E_Gerthnerova_PiN.Cambodia_School.health_Analyis.Jan14

People in Need (PiN) – School Health Situation Analysis in Cambodia
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EXECUTIVE SUMMARY
The purpose of this study is to analyze the status quo of school health interventions (projects, programmes or components
integrated into larger programmes) in Cambodia implemented by relevant governmental, non-governmental, bilateral and
multilateral stakeholders as of end of 2013. All the interventions are examined through the overall country policy framework and
differentiated by key characteristics. The study utilizes strictly qualitative method data collection, vastly through in-depth key
informant interviews at the national level. Besides relatively detailed presentation of stakeholders’ interventions in various
provinces of Cambodia, the paper also includes SWOT analysis of the sector and names some general and specific
challenges.
School health in Cambodia is found to stand on solid policy grounds integrated into various related areas; however, its
implementation remains a challenge especially at the grass-roots level due to lacking managerial capacities and heavy
dependency on personal commitment of particular schools’ principals. The role of both international and national NGOs to
enhance capacities in the sector and to implement interventions at the grass-roots level, while liking schools and communities
is significant. The multilateral and bilateral organizations have been also largely contributing to school health coverage under
different approaches, including basic services provision.
People in Need has definitely a potential to enter the area of school health, especially if taking advantage of well-developed
relationships at the community/health centers level in the targeted provinces while linking with more experienced partners
already present on the ground in the same provinces.
Cover Design & Photo: Jiri Pasz

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LIST OF ABBREVIATIONS
ACTED-PSF Agence d’ Aide a la Cooperation Technique et au Developpement – Pharmaciens sans Frontieres
BETT-BTC Basic Education Teacher Training Programme of the Belgian Technical Cooperation
BTC Belgian Technical Cooperation
CC Clear Cambodia
CLTS Community-Led Total Sanitation
DCD/MOEYS Department of Curricula Development of the Ministry of Education, Youth and Sports
DOEYS District Office of Education, Youth and Sports
DRHC/MRD Department of Rural Health Care of the Ministry of Rural Development
ECD/MOEYS Early Childhood Department of the Ministry of Education, Youth and Sports
EFA Education for All
ESC-BORDA Environmental Sanitation Cambodia - Bremen Overseas Research & Development Association
GIZ Deutsche Gesellschaft für Internationale Zusammenarbeit
HIV/AIDS Human Immunodeficiency Virus/Acquired Immunedeficiency Syndrome
HP Hygiene Promotion
INGOs International Non-Governmental Organizations
KAPE Kampuchean Action for Primary School Education
MAG Mines Advisory Group
MOEYS Ministry of Education, Youth and Sports
MOH Ministry of Health
MRD Ministry of Rural Development
PDRD Provincial Department of Rural Development
PESP Provincial Education Strategic Plan
PHAST Participatory Hygiene and Sanitation Transformation
PiN People in Need
POEYS Provincial Office of Education, Youth and Sports
PTTC/PTTC Provincial Teacher Training Centre / Regional Teacher Training Centre
RH Reproductive Health

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RHAC Reproductive Health Association of Cambodia
SC WASH School and Community Water, Sanitation and Hygiene
SHD/MOEYS School Health Department of the Ministry of Education, Youth and Sports
SP Samaritan’s Purse
THR Take-Home Rations
TTD/MOEYS Teacher Training Department of the Ministry of Education, Youth and Sports
UNICEF United Nations Children’s Fund
VVOB Flemish Association for Development Cooperation and Technical Assistance
WASH Water, Sanitation and Hygiene
WFP World Food Programme
WHO World Health Organization
NGOs Non-Governmental Organizations

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TABLE OF CONTENTS
1. INTRODUCTION 5
2. METHODOLOGIES 6
2.1. Data Collection Methods and Sampling 6
2.2. Central research question and sub-questions 6
2.3. Guiding principles & Ethical Considerations 7
2.4. Study Limitations 7
2.5. Terms Operationalization 7
3. NATIONAL SCHOOL HEALTH POLICY FRAMEWORK 10
4. KEY GOVERNMENT STAKEHOLDERS AT THE NATIONAL LEVEL 14
4.1. Department of School Health (SHD) – Ministry of Education, Youth and Sports (MOEYS) 14
4.2. Department of Rural Health Care (DRHC) – Ministry of Rural Development (MRD) 16
5. MULTILATERAL, BILATERAL AND NON-GOVERNMENTAL STAKEHOLDERS 19
6. SWOT ANALYSIS OF SCHOOL HEALTH PROGRAMMING IN CAMBODIA - 2013 43
7. GENERAL ISSUES IN SCHOOL HEALTH IN CAMBODIA 47
7.1. Inadequately Addressed Issues in School Health Interventions 47
7.2. Specific Challenges 47
7.3. General Recommendations for Implementation 48
8. FINAL RECEOMMENDATIONS & CONCLUSIONS FOR PEOPLE IN NEED’s HEALTH PROGRAMME 50
9. REFERENCES 53

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1. INTRODUCTION
In November 2013 People in Need in Cambodia articulated the demand for school health situation analysis which would serve
as an evidence for the organization future decision-making in terms of potential expansion of its existing ongoing efforts in
maternal, child health and nutrition, specifically in targeted provinces of Kampong Chhnang and Pursat. This paper aims to
respond to this demand and to present evidence on the most recent school health-oriented projects, programmes or integrated
components of key stakeholders in Cambodia, namely local NGOs, INGOS and some Royal Government of Cambodia bodies
at central level.
The central research question this study is formulated as: ‘What is the most recent situation in school health programming in
Cambodia and is there any window of Opportunity for People in Need’s Health Programme to step into this area? ’Besides to
fundamental responses to this questions, the paper also highlights challenges encountered and reflected by the stakeholders
and their lessons learnt.
The text is structured in the following way: Chapter 2 introduces papers’ methodologies in more details. Chapter 3 outlines the
current Cambodian school health policy framework with its component and priorities. Chapter 4 overviews the role and current
developments in school health at the government level, it namely pays attention to the Department of School Health/MOEYS
and the Department of Rural Health Care/MRD. Chapter 5 is dedicated to structured presentations of the most recent school
health interventions of non-governmental, bilateral and multilateral stakeholders. Chapter 6 identifies strengths, weaknesses,
opportunities and threats of current school health programming in Cambodia as reflected by the primary data. The following
chapter, Chapter 7, summarizes some general challenges and specific issues encountered by the stakeholders while
implementing school health interventions. The very last Chapter (Chapter 8) draws conclusions and recommendations for
possible People in Need’s (School) Health Programme expansion and strategies. Annexes include key informants list and
contact details.

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2. METHODOLOGIES
2.1. Data Collection Methods and Sampling
The study applied qualitative research approach while utilizing both secondary and primary data. The secondary data collection
was based on existing materials obtained firstly through internet search and later on directly from key informants (both in hard
and soft copies) which implies that primary data collection method was semi-structured interview hold with representatives of
key stakeholders. The participants’ sampling was highly purposive using snow-ball technique when especially the later stages
of the interviews were conducted in assistance with early interviewees who were asked to identify other potential interviewees.
The early interviewees were identified by the PIN Health Programme Manager based on her professional relations and
encounters with the stakeholders. The key informants were usually (former) staff non-governmental/inter-governmental
organizations and ministries operating in the area of school health in Cambodia. Given the overall insensitivity of the topic
studied, the author was usually easily provided with full names and contact details of the other (potential) key informants.
Almost all the in-depth interviews took place during working hours in the offices of the key informants. Additionally, apart from
the official in-depth interviews, there were also few opportunistic discussions held with the interviewees ‘off the record’ which
helped the consultant gain full understanding of the analyzed phenomena. After transcribing all the records of all the interviews,
the content analysis was performed.
2.2.Central research question and sub-questions
The central research question was identified to be: “What is the most recent situation in school health programming in
Cambodia and is there a window of opportunity for People in Need Health Programme to step into this area?”
The following sub-questions were formulated to create a joint answer to the central research question:
1. Who are the key stakeholders operating in the areas of school health programming integrating family health,
nutrition (food safety) and WASH?
2. What projects/programmes do these stakeholders implement?
3. Where exactly are those projects/programmes implemented and who are the (local) implementing partners?
4. Under what strategies/approaches/paradigms are those projects/programmes implemented?
5. What are the priorities and time frames of these projects/programmes?

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2.3.Guiding principles & Ethical Considerations
The author of this study was guided by the following principles while collecting, analysing, reporting and presenting the data:
ethical integrity, cultural sensitivity, collaboration and transparency. She was based in Phnom Penh and maintained regular
contact with the Health Program Manager, she provided regular updates on consultancy progress.
In case of ethical considerations, the most relevant one was to obtain informed consent through which key informants received
full and complete information about the purpose of the research. The consultant always made sure that all informants
participated freely and voluntarily. All the informants were informed in advance about their right to withdraw from the interview
any time without indicating a reason. The interviews were recorded upon oral consent. Among all the 15 key informants there
was only one who refused recording (Clear Cambodia informant) and in case of one stakeholder (World Food Programme), the
responses were obtained through written e-mail due to time constraints. One stakeholders’ main office is based in Poipet
(Samaritan’s Purse) so the interview was conducted over Skype call.
2.4.Study Limitations
During the course of interviewees, the key informants identified numerous other stakeholders active in the area of school
health; however, due to the consultancy time limitation and/or identified persons’ unavailability, not all the
informants/stakeholders identified were interviewed. However, a list of those not interviewed (incl. some contact information) is
included in the Annexes. The second major limitation of this paper is its scope restricted to Phnom Penh or central level
respectively. For the future similar research would be recommended to include views of representatives of different schools in
the sub-national level (from province to commune) and also different sub-national level stakeholders.
2.5.Terms Operationalization
Health Promotion vs. Health Education – the author of this study encountered a slight terms confusion reflected in the literature
and later on by the key informants themselves. This paper understands health promotion as creating the overall favourable
environment at all levels of education system incl. physical and social environment, nutrition, food safety, water, sanitation and
hygiene including community involvement and other aspects. To a larger extent it is described through concept of health

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promoting schools developed by WHO (see WHO, 2009). On the contrary, health education is a rigorous teaching-learning
process fully incorporated in the subjects’ national curricula and performed during corresponding lessons.
(Local) Life Skills – are defined in Curriculum Development Plan 2005-2009, local life skills is a sub-group inside the general
group of ‘Life Skills’ and addresses the practical side of life skills application and also the more immediate application (Massa
et al., 2012). General life skills include personal hygiene, safety, planning for daily life, organization, relationships and good
citizenships with high morals. There is a set of life skills the central government specifically encourages NGOs to help to
implement in the framework (Life Skills Policy was issued in 2006). Outside of this, there are “general and pre-vocational” life
skills defined which are in theory included in the National Curriculum and the central government does not consider the need
for implementation outside the regular teaching hours. Local life skills activities are perceived to be skills that students acquire
to support the family or their own income in the immediate future (ibid). The teachers at all level have to teach minimum 11
hours of (local) life skills per year per grade (Interview, December 2013).
Child-Friendly Schools – this model was introduced in 2001 to tackle persistent challenges in the education system through a
holistic approach to child development. Though it does not contain specific school health activities, it calls for safe water and
hygienic conditions at schools as well as life-skills based hygiene education. It also promotes the involvement of the
community and improved school management (Health Bureau, 2011). It recognizes child rights, including the right to quality
education with child centred teaching methods and creation of optimum learning physical and social environment. There are
two major health related components of child-friendly policy: a) Health Safety and Protection of Children (safe food, safe water
and hygienic conditions in schools, life skills-based hygiene education, regulation of food sold in schools, health care for
children, school environment with playgrounds, child protection and first aid kits); b) Participation of children and communities
in management of their school (display of pupils’/students’ work in their communities, social activities/community mobilization,
formation of Children’s/Students’ Councils and students associations, parental engagement increase to support children’s
learning at home). Overall decentralization and autonomy increase of schools is supported.
Hardware – unofficial term used by this study to label interventions (projects or programmes) primarily conducting/supporting
construction or upgrading of physical infrastructure at the school or community level. The most relevantly it concerns WASH
interventions (i.e. construction of latrines, hand washing stations, water sources, etc.).
Software – unofficial term used by this study to label interventions primarily running/supporting soft skills development/capacity
enhancement at the school or community level. It is relevant to WASH (i.e. training teachers in health promotion teaching or

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school principals in effective management) as well as to other areas. Relatively recently development partners started
introducing combination of both hardware and software (especially in WASH interventions) as issues with hardware
maintenance were encountered. Plans on annual school development and monthly expenditures have to be sent to
POEYS/DOEYS (Shoraku in Health Bureau, 2009).
Operational Budget – aims to facilitate overall schools’ autonomy to cover schools’ expenditures. There were allocation
guidelines developed to ensure availability of school supplies and to encourage the improvement of the overall school
environment. Plans on annual school development and monthly expenditures have to be sent to POEYS/DOEYS (Shoraku in
Health Bureau, 2009).
School Support Committee - its formation in every school is another way of more autonomy and decision making power shift at
the school level. It should provide a platform of all school stakeholders at the community level.
Learner-Centred Approach – sometimes also called Student-Centred Approach is a learning model that places the
learner/student in the centre of the learning process. In this approach, learners are active participants in their learning which is
more individualized. It develops problem solving skills, cooperative learning, critical thinking, creativity and reflective thinking
(Wande Valle et al., n.a.).

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Figure 1: Structure of School Health in Cambodia as of 2013, adopted from MOEYS (2013), rephrased by the author)
3. NATIONAL SCHOOL HEALTH POLICY FRAMEWORK
This chapter is going to
present the major points
of the Cambodian school
health policy framework
with its structures and
priorities. As defined by
the School Health
Department (SHD) of the
Ministry of Education,
Youth and Sport
(MOEYS), its vision aims
‘to promote school
health by focusing on
health education, health
examination service,
hygiene and sanitation,
and learning environment,
with the quality and effectiveness to educational personnel and learners in all public and private educational institutions in the
formal and non-formal systems’ (MOEYS, 2013, p.1) whereas its mission aims ‘to manage and develop programmes on health
education, health examination, first aid corner in school, hygiene and sanitation, and learning environment; to monitor, evaluate
and research to take prevention measures on communicable diseases in public and private educational institutions aiming to
improve and enhance the health status of educational personnel and learners’ (ibid). Figure 1 pictures all the areas of School
Health in the country as overseen and co-implemented by MOEYS/School Health Department and other governmental and
non-non-governmental stakeholders at the end of 2013.
Policy on School Health was launched by the MOEYS (School Health Department) in 2006 summarizing the following principal
components (MOEYS, 2013, p.2; MOEYS, 2006, p.5):

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I. To provide basic health care services to learners, lower and upper pre-service teacher trainees and educational
personnel in all public and private educational institutions to ensure equitable access to physical, mental spiritual and
social development.
II. To provide health education and focus emphasis on the communication which brings out the behavior change which is
the most important attribute to provide information, knowledge, skills and the change in attitude of accountability to
attain well-being and health safety.
III. To provide learning environment and physical health facilities suitable with the practical situations, circumstances,
geographical location and demography to ensure the effectiveness and quality of education.
IV. To enhance wide involvement from the Ministries, Institutions, all development partners and civil society in school
health issues as it is crucial to the improvement of hygiene and sanitation practice, amenity, safety and sense of
comfort in schools, communities and public places.
School health policy defines for each of the above mentioned components concrete Strategies and Approaches, the following
table (Table 1) simplifies and summarizes those for each of the four components:
Table 1: Summary of School Health Policy Components Strategies and Approaches
Component I.  All public and private educational institutions shall develop their own school health regulation
 Health care services should focus mainly on health checks, vaccinations and first aid principles in cooperation
with public health services in the local region
 Enhancing vaccination coverage to all intended recipients1
in compliance with National Immunization Policy for
school children and students
 To mitigate serious health threats2
which may occur in schools, public and private educational institutions through
timely interventions
 To encourage the establishment of health clubs in the public and private educational institutions to provide health
checks and health care, especially first aid timely
 To enhance control of psychological pressure through provision of counselling services to students with
psychological crisis from violent physical abuse, drug & alcohol abuse, domestic problems, HIV/AIDS issues,
etc. for intended recipients
1
The policy defines them as school children, students, lower and upper pre-service teacher trainees, children with disability, disadvantaged
children and children in remote areas
2
The policy speaks about food poisoning, cholera, bird flu, severe acute respiratory syndrome (SARS), endangered disease outbreaks and
environmental pollution

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 To improve the provision of safe food nutrition through school feeding programme and to encourage students to
make healthy food choice
 To expand & improve oral health programme in public & private educational institution with special attention to
pre-primary and primary schools
Component II.  To integrate health education topics into formal and non-formal education curricula at all levels, especially
messages on hygiene & sanitation, sexual & reproductive health, road safety and HIV/AIDS prevention for all
grades.
 To raise awareness on above mentioned topics through various IEC materials and group activities of existing
programmes (i.e. physical education, sports competitions, meetings and training workshops)
 To improve and expand human resources on school health issues at all levels of seniority to ensure effectiveness
and quality of medical techniques, management, monitoring and evaluation
 To enhance capacity of education officers at all level through refresher training courses on health concept
integration and sufficient teaching skills and knowledge dissemination to all intended recipients
 To strengthen Training of Trainers at all levels of teacher training colleges in order to empower them with
capacity and confidence in teaching
 To prioritize prevention of communicable diseases which often affect the communities with certain geographic and
demographic profile
 To promote school children’s rights3
to get to know themselves while having self-control and helping their friends
through Peer Education Programme, especially supporting elimination of discrimination against people living with
HIV/AIDS at all public and private educational institutions and workplaces
 To monitor and evaluate quality and effectiveness of health education through focus on behavior change
 To enhance control against the abuse of tobacco products, illegal drugs and alcoholic substances
Component III.  To improve learning environment & favorable atmosphere in both public and private educational institutions
concerning suitable locations, equipment and special needs of children with disabilities while addressing the
needs for sport/play grounds, (vegetable) gardens & green spaces, clean water sources, hand washing
facilities, canteens and dormitories.
 To equip all educational institutions with physical hygiene & sanitation facilities (rubbish bins, water
containers, soaps, hand towels, etc.)
3
And other intended recipients’

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 To set up latrines/bathrooms suitable for male, female and the disabled separately and to ensure proper
and sufficient supplies of water and sanitation care
 To encourage staff to clear & clean in the inside & outside areas of their educational institutions
 To encourage all educational institutions to promote hygiene & sanitation – such as physical hygiene and
control hygiene of food sold at the educational institutions
 To arrange favorable dumping sites for waste & garbage disposal and strictly prohibit burning & compiling
of garbage waste near the classrooms
 To promote the celebration of Hygiene & Sanitation Day or Competition Events for Neat & Tidy Schools and
Classrooms
 To strengthen the capacity of officers in charge of school health at all positions of seniority in monitoring
hygiene and sanitation measures and improvement of learning environment at all levels.
 To enhance control against abuse of tobacco, illegal drugs and alcoholic substances in al educational
institutions.
Component IV.  To strengthen the coordination between ministries and the working groups for health promotion at schools
from all relevant institutions working in school health such as: Ministries of Agriculture, Rural Development,
Planning, Finance, Environment, Women’s Affairs, Commerce, Health and local authorities, international
organizations, donor agencies, development partners and NGOs.
 To encourage the formation of School Health Committees in all educational institutions comprising directors,
hygiene and sanitation teachers, health center staff, students’-parents’ associations, local authorities and
students.
 To improve sense of ownership in regard of health promotion through information exchange about the
meetings planned to share experience from the implementation, monitoring and evaluation
 To appeal for wider involvement of private sector in maintaining hygiene, sanitation, health education and
disease prevention
 To encourage School Support Committees, students-parents associations and school staff to take part in
restoring hygiene and sanitation care, prevention of communicable diseases (esp. HIV/AIDS)
 To provide opportunities to school children, students and their parents to get involved in health promotion
activities through sharing and contributing ideas (in workshops or meetings about action plans, M & E).
Source: Adopted from MOEYS (2006)

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4. KEY GOVERNMENT STAKEHOLDERS AT THE NATIONAL LEVEL
Chapter 4 is going to present two key government stakeholders holding a crucial role in overseeing school health interventions
at the country level from the central government side. The first body presented is the Department of School Health of the
Ministry of Education Youth and Sports, the other important department presented in this text is the Department of Rural Health
Care of the Ministry of Rural Development, mostly responsible for school and community water, sanitation and hygiene
promotion.
4.1. Department of School Health (SHD) – Ministry of Education, Youth and Sports (MOEYS)
Oversees all (direct) interventions implementation related to school health in the country, coordinates with development partners
(UN agencies, other government institutions, INGOs, local NGOs and private sector). It does not implement interventions as
such, the major focus is policy, strategy, guidelines and annual plans development. It focuses on 3 major areas in school
health:
1. School health services provision (i.e. vaccinations, deworming, acid folic tablets, school feeding and health check-ups),
2. Health Education to enhance positive behaviour in communicable and non-communicable disease prevention together with
Life Skills (including comprehensive sexual and reproductive health education, HIV/AIDS prevention and STIs education,
Gender-Based Violence, etc.) which has been applied in 5 provinces among 24 – Koh Kong, Preah Sihanouk, Kampong
Chhnang, Pursat and Battambang. In 2014 scale-up is planned to Kampot and Svay Rieng (Interview, December 2013).
3. Promotion of School Hygiene and Sanitation – provision of water and sanitation in schools like latrines, washing hand
stations and other facilities promoting hygiene. Approximately 70% of schools had n 2013 (some) latrine and less than 60% of
schools had access to clean water (ibid). In hygiene promotion aspect the department also somehow collaborates with private
sector4
.
The school health administration structure at the sub-national level is represented School Health Committees at the provincial
and district level while schools having their focal points assigned among staff for school health area, In terms of partnerships
with key development partners; in 2013 the department has collaborated with the following organizations among others:
4
Corporations Colgate-Palmolive and Unilever on hand washing facilities and soaps

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- UNESCO, UNFPA, RHAC and Child Fund in comprehensive sexual and reproductive health education at the primary,
lower-secondary and upper-secondary, including non-formal education as well
- Global Fund in Malaria and HIV/AIDS prevention in all provinces in Malaria zone III defined by MOH and some
provinces in Malaria zone II defined by MOH (in total 14, mostly boarder provinces) complemented by strengthening
monitoring system support
- FHI 360 in the National Heleminthes Control Programme, as of 2014 the Government plans to scale-up the
programme from primary to all levels of education system including teacher training centres (RTTCs, PTTCs), there is
also private sector involvement5
- GIZ in FIT for School Programme aiming at hygiene promotion, there are plans for scale-up in 2014
- WHO & UNICEF – celebration of Global Hand Washing Day and Global Sanitation Day
- Fred Hollows Foundation in scale-up of eyesight health for primary schools (incl. initial screening and referrals) in
Kandal, Preah Veng, Kampong Chhnang, Kampong Speu and Kampong Thom
- WHO – Food safety and healthy diet strengthening at the school level in Phnom Penh.
The Department also supervises development of minimum standards of National Curricula including various health topics in
standardized manner. These curricula are available for use of all the development partners active in school health in
Cambodia6
, they were endorsed by the Education Minister in 2013 and were co-developed in collaboration with various
development partners, their pilot was conducted last year, in 2014 the department plans their scale-up (materials printing and
teachers’ training). Cascade training on different topics is also often provided by the SHD staff, especially at the provincial
level. The department also reflects very positively a 15% national budget increase approval for School Health in 2014.
School Health Policy Guidelines – final consultative workshop with all stakeholders took place between November and
December 2013 and the department anticipates that until the end of 2013 the final version will be submitted to the minister for
endorsement. Their approval and endorsement should guide the process of actual School Health Policy implementation which
has been poor since the policy launch in 2006. The department also reflects that there is only a minority of schools in the
country which have developed so-called ‘school health regulation’ or ‘health clubs’7
as required by School Health Policy.
Overall, the department has also been curiously anticipating the public services decentralization (including budgeting) in 2015.
5
Johnsons & Johnsons
6
The majority of the National Core Curricula are included in the ‘hard copy package’ of this report
7
It is usually a health check room in each school, ideally it should be a safe and pleasant space for health checkups and counselling

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Plans for 2014 - until mid-2014 the department plans development of clear Terms of Reference (ToR) for professionals
working in school health at sub-national level, for the same year a design of new Sub-Decree on school health is expected as
the most recent one from 1992 needs to be revised in order to reflect school health concept (the current one is only school-
hygiene oriented). There is going to be a health check-up booklet for each pupil developed, tit is expected to cover all primary
school grades (1-6), health centre staff is expected to examine all primary school children in designated schools8
at least one a
year. The current issues being discussed in this respect is the health centre staff motivation and remuneration for those check-
ups. Some selected provinces are expected to become pilots for rolling out and scaling up the initiative, incl. initial screening
by school teachers (i.e. height and weight measuring, etc.) to release burden of health centre staff.
4.2.Department of Rural Health Care (DRHC) – Ministry of Rural Development (MRD)
The Department is in charge of primary health care in rural areas; technically it is divided into three teams:
1. Community – Led Total Sanitation (CLTS)9
2. Hygiene Promotion Team
3. School – Community Water, Sanitation and Hygiene Team (SC WASH)
All the teams work very closely with Provincial Departments of Rural Development (PDRDs) to whom they provide technical
support and the capacity building at the grassroots level as the department also does not implement interventions directly but
more through cascade trainings from the central to the grassroots, PDRDs are responsible for the implementation at the sub-
national level. DRHC provides also training manuals and technical assistance; primarily it is responsible for the three of above
mentioned areas while the SC WASH team works mostly at the school level. In 2009 the DRHC started implementing CLTS
approach at the sub-national level but later on was modified towards SC WASH approach which applies more child-friendly
hygiene promotion10
. Under joint prakas between MRD and MOEYS those two ministries proclaimed to work together in a newly
formed r SC WASH Committee to promote health and hygiene at the school and community level (Interview, December 2013).
In terms of partnerships, the department works closely with UNICEF, ESC-BORDA, World Vision, SNV, East Meets West and
PLAN International in different provinces. PLAN International has a role of Executive Agency while together with DRHC
8
Approximately it is 1 health center being responsible for 10 schools in the area
9
Manual on Community-Led Total Sanitation developed by PLAN International is included in the electronic package of this report
10
CLTS is a bit more sophisticated approach and more adults oriented

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implementing interventions funded by Global Sanitation Fund. All the non-governmental partners of DRHC/MRD have a
Memorandum of Understanding signed with the ministry. The partnerships usually represent technical assistance under
hardware or software approach11
the department usually strives to complement the partners’ efforts in order to avoid duplication
in the provinces. The department prefers to work at both the school and the community level and not to separate the efforts at
the commune level, although sometimes only the School WASH is applied (out of the SC WASH approach). At the subnational
level the department works with POEYSs and DOEYSs and their School Health Committees. The partnership with UNICEF
supported more community-based water and sanitation interventions with the small grants12
to the communities to effectively
utilize the resources on WASH. DRHC/MRD usually encourages PDRDs to assist communes with ideas and technical
assistance with development of their Commune Investment Plans (CIPs) and Commune Development Plans (CDPs) to include
both software and hardware WASH components at the school and community level, with special attention to software.
In case of monitoring & evaluation, the department does the follow-up on quarterly basis, the provincial teams (PDRDs) follow
up on monthly basis with the District Monitoring & Training Team (DTMT) which directly collects data at the school level. The
schools themselves have to collect the data on monthly basis through checklists – for correct and complete filling of the
checklists are responsible Children’s/Student’s Councils whose members monitor the conditions of their school WASH facilities.
The data collection checklists usually contain data on:
1) Operations and maintenance of (mobile) hand washing stations,
2) Safe drinking water13
filtered through sand filters, and
3) Clean and green school environment14
.
As of end of 2013, the Ministry of Rural Development finalized the design of the Strategic Plan for Water and Sanitation which
was at the Council of Ministers at the moment of writing this report and the department has been hoping for the approval until
the very end of 2013/early 2014. As soon as this plan is approved, the government can start developing an operational plan
while harmonizing the approach.
11
The department itself utilizes terms subsidized and non-subsidized projects. The subsidized ones include also the infrastructural/hardware
aspect, the non-subsidized ones work only on behavior change communication at mindsets. The DRHS informants implied that the ministry
usually prefers the subsidized ones (just at the school level) to trigger the implementation (i.e. hand washing) as it is easier to provide a
subsidy to an institution with relatively clear operational and managerial delegation of tasks (compared to the community subsidy).
12
Out of total grant of 7.000 USD per community, 2.000 USD was designated for WASH – software component, however, as reported by
the key informant, many of the communes were not able to utilize those resource effectively and efficiently, mostly due to insufficient
capacity of the local administration.
13
Students/pupils are encouraged to bring their own (usually recycled) plastic bottles and to ask parents to bring boiled water from home
first and then refill in the classroom. DRHC/MRD encourages this approach due to previous negative experience with shared cups at
schools and following spread of communicable diseases.
14
Sorting out and recycling the waste, especially plastics.

18
On Global Sanitation Day 2014 the MOEYS issued prakas on individual responsibility of each public or private school to ensure
basic water and sanitation provisions from their own resources – especially the hand washing stations which DRHC/MRD
endorsed as well.

19
5. MULTILATERAL, BILATERAL AND NON-GOVERNMENTAL STAKEHOLDERS
Chapter 5 presents detailed overview of various multilateral, bilateral and non-governmental stakeholders (recently)
implementing interventions in school health in various provinces of Cambodia. The stakeholders’ interventions described differ
by paradigm (health education vs health promotion; pre-service vs in-service implementation), approach (direct school health
programme/project vs school health component integrated into larger, mostly child-friendly oriented programmes; hardware vs
software), focus (WASH at schools, hygiene promotion, nutrition or reproductive health) but also by geographical coverage,
objectives or categories and number of beneficiaries. These characteristics are structured into a table for each of the
stakeholders presenting their interventions in a rather concise manner. The vast majority of information included in the tables is
based on primary data with only minor exceptions (a source is cited if applicable).
The World Food Programme (WFP) and the World Health Organization (WHO) represent multilateral stakeholders, namely
agencies of the United Nations system. GIZ’s and BTC-BETT’s interventions are the bilateral ones included in the paper. Save
the Children, CARE, Samaritan’s Purse, VVOB and ACTED-PSF are all international non-governmental organizations which
are present in the area. Lastly, KAPE and Clear Cambodia represent local Khmer NGOs having their interventions in the field
as well.
Additionally, the author of this text collected from all the stakeholders (especially the non-governmental ones) large amount of
materials (curricula, local life skills teachers’ and students’ books, studies or pieces of research) which are electronically
attached to this document as an ‘electronic report package’ submitted with this report to the PiN Health Programme Manager.

20
WORLD HEALTH ORGANIZATION (WHO): MEKONG RAINBOW PROJECT (1 year pilot in Cambodia)
Focus Nutrition and Food Safety
Geographical
coverage
6 primary schools in Phnom Penh
Beneficiaries Teachers and pupils of primary schools (300-500 students per school), their caregivers and food vendors in those school
areas
Objectives Through multi-sectoral collaboration:1) Increase the availability of healthy and safe options, and 2) Increase consumption of
healthy and safe food
Implementing
Partners
School Health Department/MOEYS, Department of Drugs and Food/MOH, targeted schools in Phnom Penh
Overall
Approach
The project utilizes Health Promoting Schools Framework for Action and to take actions in the following components:
1) Healthy School Policies/Guidelines – as identified needs were recognized food safety practices in schools, regulations for
advertisement and promotion of fast food and regulations that require schools to comply with guidelines on creating safe
open spaces for children to engage in physical activity and buildings to be no more than 50% of the land area.
2) School’s Physical environment – as identified needs were recognized inadequate hand washing facilities and toilets,
resources for regular facilities maintenance, sources of safe and cleaning drinking water, space for planting trees, space for
trash and regular collection of trash to prevent build-up, segregation of trash and recycling.
3) Action competencies for healthy living – as needs were identified the enhancement of life skills such as knowledge on
correct tooth brushing techniques, enhanced curriculum to educate students about food safety and health food options to
make better choices, correct information provided on food safety practices and nutrition to parents who prepare food, training
on food safety practices and nutrition for school staff and vendors who prepare food.
4) Community links – not further specified.
Details
relevant to
PiN
 Training of food vendors coming to the selected primary school market places about food safety and nutrition,
resource materials are provided to schools. The cooks preparing school meals are also trained. The project
organizes school health fairs and trips are taken to local markets while having discussions on healthy food and
proper food storage.
 The project has been implemented through extra-curricular activities; there is a possibility to integrate the topic into
the regular curricula in the future if the government partners follow the WHO recommendations.
 Though not a part of this project, WHO is trialling ‘Health Promoting Schools’ Framework in 3 primary schools in

21
Phnom Penh15
. In early 2014 WHO is going to release results of the Global-School-Based Student Health Survey
(GSHS) which measures and assesses the behavioural risk factors and protective factors in 10 key areas among
young people aged 13-17 years. More in 2014 at http://www.who.int/chp/gshs/en/
End date 2013 (end of pilot)
15
The full Health Promoting Schools Guidelines developed by WHO is included in electronic package of this report.

22
WORLD FOOD PROGRAMME (WFP): SCHOOL MEAL PROGRAMME & OTHER RELATED INTERVENTIONS
Focus Nutrition and Food Safety
Geographical coverage 1350 pre-primary and primary schools in 15 provinces: Pursat, Kampong Chhnang, Prey Veng, Svay
Rieng, Kampomg Cham, Stung Treng, Preah Vihear, Odtar Mean Chey, Banteay Mean Chey, Kampot,
Kratie, Battambang, Kampong Speu, Siem Reap and Kampong Thom
Beneficiaries Total of 400,000 pre-primary and primary school pupils of programme schools
Objectives Overall: Supporting primary education by contributing to increased enrolment, attendance and promotion
and to reduce dropout rates in Cambodia.
Implementing Partners Plan International, School Aid Japan, Kampuchean Action for Primary Education (KAPE), School Health
Department (SHD)/MOEYS
Overall Approach Besides school meals (breakfasts) also supports local life skills policy under the national curriculum with
focus on school gardens (pilot in Siem Reap with PLAN International). There are other interventions
related (such as collaboration with SHD/MOEYS on publication development, etc.)
Details relevant to PiN  Food delivery to schools is organized quarterly, together with that WFP provides training to individual
schools on food storage management (cleaning warehouses, windows/roofs checks for rain
protection, commodities separation management, correct food turnover, food infestation protection)
and on food preparation (with few standard recipes and type of fresh vegetables to include in meals,
etc.).
 In collaboration with SHD/MOEYS the programme provides training to Local School Feeding
Committees on hygiene and nutrition with message on hygiene, nutrition and 5 key ways to achieve
food safety (WHO standard) together with financial support to SHD/MOEYS to design, publish and
distribute HIV/AIDS prevention education textbook in WFP target schools.
 Take home rations/food scholarship component provides food (10kg rice monthly16
) to very poor
households (determined by the ID Poor System17
) with children in grades 4-618
, priority is given to
girls where there is clear gender gap. Additional selection criteria apply to those with chronic debt. A
commitment must be given by the parents/guardians stating that the pupil will attend a minimum of
80% of classes. The local community plays a strong role in final selection of students.
16
Based on WFP’s calculation it is supposed to cover household consumption for approximately 5 days (or 10% of household income)17
The ID Poor System which was developed by the Ministry of Planning is also included in the electronic package of this report18
Grades with highest dropouts for primary education, the programme also aims at connection with the Government scholarship for the poor
programme for the grades 7-9

23
 In Siem Reap province in partnership with PLAN International WFP pilots enhanced version of SMP
where besides food provision and food safety trainings (done by WFP), PLAN adds interventions on
clean water systems, sanitation facilities construction (latrines & hand washing stations), nutrition
education, food preparation demonstration, teaching skills training, vegetables garden establishment
at school and hygiene education.
End date End-date of the current version of the programme is undisclosed. In 2011 WFP published Mixed method
impact evaluation of the programme in Cambodia for the years 2000-2010, the full report is included in
the materials electronic package.

24
DEUTSCHE GESSELSCHAFT FÜR INTERNATIONALLE ZUSAMMENARBEIT (GIZ): FIT FOR SCHOOL REGIONAL PROGRAMME
(Cambodia Country Project)
Focus Hygiene Promotion
Geographical
coverage
10 primary schools in Kampong Chhnang, Kampot, Takeo, Kampong Thom and Phnom Penh (50% urban, 50% rural
schools, the corresponding control schools are in the same districts)
Beneficiaries 8.000 primary school pupils of model schools
Objectives Overall: School health is a way of promoting child health by sustainable, effective and practice-oriented health
programmes.
3 major components:
I. Strengthening of school health within SEAMEO INNOTECH19
II. Capacity strengthening within national education system – relevant organizational structures of the
Ministry of Education are enabled to plan responsibly towards school health and to work intersectorally
and collaborate closely with health and water/sanitation sectors
III. Piloting FIT approach in intervention schools and preparation of expansion – partner organizations
have implemented and evaluated the FIT approach in selected schools with regards to future
expansion
Implementing
partners
School Health Department at MOEYS, Oral Health Office at MOH and National Centre for Parasitology, Entomology
and Malaria Control; POEYS and DOEYS at the sub-national levels, project schools
Overall Approach In relevance to the FIT Approach at School level, there are two major directions:
Construction of low cost hand washing facilities at schools with proper access to sufficient water source and serious
school commitment (incl. community contributions in cash/kind/labour – the urban schools usually contribute more
in financial aspect)
Behaviour change (via development of a habit/routine) of pupils through daily group supervised hand washing with
soap and floral toothpaste tooth brushing (supervised by trained teachers at least once a day), the pupils are
expected to become agents of change in their own families
Details relevant to
PiN
 The project office is physically based in the SHD/MOEYS compound and it seems there is a lot of on the spot
communication, capacity strengthening and coordination
19
Regional umbrella body of 10 ministries of education of ASEAN countries which are members of this organization

25
 Besides school principals, the project closely works with so-called School Support Committees
 Maintenance of the facilities is often performed by small pupils groups assigned by school principals, the project
does random spot checks of schools and their facilities (Project and SHD staff)
 Besides regular IEC materials the programme developed a detailed manual/catalogue on types of low-cost
hand washing facilities and their construction20
 Baseline indicators contain figures on pupils absenteeism rates and their tooth decays and diarrhoea incidence
 The project in Cambodia explores opportunities with UNICEF and ESC-BORDA, the country project manager is
very open to assist and explore potential collaboration
 The programme will enter the area of school health sanitation and nutrition (school feeding component) in
201421
End date November 2015
20
The current (November – December 2013) version made available to the author of this text is in English, the key informant shared that the
translation to Khmer (context) is ongoing21
At the moment of writing the report, it was not known in which country of the regional programme this expansion would happen (Cambodia,
Laos, Philippines or Indonesia). If it is Cambodia, there would be worthy to conduct a close follow-up from PiN’s side to explore it more

26
CLEAR CAMBODIA: SCHOOL HEALTH PROJECT
Focus Water and Hygiene Promotion
Geographical
coverage
102 schools in provinces of: Kampong Chhnang, Pursat, Battambong, Kampong Thom, Preah Veng and Svay
Rieng
Beneficiaries 30.200 pupils (70%) and students of primary and lower secondary schools (until grade 9), including teachers in
project schools and unspecified number of women and children under 5 years (30%)
Objectives Overall Goal: All school children in the target areas will gain improved their health and access to clean water
Objectives:
I. To increase knowledge on hygiene and sanitation of school children at schools in the target areas
II. To improve health and sanitation practices through clean water access and availability of hand
washing facility at the schools
III. To establish functioning team of volunteer school children to work with mothers who have children
under 5 years of age
IV. To involve mothers with children under 5 years of age in health activities and change their
behaviours toward good practice on hygiene and sanitation for them and for their whole families
Implementing
partners
DOEYS, POEYS and project schools; partner of Samaritan’s Purse in WASH Projects (not in this one)
Overall Approach The ‘software’ part of the project is implemented through Local Life Skills Policy (lessons on health and hygiene
promotion taught on Thursdays), hand washing with soap while using towels is practiced every day, the
programme also works with pre-test and post-test to measure pupils’/students’ knowledge. The project trains
school principals first, then the principals train the staff/teachers, simultaneously re trained so-called school
cluster leaders (1 cluster has 5 schools).
The ‘hardware’ part is implemented by provision of biosand filters (1.000 litres capacity) and hand washing stations
to schools. The targeted schools usually have to have at least 100 pupils to pay off the water quantity stored in
the filters. The community has to contribute with at least a roof for both (approx. 250-2,000 USD) which is
usually done through School Support Committees (whose representatives are usually responsible for contribution
collection).
Details relevant to  The project partially follows the Clear Cambodia WASH project where sanitation facilities (separate toilets for

27
PiN girls and boys) are already in place.
 The project trainings and messages conveying are based on quarterly basis when 1st
quarter covers hand
washing, 2nd
quarter covers safe drinking water, 3rd
quarter covers latrine usage and maintenance and 4th
quarter reflects the whole year (incl. challenges raised) and revises all the topics covered.
 In 2013 the project started piloting (in 3-4 communes in each project province) connection with the
community through volunteers recruited22
from project secondary schools who after their initial training visit
families with children under 5 years every two weeks to convey messages on health and hygiene – i.e. they
train the families on maintenance of small biosand filters. The community component contains in a way sort of
a youth support component as the volunteers receive bicycles and little per diem once working and visiting
the families. The informant identified that both the youth and their families feel proud about their kids’
community involvement and having a ‘job’.
 So far there has been a rather positive experience with facilities maintenance, including financial
responsibilities.
End date March 2014
22
In some cases they are siblings of former pupils who dropped school

28
2323
The Khmer version was being translated at the moment of writing of this report; the consultant obtained some parts already finalized
later after the interview. It is included in the package materials.
SAMARITAN’ S PURSE (SP): SET OF SCHOOL WASH PROJECTS
Focus Water and Sanitation, partially Hygiene Promotion
Geographical
coverage
4 primary schools – 1 in Battambang province (Samphor Lun district) and 3 others in in Banteay Mean Chey
province (districts O’ Chrov, Malai and Poipet city)
Beneficiaries 200-300 pupils in each primary school (totally around 1.000 pupils annually)
Objectives Overall: To improve health and well-being of primary school students of targeted schools
Enhanced knowledge and practice of pupils on hygiene promotion while all the schools create opportunities and
spaces for promoting hygiene and actively maintain their water and sanitation facilities
Implementing
partners
DOEYS, POEYS and project schools; local NGO ‘ Clear Cambodia’
Overall Approach Constructing water sources and facilities (latrines, hand washing stations) at the school level while obtaining
community contributions from schools (mostly for water filters), providing of 3 days training on hygiene promotion
Details relevant to
PiN
 Extra-curricular activity, the health promotion as such is more implemented through community-based
hygiene promotion events (projects facilitates gathering of community leaders, school representatives, pupils
and guest speakers), health and hygiene messages are conveyed through games, quizzes and other
activities.
 The project keeps using existing guidelines on WASH at Schools developed by UNICEF23
which are
distributed to the teachers and principals during training, there is no clear mechanism how to make sure that
teachers really do convey the messages to students besides distributing the manual (there is some sort of
training but to the author of this text it seems rather less formalized).
 The majority of activities seem primarily related to the construction itself and managing technical issues
(water access, soil quality, etc.) however, further need of balance between hardware and software SP
anticipates
 SP always constructs separate latrines for boys and girls and to girls’ latrines provides sanitary napkins and
baskets. However, the project does not have and integrated menstrual hygiene component (which would be
reflected in teachers’ training, there is a short section in the manual on personal hygiene of girls and boys).
 After a yearly implementation in each of the school and one year follow up a final survey (end-line) is
conducted.

29
 Further scale-up in terms of schools coverage is planned.
End date Each project is 1 year with several schools - 1 year implementation & 1 year follow, overall end date undisclosed.

30
24
Also suitable for children with disabilities25
On Thursdays there are usually no classes and this day is in schools considered as sort of a ‘technical day’, in many cases there
cleaning and clearing of school compound performed by kids and staff
WORLD VISION: SCHOOLS and COMMUNITY WASH PROGRAMME
Focus SC WASH with focus on hygiene promotion (and small nutrition component)
Geographical
coverage
Primary schools in Kandal (districts Ksach Kandal, Leuk Dek, Saang, Ponhea Leu), Kampong Speu (districts Phnom
Srouch & Samrong Tong), Takeo (districts Samrong I & Samrong II, Bourichulasa, Kirivong & Koh Andaet),
Kampong Thom (districts Prast Ballang, Stong, Prasat Sambo), Preah Vihear (Kulen, Chey Sen, Rovieng, Tbeng
Meanchey, Sangkum Thmey), Siem Reap (districts Sot Nikum, Puok, Chikreng), Banteay Mean Chey (districts Tmor
Pouk, Svay Chek & Preah Net Preah), Battambang (districts Samloth, Phnom Prek, Banan, Rukh Kiri & Rottanak
Mondol) and Kampong Chhnang (districts Chulkiri, Kompong Leng & Boribo). The programme targets 4-5 schools in
each district.
Beneficiaries Direct: primary school children, teachers & school staff
Objectives Overall: All children as agents of change in WASH aspects in their community
Implementing
partners
School Support Committees & Student Councils, POEYSs & DOEYSs (in close collaboration with district/provincial
WVI offices), Department of Rural Health Care/MRD and Provincial Departments of Rural Development, local NGO
1001 Fontaines (partner for water treatment stations)
Overall
Approach
SC WASH - Integration of school-based and community-based health promotion in order to change practice in
terms of safe water use, sanitation and hygiene. The programme provides both ‘hardware’ (school toilets of child-
friendly design24
, water sources & purifiers, water tanks, hand washing stations) & ‘software’ in terms of training of
School Support Committees members in monitoring &maintenance, the programme supports responsible waste
management (both at schools and at the community level) and aims at elimination of open defecation.
Details relevant
to PiN
 (Body) hygiene promotion is done at least once a week at the school level when hair cutting, nail cutting or hair
washing is performed. This is usually done through Local Life Skills Policy every Thursday25
. Activities like hand
washing is done on daily basis, usually supervised by teachers and assigned volunteers before the classes
start (WVI intervention schools usually have hand washing stations in every classroom)
 Health promotion at the community level is done through community events at least 2-3 times per month,
usually organized by School Support Committees, additionally the kids play games and quizzes (sometimes
connected with ‘School Birthday’ events).
 WVI also trains through TOT approach their key district stakeholders in SC WASH Approach (school principals,

31
26
This tool was reflected as too complicated and time consuming for the training participants
DOEYSs staff, DORDs, School Support Committees Members, Student Councils’ members, etc.), include also
refresher trainings usually after 6 months/1year
 Impact is monitored through KAP surveys among school children every six months (i.e. each child consumes at
school at least 5 litres of water – for drinking, flushing, etc.), the WVI with partners also conducts random spot
checks
 School gardening aspect is included in the programme through little (flower & vegetable) gardens maintained
around water source (like boreholes or wells), this is aspect is also included in community-based component of
SC WASH.
 The programme has been utilizing different tools throughout its existence, it started with Participatory Hygiene &
Sanitation Transformation (PHAST)26
, and then it proceeded to Hygiene Promotion (HP) or Community-Led
Total Sanitation (CLTS); generally, the programme changes approach/strategy every 5 years.
 Recently to programme keeps turning to more partnerships with other (smaller) NGOs present at the grass-
roots level.
End date There is at least 10 years history of SC WASH in each WVI district, end date is undisclosed.

32
27
In the second half of the project it indirectly increased its coverage due to the MOEYS approval to us the training materials developed by
VVOB in all PTTCs and RTTCs in the country.28
Trains lower secondary school student teachers29
Trains primary school student teachers
FLEMISH ASSOCIATION FOR DEVELOPMENT COOPERATION AND TECHNICAL ASSISTANCE (VVOB): STRENGTHENING HEALTH
EDUCATION IN TEACHER TRAINING COLLEGES OF BATTAMBANG
Focus Health education – enhancement of lessons & lesson materials related to health in teacher training colleges
Geographical
coverage
RTTC in Battambang is responsible for the provinces of Battambang, Siem Reap
Beneficiaries Direct: Home Economics teacher trainers at the Provincial Teacher Training Colleges (PTTCs) and Biology teacher
trainers at the Regional Teacher Training College (RTTC) in Battambang27
Indirect: 1. All student teachers at the PTTCs and ‘Biology and Earth Science’ student teachers at the RTTC, 2.
Children that are taught by the student teachers at the RTTCs
Final: Children who have attended school will be the final beneficiaries of the project because they will receive
improved and increased health education at primary and lower secondary level
Objectives Overall:
1. To contribute to achieving improvements in health education taught in Cambodian schools by ensuring that
student teachers are enabled to teach health topics
2. To ensure health education can be taught effectively during pre-service training
3. To improve the teaching of health-related topics through student teachers who graduated and take up
positions in schools
Specific: To increase capacity of Biology and Home Economics teacher trainers at Battambong Teacher Training
Colleges (TTCs) to teach health education topics to student teachers that are covered in the school curriculum, using
a Learner Cantered Approach.
Implementing
partners
School Health Department/MOEYS, Teacher Training Department/MOEYS, National Centre for Health
Promotion/MOH, Regional Training College (RTTC) in Battambang28
, Provincial Training College (PTTC) in
Battambang29
Overall
Approach
VVOB in general focuses on meso/intermediate level (in this case teacher training colleges), based on its mission and
vision it does not work at the macro level (policies change) nor does it focus on micro level (individual schools or

33
children). Together with implementing partners the project aimed at development of updated core curriculum for use in
the TTCs, development of relevant teaching materials and aids and at promotion of Learner-Cantered Approach
Details relevant
to PiN
 Home economics as suitable subject for conveying health messages was chosen because all primary school
students study this subjects; Biology was chosen because all lower secondary school students study that [for both
subjects there the existing curriculum includes several topics:
 a) Home economics contains 30% nutrition – kinds of food/safe food/healthy food (Grades 1-3); 30% Hygiene –
body & body parts, hands, teeth, toilet (Grades 1-3); 20% disease prevention – causes & prevention of different
diseases, place and function of health centres (Grade 2-3); 20% addictions – consequences of risky behaviour
like drug use or gambling b) Biology contains 40% disease prevention – identification, prevention and treatment of
illnesses and viruses that affect digestive/respiratory/nervous systems; 30% addiction prevention – drug
categories, alcohol, tobacco & other drugs consumption, drug avoidance; 20% Sexual & Reproductive Health –
effect of HIV/AIDS on immune system, modes and prevention of transmission of STIs; 10% child care –
communication with infant, feeding & hygiene practices, safe environment].
 Observation checklists were used to assess the student teachers’ level of school health teaching (including
learner-centred approach) in practicum schools
 The teaching materials were developed through working groups containing all implementing partners
End date 2011 (started in 2005 under slightly different focus, in 2009 reformulated to final format)

34
30
Some of the drafted versions are included in the electronic package of the report31
Also included in the electronic package
BELGIAN TECHNICAL COOPERATION (BTC): BASIC EDUCATION TEACHER TRAINING PROJECT (BETT)
Focus Health education – enhancement of lessons & lesson materials related to health in teacher training colleges
Geographical
coverage
225 primary and lower secondary schools in Siem Reap, Odtar Mean Chey and Kampong Cham provinces
Beneficiaries More than 112,000 pupils, students and teachers (incl. 111 School Support Committees); 6,400 pupils (scholarship
recipients) of lower secondary schools
Objectives Overall: Improved quality and more equitable access to basic education in the 3 targeted provinces within the
framework of the Education Sector Support Programme (ESSP)
I. Expansion and rehabilitation of school facilities and facilities of provincial and regional teacher training
institutes
II. Increased primary to lower secondary transition rates for the most vulnerable
III. Improved quality of education leading to an increase of promotion rates per grade through
strengthening (in-service) teacher training and curriculum development
Implementing
partners
Teacher Training Department/MOEYS, Curriculum Development Department/MOEYS, PTTCs in the provinces,
schools and School Support Committees
Overall Approach Alternative child-friendly school design, BETT constructed classrooms in 83 primary and 28 lower secondary schools,
each school was supplied with equipment, sanitation facilities and access to water and it rehabilitated provincial
teacher training colleges (PTTCs) in Siem Reap and Kampong Cham.
Details relevant
to PiN
 The project developed teacher training materials30
trained teacher trainers, education officers & school directors
to improve teaching and learning of mathematics, early literacy, reading promotion and health education.
 BETT also developed in-service training component for all Mathematics teachers and 24 teacher training
institutes nation-wide
 The project supported a non-formal education initiative to promote access to teacher trainings in order to
overcome teacher shortage in the disadvantaged province of Otdar Mean Chey.
 After 2009 some BETT project efforts were merged with VVOB project, especially in terms of the teacher
training materials design (curricula of Home Economics, Biology and some Physical Education)
 Their materials used as a primary source a famous global WHO material called Facts for Life31
which is very

35
Note: BTC is not active in Cambodia as the country is not on the Belgian Development Cooperation priority countries’ list any
more.
user-friendly
 The project aimed to include Learner-Centred Approach with several outdoor activities and actual practice of
behaviour
 Part of the project also paid attention to development of school libraries (including publications on health)
End date 2011 (Complete implementation took place between 2003 – 2011, the health education component was integrated in
2009)

36
AGENCE d’AIDE a la COOPERATION TECHNIQUE et au DEVELOPPEMENT – PHARMACIENS SANS FRONITERES (ACTED-
PSF): SEXUAL & REPRODUCTIVE HEALTH AT SCHOOLS
Focus Comprehensive Sexuality and Reproductive Health Education
Geographical
coverage
2 secondary (both upper and lower) and 2 tertiary schools in Prey Veng province
Beneficiaries Totally around 600 lower secondary, upper secondary and tertiary school students (aged 10-24 years)
Objectives To enhance comprehensive sexuality and reproductive health knowledge among school youth and to increase
their access to better quality services
Implementing
partners
2 Local NGOs: Dannok Toek/Goutte d’Eau in Prey Veng, Women’s Organization for Modern Economy &
Nursing (WOMEN) in Prey Veng, Provincial Health Department, Municipal Health Department/MOH, National
Centre for HIV/AIDS, Dermatology and STDs, National AIDS Authority
Overall Approach ACTED-PCF usually enhances technical capacity of implementing partners in terms of SRH who later on
implement activities at the grass-roots level
Details relevant to
PiN
 Community-based SRH Promotion, including curricula development due to reported insufficiency of
official/government curricula
 The project is implemented under Local Life Skills Policy scheme so in fact it is extra-curricular, the
technical staff of partnering local NGOs trains students directly once a month for two hours (2-3 topics
covered only)
 Adolescent girls are specifically targeted only in terms of attendance of SRH Education lessons (there
has to be more than 60% female attendees at the health promotion events)
 The project uses KAP surveys to monitor impact and draw lessons learnt
 There are 10 main components in ACTED-PSF ‘Curricula’: 1) Body Development (reflects menstrual
hygiene topic), 2) Family planning/birth spacing, 3) RTIs/STIs, 4) HIV/AIDS, 5) ANC and PNC, 6)
Gender-Based Violence, 7) Youth Rights in SRH, 8) – 9) SRH Counselling and Demand Stimulation
(Referral to Health Centres), 10) Communication
 All the topics aim to tackle the regular (cultural) misconceptions the youth comes up from their homes
 ACTED-PSF is the first NGO working with adolescents in Prey Veng
 The project usually follows up on (girls’) dropouts – through peer groups

37
Note, ACTED-PSF together with KAPE & Sovanna Phum submitted a concept note to the EC on SRH Education in December 2013
End date October 2014 (2 years duration)

38
KAMPUCHEAN ACTION FOR PRIMARY EDUCATION (KAPE): SCHOOL FEEDING PROGRAMME & HEALTH SCREENING
PROGRAMME
AND RH AT SCHOOLS, WASH & HYGIENE PROMOTION COMPONENTS
Focus Nutrition & Health Checks; growing component of Reproductive Health
Geographical
coverage
60 primary schools in Kampong Cham (core province), smaller interventions in Svay Rieng, Prey Veng, Kratie &
Mondulkiri
Beneficiaries Primary school children of 60 primary and lower secondary schools in Kampong Cham
Objectives There is not a single objective/sets of objectives due to many different components of programmes
Implementing
partners
WFP (KAPE is their implementing partner In Kampong Cham province), Reproductive Health Association of
Cambodia (RHAC) – their clinics in Kampong Cham; World Learning & Department of Curricula
Development/MOEYS for the national life skills curricula design & development, Schools & Children’s/Students’
Councils32
; Primary Education Department/MOEYS
Overall Approach Addressing issue of morning hunger through school breakfasts – in the programme with WFP, KAPE provides the
training to the cooks who are recruited by the community (WFP provides the meals), KAPE also does monitoring of
the programme. In health screening programme it uses its network of health providers to identify especially
countryside children who are physically challenged or disabled (i.e. serious ears or eyes infections, cleft palate,
etc.). RH component is done through referral to Reproductive Health Association of Cambodia (RHAC) & Girls’
Councillors Networks
Details relevant to
PiN
 Take-home Rations component – scholarship programme to keep pupils from disadvantaged background
at schools (THR once a month – rice, salt, beans33
).
 Teacher training component - KAPE trains 2-3 teachers at each schools about nutrition, parasites, those
teachers are also responsible for deworming in those schools (distribution of the pills)
 Teachers/school principals are trained in basic initial Health Screening of the kids, if there is a referral
needed, the programme pays for the transportation (of a kid & parents), the provider in (KAPE’s network)
usually provides the service for free, over a year there is usually around 1,000 referrals34
to specialists
 A few years ago KAPE did a study (pilot in 10 schools) on the use of micronutrients sprinkled down on
rice, especially on receptiveness of parents and kids to use it on their rice35
, including the waste
32
Children’s Councils are established at the primary school level, Students’ Councils work at the secondary schools level33
Here the author indicated discrepancy on THR composition between the WFP source and KAPE source, there might be possibly slight
changes by implementing partners/provinces34
Physical challenges or disabilities, serious eye or ear infections, clefts, problems with testicles and many different kinds of uncured
conditions (Interview, December 2013).

39
PROGRAMME
management36
. Overall, the study found high level of receptiveness.
 RH Education implemented through Girls’ Counsellor Networks at secondary schools –focuses on dropouts
via peer network, addressing other issues like body changes (uses book Growth & Changes 37
), discreet
service of social support network (both peers and teachers are involved)
 KAPE developed with Department of Curricula Development/MOEYS & World Education official Life Skills
Curricula for Lower Secondary Schools38
with 30 modules divided into 3 domains: I. Pre-Vocational, II.
Economic & Business Studies and III. Social Relevance Skills, two additional modules cover issues of
WASH at Schools and Drug abuse prevention. All of them are done in the format of a lesson plan for the
teachers (each has 2 hours39
) and KAPE also provided in-service trainings for the teachers (‘how to teach
it’), the modules include student hand-outs & evaluation frameworks, learning slides and posters. KAPE
also builds WASH infrastructure/hardware with maintenance trainings for teachers & children’s/students’
councils to lead the activities
 Life Skills Component assesses impact through KAP surveys to compare attitudinal level of the students
at the beginning and in the end of the intervention and evaluation through observation checklists of the
teachers (teaching life skills) and both teachers’ and students’ self-evaluation.
 Life Skills at the school level is implemented through small grants40
cycles which cover small incentives
for the teachers, additional teaching materials. The schools do needs assessments at the beginning of the
school year to address the 6 dimensions of Child-Friendly Schools Framework, school have to identify
their own needs & manage the funds; the schools have to be motivated.
End date Local Life Skills Component ends in 2014 (started in 2009), the rest is undisclosed as they are smaller integrated
35
It changes a flavor36
I.e. 120 children consuming 120 little packages per one meal on daily basis37
‘Growth and Changes’ – is a book on physical and psychological body changes (incl. menstrual hygiene) written by Sommer & Connolly
together with Cambodian adolescent girls. Although the book is very straightforward and open minded, it has been evaluated by teachers
and students in regular classrooms and peer groups of CARE interventions (trialled the publication in 4 lower secondary schools in
Rattanakiri), Save the Children and Room to Read have been distributing the book at a larger scale, CARE expects another rounds of
publications from the authors to redistribute them in first half of 2014. Key informants who indicated usage of this book spoke about
enthusiastic reactions by all students, teachers and parents, according to the same sources, the authors have been working on a similar
publication for adolescent boys. The electronic version of the book is included in the electronic package of this report.38
They are part of the electronic package to this report as well39
MOEYS officially 2 teaching hours of life skills per week (per class), for lower secondary students usually start at the second terms, lower
secondary teachers usually teach 14 hours a week40
Provided yearly in cash with technical support based on the lower secondary’s schools’ managerial advancement:1)Advanced (2-3.000
USD), 2)Intermediate (2.000-1.500 USD) and 3) Basic (1.500-800 USD)

40
PROGRAMME
parts of other larger programmes
CARE INTERNATIONAL: MARGINELIZED ETHNIC MINORITIES PROGRAMME41
(incl. some health & hygiene promotion components)
Focus Education ‘project’ with WASH, Nutrition & SRH component and Food Security ‘project’
Geographical coverage Primary and lower secondary schools in Ratanakiri, Stung Treng, Mondulkiri, Kratie and Preah Vihear
provinces
Beneficiaries Ethnic minorities42
- indigenous ethnic minorities Khmer-Loeu ethnic family living in the mountainous
areas of Cambodia
Objectives Overall: To address underlying causes of poverty and social injustice
Implementing Partners Save the Children, Marie Stopes International (in Maternal & Child Health Programme), UNESCO,
Mines Advisory Group (MAG), local NGO ‘Can Do’, POEYS, DOEYS, Primary Education
Department/MOEYS, Early Childhood Education Department/MOEYS, Ministry of Rural Development
(in WASH activities), School Support Committees
Overall Approach Holistic/integrated approach43
in order to make significant (positive) change for the impact group of
ethnic minorities, works with numerous partners; education part utilizes bilingual approach
Details relevant to PiN  There are no interventions in school health yet44
but CARE is highly interested to expand to that
area as well
 Food security component was promoting vegetable gardening/horticulture both at community &
school level during the dry season
 Under the Education Section – they work within the Life Skills Policy focusing on negotiation skills,
self-understanding and well-being narrowing it down to understanding of health issues, nutrition &
hygiene – integrating the issues into bilingual curricula based on the national curricula (integrating
mathematics, social studies, hygiene and nutrition into the same textbook developed by CARE)
 Interesting example: familiarizing indigenous students with health centres (concept) – making sure
the audience understands what is happening at a health centre
41
CARE International centers all their projects into 2 major programmes at the national level, the other one is called ‘Poor and Vulnerable
Women Programme’, this applies to other countries as well42
CARE uses the term impact group (instead of beneficiaries)43
Dropping out the project approach44
As of December 2013

41
CARE INTERNATIONAL: MARGINELIZED ETHNIC MINORITIES PROGRAMME41
(incl. some health & hygiene promotion components)
 Trains indigenous teachers in bilingual education at the in-service level, the channel to schools has
been WASH/hygiene promotion component (this has been also connected to girls’ dropouts once
reaching puberty).
 Boarding schools with scholarship component – for 300 students per year between upper primary
and lower secondary to address dropouts, small WASH, health and nutrition components are
included; training of students on maintenance took place. Scholarship is provided in food & non-
food items, students cook themselves45
.
 In nutrition promotion at the community level cooking contests proved to be really popular
 CARE started trialling ‘Growth & Changes’ publication at the project sites in rural (mountainous)
areas to facilitate their peer counselling Girls’ Leadership46
Component – for lower secondary
school girls, there is also a focus on body changes (incl. menstrual hygiene)
 WASH activities are conducted more at the community level in hardware manner (ponds
construction), at the school level CARE provides wells, hand washing stations and pumps. Software
parts are usually channeled through water user groups at the community level and
students/teachers trainings at the school level.
 School Support Committees are key partners in ownership creation
End date Undisclosed; the Girls’ Leadership Component started in mid-2012
45
CARE conducted an evaluation research on survival rates in their supported schools (incl. scholarship recipients, etc.) and, the report is
included in the electronic package of this report46
Hard copy of bilingual material on Girls’ Leadership developed by CARE is part of hard copies package of this report

42
SAVE THE CHILDREN: EDUCATION PROGRAMME
Focus Early childhood and primary education with integrated health components
Geographical coverage Pilot schools in Siem Reap, Preah Vihear, Kampong Cham, Kampong Chhnang, Koh Kong, Prey Veng,
Pursat and Kratie provinces, after a pilot is successful, the approach is scaled-up to all other schools in the
provines
Beneficiaries Pre-school and primary school children (special attention to grade 6 transferring to secondary level)
Objectives To facilitate equitable access to primary schooling and to improve learning outcomes and quality of learning
Implementing Partners Primary Education Department/MOEYS, Early Childhood Department/MOEYS, Teacher Training
Department/MOEYS, Curricula Development Department/MOEYS, POEYSs, DOEYSs, PTTCs, Children’s
Councils and School Support Committees
Overall Approach Child Friendly Schools Framework, linking education to health care and livelihoods under one integrated
approach, Save the Children also work at the national level in policy change area, does not create additional
curricula or other materials, it aims to enable teachers to use current existing curricula in Learner-Centred
Approach and apply appropriate teaching methodologies in both core curricula and local life skills teachings
(reflection, active students’ participation & knowledge application)
Details relevant to PiN  No (full) school health programmes - more integrated approach, expansion is planned in the upcoming
years
 Currently training of provincial/district level government staff
 Working with POEYS to reflect priorities from Education Strategic Plan (ESP) into their own Provincial
Education Strategic Plans (PESPs) – ideas, commitment, etc.
 In terms of Local Life Skills Policy teachings is done through action research/investigation learning by
students, i.e. in WASH & hygiene promotion lessons children are asked to identify toilets in their
neighbourhood, follow up on their status (cleanliness, functioning, etc.) and follow-up on health status
of their families (i.e. diarrhoea or fever incidence), once a month a health centre staff visits the schools
and students ‘report’ to the health centre staff and discuss the causes, prevention and basic treatment
→ this approach is piloted in Kampong Chhnang province in 2 schools in Tik Phos District (!) The
health centre staff provides basic training to teachers to have stronger base in health promotion. In case
of nutrition, older kids monitor height and weight of the younger ones (Grade 1) and track it over time,
the case of underweight or stunting can be discovered much earlier (peer programme) and the kids are
referred to health centres. The same counts for vaccinations and deworming.
 The school selection for other topics integration is customized – some are stronger in health, some in

43
SAVE THE CHILDREN: EDUCATION PROGRAMME
community links, some in nutrition, etc. → each school follows up its own agenda, at the end of the
month they have to report to the DOEYS.
 Started piloting disaster risk reduction and climate change adaptation education in coastal provinces
(also Kampong Chnang, Tik Phos District)
 Organizes Children Congresses at the district level – children present important (health) issues they
discovered within their communities to the senior leader at the provincial level → soft advocacy process
applied.
 Community waste management component facilitated by school children
End date Undisclosed.
6. SWOT ANALYSIS OF SCHOOL HEALTH PROGRAMMING IN CAMBODIA - 2013
The following chapter analyzes the above described interventions with relations to policies in terms of their strengths, weaknesses,
opportunities and threats using the SWOT analysis tool. The major finding from this exercise confirms the hypothesis that there is a
solid policy framework in place which faces constant challenges of lacking commitment at different levels of administration as well as
sufficient managerial skills of effective and creative stewardship of the available resources. Overall, there is a clear gap between policy
formulation and actual policy implementation at various levels. However, the analysis also documents positive examples and initiatives to
fill this gap within the strengths and opportunities sub-sections.

44
TABLE 2: SWOT ANALYSIS OF SCHOOL HEALTH INTERVENTIONS IN CAMBODIA – PART I
Strengths
 Solid policy framework in place reflecting Education for All (EFA), Child-
friendly schools model, Cambodia MDGs and others
 Some interventions aiming at developing habits/behaviour change
through every day practice which is monitored (i.e. hand washing)
 Increase budgetary commitment by the Government for the year 2014
(15% increase for School Health Department)
 Finalization of the School Health Policy Guidelines and its anticipated
endorsement at the end of 2013/beginning of 2014.
Opportunities
 Leveraging upon existing materials (curricula, life skills manuals, extra-curricular manuals, etc.) developed
by numerous partners
 Pre-service level interventions – working with Regional Teacher Training Colleges (RTTCs) and Provincial
teacher Training Colleges (PTTCs) to work with mind sets of teachers to be (long term approach)
 Working closely with schools and local authorities (POEYS and DOEYS) on intervention design and work
plans
 Strengthening skills-based learning methods in the national model curricula containing school health topics
 School Health Department (MOEYS) is open and keeps positive attitude to development partners
 Close collaboration with the government partners at the district and community level (incl. capacity building
components)
 Exploring and piloting Learner-Centred approach in participatory ways enhancing life skills (school gardens
& market visits, school waste management experiments, group work)
 Connecting schools, health centres and community in promoting healthy behaviours through youth networks
(interns, volunteers)
 Experiments with motivating schools – submitting simplified ‘proposals with work plans’ to implementing
development partners based on their needs and motivation
 Connecting school-based health and community health through youth involvement via
volunteering/internship schemes integrated into programmes

45
TABLE 2:SWOT ANALYSIS OF SCHOOL HEALTH INTERVENTIONS IN CAMBODIA – PART II
Weaknesses
 Training-based interventions by numerous development organizations which are in many cases
ineffective and time consuming (teachers are often out of schools due to trainings and face extra
burdens)
 Lacking WASH infrastructure (hardware) in schools – 48% of schools are without access to water source
and 31% without a toilet (MOEYS, 2013) which is of a primary concern of school representatives
 The majority of national curricula is filled with facts and data but lack resources on teaching
methodologies (i.e. how to develop an interactive lesson plan on different health topics)
 Extreme discrepancies in level of school commitment and attitude to effective resource utilization
 Some interventions still focus more on the hardware/infrastructure side without proper assurance that
the health messages will be really conveyed to students and staff (some WASH interventions)
 School Health policy is too broad for full achievable implementation, it has to be guided with (at least)
minimum standards of school health required at the grass-roots
 Core curricula and even many other extra-curricular materials are full of facts and figures on health but
only very few materials include lesson plans promoting Learner-Centred Approach (how should teachers
convey the health messages in participatory and practical manner promoting certain skills)
 The relevant government bodies (School Health Department/MOEYS; Department of Rural Health
Care/MRD) usually cannot estimate the total annual inflow of resources to the sector due to many
standing-alone small scale projects of small NGOs/private supporters-individuals’ which do not inform
the Government about their activities (leads to fragmentation)
 Inadequate system of new teaching/training materials distribution to schools, especially to those in
remote provinces
Threats
 Creating parallel systems
 Ongoing design and development of new and “different but the same” curricula / extra-
curricular manuals by different organizations
 Teachers’ overload and lacking motivation (both financial and personal) in many cases
leads to overlooking of implementation of Local Life Skills Policy (which is in fact extra-
curricular)
 School health sector in general is underfunded and highly dependent on development
partners and donors
 High turnover of staff in education sector (especially school principals and good quality
teachers) undermines long term commitment to interventions (high volume of the trained
teachers leave the sector)
 Extremely limited access to water in some areas excludes schools from certain school
health programmes (I,e. hygiene promotion)
 Poor managerial capacity of many schools at all primary, secondary and tertiary levels, in
many cases the issue is not limited resources but their management (they are significant
discrepancies between schools in this respect)
 Compared to subjects like Khmer or Mathematics, health is usually not considered a ‘core
topic’ for the majority of teachers also due to their overload with heavy curricula packed
with topics. In many cases they skip the health topics in order to finish core subjects on
time
 Still too many stand-alone infrastructural improvements-oriented projects/programmes (in
many cases constructed by small NGOs/private philanthropists, etc. ) without broader

46
context settings and limited evidence on long term use
 Different organizations (especially INGOs) competing for the time of the ministries’
departments or the departments at the sub-national level

47
7. GENERAL ISSUES IN SCHOOL HEALTH IN CAMBODIA
This chapter presents general issues in school health programming identified by the key informants throughout the interviews. The text
has there sub-chapters structured into bullet-points. Sub-chapter 7.1. pays attention to inadequately addressed issues in school health
interventions. The author of this text kept its focus rather broad to capture all the issues identified. The second highlights some specific
challenges faced by the stakeholders during the implementation. Subchapter 7.3. summarizes general recommendations given to PiN as
a potentially new player entering the arena of school health in the country.
7.1. Inadequately Addressed Issues in School Health Interventions
- Low attention to non-communicable disease burden and generally unhealthy diet (fat, sugar, oil and salt over consumption)
- WASH at all levels of schooling with fully functioning and integrated hardware and software approach components
- Inadequate coverage of comprehensive sexuality education at secondary schools (incl. both reproductive health and HIV/AIDS
prevention equally. Until recently, there has been stronger focus only on HIV/AIDS prevention)
- Unavailability pre-school services especially for families with children under 5 year of age to address their stunting as it affects
persons’ capabilities and school performance later on
- Inadequate attention to mental health at all levels of education system in the country
- Ignorance of drug abuse prevention at schools in more in-depth way as it turns out to be significant social issue especially in
urban and peri-urban areas
- Significant negative impact on economic land concessions on educational attainments of girls and boys (wage labour in
plantations, garment factories, etc.)
- Lacking compassion among health and education staff within the whole health care and educational systems in Cambodia
- Prioritization of WASH at primary schools compared to lower and upper secondary ones has indirect impact on girls’ dropouts
during puberty and adolescence
7.2. Specific Challenges
- Very weak implementation of Local Life Skills Policy at the school level
- Difficulties to work on SC WASH with migrant communities in boarder areas when people (especially men) who were trained in
facilities maintenance migrate for work abroad no one can maintain the facilities regularly

48
- Difficulties to work on SC WASH with floating communities on Tonle Sap lake
- Working with teachers’ mind-set and hierarchy issues in terms of Learner-centred Approach (not limited just to health
education) in many cases pupils/students are not even allowed to ask questions and develop critical thinking so they are
obliged to memorize numerous health facts instead of development of skills and problem-solving attitudes
- Shortage of good quality trainers at both national and provincial level for certain topics within school health
- Human resource shortage and turnover at all levels of schooling hinders continuity and achievement in programmes
- Core curricula (including health messages) are very superficial in terms of coverage
- At the primary level, teachers tend to focus more on literacy and numeracy as life skills (instead of health)
- High utilization of cascade training among limited quality trainers so the real (health) messages often get lost in the process
- Appointment of school principals is mostly based on their political affiliation, not on competence and performance
7.3. General Recommendations for Implementation
- Focus on one core set of strong health messages and work around them, beware of fragmentation
- In case of WASH at schools (hardware) implementation , focus on low-cost and simple, locally available materials; do not
forget to include software interventions; besides training, there should be close follow up with the teachers in terms of regular
conveying messages to students and practicing the desired behaviour with them
- Enable the schools to become an equal partner in intervention design at the very beginning
- Strengthen communication and cooperation with the department leaders, provincial and/or district offices, involve them in
activities planning
- Once working with school children, the intervention should somehow involve their parents/families too (at least with School
Support Committees), one way could be supporting youth community leaders
- Take advantage of existing materials, guidebooks, manuals, curricula, catalogues, etc. instead of spending time on developing
new ones
- If working with TOT approach or regular training approach, do not forget to include refresher trainings (relevant especially to
WASH facilities maintenance if relevant)
- Aim to convey the majority of health messages through core-curricula in order to sustain the programme results after phasing
out
- Come up with fair and efficient incentive system for teachers, especially once working within Local Life Skills framework
- Make the direct link between the supply and demand: schools and health centres striving for similar results

49
- Work with motivated schools which can utilize resources properly → the resource allocation should not be
based only on basis of need
- Apply holistic approach: training-materials/curricula-management-capacity building – under Child Friendly Schools Framework
- Avoid strict thinking in categories (like WASH-only, nutrition-only), invest in integrated approaches which address communities’
issues in more comprehensive and holistic way

E_Gerthnerova_PiN.Cambodia_School.health_Analyis.Jan14

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