Lessons learned in the implementation of strategies in schools: the case of Chile.

Marcia Erazo

1990 1995 2000 2005 2010 20150

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Obesity prevalence

Africa

Asia

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Global

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www.thelancet.com Published online February 4, 2011

BMI (KG/M2)

2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

Total Obesity 17 17 16.7 17.3 18.5 19.4 21.8 20.8 21.5 23.1 22.1

Males NaN NaN NaN NaN NaN NaN 21.8 20.6 21.2 23 25.3

Females NaN NaN NaN NaN NaN NaN 21.9 21 21.8 23.2 18.8

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School-children obesity rates

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School-based strategies

• Chile, following the guidance of the World Health Organization, in 2007 implemented a series of strategies at schools (1000 schools nationwide).

Main strategies • Healthy kiosks: To reduce the exposure to “junk

food” at school.

• Physical education: To increase the total hours of physical activity

• Health promotion: To introduce health topics on a regular basis at school

Objective

• To analyze the barriers and facilitators to the implementation of strategies in schools.

• Complete reports at:• http://www.minsal.cl/portal/url/page/minsalcl/g_proteccion/

g_alimentos/prot_ego.html

First evaluation (2010)

• Qualitative evaluation, aimed to evaluate the process of implementation at regional and community level.

• Focus group and key stakeholders interviews.

Results

•At regional level:•Horizontal articulation:

• Technical orientations are applied al community level.

• Metropolitan area, there is a lack of coordination.

• There is inter-sectorial work between sports and educational institutions, that work together.

Results

• Vertical integration:

• There is intra-sectorial integration, especially when, at community level, there is a person designated to work the health promotion.

• Monitoring, supervising and accompanying the implementation at community level

Results

• Horizontal articulation at community level:

• There is inter-sectorial work.• Only actions at school level, once a

month.• “The school” sees this activity as an

“extra”.

Second evaluation (2010)

• Quantitave and qualitative methods

• Weight, height• Interviews

Results

Results

Results

Results

Third evaluation (2011)

Facilitators

• Principal’s will, by encouraging healthy habits.

• Possitive assessment of students in more hours of physical activity.

Barriers• Selling unhealthy foods at school.• To give money to children• Lack of continuity of interventions.

• Lack of intra-extra sectorial coordination• Managerial failure

• Lack of “political agreement”

School-based intervention in one community

• Presented in a seminar of successful practices to prevent childhood obesity, organized by PAHO, in Santiago-Chile, January 21-22, 2013.

• Conducted by Municipalidad de Peñalolén• http://www.paho.org/chi/

School-based intervention in one community

• Intervention:• Physical activity:

• 3 hours a week, in different days, specialized teacher, active pauses.

• Healthy eating and nutrition• Anthropometry• Healthy eating education to children, parents

and school community.

• Healthy kiosks• Health promotion

Results

Physical activity

2009 2012

Hours 100% <2 a week 100% 3 hrs a wek

Distribution 1 day a week 3 days a week

Professional General teacher Specialized teacher

Active pause

Healthy kiosks

• Change in “terms of reference” to manage to kiosks

Lessons learned• Sustainability of the program is given by:

• Central management• Coordinated Inter-sectorial work• Inclusion of the strategies in the community

health plans and official documents.

Lessons learned

• Successful of the program is given by

• The leadership and commitment of the school principal,

• Permanent monitoring of the correct implementation of strategies,

• Fcus on promoting healthy habits to children and their families,

• Reinforcement by regulation within and outside of the schools of junk food

Thank you!!