Ensuring that children are healthy and able to learn is critical. Poor health and malnutrition among school-age children lead to low school enrollment, absenteeism, poor classroom performance, and early school dropout. School-based programs that counteract these factors and promote good health, hygiene, and nutrition benefit many of the poorest and most disadvantaged children.

In Zambia, where malaria, malnutrition, and parasitic infections are endemic, and where the prevalence of HIV is as high as 20%, Creative Associates is working with the Zambian government to place schools at the forefront of the battle against disease. The CHANGES (Communities Supporting Health, HIV/AIDS, Nutrition, Gender, and Equity Education in Schools) project is implementing a cost-effective and sustainable strategy for reaching children and the greater community with health services and health education. It represents a multi-sectoral project that integrates education, health, and community development. The program mobilizes schools and communities across Zambia; more than 30,000 students, as well as hundreds of teachers and health workers, are participating.

CHANGES has two components - school health and nutrition, and community sensitization and mobilization - both of which incorporate HIV/AIDS awareness activities and a small grants mechanism.

Under the school health and nutrition component, teachers are trained to administer deworming medicines and micronutrient supplements to students. Teachers are also trained to include health education in their classes. Under the leadership of the Ministry of Education, the health and nutrition component is expanding to 160 schools in Eastern Province, and there are plans to expand into several other provinces. Recently, CHANGES completed the third annual testing of students who had received deworming treatment and micronutrients. The biomedical data and cognitive scores from those tests are used to identify the link between healthier students and enhanced ability to learn. Findings to date have shown a clear correlation between health and cognitive ability.

Awareness-raising activities have focused on preventive health and increased educational opportunities for girls. CHANGES uses street theatre performances and other mobilization strategies to focus communities on public health, education, HIV/AIDS prevention, and the importance of girls' education. The program also trains government officials on the value of gender equity.

Grants to schools and communities have provided learning materials and resource centers for children. Over 50 grants have been awarded, with 10 more awaiting approval. The grants help local community groups build on the work of CHANGES by supporting girls' scholarships, establishing school gardens, and constructing latrines, safe water systems and health and education resource centers. Several of these grants are assisting vulnerable children, including orphans girls and those affected by HIV/AIDS.

The AIDS epidemic in Zambia is among the most severe in the world and threatens to undo decades of social and economic development. Educating young children about health is essential to reducing the spread of the virus.
CHANGES is collaborating with the Ministry of Education to implement life skills and HIV/AIDS prevention activities in the curriculum. HIV/AIDS and teacher guides are translated into local languages. On the broader policy level, CHANGES is conducting the first comprehensive assessment of the impact of HIV/AIDS on the education sector. The results will help guide future government policy.

CHANGES is funded through USAID's Basic Education and Policy Support (BEPS) Activity through July 2005.