Action-oriented health education in the context of Kenyan primary schools

1. Action-oriented health education in the context of Kenyan primary schools W. Onyango-Ouma, PhD Senior Research Fellow Institute of Anthropology and Gender Studies University of Nairobi KENYA

2. Outline • Introduction – concepts in HPS, participation and action • Action-oriented and participatory health education • Experiences from the Kenya school health education program • Pupils’ ownership and participation • Teacher training and involvement • Findings • Conclusions and recommendations

3. The Definition of Health • Health is "...a state of physical, mental and social well-being, and not only the absence of disease and disability." • Health includes two different dimensions: • well-being, quality of life • absence of disease and disability

4. Overlapping concepts in HPS • Ottawa charter: enable people to increase control over and to improve their health • New Concepts: Empowerment, Action Competence, Health Literacy, Self Efficacy etc...

5. The Concept of Participation • Participation – what is it about? • students have to be involved in decisions about content, process and outcome • Participation – why is it important? • ethical reasons • “learning efficiency” reasons – creating ownership • “educating for democracy” reasons

6. The Action Concept • Action – what is it about? • target groups’ decisions • change perspective • Action – why is it important? • facilitating change (lifestyle and living conditions) • “learning efficiency” reasons (“learning by acting”) • Action can be both individual and collective

7. Components of Action Competence • Knowledge/Insight • Commitment • Visions • Action experiences • Critical thinking • …

8. Action-oriented and participatory health education • A well-defined education approach developed among other places within the Danish network of HPS (Jensen 1997, 2000) • It is an integrated part of this aprroach that pupils should take action aimed at influencing ”real-life’ conditions as part of their learning processess • Action and participation are interrelated although participation may not always involve action • Facilitates the development of pupils’ ownership and processes leading to concrete change

9. The School Health Education Programme • Conducted between 1999 - 2002 • Involved 9 primary schools in Bondo district, Western Kenya • 536 of 2250 pupils directly involved • Aim: To explore, identify and improve the conditions for an action-oriented and participatory health education programme • Key concepts: Participation, Action and Action Competence

10. Key Actors • Researchers • Pupils • Teachers and Education Inspectorate staff • Trainer of trainers in action-oriented approaches • Community members • Actors played different complimentary roles essential to program implementation

11. Study Design • Intervention design with pre- and post- intervention measurements/stages • Three interventions were implemented: • Use of flipcharts as an interactive tool in the school health education • Establishment of an extra-curricular health club • In-service training through continuous professional support

12. Distribution of schools by intervention

13. Pupils’ ownership and participation 1) Use of Flip charts • Developed together with pupils • A strong notion of pupils’ participation in school and in the community • Content - transmission and prevention of worms • Teaching was action-oriented and participatory to develop pupils’ ownership • E.g., pupils got tasks to discuss what they could do to prevent worms at school and home • Teaching using flip charts created an enjoyable learning environment for pupils

14. Pupils’ ownership and participation 2) Health clubs • Pupils decided on membership while teachers acted as facilitators • Activities linked to concepts of action and participation • Pupils identified and took tangible actions to change their health conditions at school and home • Pupils were the main decision-maker s of when to meet and what to do • The informal climate in HCs motivated pupils to participate and take ownership

15. Teacher training and involvement 1) Initial training • Teacher training was an integrated part of the project • Aim: To develop teachers’ knowledge and commitment toward participatory and action-oriented teaching /learning • Two workshops of 2 days each conducted to build capacity to effectively participate in the project • Training involved – key health education concepts including action, participation and action competence

16. Teacher training and involvement • Teachers were also exposed to different intervention types • Training enabled teachers to develop ownership of the form and content of the intervention as well as key concepts involved 2) Continuous professional support • Provided to teachers in 3 schools as part of the intervention to strenghthen their skills and competencies for implementation • Researchers provided support through regular mini-seminars of 2-3 hrs on fortnightly basis • Teachers had the freedom to decide on their implementation time frame - ownership

17. Findings • A combination of health clubs and flip charts had the greatest impact on puplis’ competence and knowledge • Conditions that facilitated participatory teaching/learning include teacher attitude, availability of materials and teacher/pupil relationship • Changes in pupils’ environmental and hygiene choices • Actions encouraged and fostered creativity and resourcefulness among pupils

18. Conclusions • Genuine participation helps to build ownership (but in a dialogue with a professional) • Students’ own actions help to build ownership (but as integrated elements) • All ages and all socio-economic groups can benefit from participatory and action-oriented approaches • A genuine participatory approach implies a multidimensional concept of health

19. Recommendations • Teacher training: teachers need to develop competence to teach with participatory approaches • Collaboration between school and the community: ’Authentic ’ and action-oriented teaching approaches where pupils take action in the community builds closer links between school and community e.g. use of health clubs • Learning materials and models: The use of materials and models with a ”built in” participatory and action-oriented approach should be developed and disseminated to teachers