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

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

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

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

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

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

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

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

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

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

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

12. Distribution of schools by intervention

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

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

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

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

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

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

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