By Sandrine Bohan-Jacquot
Inclusive education is often misunderstood as a way to integrate children with disabilities into “regular” classes. But in fact, it’s a broader strategy that not only covers children with disabilities, but attempts to remove barriers that prevent any child from participating meaningfully in education.
Working on education in developing countries, I‘ve learned the hard way that promoting inclusive education means having to involve governmental and non-governmental actors from multiple sectors, namely education, health and social affairs. However, I regularly face the invisible but also firmly fixed frontier of each sector.
Let me (over)simplify: on one hand, there are education stakeholders (who are supposed to buy books, train teachers, build schools, etc.), and on the other hand, there are health stakeholders (who are supposed to procure medicine, train medical staff, build hospitals, etc.). I wish life was that simple and thematically organised…
The thing is, I keep bumping into health issues in my education work, and they’re a serious hindrance to implementing inclusive education. I face issues I hardly can respond to because I’m told they’re health / WASH / nutrition issues, not education ones. I disagree. They’re also education issues because inclusive schools need to be “healthy”. They’re education issues because better hygiene means getting sick less and going to school more. Because children with empty stomachs cannot learn. Because there’s no one to refer children to who can provide the support they need to learn (such as speech therapy, psycho-social support, rehabilitation or assistive technology providers).
These six health-related issues are some of the biggest hindrances I’ve encountered to inclusive education in developing countries:
1. Water access
Many schools I’ve visited in Burkina Faso, Cambodia, Ghana, Malawi, and South Sudan have no piped water or even access to wells. This means children have to bring their own water to drink during the school day, which is problematic, as they might not have sufficient water resources at home, either. It also generally means the school has limited hand-washing procedures–and therefore high rates of diarrhea. Another lesser-known consequence of limited hand-washing is high rates of eye infections, because children touch their eyes with dirty hands. A lack of water also means fewer options for income-generating activities at the school (how do you grow vegetable or raise goats without water?) and no vegetable garden for either teaching or feeding purposes.
In Cambodia, I observed that many children appeared to suffer from malnutrition, which surprised me in a country that has been at peace for more than 30 years. Malnutrition can significantly affect children’s growth and their cerebral and psychomotor development, limiting their ability to learn. Yet nutrition is rarely a component of inclusive education projects in Cambodia, even though it would be so relevant there and in many other countries. After all, “Ventre affamé n’a pas d’oreilles.” Hungry bellies have no ears.
On top of the problem of limited hand-washing, potable water is not readily available in most developing countries. Many people do not treat their water because it requires purchasing chlorine or filters or using wood, fuel or electricity. As a result, the rate of diarrhea is high. At the same time, diseases caused by intestinal worms pose a threat to education, but research has demonstrated that deworming treatments help students learn more and stay in school longer.
4. Open defection
In every country I’ve visited, I’ve seen open defecation. Latrines are sometimes available at schools, but usually in insufficient numbers (one or two for hundreds of students) and are sometimes not used because they’re too dirty, as the whole community may have been using them. Plus, they’re rarely accessible to persons with disabilities. The lack of latrines particularly affects the schooling of girls when they begin menstruating. A research study conducted by the World Bank Group shows links between latrine availability and children’s size and development, confirming the need for proper toilets (and use of them) in schools.
5. Health services
In inclusive education, schools should respond to the learning needs of all children. For children with disabilities, for instance, it means providing access to rehabilitation measures and assistive devices. For those with physical and sensorial disabilities, you may find a few services in developing countries (e.g., wheelchairs, glasses, hearing aids, etc.), but many other services, such as speech therapy, rarely exist. In Cambodia, for example, there are no speech therapists and no programs to train them.
Yet, this service would save lives: people with untreated swallowing disorders are 13 times more likely to suffer premature death. It would also serve all children with difficulties learning to speak, communicate and simply learning to read. This could meet an enormous need, as only around 50% of children in Africa are able to read and write by the end of their fifth year of schooling. However, global poverty could decline by 12% if all students in low-income countries acquired basic reading skills.
If we start talking about mental health, the needs are huge and just not covered. Mental health is the “the poor cousin” of heath programs in developing countries. According to the World Health Organisation (WHO), there are 0.05 psychiatrists and 0.16 specialised nurses per 10,000 inhabitants in low-income countries. High-income countries have 200 times more. In 2012, Cambodia’s Centre for Children and Adolescent Mental Health had one psychiatrist and seven beds, for a population of around 14 million people who suffered the Khmer Rouge genocide 40 years ago.
6. Lack of health staff
Teachers in many developing countries are often asked to identify and screen for disabilities, to offer psychosocial support, to refer children to specialised services, etc. But teachers are meant to teach, not to do the job a school nurse. Where these services are needed, we should advocate for hiring nurses to conduct school visits on at least an annual basis. They may not reach the most vulnerable out-of-school children, but it would be a start.
In the status quo, we train teachers to teach in front of hungry children, who are at risk of limited cerebral and psychomotor development or who are not even at school because they’re sick. We ask parents, school committees or parent-teacher associations to participate in income-generating activities they have no means to implement. We ask teachers to perform health services.
These issues might not technically be in my sector, but they’re a serious hindrance to everything I try to implement in schools. It’s time for health to come into schools, and time for us to more seriously discuss cross-cutting issues.
Sandrine Bohan-Jacquot is a consultant working with the Enabling Education Network (EENET) in Cambodia. She specialises in the fields of inclusive education, disability and teacher training, and has six years of teaching experience. Sandrine has also consulted and implemented projects for a variety of governments, international agencies and NGOs in Central Asia, Southeast Asia and Africa.
Featured image shows primary school students participating in a school feeding program in Malawi. Photo by Sandrine Bohan-Jacquot.
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