Including children with disabilities: challenges and responses in school health and nutrition programmes

by Sergio Meresman, Rosangela Berman Bieler and Katia Edmundo

The Global Report on Disability jointly produced by the World Health Organization (WHO) and the World Bank has focused attention on one of the larger yet less spoken about issues in development -  people with disabilities. With over one billion or 15% of the global population, people with a disability are one of the world's largest minority groups and yet they are also one of the most excluded and impoverished. According to the report, even in developed countries disabled children are three times more like to be denied healthcare than other people. Children with disabilities are less likely to start or stay in school than other children. Most common and powerful barriers include stigma, discrimination, inaccessible transport, unprepared classrooms and teachers. In developing countries the picture is even worse. Despite a robust disability rights movement and a shift towards inclusion, disabled people remain second-class citizens. Children who live with a physical, sensory, intellectual or mental health disability are amongst the most stigmatized and excluded of all the world’s children.  Misunderstanding and fear of children with disabilities result in their marginalization within the family, community, at school, and in the wider society.  The discrimination they suffer leads to poor health and education outcomes; affects the self-esteem and chances for participation and interaction with others, and puts them at higher risk for violence, abuse and exploitation. Download the Education Chapter from the World Disability Report

Children with disabilities – facts and figures Whilst there is no reliable data on the global number of children with disabilities some estimates put their number at 150 million worldwide (or 1.3% of children). However this number is likely to be too low due to the probability of wide-scale under-reporting of children with disabilities.  Research shows that even in the more developed countries there is a core incidence of 2.5% of children with disabilities. This rises to 10% if children with learning and behavioural disabilities are also considered. In countries with high levels of poverty and instability, rates are likely to be higher still. Most live with the reality of exclusion. Are faced with one of the most significant barriers − limited access to education. Children with disabilities are: At around 90% chance of not attending school in a developing country More likely to be denied the right to grow up in a family environment than their able-bodied peers 46 times more likely of being institutionalised if disabled in CEE/CIS countries. 1.8 times more likely to be neglected 1.6 times more likely to be physically abused 2.2 times more likely to be sexually abused than children without disabilities In some countries, 90% do not survive beyond the age of 20 and 90% with intellectual impairments do not survive beyond the age of 5. Source: UNICEF, 2011.

Relevance of inclusion into school health and nutrition programmes:

Promoting effective nutrition programmes within schools and communities can help to prevent disability:

•  A well-known determinant of disability is inadequate nutrition both at birth and during childhood.

For countries to achieve Education for All and to meet the Millennium Development Goal of universal completion of primary education, access to education must include all children including those with disabilities:

• Children with disability face numerous barriers to access education and to remain in schools: Disability is the single most important determinant of illiteracy,  for example, in Uruguay 40% of illiterate 15 year olds were disabled.

Promoting inclusive school environments implies creating better conditions for children with disabilities and for those with HIV and AIDS or other highly stigmatized conditions:

• Stigma and discrimination strongly affects children with disability: Structural barriers and long standing stigma and discrimination can prevent access to public policies or services, from poverty reduction strategies to school lunch, sex education or distribution of condoms.

School health and inclusion in practice: the experience of Everyone’s School

Knowing this reality the Everyone´s School/Escola de Todos programme aims to support the school health community to effectively respond to exclusion to education.

Implemented in Brazil and Uruguay, the programme is a collaboration between The Center for Health Promotion (CEDAPS), the Inter-American Institute on Disability and Inclusive Development (iiDi), Partnership for Child Development (PCD) and several local counterparts.

CEDAPS is one of the most experienced organizations implementing school and community health programmes in Brazil. Its involvement meant that the programme could build on the existing knowledge and policies already in the field, engaging key partners and avoid the duplication of strategies.

The involvement of iiDi facilitated a participatory approach which brought together a large network of civil society organizations working in the area of disability (e.g., special education teachers, rehabilitation specialists, and community-based disability organizations).  With each organisation bringing with it different ideas and lessons learnt.

The focus of the project was on developing integrated approaches and resources to link the promotion of health and inclusion in schools.

Results

Within four years, the project has:

•  Trained more than 80 trainers and provided technical assistance to School Health and Inclusion Networks in Brazil and Uruguay.

• Involved key local sectors and actors in creating and sustaining Everyone’s School/Escola de Todos Councils in Brazil and Uruguay, ensuring long-term institutional support through the initiative.

•    Produced an Everyone’s School/Escola de Todos Kit which included:

•  A teachers’ manual,
• CD for trainers
• Two games for students
• Website and blog
• Promotional brochure and t-shirts
• Everyone’s School/Escola de Todos posters and dissemination activities during education- and health-related conferences in Brazil and Uruguay
• A documentary film
  

•  Implemented a strategy for mainstreaming Everyone’s School/Escola de Todos principles and operational tools into existing school-based activities agreed with the Ministry of Education and the National AIDS Programme.

The following activities are currently in process:

In Brazil

• The Brazilian National HIV and AIDS Programme, Ministry of Education and the School Health Networks in the country are currently in the process of integrating Everyone's School/Escola de Todos into their regular AIDS prevention and health promotion programmes. This is a powerful scale up process that is connecting the dots of Health, Inclusion and Participation in the school setting and Youth Networks.
•  Distribution of Everyone’s School/Escola de Todos Kit and its national dissemination.
• Technical Assistance to the Secretary of Inclusive Education in Rio de Janeiro, participation in training of trainers and dissemination of resources.
• Follow up to online exchange with participating schools through the project blog www.escoladetodos.net and the monthly Everyone’s School/Escola de Todos Newsletter.
• Participation in a National School Health Conference in Brasilia and dissemination of resources at the Regional AIDS and Disability Conference, June 2010.
  

In Uruguay

•  Requested by the Ministry of Education with collaboration from PCD Everyone’s School/Escola de Todos started to implement a study on sex education in special and inclusive schools in Uruguay. This study will generate recommendations and resources for implementing inclusive approaches to sex education. Families have been involved and already a publication to address parents on how to facilitate the healthy development of their children is under preparation.

• The project has drawn the attention of many agencies and has been declared of “special interest” by the Ministry of Education (Resolution 2213/7, March 2010). Sex education for children and adolescents with disabilities is an area largely neglected and is a key to future collaborative endeavours with school health programmes in Uruguay and other countries.

Opportunities for collaboration in Lusophone Africa

As all project materials and expertise are in Portuguese, it would be possible to utilize them (with few adaptations) in Lusophone Africa. Taking advantage of capacity and expertise already available in Portuguese will contribute to inclusive school health programmes in Africa, integrating health, education and national AIDS prevention efforts through south-south technical assistance and collaboration.