Across Jordan’s Syrian refugee camps, government schools and the Makani informal education centers established by UNICEF can have an impact on the health status of refugees at a school-going age, especially when these schools and centers implement an effective school health program where education is integrated with health. School children, as refugees, can lead a healthy life and protect themselves from various health hazards they are exposed to within their surrounding environment.

To model the national School Health Program implemented jointly by the Jordanian Ministries of Health and Education (MoH and MoE) in government schools throughout Jordan, the Integrated School Health (ISH) project was first piloted by UNICEF in 2014. It aimed to provide school health services in three government schools located in the country’s Syrian refugee camps.

Based on the positive outcomes of the pilot phase, UNICEF decided to expand the project in 2016 to include all government schools and Makani centers across all Syrain refugee camps in Jordan; namely, Zaatari, Azraq, the Emirati-Jordanian, Cyber City and King Abdullah camps. Throughout its duration, the ISH project aimed to improve the health and educational outcomes of Syrian refugee children and youth. More specifically, it aimed to deliver capacity building, information management, monitoring and evaluation to organize key stakeholders towards the establishment of a comprehensive, inclusive and integrated school health program for a coordinated multi-sector quality school health service delivery.

To be part of the response efforts made to Syrian children, EMPHNET collaborated with UNICEF and the Jordanian Ministries of Health and Education on a two-year project under the title Strengthening Management systems for Scaling Up Integrated School Health (ISH) in government schools and Makani informal education centers in Syrian Refugee Camps in Jordan.

The project was carried out over two phases: the first was in 2016 and the second was in 2017.

ISH in 2016

In its first phase, the ISH project was implemented from January until November 2016. During this phase EMPHNET collaborated with UNICEF, the Ministries of Health and Education, and various NGOs and CBOs in Jordan to achieve the phase’s deliverables.

First, EMPHNET supported the strengthening of communication and information sharing among the project’s stakeholders, thus organizing regular stakeholder coordination meetings in every camp. Over a period of ten months, a total of 24 coordination meetings were conducted. These meetings aimed to establish strong partnership and coordination mechanisms between the education and health sectors and the camp’s various NGOs/CBOs.

The meetings were attended by representatives from the MoH and the MoE; UNICEF; WASH, Health, and Nutrition sectors; the UNHCR; ACTED; Save the Children Jordan; the International Medical Corps (IMC); Relief International (RI); International Relief and Development (IRD); the Institute of Family health (IFH); and Jordan Health Aid Society (JHAS), among other entities.

Second, EMPHNET, the MoH and the MoE, developed guidelines for the ISH project. These guidelines were adapted from the MoH guidelines to fit the health demands and context of the camps and were later approved by all involved entities. Designed to set standards for the provided health services and their quality, these guidelines mandate the requirements for maintaining a healthy, safe, and secure school environment for students within this community. They ensure the provision of health education and health services.

EMPHNET also helped build the capacities of staff from the MoH and the MoE as well as outreach teams from NGOs and CBOs in the areas of providing quality school health services and managing the school health program. Thirty-two health education training workshops were conducted for Makani facilitators and 50 for the school teachers to enable them to effectively deliver critical health messages to Syrian refugee children and youth.

The workshops covered a range of health education topics, jointly determined by EMPHNET the MoH and the MoE, to fit the needs of children at the camps. The topics included Personal Hygiene; Dental and Oral Health; Smoking, Drug, and Alcohol Use; Reproductive Health; Safety, Injury Prevention, and First Aid; Nutrition and Healthy Eating; School Health Environment; Role of Teachers and Facilitators in Students’ Health; and the ISH Referral System. To ensure the sustainability of these capacity building activities, EMPHNET provided post-training supervision for the facilitators and teachers by implementing health education sessions for the children and youth in the Makani centers and schools.

Furthermore, health promotion Training of Trainers (ToT) workshops were conducted for Makani facilitators. More specifically, a total of 326 facilitators were trained, the majority of whom were Syrian volunteers working for Relief International (RI), the Norwegian Refugee Council (NRC) and Save the Children International (SCI) Makani centers in Zaatari camp. The data collected on post-training activities done by these facilitators shows that most incorporated the health messages given in the workshops within existing Makani activities.

EMPHNET also conducted health promotion workshops for school teachers at the camps. These workshops focused on providing trainees with information on health priority topics that must be incorporated in raising the health awareness of students. According to the reports provided on the post-training activity by the teachers, approximately 12,500 students received the health messages through health education awareness materials, communication with the parents, and health campaigns.

The Digital ISH Data Management System

EMPHNET developed a Digital ISH Data Management System for the digitalization of student’s health records. The data management system collects, stores, and analyzes student health data in one place to facilitate the use of data management and analysis for strategic planning and policy development.

While the data management system is primarily web-based and has its database on a server, it also has an android version to allow for offline data entry in the camps where internet connectivity can be unreliable.

On this system, student profiles have been registered: each profile included the student's name, date of birth, sex, school name, camp name, and student ID (when applicable). In addition, results from the health services provided for each student- during the ISH project phases- were recorded using electronic forms for immunization, height/weight, vision screening, physical and dental examination, referrals, and feedback. These records mirror the fields/questions on the student’s paper-based health cards.

As part of the ISH project, health services were provided in the schools that were not delivered prior to the project’s implementation. EMPHNET coordinated with the IRD, the SCJ, the MoH, and JHAS to provide bivalent polio. diphtheria and tetanus vaccinations, dental and physical examinations, as well as weight and height measurements.

These examinations showed that the most common health problems were dental and oral-related: Several students were discovered to have gum disease, dental plaque, and malocclusion. Moreover, many students had vision impairments ranging from mild to severe, a majority of which required corrective glasses. Students who were observed on their health problems and were immediately referred for further examination or treatment.

ISH in 2017

During the second phase of the project lasting from December 2016 until May 2017, ISH services were provided to 11 newly established schools (4 schools in Zaatari and 7 schools in Azraq camp) . These schools were not covered during the first phase of the project. Services were also provided to the newly enrolled students in the schools and Makani centers.

The goal of this phase was to ensure the smooth hand over of the ISH project to the Ministries of Health and Education, for which a detailed project handover plan was drafted and endorsed by both UNICEF and the ministries. Moreover, capacity building activities were done for the MoH and the MoE staff to ensure that they can effectively run the project after the handover is completed.

A notable achievement for the project in its second phase was the training of 80% of school teachers in 41 schools. More than 80% of the facilitators and Syrian volunteers at 32 Makani centers in 5 Syrian camps were trained in areas of health promotion and education messages. The training covered Healthy and Balanced Food; Food Safety and Hygiene; Oral and Dental Health; Smoking; Personal Hygiene; Diseases Related to Lack of Sanitation; and Health Education.

EMPHNET also conducted five health education and promotion workshops for the new teachers in the new schools: three workshops for Azraq and two for Zaatari. In their post-training activities, these teachers conducted health education for school children, developed awareness materials, and conducted health awareness campaigns for students and parents.

EMPHNET also conducted four school health committee workshops; two for Azraq and two for Zaatari.

It also facilitated and managed the provision of medical services (physical health and dental examination) of 1st, 4th ,7th and 10th grades and immunization services to 1st and 10th grades in the camps in all schools and Makani centers. EMPHNET in cooperation with MOH staff continued providing medical services to school students in Zaatari, Azraq and EJ camps. 14 Female and 10 male students in Makani centers in Azraq camp received health services.

The Digital ISH Data Management System

In this phase, the ISH team worked to strengthen the Mobile Data Collection (MDC) data management system by developing guidelines for the system and building the capacities of the MoH and other implementing partners on data entry, monitoring, analysis, and feedback cycle. By the conclusion of the project, the MDC software program and all relevant data will be transferred to the MoH server, and all tablets and computers will be handed over to the ministries’ school health technical departments. EMPHNET is working gradually to transfer the database and the software to MoH through EMPHNET conducting MDC-ISH data system handover meeting with MOH IT Department.