Evaluating the impact, investment case and scale-up of 'Health Promoting Schools' in Fiji

Background

The Pacific Islands experience some of the highest burden of noncommunicable diseases in the world especially diabetes mellitus and obesity with the Pacific Forum Leaders declaring the situation a “human, social and economic crisis”. According to a Fiji Adolescent Health Situational Analysis: 2016 by the Fiji Ministry of Health and Medical Services, Fijian adolescents experience excess burden of noncommunicable disease that include physical and mental illness.

In 2016, Health Promoting Schools (HPS) was launched in Fiji. This is cross-sector program developed originally by World Health Organisation (WHO) aims through the school curriculum to improve health and wellbeing by addressing common risk factors in three areas: (1) diet and physical activity, (2) water, sanitation and hygiene (WASH), and (3) mental health and wellbeing. From 2016 to present, 285 schools (out of total 907) implemented the HPS program. Thus far little evaluation evidence exists from this initial phase to inform the scale-up of HPS, particularly the next phase of expansion to 200 schools.

Aims

The goal of this research program is to evaluate the impact, investment case and sustainability of the Health Promoting Schools program in Fiji. The project will specifically address the following research questions:

1. What are the lessons for program design and implementation that can be gained from the initial rollout of HPS in 285 schools?

2. How do we take on board these lessons to co-produce the next phase of expansion of the HPS?

3. What is the effectiveness and equity impact of HPS?

4. What is the investment case for HPS?

5. How do schools sustainably embed HPS into their curriculum?

Project plan

This research is a partnership between the George Institute for Global Health, Fiji National University and the Fiji Government (Education and Health ministries). The study will capitalise on the phased rollout of the HPS to generate real time evidence that successively informs implementation in its different stages:

1. a mixed methods process evaluation will be carried of the initial rollout to the 285 schools to understand the factors that influence implementation, and generate lessons for the subsequent phase of the rollout;

2. using the findings from (1) a series of co-design workshops will be held across Fiji to obtain community input into the next stage rollout;

3. a prospective evaluation of the effectiveness of the intervention, comparing outcomes at baseline and 12 months between:
   (i). 200 new schools receiving HPS vs 402 schools yet to receive HPS (‘no intervention’). This will assess the initial intervention effect.
   (ii). 285 schools who have had HPS since 2016 vs 200 new schools receiving the intervention. This will assess potential change in effectiveness over time. The outcomes being assessed based on online survey of all primary and secondary aged children (n = 224,000), will be quality of life, diet and exercise, hygiene and sanitation (behaviours and environment) and mental health;

4. Economic evaluation and budget impact analysis will be carried out to assess the investment case for HPS. The economic evaluation will involve trial-based cost effectiveness analysis (cost per QALY gained) and cost consequences analysis to identify the suite of outcomes achieved relative to cost. The budget impact analysis will assess the overall costs to government of scale-up;

5. Sustainability analysis in which we will use a questionnaire previously developed to assess progress of individual schools in embedding HPS into its curriculum. Data will inform individual schools and government of areas of improvement in relation to the wider implementation. Using this tailored adaptive approach to evaluation, we ensure that the HPS evolves into a program that has the best chance of realising its underlying potential for health, educational and social outcomes.

Principal investigators

Team members

Funding organisations

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