The Health-Promoting Schools (HPS) Regional Initiative is also part of PAHO's Healthy Settings approach. As such, it advocates for Health Promotion strategies in the school setting to improve the health and well-being of students and the school community, including teachers, families and the surrounding school population.
Today children, adolescents, and young people require an education for life aimed at the development of their innate capacity to learn to be, learn to learn, learn to do, learn to live with others, as well as to learn to undertake actions. For this, there is the need for the implementation of participatory education to develop students' analytical and inquiring capacity, and to strengthen their principles of respect for human rights, equity, and collective values.
Schools have the responsibility for the implementation of health related activities. Traditionally, these activities have been characterized by ad hoc efforts, mostly directed to improving conditions of hygiene and environmental sanitation, preventing communicable diseases, treating specific diseases, and performing sporadic medical examinations or screening tests. As a result of the health and education sector reforms, being implemented by the majority of countries in the Americas, Health Promotion strategies are now being implemented in the school setting, thus creating new opportunities for the implementation of comprehensive school health programs throughout the Region.
The HPS Regional Initiative proposes the use of health promotion strategies that apply theories, models, and tools with solid scientific bases. PAHO/WHO formally launched the Initiative in 1995, in response to countries' needs and priority for comprehensive and sustainable school health programs, and as a commitment to Health Promotion in the school setting [71
]. The Initiative is based on a comprehensive conceptual framework, with a multidisciplinary and multisectoral approach that considers people in the context of their daily life, within their family, their community, and their society.
HPS promote the development of knowledge, abilities, and skills to allow individuals to care for their health and that of others, to minimize risk behaviors and especially to adopt and maintain healthy lifestyles [72
]. The Initiative contributes to the establishment of equitable social gender relationships, encouraging civic spirit and democracy, and strengthening the traditions of solidarity and community participation. It advocates for the promotion and protection of human rights and fundamental freedoms in schools and surrounding communities. As such, also contributes to the MDGs.
A regional survey in 19 Latin American countries [73
] showed that 94% of the countries were developing the HPS strategy. In almost all cases (90%), the HPS strategy is being implemented in public primary schools in urban areas. 82% of the countries have school health plans predominantly in primary schools. 94% of the countries have policies aimed at health promotion of the school-age population, and 82% have specific policies related to the Health-Promoting Schools strategy. 30% of the countries have designated budgets to finance school health programs. NGOs (national or local) support the financing of such activities in 71% of the cases. About one-third of the countries (29.4%) received loans or financing from international organizations to support school health programs. These data, together with other vital information from the countries, as well as information from case studies and countries' visits provided the foundation for the development of the Plan of Action 2003–2012 for the Health-Promoting Schools Regional Initiative [74
The Health-Promoting Schools Regional Initiative is composed of three main components [74
]: comprehensive health education, including Life Skills training; healthy physical and psychosocial environments; and health and nutrition services and active life. The comprehensive Health Education component, which includes Life Skills training, is directed to strengthen the capacity of children, adolescents, and youth to acquire and utilize knowledge, attitudes, values, skills, and competencies necessary to promote and protect their own health and that of their families and communities. 88% of Latin American countries include Health Education as a transversal element of their school curricula [73
]. Subjects covered by the health educational activities include addictions (94%); personal hygiene, sexual and reproductive health, physical education and sports (88%); HIV/AIDS, food and nutrition, utilization of health services (82%); and self-esteem, immunizations, waste management, and life skills (70%). Most Latin American countries include physical exercise and recreation.
The creation and maintenance of healthy school settings and surrounding environments, the second component of the Initiative, must guarantee minimum conditions of safety and environmental sanitation conducive to the health, well-being, and development of the maximum potential of children and other members of the educational community. 70% of the countries have policies to prevent smoking in schools, and 64% have programs to prevent violence in the school setting. There are major disparities among the countries of the Region with regard to the number of schools with access to water and drinking water, and in at least half of the countries where this information is available, the coverage of these services is low or unsatisfactory [73
The third component, access to health and nutrition services and active life in the school setting, aims to the development of planned and organized activities that respond to the needs and priority of students and the educational communities. 76% of countries have established guidelines about health services to be provided to the school population, which almost always include periodic medical controls, vaccination and, to a very limited extent, other interventions such as early detection of scoliosis, psychological counseling, and gynecological care [73
Member States, under the auspices of the HPS Regional Initiative, are developing Regional Guidelines for certification and accreditation of HPS. These Guidelines will facilitate the strengthening of school health programs and activities throughout the Region to ensure the quality and sustainability of the planning, implementation, and evaluation of Health Promotion strategies in the school setting [73
A Health-Promoting school is a school that [74
• Implements policies that support dignity and individual and collective well-being and offers multiple opportunities for the growth and development of children and adolescents within the context of learning and success of the school community (including educators, students, and their families);
• Implements strategies to promote and support learning and health, utilizing all means and resources available for this purpose and involving personnel from the health and education sectors and community leaders in the implementation of planned school activities (e.g., comprehensive health education and Life Skills training; strengthening of protective factors and reduction of risk behaviors; facilitation of access to school health services, nutrition, and physical education);
• Involves all members of the school and community (including teachers, parents, students, leaders and non-governmental organizations) in decision-making and the implementation of interventions to promote learning, encourage healthy lifestyles, and carry out health promotion projects in the community;
• Has an action plan to improve the physical and psychosocial school environment and surroundings (e.g., standards and regulations for school environments free from smoking, drugs, abuse, and any form of violence; access to safe drinking water and health facilities; nutrition services), trying to set a good example through the creation of healthy school environments and the implementation of activities planned outside the school setting aimed at the community;
• Implements actions to evaluate and improve the health of students, the educational community, families, and members of the community in general, and works with community leaders to ensure access to nutrition, physical activity, counseling, and health and referral services;
• Offers relevant and effective training and educational materials to educators and students; and
• Has a local committee on education and health with the active participation of parents associations, NGOs, and other organizations in the community.
LAC network of Health-Promoting Schools
Health-Promoting Schools Networks in LAC offer unique opportunities to continue the dialogue on health promotion and health education in all settings, and to facilitate the sharing of ideas, resources, and experiences to nurture the commitment and enthusiasm of school health personnel and experts dedicated to improving Health Promotion programs and activities in the school setting.
The Latin American Network of Health-Promoting Schools originated at the First Meeting of the Network, in 1996 in San José, Costa Rica [75
]. The second meeting was held in Mexico in 1998; the third meeting in Quito, Ecuador, in 2002 [76
]; and the fourth meeting in San Juan, Puerto Rico in 2004 [77
].For the Caribbean countries, the first constitutive meeting of the Caribbean Network of Health-Promoting Schools was held in 2001, in Bridgetown, Barbados [78
]. As of 2002, 29% of the countries had created national networks of HPS. All Latin American countries and 14 Caribbean countries are currently participating in the LAC Networks of Health-Promoting Schools.
Planned strategies for strengthening Health-Promoting Schools in the Americas
Member States, under the auspices of PAHO/WHO, have defined six major strategies and pertinent lines of action for the period 2003–2012 [74
]. The six strategies and respective lines of action for 2003 to 2012, channeled through the three components of the Health-Promoting Schools, are firmly supported by healthy public policies that facilitate the implementation of school health programs and activities that aim to sustainable human development. The six strategies are:
1. Advocacy for comprehensive school health programs and the Health-Promoting Schools
2. Institutionalization of the Health-Promoting Schools strategy and formulation of healthy public policies in the educational communities
3. Strengthening participation of key actors in the management of school health programs
4. Strengthening the capacity of Member States to manage the Health-Promoting Schools Initiative
5. Research, evaluation, and surveillance systems for the development of comprehensive school health programs
6. Mobilization of resources
In summary, as a result of the health and education sector reforms being implemented by the majority of the countries in the Americas, Health Promotion strategies are now being implemented in the school setting, thus creating new opportunities for the creation of comprehensive school health programs throughout the Region. The HPS regional initiative offers an important entry-point for the ND agenda, through the Education and Health sectors, which can strengthen countries' capacity for the planning and implementation of comprehensive school health programs, such as Health-Promoting Schools, which will facilitate the processes for addressing ND, including deworming programs in the school setting.