All REAP News News May 25, 2020

School-based Health Interventions Shown to Improve Learning Outcomes

REAP research greatly contributed to this Education Policy Insight published by the Latif Jameel Poverty Action Lab (J-PAL), which documents eight randomized evaluations in Burkina Faso, China, Kenya, and the United States showing that health interventions delivered at schools can improve student health and positively affect learning outcomes.
Middle school kids work at desks in a run down classroom in rural China.
Rural Education Action Program

In May 2020 the Latif Jameel Poverty Action Lab (J-PAL) published an Education Policy Insight, Improving Learning Outcomes through School-based Health Programs, that draws on 8 randomized evaluations across the world to show that school-based health interventions not only improve students overall health, but also improve their learning outcomes. The report cites several REAP studies conducted in classrooms across rural China including a text messaging health intervention, vision care intervention, and nutritional training and supplementation program. More specifically it uses data and conclusions from the following REAP publications:

Eggs Versus Chewable Vitamins: Which Intervention can Increase Nutrition and Test Scores in Rural China?, China Economic Review

Nutrition and Educational Performance in Rural China's Elementary Schools: Results of a Randomized Control Trial in Shaanxi Province, Economic Development and Cultural Change

Text Messaging and its Impacts on the Health and Education of the Poor: Evidence from a Field Experiment in Rural China, World Development

Seeing is Believing: Experimental Evidence on the Impact of Eyeglasses on Academic Performance, Aspirations, and Dropout among Junior High School Students in Rural China, Economic Development and Cultural Change

Improving the Health and Education of Elementary Schoolchildren in Rural China: Iron Supplementation Versus Nutritional Training for Parents, The Journal of Development Studies

To learn more about their comparative findings you can access the policy insight here or read the below summary:

J-PAL Policy Insight Summary

Many children are struggling to master basic skills in reading and math despite a dramatic rise in school enrollment around the world. For instance, India’s 2018 Annual Status of Education Report (ASER) found that only about half of all grade 5 students in rural India could read a grade 2 text [1]. Assessments showed similar results in other countries, from Malawi to Nicaragua to Zambia [13]

Especially in low- and middle-income countries, poor health is often a key barrier that students must overcome in order to be able to learn. The health of schoolchildren may fall through the cracks of government systems in which education departments focus on pedagogy and school infrastructure, while health departments focus on health workers and medical infrastructure. Improving the coordination between health and education systems could address this gap. School-based health interventions have been effective at increasing learning outcomes, and many can be delivered at a low cost, although the relative cost-effectiveness varies depending on the specific approach and context. 

Results from eight randomized evaluations in Burkina Faso, China, Kenya, and the United States show that health interventions delivered at schools can improve student health and positively affect learning outcomes. 

The programs included in this insight address a variety of health issues. A school-based deworming program increased learning outcomes by directly treating a contagious condition at school. Other programs increased learning outcomes by delivering iron supplements or eyeglasses, addressing non-contagious conditions that nonetheless inhibit the ability of children to learn. Finally, some programs increased learning outcomes through a broader health and anti-poverty approach of providing free meals at schools. Meanwhile, programs that aimed to improve health by providing only information typically did not improve health or learning outcomes unless accompanied by other complementary interventions.   

In contexts where students experience poor health and learning levels are low, policymakers may want to consider school-based interventions that directly address child health. If interested in implementing health information campaigns, policymakers should also consider the extent to which parents will be able to understand and act on the information provided. 

Finally, cost data is included in this insight when available. Of the studies that provided cost data, deworming had by far the lowest per-child costs. All included cost information is based on estimates from individual research teams and therefore may differ based on context and which factors researchers took into account. Additionally, while the potential cost of a program should be an input into a policymaker's decision-making process, both the relative cost-effectiveness of and need for a program relies not only on cost but also the extent of that health problem in the area. Policymakers must carefully consider the existence and prevalence of various health issues in their area and then incorporate cost as one input into plans for how to address these challenges.

Read the full Policy Insight here.