The importance of school feeding programmes, particularly during the COVID-19 pandemic

This is a summary of a Field Exchange views article that was included in issue 66. The original article was authored by Maree Bouterakos, Michele Doura, Mutinta Hambayi and Donald Bundy.

Maree Bouterakos is Head of Nutrition at the Programme Division of the World Food Programme (WFP) in Vientiane, Lao PDR.

Michele Doura is the Programme Policy Officer at the School-Based Programmes Division of the World Food Programme headquarters.

Mutinta Hambayi is Senior Regional Advisor for Nutrition, HIV and School Based Programmes at the Nutrition and School-Based Programmes Division of the WFP Regional Bureau for East and Central Africa, Nairobi, Kenya.

Donald Bundy is Professor of Epidemiology and Development and Director of the Global Research Consortium for School Health and Nutrition at the London School of Hygiene & Tropical Medicine, London, UK and Senior Advisor to the World Food Programme.

Nutrition and health in middle childhood

Health and nutrition during middle childhood (5-9 years of age) receives less attention than that of younger children or adolescents. However, this life stage is critical for learning and intellectual development as well as for shaping attitudes and behaviours. Investing in nutrition, health and education during middle childhood, and sustaining this into adolescence, will help children to reach their full potential and become productive adults while breaking the intergenerational cycle of malnutrition. However, in low- and lower-middle income countries (LLMICs) investments in education greatly exceed those in health and nutrition despite the fact that illness, hunger and malnutrition compromise school enrolment, regular attendance and learning.

Integrating education and health

The rates of enrolment in education have increased over recent decades, reaching 91% in many LLMICs. Thus, school platforms provide important opportunities for improving nutrition and health outcomes in LLMICs. Despite this, approximately 59 million primary school-age children are out of school, half of whom live in sub-Saharan Africa. These children are missing out on learning due to poverty, discrimination, poor-quality education or hunger. Several interventions are required to reduce these barriers, creating safe school environments for children to learn while also accessing health and nutrition services.

Benefits of school feeding

The benefits of school feeding go far beyond a school meal and include increased enrolment and sustained attendance in school, particularly for girls. By providing healthy balanced meals, school feeding programmes can improve overall micronutrient status and reduce the prevalence of anaemia in primary school-aged children and adolescent girls. They may also reduce vulnerability and boost family incomes, particularly in times of crisis. In humanitarian contexts specifically, school feeding can limit the negative consequences on health, nutrition and education thus lowering the barriers to accessing and completing education, especially for girls. Including local food sources in school meals also promotes the consumption of diversified diets while enhancing local economic development.

Depending on the context, nutrition situation and the human, financial and infrastructural resources available, an integrated school-based package of services can address health and nutrition challenges synergistically and enhance cost-efficiency. Such a package could include school feeding, either in the form of a midday snack or a hot meal, alongside complementary health and nutrition components such as deworming, vaccinations, supplementation, sexual and reproductive health, school gardens, nutrition education and water, sanitation and hygiene.

Why schools are useful platforms

Economic analyses identify schools as cost-effective platforms for delivering an integrated package of essential health and nutrition services to schoolchildren. Interventions delivered through schools often provide more opportunities to reach children than those delivered via health facilities, particularly in rural areas. Incorporating community outreach mechanisms within the education system further promotes health among children in LLMICs.

School meals – a high return for children, families and communities

Global estimates suggest that at least 388 million pre-primary, primary and secondary school children in 161 countries receive daily school meals. For 14 LLMICs, a cost-benefit analysis showed that the potential economic returns on investment for school feeding are comparable to the most cost-effective solutions promoted by the Copenhagen Consensus¹. However, a recent analysis by the World Food Programme (WFP)² showed that, of the 251 million children living in countries with poor nutrition, 73 million children from 60 countries (84% in Africa, 15% in Asia and 1% in Latin America) live in extreme poverty (less than USD1.85 per day). Supporting governments to reach these children with nutritious meals and other school health and nutrition interventions is a priority.

The COVID-19 pandemic

Impact of school closures

The COVID-19 pandemic and the subsequent school closures resulted in 1.6 billion children being excluded from schools worldwide. While school closures may have reduced COVID-19 transmissions in the short-term, they have had serious implications on children’s learning, safety, health and wellbeing. For many children, particularly those from the poorest countries and those already marginalised or in vulnerable situations, these adverse effects could be lifelong.

Children have faced substantial risks during the COVID-19 pandemic including deepening poverty, threats to their survival, health and child safety and an exacerbation of the learning crisis³. Widespread unemployment and income loss will severely test the abilities of households to keep students in school and many may be kept out of school even when they reopen. The longer that marginalised children are out of school, the less likely they are to return, thereby increasing student dropouts, particularly for girls. School drop-out is also linked with increased child labour, child marriage and transactional sex for children and adolescents. When meals are no longer provided at school, children and their families miss out on essential safety nets and a much-needed source of nutritious food.

Mitigation measures and getting back to school

In many countries, alternatives to learning and school feeding have been implemented by governments and organisations such as the WFP during school closures. Lessons were taught online and school meals were replaced with take-home rations, cash transfers and other alternatives. Together with UNICEF and the Food and Agriculture Organization, WFP developed guidance for governments to mitigate the effects of the COVID-19 pandemic with a particular focus on the nutrition of schoolchildren. WFP has also mapped and developed a dashboard to monitor school closures globally, including tracking the number of children not receiving school meals. Up-to-date information on government actions to support out-of-school children is also provided. However, even well implemented coping mechanisms are an expensive and inefficient alternative. Data from the WFP indicates that current mitigation efforts in 70 countries reach only 40% of the 17 million children reached by school feeding programmes prior to the pandemic.

Since measures to reduce the spread of COVID-19 are predicted to remain for years, there is an urgent need for solutions that allow countries to safely return their students to the classroom. To support this process, the ‘Framework for Reopening Schools’ developed by four key organisations (United Nations Educational Scientific and Cultural Organization, UNICEF, the World Bank and the WFP) aims to inform national preparations and guide implementation.

Conclusion

The consequences of COVID-19-related school closures on the economic security and wellbeing of children, their families and communities are likely to reverse progress in education over recent decades. Getting children back to school and utilising this platform for improved nutrition and health will have a tremendous impact on future generations. Since the beginning of the pandemic, there has been more momentum and opportunity to rally governments, donors, organisations and communities around education, health and nutrition. Nations need to recalibrate efforts to ensure that health and nutrition programmes target middle childhood, ensuring that schoolchildren have access to quality meals, become healthier and have better learning opportunities.

For more information, please contact Maree Bouterakos at: maree.bouterakos@wfp.org