For more than 27 years Dr Lesley Drake from the School of Public Health has been involved in efforts to feed school children in low-income countries.

Research has shown the importance of nutrition on health development but this has a social impact as well. Providing nutritious meals for low-income communities allows children to attend school more regularly and receive a better education, improving the opportunities and prospects for individuals, families and communities.

The Partnership for Child Development and Dr Drake were recently highlighted as an example of best practice by The Parliamentary Review.

We spoke to Dr Drake about the Partnership for Child Development, the importance of school-based nutrition and health programmes, and what the UK could learn from the success of programmes in low-income countries.

What is the partnership for child development and why was it set up?

“The Partnership for Child Development (PCD) was set up in 1992 to address the health, nutrition and education needs of school-age child and adolescents in low and middle-income countries.  “Survive and thrive” is now a common concept, with so many more children wonderfully surviving the first few years of life than ever before, but what happens then?  How do we support children to move through childhood, adolescence and reach their full potential as adults?

We need solutions and we have them.  Education is a sure bet.  The school is an incredibly stable platform to kick start this support.  Governments are recognising this, whether this be the United Kingdom, Nigeria, Brazil, the recognition is global. We are paying attention to this and not just primary education, but to develop systems and opportunities in place to ensure that children progress to secondary education, for both the boys and the girls.

We all know that if a child is ill, or just simply hungry, they don’t go to school and even if they do make it to the classroom, they cannot take full advantage of the learning opportunity. We can put in place simple health and nutrition interventions in schools that can help.  Whether this be providing lunch to feed and nourish, eyeglasses to better see the blackboard, pills to deworm, combat anaemia, vitamin A deficiency, these are examples to name a few. Many countries are implementing these cost-effective services to great effect and increasingly to scale and seeing kids coming back to school and taking advantage, learning and achieving results.

PCD, provides evidence-based technical support to governments recognising the importance of the investment in their children. We believe in evidence into action. We deliver an evidence-based, quantitatively evaluated on-going assessment to governments and donors alike and we are committed to knowledge transfer and capacity building to ensure that nations can deliver these programmes themselves on the journey to self-reliance and build the skills of their nation.”

What sort of impact have these social health programmes had on communities?

“There have been significant impacts on communities.

The concept of “homegrown school feeding” means that governments are buying from local farmers (often the parents of the children we want attending school) and providing a stable income and market, with an agreed price. Farmers are also provided with expert assistance to improve farming techniques and resources and advice on creating cooperatives and managing bank accounts and finances. A great example of this is the chicken farmers of Osun State in Nigeria (the first state to take up the school feeding programme) became the largest providers of chickens to Kentucky Fried Chicken Nationally.

Children are going back to school, especially girls. Communities are starting to recognised the value of a girl’s education and how she can contribute to the wealth of the family and nation. This extends to the issue of water and sanitation. Children will often use tree if latrines are dirty or smelly (if there are any in the first place). However, girls on their period need access to privacy and hygienic facilities. In many countries latrines are neither leading to many girls staying away from school during their “time of the month”, and many don’t come back or at the least miss vital days of education. We are working hard with partners to find solutions to this particular problem.

There is also a knock-on effect for the local community. In Nigeria, for example, there are over 100,000 caterers now employed. They have all received training and certification and are often seen as the ‘best caterers’ leading to employment at the weekend for weddings and celebrations. They also contribute to local economies buying pots and pans (through an interest-free loan) and uniforms. They become a key part of local communities, for example in Mali the homegrown feeding programme has survived a coup d’etat because it was so embedded in the community.”

How is the work funded and is it a challenge to ensure this continues at the local and national level?

“Over the years, we have had funding from multiple donors including the World Bank, the Bill and Melinda Gates Foundation, the UN World Food Programme, the MacArthur Foundation, Table for Two, Dubai Cares.  The challenge is twofold: firstly, to support countries to move to domestic financing and the capacity to deliver the programme (moving school health and nutrition into policy and out of politics); secondly; to secure funding for ourselves to support countries in this move to self-reliance, providing the evidence and impact evaluation to justify ongoing budget allocation.”

The Partnership for Child Development has been running for more than 25 years, but it must have faced some major challenges over the years?

“We continue to evolve. We grow with the evidence and I am proud of that. When we started our focus was on schoolchildren aged 5-14 in low and middle-income countries. This has now widened to the first 8000 days of life – the first 1000 days has been a primary focus of the global health community and we are strong advocates supporting ways to investing the next 7000 days that will take a child to adulthood.

A key recent publication was that of Disease Control Priorities (3^rd edition) – a once in a decade publication that seeks to bring agreement within the scientific community around health priorities. This is a publication that you would see on the desks of Ministers of Finance across the globe and the first edition convince Bill Gates to focus his philanthropic efforts around health. For the first time the publication had a chapter dedicated to child and adolescent health and development. I was the lead author on a chapter focussing on school feeding and many members of PCD contributed to the publication.

There will always be challenges, especially securing funding but we continue to seek opportunities from all sources.”

Are there any remaining barriers for the partnerships and similar school-based community health programmes?

“The challenge is cross-sectoral collaboration. Finding ways for the health and education sectors to work together is tough – not through lack of desire but often the challenge is about who foots the bill. A key best practice solution is involving political leadership – in Nigeria the programme is one of only 4 that form part of the Vice President’s Social Protection Programme, so it forms part of his overarching vision. This silo effect is not limited to within countries – it extends to funders as well, as they will often either fund health or education or agriculture. We aim to provide an evidence-based approach that can help funders merge their ‘siloes’.”

What's next for the partnership - where do you see it in the next 25 years?

“Remaining at the cutting edge of science and translating this into real world solutions will always be our place. Whilst retaining our HQ at Imperial, we are looking to strengthen our global roster of experts in different fields and widen our horizons to respond to the ever-growing demand.

School health and feeding has seen a resurgence in interest at the UN level. In June, there was a meeting convened by UNESCO and WFP to drive a real movement. The WHO and FAO have agreed to develop joint guidelines for “food and health”. We are acting as an advisor to this work, it will take decades but we are there to ensure it happens and is evidence-based.”

Are there any lessons learned from running programmes in low-income countries which we can apply to the UK?

“Good question. In 1906, the UK government began its welfare programme by implementing school feeding. 100 or so years later we still have this programme. It is a strong social safety net for us – as a child I had free school meals and look at me now. We saw this programme adapt to the times especially during the 2008 recession where schools were opening their doors to poor communities during the school holidays to ensure they had one hot nutritious meal a day.

There is an opportunity to use the lessons learned from around the world, in particular the concept of using locally sourced foods, to strengthen our own programme – an investment in local communities and our own human capital).”