Factors influencing the National School Health Policy implementation in Lao PDR: a multi-level case study

Saito, Junko; Keosada, Ngouay; Tomokawa, Sachi; Akiyama, Takayuki; Kaewviset, Sethavudh; Nonaka, Daisuke; Waikugul, Jitra; Kobayashi, Jun; Souvanvixay, Mithong; Jimba, Masamine

doi:10.1093/heapro/dau016

Cited by 39 publications

(87 citation statements)

References 17 publications

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“…However, this is a costly part of the intervention and these costs were also not quantified in our study. Previous studies for the United States and Lao PDR have also pointed at the importance of training and capacity building to sustain school-based health programs [27,28].…”

Section: Discussionmentioning

confidence: 99%

Home-grown school feeding: assessment of a pilot program in Nepal

Shrestha

Schreinemachers²,

Nyangmi³

et al. 2020

BMC Public Health

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Background: The Nepal School Meals Program reached 600,000 schoolchildren in basic education in 2017 and plays a key role in the government's strategy to increase children's academic and nutritional outcomes. A large part of the program is implemented through cash transfers with schools responsible for the school meal delivery. Home-grown school feeding, an approach in which local communities are given greater control over the school meals program and part of the food is sourced locally, may strengthen local ownership and improve meal quality, but there is a lack of evidence for impact. Methods: This study piloted home-grown school feeding in 30 schools reaching nearly 4000 children in Sindhupalchok and Bardiya districts in Nepal with the aim to assess operations and outcomes in comparison to the regular cash-based school meals program. The study used a one-time post evaluation with a mixed methods approach. Qualitative data were collected through 12 focus group discussions and 28 key informant interviews with government and school staff, parents, cooks, cooperative members, World Food Programme representatives and other stakeholders involved in the pilot program. The quantitative part applied a quasi-experimental design and used cross-sectional data collected from 1512 children in 30 pilot and 30 control schools. Results: The quantitative data indicated that children in the pilot schools had a significantly higher provision of midday school meals (+ 19%; p < 0.01) and a higher school meal quality in terms of dietary diversity (+ 44%; p < 0.01) and nutritional content (e.g. a 21%-points higher consumption of vitamin A-rich fruit and vegetables; p < 0.01). The qualitative data identified key drivers of these positive outcomes as the use of standard meal options, capacity building of local stakeholders, strengthened community ownership and accountability mechanisms, and local food supply chains. Maintaining the observed gains would require a 20-33% increase in the current budget per school meal in addition to the cost of capacity building. Conclusions: This study for Nepal shows that home-grown school feeding strengthened operations of the school meals program and led to a significantly higher meal provision and quality of school meals.

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Section: Discussionmentioning

confidence: 99%

Home-grown school feeding: assessment of a pilot program in Nepal

Shrestha

Schreinemachers²,

Nyangmi³

et al. 2020

BMC Public Health

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“…The Health Policy Analysis Triangle (HPAT) was adopted as the overarching framework for study design and analysis. It is deemed appropriate for health policy analysis (52), and has been applied in similar nutrition policy research (16,17,53,54). The four constructs of the HPAT (Actors, Context, Processes and Contents) prompt investigation into how different aspects of the policy context affect the way in which a policy is developed and disseminated (52,55,56), the way individual and groups of actors interacted with the process of policy-making and implementation (42,47,(57)(58)(59)(60), and the development and interpretation of policy contents.…”

Section: Theoretical Frameworkmentioning

confidence: 99%

“…As with any case study, a potential limitation to the transferability of ndings is the in uence of local contextual factors on policy processes. To maximize transferability beyond the Samoan context, we based our analyses on a political sciences framework that has been applied in multiple contexts (16,53,54). In addition, we explicitly attempted to identify local contextual factors, and focus on opportunities for lesson drawing as applicable to other contexts.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

“…Schools are already tightly regulated by governments, and should be straightforward targets for regulation (8, 10). However, evidence from both high-income (13)(14)(15) and low income (16)(17)(18) countries in the Western Paci c Region suggests that implementing and maintaining compliance with school food standards has proved di cult. Reasons include the lack of emphasis placed on the school food environment by administrators and the broader school community, and the absence of effective enforcement mechanisms (19,20) .…”

Section: Introductionmentioning

confidence: 99%

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Identifying opportunities to strengthen school food environments in the Pacific: a case study in Samoa

Reeve

Thow

Bell³

et al. 2020

Preprint

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Background: Despite global recommendations to prioritise policies that create healthy environments within education institutions, the implementation of effective healthy school food policies has proved challenging for many countries. This study examined the experience of Samoa in introducing a stronger policy to improve the healthiness of school food environments. Our aim was to identify opportunities to strengthen healthy school food policy implementation in Samoa and other comparable contexts. Methods: We used a qualitative case study approach, underpinned by policy science theory. We conducted in-depth semi-structured interviews with 30 informants, coupled with analysis of relevant documents, to generate a detailed understanding of the relevant policy implementation processes in Samoa, and the perspectives and capacities of key implementation actors. Data collection and analysis were guided by the Health Policy Analysis Triangle supplemented by other policy theories relevant to policy process. Results: Samoa’s school food policy operationalizes international ‘best practice’ recommendations. We found health policymakers and leaders in Samoa to be strongly committed to improving school food environments. Despite this, there continued to be challenges in ensuring compliance with the school nutrition standards. Key issues that negatively impacted on the policy’s effectiveness were the lack of priority given to school food by stakeholders outside of health, the high prevalence of unhealthy food in the areas immediately surrounding schools, and the high degree of agency exercised by actors in and around the school. We noted several opportunities for policies to be effectively implemented and sustained. Respondents identified community level leaders as potentially pivotal stakeholders, particularly in a context where school governance draws heavily on community representation.Conclusions: Despite previous commitment to the issue, political and community leaders need to be re-engaged to identify the institutional and operational changes required to improve the implementation of healthy school food policies. Strong incentives for compliance and effective enforcement mechanisms are likely to be crucial to success.

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“…However, evidence from both high-income (11)(12)(13) and low income (14)(15)(16) countries in the Western Pacific Region suggests that implementing and maintaining compliance with school food standards has proved difficult. Reasons include the lack of emphasis placed on the school food environment by administrators and the broader school community, and the absence of effective enforcement mechanisms (17,18) .…”

Section: Introductionmentioning

confidence: 99%

Identifying opportunities to strengthen school food environments in the Pacific: a case study in Samoa

Reeve

Thow

Bell³

et al. 2019

Preprint

View full text Add to dashboard Cite

Background Despite global recommendations to prioritise policies that create healthy environments within education institutions, the implementation of effective healthy school food policies has proved challenging for many countries. This study examined the experience of Samoa in introducing a stronger policy to improve the healthiness of school food environments. Our aim was to identify opportunities to strengthen school food policy implementation in Samoa and other comparable contexts.Methods We used a qualitative case study approach, underpinned by policy science theory. We conducted in-depth semi-structured interviews with 30 informants, coupled with analysis of relevant documents, to generate a detailed understanding of the relevant policy implementation processes in Samoa, and the perspectives and capacities of key implementation actors. Data collection and analysis were guided by the Health Policy Analysis Triangle supplemented by other policy theories relevant to policy process.Results Samoa’s school food policy operationalizes international ‘best practice’ recommendations for school food policy, and provides insights into the outcomes resulting from high level political commitment. We found health policymakers and leaders in Samoa to be strongly committed to improving school food environments. Despite this, compliance to the school food policy had continued to face challenges. Key issues that negatively impacted on the policy’s effectiveness were the broader food environment in which schools were surrounded by unhealthy options, the lack of priority by stakeholders outside of health, and the high degree of agency exercised by actors in and around the school. We noted several opportunities for policies to be effectively implemented and sustained. Respondents identified community level leaders as potentially pivotal stakeholders, particularly in a context where school governance draws heavily on community representation.Conclusions The re-engagement of political and community leaders to identify the institutional and operational changes required, including a fully-enforceable accountability mechanism, may be needed to improve and embed effectiveness.

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Factors influencing the National School Health Policy implementation in Lao PDR: a multi-level case study

Cited by 39 publications

References 17 publications

Home-grown school feeding: assessment of a pilot program in Nepal

Home-grown school feeding: assessment of a pilot program in Nepal

Identifying opportunities to strengthen school food environments in the Pacific: a case study in Samoa

Identifying opportunities to strengthen school food environments in the Pacific: a case study in Samoa

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