How prioritizing health in schools can also promote learning

When I first started a literature search for a new policy insight about improving learning through school-based health interventions, the world looked very different than it does today. 

Research shows that in order for students to learn, they need to be healthy enough to think, read, reason, and, even more fundamentally, to see what’s happening in the classroom. Without a healthy foundation on which to build, children may not develop the skills they need to succeed in the classroom. 

Through my literature search, I quickly learned that not only was health an important factor in improving learning outcomes, but also that schools could be particularly convenient and cost-effective places to address these health concerns.

First, schools are often busy, crowded spaces where it is especially important to limit disease spread.

Second, treating some children in a school may positively affect other students who are not treated, in the case of conditions that are spread through close contact.

Third, delivering a health program at school can solve the “last-mile problem” faced by many social programs: If children are already gathered at school, one can conveniently administer treatment to many people at once.

But when the current pandemic hit I wondered how the policy insight I’d been working on for more than six months could be relevant for this new reality. At first, I worried about the usefulness of pointing out that schools are good venues to deliver health programs during a time when many schools worldwide are closed. For as long as COVID-19 remains a threat, health experts rightly warn against gathering together in one location—the very thing that makes schools such an ideal place to deliver health programs in the first place. 

But as communities and governments find new and resilient ways to support families during the pandemic, schools have stood out as useful nodes within communities. For example, schools or Ministries of Education in many countries worldwide are providing much-needed nutritional support to families struggling to feed their children. 

The lessons from rigorous research included in this policy insight acknowledge the reality that schools have ties to many children at once and have an already established interest in their wellbeing.

School closures due to the pandemic have highlighted a fact that was already front of mind for many families: students often rely on their school for nutrition, mental health resources, and more. Schools are therefore already accepted sources of health support, and there is potential for this support to be expanded. 

Key takeaways

Below are the takeaway messages from J-PAL’s new policy insight on improving learning outcomes through school-based health interventions. Read the full insight here. 

• In general, schools are a good venue to cost-effectively and conveniently deliver health services to more children. It is more convenient and less expensive to bring a few health workers to a school to administer treatment to many students at once than to reach each student individually at home or require additional trips to health centers. Health programs administered at schools may also improve take-up, since high rates of health worker absenteeism and closure of health facilities may reduce the likelihood of parents using these services. For example, in Udaipur, India, researchers found that health centers were closed more than half of the time that they were scheduled to be open. 
• Treating contagious conditions such as intestinal worms can be an especially cost-effective intervention that may lead to longer-term increases in test scores and cognitive functioning. Schools may be a particularly important place to address this problem, as sick children can infect other children at school. Given that even children who do not receive treatment benefit from a lower overall community wormload in areas with high initial rates of intestinal worms, school-based mass deworming is an extremely cost-effective intervention that has been scaled up to reach hundreds of millions of children in Ethiopia, India, Kenya, Nigeria, and Vietnam. 
• Non-contagious medical conditions may also present a barrier to learning. For example, directly treating micronutrient deficiencies such as anemia at school has been shown to increase learning outcomes in China. Poor eyesight is another non-contagious medical condition that can make it difficult for children to learn at school. If students are physically unable to see well enough to read, providing them with eyeglasses may increase learning outcomes, as shown through evaluations in China and the United States. 
• School-based feeding programs address the general health status of students rather than one specific condition, and may also increase learning. School feeding programs, such as these examples from Burkina Faso, can reduce macronutrient and caloric deficiencies, which may be especially important in areas with widespread food insecurity. 
• In contrast to direct treatment at school, indirectly addressing poor health by providing information has been less successful at affecting either health or learning outcomes. Health information campaigns (such as telling students about their eyesight problems in the United States or telling parents about their children’s anemia in China) did not improve learning when not accompanied by a complementary intervention. This may have been because the importance of the information was not conveyed or because parents either did not understand or did not have the ability to act on it.   

Once it’s safe to re-open, schools may be particularly important venues for re-establishing many kinds of support that children have been lacking while stuck at home during the pandemic. Doing so holds the promise of improving not only health but also learning outcomes.