stakeholders shall jointly carry out monitoring and
evaluation of SHN interventions
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c) The capacity of all officers participating in monitoring and evaluation at all levels
shall be strengthened
d) MOE shall develop and integrate a comprehensive SHN information system with
measurable indicators into the existing Education Management information Systems
(EMIS)
e) The impact assessment ofthe SHN programme shall be carried out every three years.
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Annex 9:
Options for Implementatio,n of School Health and Nutrition
Programmes (CHANGES 2005)
Lowfuiriifual
cofu <orieritsforSHN
De-worming and micro￾nutrient supplementation
administered by teachers
Teachers and health workers
trained (1 day orientation)
some trained through zonal
systems by ZIPS using SCI
model or a 2 day course that
is more inclusive of SHN
elements
Administrative/managerial
training for district and
provincial staff (2 day)
Intersectoral committees
formed at district and
provincial levels
Health promoting committees
formed at school level
PTA members and
communities sensitized by
teachers and other means
Some IEC use for advocacy
and sensitization
Some attention to water and
sanitation issues- pit latrines
and keeping a clean
environment
Some use of health cards
Local production unit in place
Monitoring by district and
provincial MOE/MOH
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De-worming and micro￾nutrient supplementation
administered by teachers
Teacher and health worker
training (2-3 day course)
Administrative/managerial
training for district and
provincial staff
Written school health policy
and SHN action plans
Intersectoral committees
formed at district and
provincial levels
Health promoting committees
at school level
Fresh Framework pillars
implemented (health policy,
life skills, health services,
access to water and sanitary
facilities)
PTA and community
sensitization done using
meetings/public forum or
Theatre for Community
Action Approach
Local production unit with
orchard and vegetable
garden
Small resource centre in
schools (HIV/AIDS, SHN)
accessible to community
members
Strengthening of PTAs
School Health cards in use
and links established
(Schools, health centres and
communities)
Water source being checked
and treated with chlorine
Adequate VIP latrines
Other environmental issues
addressed such as hand
De-worming and micro￾nutrient supplementation
administered by teachers
Training of teachers and
health workers in drug
administration (4 day
course)
Managerial and
administrative training for
planners and managers at
district and provincial level (2
day course)
All basic schools involved
Teachers providing health
education using flip charts
on worm prevention
Teachers using life skills
interactive methodology
School Health Cards being
used-information recorded
correctly and linked to health
services
Health policy written and an
SHN action plan available
Sensitisation of communities
using various methods
Formation of intersectoral
committees at National,
provincial and district levels
Formation of Health
Promoting committees at
school level
Strengthening of PTA and
training of community
members in RPA
Pit latrines and water
adequate
Involvement of CBOs
Local production units in
place and producing food for
pupils
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washing facilities pupils encouraged to eat
Monitoring by district and snacks and in some schools
provincial planning office- provided with meals
integrated School has HIV/AIDS and
MOE/MOH/MCDSS SHN resource corner
accessed by community
members
Implementation of Fresh
framework
Health policies, like skills,
water and sanitation and
access to health services.
Awareness of these issues
by all SHN schools
Intersectoral coordination
committees in place at
district and provincial levels
Active broad-based media
campaigns using printed and
broadcast media
Coordination with IRI
programmes
Regular monitoring by
MOE/MOH/MCDSS
Inclusion of HIV/AIDS,
Malaria, oral and eye health
issues
Inclusion of life skills training
for water/sanitation/hygiene
and HIV/AIDS
Active School clubs
including anti aids, SHN, etc.
SHN data from school s
treatment records and
school health cards used by
district and provincial
planners and SHN focal
points
Monitoring by district and
Provo planning-integrated
MOE, MOH, MCDSS
Note: One can choose different packages as long as the key elements are included and then select
other elements as the programme expands and as resources are available.
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Community Sensitisation and Mobilisation Campaign Model
.....1------- Development of action plans to sensitise and mobilise
every school and community in the district.
ing ofZonal-level Community
itators
ximately 25-30 community-based government
yees from each ofthe three line ministries￾ation (Zonal Heads/Zonal Inset Providers/Zonal
/AIDS Focal Points), Health (Environmental Health
hnicians), and Community Development
ommunity Development Assistants}--per district.
Development of District monitoring plans.
Provincial-level officials from each ofthe three line
ministries.
District-level officials from each ofthe three line
ministries.
hool catchment areas per dist .ct
er catchment area
1.
Research and Verification
3. Communi
Mobilisation
Implementation of actl
Zonal-level Community Facl
• Community-wide meetings
• Focus group discussions
• Special target group training
• Development of community- and school-based
action plans
i
Based on community and school action plans
Diverse initiatives based on community circumstanfes
needs. Including, but not limited to:
• Community-supported activities
• Small l!rant-sunnorted activities
4.
Community- and School-based
Interventions
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