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WHO
Collaborative Programme
Promotion
of Healthy Lifestyles
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Situation analysis
1. Health promotion policy and information to the public
The Head of the Health Education department (HED) at the MOH is currently being occupied by one senior technical staff member who is supposed to coordinate all types of responsibilities of coordinating and collaborative nature. HED focal points are absent at the provincial and district health authorities. The HED does not have the capacity to develop strategies, plan and implement activities at national level. A considerable number of NGOs, UN agencies and non-health government sectors have been involved in health education activities varying from mass media campaigns to the development of materials.
A WHO consultant visited Lebanon in 1996 to review the health education situation in the country at government and private levels and to prepare strategies for strengthening the national program. The consultant highlighted the need to take into consideration the following points before planning any Health Education program: the absence of government policy, weak infrastructure at all levels, lack of specialized manpower, and lack of baseline information and coordination among implementing groups. Advocacy was made in order to reach an agreement on the need to revitalize health education in the public sector. Different UN agencies showed interest: WHO contribution to the consolidation of the Health Education Department in 1995 was the implementation of a training workshop for the MOH's staff and representatives from NGOs who are active in the health education field. The main goal of the workshop was to create a network of interested field workers at Qada level, who can collaborate on the implementation of national programs as well as apply community mobilization interventions. UNICEF recruited a specialist for the development of material whereas UNFPA allocated a budget for strengthening the IEC components of the reproductive health project.
During the past biennium, the WHO reinforced the Health Education Department by supporting the recruitment of a short-term consultant who undertook a situation analysis and proposed a strategy and plan of action for strengthening the health education department. Following the assignment, the head of the Health Education Department organized, with the support of the WHO, a workshop on the Role of Nursing In Health Education. WHO continued to support the recruitment of the project coordinator for the school health education project that is supporting the government in the establishment of a comprehensive school health promotion program. Moreover, the reproductive health program at the MOH has also recruited a health education specialist for the provision of technical support to the program. On the other hand efforts in the MOSA led to the creation of an IEC unit that coordinated the health information and social related activities. It has also recruited a health education and strategy -planning specialist for the IEC component of its reproductive health project.
Joint projects between the MOH and the WHO led to the development and implementation of considerable national and community based promotion activities mainly in the following issues: AIDS/STDs, NCD, Oral Health and reproductive health.
AUB has been the only University that offered a specialized graduate program in HED until 1987. In 1998, the Health Behavior Department at the Faculty of Health Sciences revived and strengthened its health education master degree. WHO is contributing in this respect through the provision of training sites to the residents of this program. In addition, the Health Education Resource Unit (HERU) at AUB is now being reactivated and will help in improving the efforts invested at country level. WHO also offered training sites to B.S students from Balamand University graduating in Public Health and Development Sciences.
The HED has planned two major activities for the coming biennium: the first one is related to the identification of media focal points, and to strengthen their skills in the provision and dissemination of health related messages and issues. Coordination will be done with various active projects and programs such as the AIDS/STDs, Tobacco, NCD etc. WHO will seize this opportunity to sensitize the media and establish collaboration plans with them foster health awareness for the public. On the other hand the department is also planning to develop a manual on how to conduct media campaign within the Lebanese context. The head of the HED has until now built lots of experiences in this domain and is planning to share it and train specialists from NGOs in this context. For this purpose there is a need to compile all the previous material developed and develop the training manual.
Objective:
The main objective is to foster healthy lifestyles throughout the whole life span to attain the best possible quality of life through promoting and maintenance of environments, conditions and interventions supportive to healthy living. The focus will be on enhancing positive dimensions of health to build up health potential and maintain health balance as well as discouraging negative attitudes and behaviours to reduce the risks of ill health.
2. School health education and promotion: Healthy Schools
2.A. School Health Education
The Lebanese government has launched a National Plan for the development of Education, mainly targeting the General Education and trying to answer the shortcomings at both the infrastructure and the human level. The Educational Reform Plan that was elaborated in 1994 by the National Center for Educational Research and Development (NCERD) focuses on the teaching quality component. Among its major objectives is to improve the general education quality, in particular the basic education through specific and precise actions on the various inputs of the learning process: revising the school curricula, in-course teachers' training, producing and disseminating textbooks and teaching material and re-organizing the public school network.
Along with the decision of the Lebanese government to integrate the environmental and health concepts into all disciplines and at all levels, WHO took the initiative to assist the national authorities in developing a strategy and a plan of action for the integration of health education in the national curriculum. A short-term consultant was recruited for that purpose and later on, a project-document was submitted by WHO to the NCERD. The project document included 3 components: two that were implemented with the NCERD (the research and the curricular components); and the third one, the extra-curricular evolved later on, and became a project with the Orientation and Guidance Department at the Ministry of Education. UNICEF, UNESCO /UNDP and UNFPA revealed interest in the project, especially in the environment component (UNESCO/ UNDP and UNICEF), and the extra-curricular activities (UNICEF). WHO acted as a coordinator and secretary for the project. WHO was able to get financial support to the project from the AGFUND amounting to US $79,000.
Objectives of the project:
- To integrate health and environment concepts within the national curriculum at all levels
- To launch extra-curricular activities through the establishment of school clubs
Achievements:
2-A-Curricular component:
- Implementation of a behavioral study among school students, their mothers and teachers
- Establishment of a reference corner at NCERD including health education material
- Issuance of two curriculums: the health and the environment ones in ministerial circulars in November 2000 under the following numbers 71/m/98 and 73/m/98 respectively
- Mobilization meeting for the book coordinators working with NCERD.
- Mobilization meeting for the publishers of the scholastic books working for the private sector
- Development and dissemination of a teacher's manual on health and environment education
- Sensitization meetings to trainers of all disciplines for the second and third years
- Integration of the health messages within the second and third years of each cycle
- Assistance in the development of a course on health and environment education for the teacher's training Centers of the Lebanese Government
- Assessment study of what had been integrated in the scholastic books for the basic education level
2-B Extra-Curricular components:
- Development of the final draft of the School Club Policy that was issued in a ministerial decree
- Issuance of two ministerial decrees specifying the new roles (for a year)of the health educators and health supervisors as per the New Education Reform Plan
- Development of the first drafts of the educational kits on the following health issues: oral health, nutrition, tobacco and drugs, including reference material, visual aids for students and parents.
- Development of preliminary drafts of the educational kits on the following environmental issues: air and water pollution, deforestation and ???
- Meeting with school health supervisors regarding their new roles and the launching of school clubs
- Mobilization meetings to school principals and inspector on the launching of health school clubs in 30 schools.
Constraints
2-A- Curricular
- Since the project had to adhere to the time schedule of the NCERD, and since the project started in 1998, it was not possible to integrate the health and the environment concepts as per the curriculums for the first years of each cycle. It is expected to compensate for that when the NCERD evaluate its curricula in the year 2003. The results of the assessment study can be of use.
- Absence of a clear evaluation methodology at the NCERD regarding the implementation of the new national curricula hinders the development of a well and clear defined plan of action for the evaluation of the health and environment education component.
2-B- Extra-curricular
- Lack of a clear decision regarding the specific roles of the previous health educators and supervisors.
- The educational kits on environmental issues need thorough revision and additional funds to be finalized.
- The population issue has not yet been carefully dealt with. Now that the UNFPA has finalized its 5th year plan (2002-2006), it is expected that technical support would be provided to launch extra-curricular activities, and assess what has been done in the scholastic book.
Future directions:
For the next biennium, the project will be focusing on building the capacity of the staff at the Ministry of Education as to support the launching of school clubs in the 30 primary schools, and provision of these schools with reference material to be able to launch extra-curricular activities. The possibility of extending this experience to reach intermediate and secondary students is of priority. On the other hand close contacts will be done with the NCERD in order to assess the possibility of further collaboration mainly for evaluating what has been implemented until now.
Contacts with other UN organizations, as well as other WHO supported programs will be maintained in order to assess further collaboration and widen the scope of partnership. The educational kits that will be planned be focusing on mental health and healthy lifestyles' related issues.
3. Oral Health Promotion
Situation Analysis and objectives
A pathfinder oral health survey was conducted in 1994. It disclosed high prevalence of dental caries and periodontal disease among 12 and 15 year old children in Lebanon. A national oral health survey conducted by the Lebanese University was completed in 1995. The results confirmed the high prevalence of dental diseases; among 12 years old children, prevalence of caries is of 93% with a mean DMFT of 5.7% per child. It is considered one of the highest in The Eastern Mediterranean Region. No signs of fluorosis were observed in the surveyed regions. Fluoride content of drinking water is very low and fluoridation of water or salt is not practiced.
In May 1999, a proposal for salt fluoridation in Lebanon was developed with support from WHO/EMRO. Work to implement the component of baseline studies including oral health survey, water fluoride levels, fluoride excretion, and fluoride dentifrice were executed. These studies were implemented by the Lebanese University assisted technically in this task by the head of the WHO Collaborating Center in Oral Health at the University of Texas USA, Dr. Baez.
The main directions for oral health care are to:
- consider systemic fluoride supplementation as a priority intervention (salt fluoridation) to reduce 30-40% of the prevalence of dental decay in Lebanon
- To prepare a national oral health plan for the country so as to combat oral health problems;
- To improve population accessibility to dental care;
- To review the oral health human resources situation to address problems of mal-distribution and inefficient utilization.
Constraints:
The implementation of the fluoridation project depends on the introduction of changes to decree number 1781 dated 1/9/1971 regarding the supplementation of chemicals to salt and its approval by the parliament.
Objective:
· Implement the proposed salt fluoridation proposal prepared by the nationals with support from WHO.
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