Papa Sehat (Healthy Control Boards)
School age is the golden age for introducing and instilling the values of clean and healthy living behaviour (CHLB) in children. Encouraging children to adopt CHLB is a key focus of Indonesian primary schools’ activities, with the aim of reducing levels of contagious illness and increasing good nutrition. This is especially important to introduce at a young age, as many schools and homes do not have access to clean running water and lack adequate toilets and hand-washing facilities.
Children make up over 30% of Indonesia’s total population of 240 million, and the majority complete at least primary and junior secondary school. There are more than 250,000 public, private and religious schools across all levels of education. This has led to a significant variety of different approaches in educating children about clean and healthy living behaviour (CHLB), often resulting in insufficient understanding about hygiene and, ultimately, high levels of child illness. Between 40% and 60% of Indonesian school-aged children had worms in 2005 according to data from the Ministry of Health; 23% suffered from anaemia in 2007 (Buana Foundation); and over 100,000 children die from diarrhoeal diseases every year (WHO).
In 2009, Abdul Aziz Dg. Rani, a teacher at a primary school in Takalar District, became concerned about high levels of student absenteeism due to diarrhoeal illness. He began working on a new approach on how to better support students and teachers implement CHLB activities. He realised that in order to properly learn, students needed to play active roles in CHLB activities, not just sit there and absorb information in one-way teaching sessions.
Students were tasked with creating their own Healthy Control Boards for each classroom from coloured cardboard and recycled plastic. The boards listed all the CHLB activities that students should do every day:
1. Bathing with soap and shampoo
2. Brushing teeth with toothpaste
3. Washing hands with soap in running water
4. Cleaning and trimming finger and toe nails
5. Combing hair
6. Cleaning ears and nose
7. Using clean toilets
8. Drink boiled water
9. Dress cleanly and neatly
10. Dispose of rubbish in the right place
11. Don’t eat unhealthy snacks
12. Eat breakfast
13. Guide younger siblings to live cleanly and healthily
14. Deliver hygiene and health messages to family members at home.
Each morning before class begins, students fill in the board and register whether they have completed each activity by dropping their names into the ‘yes’ or ‘no’ boxes for each activity. Overseen by a ‘Healthy General’ – a student elected to the role to guide others – students then make weekly reports to their teachers, who in turn compile monthly reports for the school to assess its progress on CHLB.
Students from the first trial school in Takalar District showed enthusiasm for the program, and health results were also positive. Prior to the introduction of the Healthy Control Boards, just seven (20%) of 35 grade 6 students at the school met CHLB criteria; after the boards, all 35 students fulfilled them. Furthermore, in an average week after the boards’ introduction, just two students (6%) experienced diarrhoea, compared to eight students (23%) prior to the program.
What Makes Your Project Innovative?
Most Indonesian schools implement CHLB activities, but each school’s overall program varies significantly in implementation as well as success. What is innovative about the Healthy Control Board is that it requires students to think about CHLB every day, encouraging them to evaluate whether they are genuinely putting healthy behaviours into practice. The control board supports them to be honest in their reporting because they will feel embarrassed in front of their friends if they admit to not performing CHLB activities. However, students are not shamed if they were unable to do one of the activities, but rather encouraged to remember the importance of CHLB and to do better next time.
Additionally, the Healthy Control Board and Healthy General elements mean that CHLB activities are participatory from beginning to end. Students are involved in planning, implementation, and evaluation; they are not simply instructed to do something by a teacher, but rather make their own commitments.
What is the current status of your innovation?
After successfully being trialled in one class at one primary school in 2007, the program was expanded to other classes at the school. Other schools became interested and the material was introduced to the local teachers’ working group for further discussion. The Takalar District Education Office decided to adopt the innovation at another 89 schools by 2011, reaching more than 15,000 students.
Since 2018, the innovation has been officially incorporated into the broader CHLB program in Takalar. Following a circular letter from the Takalar District Head, all 248 primary schools in the district are now implementing the Healthy Control Boards activities.
Collaborations & Partnerships
The principal strongly supported the initiative, and following the success at their own school, began collaborating with the South Galesong Sub-District’s school principals’ working group to replicate the program across the Sub-District. For expansion across the whole of Takalar District, the District Education Office ensured activities were standardised and budget allocations were available for capacity building on CHLB, while the District Health Office assisted through training teachers.
Results, Outcomes & Impacts
In 2009, when the innovation was first developed at implemented, 25 students in grade 6 at one school in Takalar District participated in the trial. Following the introduction of Healthy Control Boards, 100% of students met CHLB criteria (compared to just 20% prior to the trial) and only 2 students (6%) experienced diarrhoea (versus eight students [23%] before the program). Later that year, the program expanded to all 200 students at the school.
By 2011, 90 schools in Takalar District had adopted the program, and following a circular letter from the District Head in 2018, all 248 primary schools are now implementing the Healthy Control Boards.
Challenges and Failures
At first, students did not think the Healthy Control Board was an important activity, but with time, they came to understand that it is a useful reminder and way of evaluating their CHLB.
Some teachers have struggled with the activity because they also do not see it as useful – they assume students will be able to achieve CHLB without the boards, for example, or alternatively think their students are too young to complete the boards. With training and support, teachers can begin to understand as well as adjust the boards to their own students’ ages, maturity levels, and needs.
Finally, some parents do not think that their children should participate in school cleaning activities. They argue that there are janitors to perform this role. Through awareness raising, however, parents also begin to understand that if children keep their schools neat and tidy, they will adopt clean behaviour and implement it at home as well.
Conditions for Success
To succeed, the innovation requires well-motivated teachers who are trained on the importance of CHLB for children’s health and growth. It also required students to feel that they are active participants in the program rather than just passive recipients of information.
It should be noted that some elements of the CHLB activities may not be achievable in some areas, for example where clean running water is not available, or may prove difficult for poor families or families living in remote areas with limited access to basic sanitary products such as soap, shampoo, toothbrushes, and toothpaste. School budgets should also include allocations for the purchasing of soap and the installation or improvement of sanitation facilities. Local education and health offices should work together to ensure that CHLB is achievable at both school and home.
In addition to Barru and North Luwu districts in South Sulawesi Province, other provinces such as Papua and East Nusa Tenggara have begun adopting the initiative in eastern Indonesia. Takalar District hopes that other areas will continue to be inspired by the innovation and join them in implementing it.