Nutrition-Friendly Schools Initiative in the State of Palestine

This is a summary of a Field Exchange field article that was included in issue 66. The original article was authored by Selena Bajraktarevic, Kanar Qadi, Amani Badwan, Younis Awadallah and Rania Abueita.

Selena Bajraktarevic is Chief of the Health and Nutrition Programme with UNICEF, State of Palestine.

Kanar Qadi is a Health and Nutrition Specialist with UNICEF, State of Palestine.

Amani Jouda is the Maternal, Newborn and Child Health Project Manager at the UNICEF Gaza Field Office.

Younis Awadallah is a Health Specialist at the UNICEF Gaza Field Office.

Rania Abueita is a Project Coordinator with UNICEF’s local NGO partner.

Background

Palestine is affected by a protracted humanitarian crisis. As a result, Palestinian children and adolescents face vulnerability to violence and hardship, with limited access to essential services including health, nutrition, education and safe water and sanitation. In 2018, the Nutrition-Friendly Schools Initiative (NFSI) was implemented with support from UNICEF. It aimed to support the Ministry of Education (MoE) and the Ministry of Health (MoH) to establish healthy dietary and physical activity habits and to improve the nutritional status of school-age children from the most vulnerable districts in the West Bank and the Gaza Strip.

The NFSI Programme

The programme aimed to strengthen the involvement of parents, families and communities, complementing formal ongoing school interventions and creating an enabling environment for sustainable positive change around nutrition and healthy lifestyles. As a package of interventions, the NFSI framework outlines 26 essential criteria within five broad components: school nutrition policies, school community awareness and capacity-building, nutrition and health-promoting curricula, supportive school environments for healthy nutrition and supportive school nutrition and health services.

As the State of Palestine (SoP) was the first country in the region to implement the NFSI, the international NFSI was adapted to the country context, translated into Arabic and endorsed by the MoE with support from a national NFSI steering committee. The steering committee included representatives from local and international partners including United Nations agencies, the MoE, the MoH, local non-governmental organisations (NGOs) and others. The MoE, in coordination with a local NGO partner and the MoH, led the process and developed an action plan to support the implementation of the NFSI. The MoE also designed a practical manual that incorporated national objectives and the implementation strategy and guidelines.

The initiative was launched locally in 2018 and included an initial self-assessment conducted by 34 schools. The assessment was conducted to evaluate the needs of schools in relation to the 26 criteria within the NFSI. Based on this, the schools developed action plans outlining key activities to implement the NFSI criteria. This was followed by a capacity-building programme for teachers and school-aged children to develop school-based policies and action plans.

Key activities

As part of this initiative, UNICEF and partners supported the MoE to conduct a number of activities including:

• Revising and upgrading the national school nutrition strategy to incorporate the NFSI approach. 
• Revising, updating and translating the Palestinian Maternal, Child and Adolescent National Nutrition Protocol in order to reflect currently accepted best practices on adolescent nutrition.
• Developing a referral system between schools and primary health care clinics in the targeted governorates to refer any school-age child with anaemia for further investigation.
• Revising and updating the current training package on school nutrition to integrate the NFSI steps and relevant guidelines.
• Developing a package of nutrition interventions which included the revision of curricula to include life skills and health and nutrition promotion messages alongside physical activities. Several Arabic brochures and leaflets were created on the NFSI which were distributed to all school children and key community representatives. 

More specifically, at school level several activities were conducted (as outlined in the action plans). Broad activities to support the NFSI included:

• Refurbishing 10 schools to improve water and sanitation facilities as part of the enabling environment interventions.
• Providing canteen and sports equipment and hygiene materials.
• Providing micronutrient supplements through the MoH for anaemic children.
• Implementing a capacity-building programme for schoolteachers, administrators and school-age children to develop their knowledge and raise awareness of optimal nutrition behaviours.

Communication-related activities included:

• Conducting awareness-raising sessions with school-age children on anaemia and lifestyle modifications.
• Developing and disseminating positive messages on healthy diets and hygiene promotion. This included the development of an interactive game for school-age children.
• Developing educational and communication material for community awareness. This included messaging through radio and television channels. Parents were also provided with educational material regarding the NSFI programme and the importance of healthy nutrition.

Special event-related activities included:

• Conducting monthly or weekly group breakfast events in targeted schools where children were encouraged to bring healthy breakfast foods from their homes to eat together at school.
• Holding drawing competitions in schools at both the local and national levels to identify the ‘best’ healthy/nutrition-related painting.
• Composing theatre plays and songs to promote healthy lifestyles.
• Developing school gardens and planting vegetables for consumption by children.

All activities were documented on a closed Facebook group for all the West Bank schools with 160 active members including school directors, teachers and health committees.

COVID-19 adaptations

• The programme’s activities shifted to online platforms.
• Emergency activities included the procurement of new resources for schools such as hygiene kits for school staff and canteen owners.
• Social and other media platforms were used to promote nutritional messages and physical activity.
• A tele-counselling dietary programme for children, adolescents and their families was launched.
• A free game application was developed on healthy nutrition, targeting school children between 12 and 15 years of age.

Results                                                              

• The initiative reached a total of 16,638 school children from 34 schools.
• Nearly 395 teachers were trained within the capacity-building programme.
• A face-to-face training to introduce the updated protocol was conducted in the Gaza Strip. Six five-hour virtual training sessions, attended by 100 participants, were conducted for the West Bank.
• Efforts were made to improve monitoring systems and data availability including indicators on the nutrition of school-age children.

Successes, challenges and lessons learned

Successes

• The NFSI was able to reach many adolescents despite the challenging context within the SoP.
• The Palestinian authorities committed to enhancing nutrition among school-age children and ensuring proper actions to address malnutrition among this age group.
• For the first time, the SoP included adolescent nutrition in the national nutrition protocol and defined clear procedures and steps to address the screening and treatment of malnutrition among adolescents. The revised protocols greatly helped to ensure that adolescent nutrition was prioritised and that school-aged children received nutrition screening.
• In response to the COVID-19 pandemic, the initiative quickly shifted to digital platforms and continued to mobilise and actively engage school-age children.
• There was increased awareness among school-age children on healthy nutrition behaviours.

Challenges

• The absence of a national protocol for adolescent nutrition was noted to be a tremendous challenge in the early stages of implementation.

• It was challenging to coordinate the various nutrition partners.
• The spread of COVID-19 led to many challenges, for example weak internet connectivity in some areas limited school-age children’s participation in online activities.

Lessons learned

One of the most valuable lessons learnt during the NFSI implementation was the importance of inter-ministerial cooperation and the engagement of all relevant nutrition partners. Consultation workshops were frequently organised which enabled discussions on learnings and how to overcome any challenges. At the national level, a strategic consultation workshop took place entitled ‘Investment in Nutrition in Palestine’ during which the NFSI initiative was presented and discussed. This workshop resulted in key recommendations being incorporated in the Palestinian NFSI and considered for future phases.

Conclusion

UNICEF, the MoE, the MoH and nutrition partners were able to implement the NFSI activities to a high standard despite the challenging context within the SoP. In the coming years, UNICEF and national partners will look to expand implementation.  

For further information, please contact Selena Bajraktarevic at sbajraktarevic@unicef.org

Additional media content for the initiative can also be found via the following link:

https://www.facebook.com/groups/nutritionfriendlyschools/permalink/809959116176764/