Faced with problems of unwanted pregnancy, HIV/AIDS/STI, violence and substance abuse among adolescents, the Erongo region has recognised the school setting as an entry point to education about reproductive health and behaviour. In 1996 the region adopted the WHO School Health Initiative. Between 1997 and 1999 there were a series of training, base line studies and discussion meetings. The Erongo School Health Initiative was launched in June 1999.

ESHI aims to improve the health status of school-going children and adolescents through active participation in health activities that complement existing programmes. The initiative is piloted in one region, and can then be applied to others. Entry points for improving the health of participating children and adolescents have been identified as:

-AIDS/HIV/STD/TB prevention
-Prevention of violence, gender respect and awareness
-Prevention and control of helminth infections

ESHI aims to improve the knowledge and skills of 90% of learners, by 2005, in prevention of AIDS/HIV/STD/TB, helminth infections and violence. Health education is included in the curriculum and life skills training provided on specific topics such as nutrition, personal hygiene and disease prevention. The programme includes teacher training, provision of school health services, effective monitoring, strengthening of multisectorial involvement and networking in school health programmes. School health services include immunization, screening and referral for sight and hearing problems.

The appraisal team was composed of a regional representative of the MOHSS and the WHO medical officer of reproductive health who visited ten schools selected for the bronze award. At each school, district staff (responsible for the school health programme) joined the team, which appraised the school under six different headings – the school building and its surroundings; the students, school board and staff; the health education programme; communication with the health team; the health services; the general impression of the school as a healthy environment. A point was made of inspecting the toilets, sickbay and library of each school.

• School buildings and surroundings: Most schools exhibited the “School Health Charter” (expressing the vision of the school and a common aim for the school community) in the foyer of the school and in the corridors. Surroundings tended to be clean and kitchens were found to be in hygienic conditions. Most schools had initiated cleaning of the toilets and personal hygiene measures (e.g. soap and clean towels). Some schools had gone as far as to introduce drinking water facilities.

• School population: Learners observed a high level of personal hygiene and were involved in cleaning up campaigns (including their own classrooms). Students were found to display an impressive level of knowledge with regards to health issues such as HIV/AIDS and teenage pregnancy and preventative measures. Teachers showed high motivation and health education talks had become a routine activity, while the smoking habits of the teachers had been addressed. The broader school community also showed an increased interest in the health programmes, with parents donating cash and kinds as well as learning about healthier lifestyles for their children (e.g. lunch provisions had improved for many of the students). Local businesses contributed through donations, such as toilet facilities.

• The health education programme: All schools covered disease and health issues in their school curriculum with many initiating monthly topical projects. Life skills’ training was also provided on subjects such as nutrition, personal hygiene and disease prevention (including HIV/AIDS). Students’ participation in “My Future My Choice” (a UNICEF supported Life Skills programme) was strongly promoted and extended to lower age groups.

• Communication: There is a generally good relationship between school and clinical staff, and health workers are supported in the execution of the school health programme. Contact teachers and district PHC Supervisors meet yearly to discuss school health programmes, activities and future plans. Nurses are invited to give health lectures; particularly on sexuality and HIV/AIDS/STDs/TB whilst the schools themselves participate in national health events (e.g. “World Health Day”). All school libraries have health related books; however, there is a need for simple material relating to adolescent reproductive health issues.

• Health services: Immunization is provided according to the available school health programme. In areas where the programme is well established, immunizations are given to only ten years as a booster against Polio, Diphtheria and Tetanus, whereas girls 15 years of age are receiving Tetanus Toxoid in order to ensure prevention of neonatal Tetanus. In more disadvantaged schools, nurses are still caring for 5 year boosters. Efforts are made to prevent double dosing through obtainment of consent and strategies are being discussed to ensure that all children are vaccinated – particularly where reports are made of children visiting private physicians for immunization purposes. Screening for hearing and sight has also been initiated in conjunction with referral mechanisms.