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IPPCF Frameworks: Healthy Schools

  • Glossary Term (GT)
  • Capacity Building (CB) Practices for this IPPCFr
  • WoG Practices for this IPPCF
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The term "healthy schools" (HS) generally refers to a comprehensive approach to promoting health and well-being school-based and school-linked policies and programs. A healthy schools approach typically includes various components aimed at creating an environment that supports the physical and mental health of students, staff, and the broader school community. These can include healthy policies, health & life skills education/curricula, student health services as well as a supportive and healthy social and physical environment. The components tend to be more numerous and developed in high resource countries than in low resource and conflict-affected contexts where teachers are often asked to deliver primary care services and informal learning activities (rather than classroom instruction) are focused on fewer health problems. Although good overall health is generally accepted as condusive to student learning, research studies show that preventing severe health problems such as hunger, teen-age pregnancy, bullying, life-altering accidents and vision/hearing problems is more relevant to academic success than impacting longer-term health problems such as obesity/overweight, smoking or low levels of physical activity.

A  Healthy Schools Intersectoral Policy-Program Coordination Framework (IPPCF) can involve several sectors in promoting health. However,  the education and health sectors are the primary partners. The primary focus is on physical and mental health to a variety of issues in a variety of countries and contexts. These include nutrition, physical activity, HIV/sexual health, mental health and others.  Several research reviews of the application of the framework, including this Cochrane systematic review, have reported positive effects on knowledge, attitudes and child/adolescent behaviors on different issues,

The HPS framework  and HPS Standards published by WHO is the most recognized of several versions that have focused on physical and mental health. Other early versions that emerged in the 1980s included and emphasis on values & principles (Europe), a defined set of programs (United States), comprehensiveness & coordination of interventions (Canada) and accreditation of local schools (Taiwan). More recent models of HS approaches include an emphasis basic health programs in low resource countries (UN inter-agency network on School Health & Nutrition) . centralized planning (China) and participatory school change processes (Eurohealth)
See our list of applications of the Healthy Schools framework by clicking on the Multi-Intervention Programs (MIPs) section in the drop-down menu on the right hand side of this web page.
  • See the Section on Healthy/Health Promoting Schools in this web site for more information and discussion of this  multi-component approach 
See our List & Checklist of leading
Multi-Component Approaches (MCAs) & Multi-Intervention Programs (MIPs)
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Use the drop-down menu below to access more information on each IPPCF
Multi-Component Approaches (MCAs)
​Promoting Educational Success
  - Inclusive, Equitable Child-Friendly
​- Early Childhood Education
- Social, Emotional, Life (Living) Skills
- Students with Disabilities
- Transition to Work or Training
Barriers to Inclusion & Equity
- Out of School/Dropouts
- Gender related Barriers
- School Health & Nutrition
- Healthy Schools
- Discrimination/Racism
- Safe Schools (Violence, Bullying)
- Safe Schools (Crime, Drugs)
- Community Schools (Poverty)
- Disaster Risk Reduction
- Global Citizenship
- Peace Education
- Education for Sustainable Development
- Conflict-Affected Countries
- Low resource Countries
- Indigenious Schooling
- Minority Communities
Building Core Components
- Macro-Policy & Coordination (FRESH Framework)
- Integrated Student Services
- Physical Resources (WASH) 
- Safe School Buildings
- Curriculum & Extended Education (H&LS/PSH/HWB)
Multi-intervention programs (MIPs)
​​​Child Development
-  Child growth & development
-  Vision,
-  Hearing
-  Child Abuse & Neglect
-  Family Violence
-  Child Sexual Abuse 
-  Menstrual health & hygiene
Healthy/Risky Behaviours
-  HIV/STI, Sexual Health 
-  Sbstance abuse/tobacco use
-  Physical activity
-  Accidental injury/safety
-  Mental health/illness
- NCDs
-  Chronic health conditions
-  Sun safety
-  Evironmental hazards
-  Climate crisis health threats (Heat, Floods, Zika virus, Dengue Fever)
-  Infectious Diseases
- Immunization/Vaccinations
-  Oral/dental health
-  School Feeding/Meals
-  Obesity/overweight
Child Safety/Security
-  Child Trafficking/ Exploitation
-  Refugee students/immigrants
-  Bullying, Cyber Bullying
-  Gangs, gang involvement
-  Isolation, alienation, violent extremism, school shootings
This summary was first posted in in November 2023. It was revised on 13-12-2023 and is now published as a "first draft". We encourage readers to submit comments or suggested edits by posting a comment below or on the Mini-blog & Discussion Page for this section.
This tab on this page provides examples of, evidence for, and guidance about capacity building systems/organizational change practices that have been or can be used with this Intersectoral Policy-Program Coordination Framework (IPPCF).

These are several examples (Good & Bad) of capacity-building/systems change for this IPPCF:
  • A survey (p3) of members of the Schools for Health in Europe (24 of 40 member countries responded) found that while most countries implement individual health activities in schools, only one country reported in the survey that most schools use the HPS framework to coordinate those activities (CB#2). The report on the survey defined School health promotion as "various health promotion activities in schools. These activities can focus on multiple health-related themes such as physical activity and mental health, for example in the curriculum or in the policy of the school. This can, but does not necessarily, imply that the school has a structured and systematic plan according to the principles of a formal health promoting school." The definition of a "Formal HPS approach" according to SHE, describes schools that implement a structured and systematic plan for the health, well-being and the development of social capital of all pupils and of teaching and non-teaching staff. This is characterized as a ‘whole school approach’ and these schools actively involve pupils, staff and parents in the decision-making and implementation of health promoting interventions in the whole school system."

  • The Country Case Studies for Health Promoting Schools which were prepared as part of the process developing the revised HPS standards reveal a similar problem of countries not being aware, able or willing to use or require a coorinated set of interventions (CB#2). The key informant interviews were done in several low and middle resource countries, including Bhutan, Indonesia, Paraguay, Philippines, Senegal,. South Africa, Tunisia and Ukraine. Most had HPS "policies" in place for many years. Most of these countries had development partners (donors, foundations and UN agencies) as active partners. Most relied on a health and/or life skill curriculum focused on a few basic health topics as the ongoing focus within schools. The barriers to implementation and sustainability in each case study add to our argument for longer term, capacity-building, inter-ministry planning and coordination. The common findings from the case studies make the case for a paradigm shift in more specific terms:
    1. The HPS approach was considered aspirational.The main explanation for its aspirational given was that the countries were not comprehensively implementing HPS as defined by WHO and UNESCO. HPS would be overly ambitious for their context. (CB#1)
    2. Many countries are at an early stage of HPS implementation (despite many years of operation). A number of informants noted a highly programmatic focus in school health promotion and that programmes, such as those on WASH and nutrition, tended to be implemented discretely. They considered that more effort was required to identify common objectives. (CB#24)
    3. Collaboration between the health and education sectors is common and usually through informal communications between ministry officials or funded programs delivered by development partners. However, coordination through formal agreements, assigned coordinators etc is not common. (CB#6)
    4. National policies and implementation plans or guidance manuals were also reported as enablers for health promotion in schools but did not always result in a dedicated budget for school health promotion (CB#15)
  • (From WHO HPS Case Studies)  "The national commitment to school health in Bhutan is guided by a 10-year road map, the Bhutan Education Blueprint 2014–2024 (31). The National Education Policy also includes a 5-year plan, with “clear goals and expectations for the education sector [as well as] work with external agencies and development partners and planning commission on the areas for interventions”, which suggests that school health policies will be sustained. The key informant considered, however, that school health policies would be viable only with dedicated, sustained financial resources and capacity-building for teachers and school leaders beyond the current school health programmes, which are delivered largely by development partners." (CB#10)
  • A journal article reflecting on the difficulties of gathering policy documents for the WHO survey on 2018-2019 Sexual, reproductive, maternal, newborn, child and adolescent health identified a related challenge in the respondent misunderstandings about declarations, policies, standards and similar terms. The survey WHO data portal notes that a majority (over 80%) of responding countries reported that they have national standards for Health Promoting Schools. 150 countries responded to the survey but only 101 countries provided documents that could be assessed by the researchers. As a result, "Overall, of the 101 countries included in the validation of responses against policy, guideline, and operational guidance documents, a quarter of the validated survey responses (26%) corresponded to information found in the source documents (matches)" (p 2418). (CB#2)

Here are sources of evidence (research & fact-finding) of capacity-building/systems change for this IPPCF:
  • the need for a paradigm shift to achieve sustainable healthy schools programs has long been recognized. A 2003 analysis of the Quebec CSH program identified several conditions that were not being met. These included
    - negotiated planning and coordination to support the comprehensive, integrated nature of the approach (CB#3)
    - requiring intersectoral action to actualize the partnership between school, family and community (CB#2)
    - political & financial support from decision makers for adequate implementation (CB#5)
    - evaluation as a means to help develop effective (comprehensive) interventions further (CB#17)
  • In a detailed study based on complex systems theory and applied to several settings, including schools, Greaux et al (2023)  suggested that the “conditions that acted regularly as bottlenecks for implementation can possibly be explained by the way structural factors, i.e. the socio-economic and political context, are arranged, and which are operating ‘one level up’ from an intervention”.
  • a 2020 survey of SH coordinators in the European network (Schools for Health in Europe) made a distinction between schools doing "school health promotion" and those following a "formal HPS approach" or framework. The country report (p.3) noted that less than one-half of schools in most countries were using the HPS framework. The summary report (p.4) stated that staff in schools implementing SHP efforts as separate actions and activities, were often unaware of the need for a systematic whole school approach. The data on the responses of 24 country coordinators of the 40 members of SHE provides country level data on those countries and their capacity to apply a policy requiring coordination of interventions (CB#1)
  • The 2018 WHO Sexual, Reproductive, Maternal, Newborn, Child and Adolescent Health (SRMNCH) Policy Survey (p.10) found that almost two thirds of countries (64%) have national standards for health promoting schools (CB#), and over half (52%) monitor implementation of these standards. However, at the time of the publication of the report, WHO had not had the opportunity to correlate the responses from government officials with the documents provided, nor to validate/share the country responses with others in the country (See p.11 pf the report). A journal article prepared by the WHO researchers discussed the challenges of the survey/document collection process, creating a comparable policy database and verifying the responses to the survey. One of the challenges was respondent confusion about the different types of documents (p.4) (ie, between a law, policy, guideline, or strategic plan).(CB#2)  It should also be noted that these definitions did not describe what is meant by a "standard" which is the one used for reporting on HPS. The article (p.4) notes that only 26% of survey responses were able to be matched with policy or guidance documents provided by the respondents. The article refers to a publicly available database but access does not seem to be readily available. This discussion underlines the need for greater attention from advocates, practitioners and policymakers about terms, practices and strategies related to systems and organizational development (CB#22) and WoG#1).

Here are some of many guidance documents/reports promoting capacity-building/systems change for this IPPCF:
  • In 2015, WHO convened an expert meeting to review the school-based interventions and the HPS initiative at global level. A summary of that meeting reported that experts have identified eight major barriers for an effective implementation (and sustainability) of HPS initiatives: These included a lack of policies, guidelines, scale up plans, policy implementation; Insufficient lobbying and advocacy for HPS and school health activities; Insufficient amount of and timeliness of budget allocation; lack of coordination among related ministries and stakeholders (e.g. UN bodies, NGOs and academic institutions);lack of technical capacity on human resources and training; lack of quality and quantity of resources for implementation; lack of monitoring and evaluation, as well as insufficient data and evidence for promoting HPS and school health interventions; and cultural barriers to implementation. The 2015 WHO meeting concluded with the following nine points, recognized as key factors for implementing school health programmes successfully with limited human and financial resources; 1) establish systems for collecting better data, monitoring, reporting, providing evidence and utilizing evidence to make policy and implementation plans (CB#18)  2) strengthen inter- and intra-ministerial cooperation and collaboration among all stakeholders at all levels (CB#20) ; 3) strengthen advocacy at all levels for moving from policy to implementation (CB#18) ; 4) ensure sustainable funding, better costing, long-term financing plans and procedures (CB#6 & #16) ; 5) establish the health education curriculum as a home for all topics (CB#24); 6) develop institutionalized human resource development plans, such as pre-service and in-service training for teachers, health personnel and government staff (WoG#19); 7) promote a comprehensive approach (CB#1); 8) collaborate with all stakeholders at all levels (including the private sector) (CB#9); 9) promote the engagement of parents, students and teachers (CB#14).
  • The revisions to the WHO HPS Standards published in 2021 includes a section on Government policies
    and resources (pp. 17-18) whereby the whole of government is to be committed to and invest in making every school a "health promoting school". (This is not the same thing as WoG approaches that promote the education and overall development of the whole child, aspects of which are supported by other IPPCF frameworks). A HPS school is "a school that is constantly strengthening its capacity as a healthy setting for living, learning and working. A health-promoting school is contributing to all domains of well-being (see Box 2). The concept of HPS embodies a whole-school approach to promoting health and educational attainment in school communities." (In other words, the whole of government approach is supportive, but the unit of action is the school and the results are often to be measured and monitored at the school level. (CB#10, 11, 12 & 13) This differs from our definition of IPPCFs which states that "Intersectoral coordination is required if schools are to act as the delivery hub for a variety of school-based and school-linked services and programs promoting educational inclusion & equity". In our Handbook Section on our page on IPPCFs, we note that a systematic review and several case studies report that no school level approach has been sustainable and a detailed study using complex system theory suggesting that we look upwards in the education and health systems. We also note that often HPS policy and programming is primarily concerned with what educators and the education system will be doing, rather than having a reciprocal, negotiated and strategic partnership, with all partners contributing staff and funding (CB#3). (Nevertheless, the HPS Standard One and its 10 sub-standards (pp17-18) does describe actions to be taken on national policy, leadership, intersectoral partnerships and funding to support every school being a health promoting school. However, the other seven standards and their 50+ sub-standards are focused on the school, except the section on school health services which does propose national standards)
  • The WHO Implementation Guide for HPS is a better fit with our view of IPPCFs when it states that Inter-sectoral government coordination entails "development of a national plan for whole-of-government coordination of HPS, identification of roles and responsibilities for multiple sectors (education, health, and possibly social services, housing, employment and culture) and levels of government as well as development of practical structures for collaboration group(s) across multiple sectors and levels of government". (The WHO sub-standards (p.17) elaborate on these, with items similar to the list of capacities discussed here.) However, the implementation guide does not provide any detail and only one example (Bhutan - the citation was unavailable) of inter-ministry policy coordination. Most of the other suggested implementation steps and indicators within the HPS Implementation Guide refer to actions to be taken at the school level, or primarily by educators.(e.g. p7 - policy development is to occur in the education ministry/schools to make health a priority but does not discuss health ministry/agency policy on promoting student success. e.g. Standard One states that a "national education policy or strategy recognizes HPS as a means to achieve national development goals through education...)

















































  • [1] Deschesnes, M., Couturier, Y., Laberge, S. and Campeau, L. (2010), How divergent conceptions among health and education stakeholders influence the dissemination of healthy schools in Quebec, Health Promotion International, Vol. 25 No. 4, pp. 435-43


    [1] Nastaran Keshavarz Mohammadi, Louise Rowling, Don Nutbeam, (2010) Acknowledging educational perspectives on health promoting schools, Health Education, Vol. 110 Iss: 4, pp.240 – 25


    [1] Venka Simovska, Lone Lindegaard Nordin and Katrine Dahl Madsen (2015) Health promotion in Danish schools: local priorities, policies and practices, Health Promotion International, (2015) doi: 10.1093/heapro/dav009


    [1] Junko Saito, Ngouay Keosada, Sachi Tomokawa, Takeshi Akiyama, Sethavudh Kaewviset, Daisuke Nonaka, Jitra Waikugul, Jun Kobayashi, Mithong Souvanvixay and Masamine Jimba (2015) Factors influencing the National School Health Policy implementation in Lao PDR: a multi-level case study, Health Promotion International (2015) 30 (4): 843-854. doi: 10.1093/heapro/dau016


    [1] Michaela Adamowitsch, Lisa Gugglberger and Wolfgang Dür (2014) Implementation practices in school health promotion: findings from an Austrian multiple-case study, Health Promotion International, Advance Access
    10.1093/heapro/dau018


    [1] Behrouz Fathi, Hamid Allahverdipour, , Abdolreza Shaghaghi, Ahmad Kousha, and Ali Jannati (2014) Challenges in Developing Health Promoting Schools’ Project: Application of Global Traits in Local Realm, Health Promotion Perspectives, 2014; 4(1): 9–17, Published online 2014 Jul 12. doi: 10.5681/hpp.2014.002


    [1] Amanda Hargreaves (2012) The perceived value of Health Education in schools: New Zealand secondary teachers’ perceptions, Journal of Curriculum Studies, Volume 45, Issue 4, 2013 pages 560-582


    [1] Lisa Gugglberger and Jo Inchley (2014) Phases of health promotion implementation into the Scottish school system, Health Promotion International, Volume 29, Issue 2,

This summary was first posted in in November 2023. It was revised on 13-12-2023 and is now published as a "first draft". We encourage readers to submit comments or suggested edits by posting a comment below or on the Mini-blog & Discussion Page for this section.
This tab on this page provides examples of, evidence for, and guidance about how this framework (IPPCF) has been or can be part of Whole of Government (WoG) or inter-ministry approaches to the education and overall development of children & adolescents. (This not the same as using WoG approaches to strengthen a specific program or IPPCF (framework - which is examined in the tab on capacity-building), the WoG approach is supporting the whole child.)

These are several examples (Good & Bad) of how this IPPCF can be part or strengthen Whole of Government approaches on the education and development of the whole child::
  • The 2009-18 strategy for Health Promoting Schools published by the Prime Minister's Office in Kosovo[ is an example of how priorities can be developed to respond to documented contextual needs as well as one that addresses urgent issues and system capacity. The Kosovo action plan includes a review of the recent events and trends in the country, data about the status of schools at that time and a selection of six priorities. The strategy was developed by a large and well-informed stakeholder group that included national experts and stakeholders as well as UN agencies. The plan engaged several ministries of the Kosovo government and was led by the Prime Minister’s Office. The strategy also reviewed and aligned the HPS strategy with other frameworks in the country such as Child Friendly Schools(WoG#3). The six priorities were also further defined into measurable objectives and activities. They were:(a) Supportive school social environments, (b) Healthy physical environments including playgrounds and facilities, (c) Training of educators in health promotion, (d) Improved care for students in schools,  (e) Reduction of violence in schools and (f) Adoption of the European HPS framework (WoG#2)
  • The European network of health promoting Schools (Schools for Health in Europe) and the Joint Consortium for School Health in Canada both recommend that their participating members have SH Coordinators jointly named by at least two ministries (WoG#18)
  • The Surrey school district in Canada has their coordinators on safe schools, community schools and healthy schools reporting to the same person in senior management.(WoG#18)
  • The International School Health Network (ISHN) submitted a "better practices" brief to the UN Transforming Education Summit that recommended whole of government approaches and actions to change systems/ministries of government so that Intersectoral Policy-Program Coordination Frameworks (IPPCFs) can be coordinated and sustained.




Here are sources of evidence (research & fact-finding) on how this IPPCF can be part or strengthen Whole of Government approaches on the education and development of the whole child:



Here are some of the many guidance documents/reports about how this IPPCF can be part or strengthen Whole of Government approaches on the education and development of the whole child:




This summary was first posted in in November 2023as a "first draft". We encourage readers to submit comments or suggested edits by posting a comment below or on the Mini-blog & Discussion Page for this section.

​For updates and reader comments on this section of this web site, go to our
Mini-Blog on Common Topics &Terms

Here is our list of topics for this section:
- Introduction & Overview
- Education Equity, Inclusion & Success - Intersectoral Policy-Program Coordination Frameworks (IPPCFs) (published at global level)
- Multi-component Approaches (MCAs)
- Core Components         - School Culture & Climate
          - Staff Wellness
          - Student Conduct & Discipline
          - Engaging/Empowering Youth
          - Parent Participation
          - Community Involvement
  • Physical Environment & Resources
- Multi-Intervention Programs (MIPs)
  • How to Build a Multi-Intervention Program
- Single Interventions (Issue-Specific Programs, Policies, Services, Practices)

- Learning/Behaviour Models (LBMs)

- Behaviour & Learning Theories

- Government/Inter-sector Actions & Levers - Workforce Development
  • Workforce Planning in HPSD
  • Teacher Education & Development
    - Early Childhood Educators
    - Primary School Teachers
    - Secondary PSHE Specialists
    - Home Economics Specialists
    - Physical Education Specialists
    - School Counsellors
    - School Psychologists
    - School Principals
  • Preparing Other Professionals to Work with or within Schools
    - School Nurses
    - School Social Workers
    - School Resource (Police) Officers
    - Security/Civil Protection Guards
    - Teaching/Learning Assistants
    - School Administrative/Clerical Staff
    - School Maintenance Staff
    - Pastoral Counsellors
    - Community Volunteers & Elders
    - Emergency Relief Aid Workers
    - Development Aid Workers
- Systems Approaches
  • A Systems Focused Paradigm
  • Contextualizing Approaches & Programs
  • Implement, Maintain, Scale Up & Sustain Programs & Approaches
  • System & Organizational Capacities
  • Integrate Within Education System Mandates, Concerns & Constraints
  • Better Use of Systems Science & Organizational Development Tools