Healthy Learners: embedding health education systems within government structures

Read how Healthy Learners designed their solution to be integrated into Zambia’s health and education systems, ensuring long-term sustainability.

Situation

Problem: School-aged children have limited access to healthcare. While many programmes focus on early childhood (under-5), the health needs of older children go critically overlooked.
Solution: Healthy Learners partners with the government to train teachers as community health workers, harnessing technology and linking schools with the healthcare system.
Impact: Over 4,000 health workers trained in 598 Zambian schools, providing health services to 980,000 students and improving well-being.
Annual operating budget: $9.8 million

Funding model at scale

Healthy Learners improves children’s health by training teachers to monitor students’ health and provide basic medical care. Additionally, teachers refer serious cases to government health facilities for further treatment.

Working closely with the Zambian Ministries of Health and Education, Healthy Learners integrates its model into government structures and systems, leveraging existing personnel.

By influencing partners, such as governments, to cover service delivery costs, Healthy Learners has developed a cost-effective strategy for scaling impact. Their success can be attributed to their commitment to embedding the model within government structures from the start. This strategy effectively reduces costs at scale and gives the solution the best chance of long-term sustainability.

Healthy Learners calculates that creating its programme outside of existing government structures would be five times as costly.

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Healthy Learners calculates that creating its programme outside of existing government structures would be five times as costly.
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Four key factors to partnering with government

Healthy Learners’ successful strategy to embed health education systems within government structures was built on four core approaches:

First, they proved impact through partnerships with academic institutions like Harvard and evaluations showing the programme’s health benefits and cost-effectiveness. They are now launching a $4 million randomised controlled trial (RCT) to deepen this evidence base.
The second step was building government partnerships from the start.

They collaborated with Zambia’s Ministries of Health and Education, signing MOUs and engaging stakeholders across national, provincial, and district levels. They also built capacity within government systems by training teachers and health workers.
They also provided tangible infrastructure by constructing health rooms in schools. These spaces served as a sign of government commitment, enhancing the programme’s visibility and political support among government partners.
Finally, advocating for policy and funding played a crucial role. Healthy Learners worked closely with Parliament to secure a dedicated budget line for the programme within health and education ministries. This ensured sustainable government funding to scale up.

Although embedding health education systems in existing government structures absorbs a significant portion of delivery costs, Healthy Learners must still fundraise to support essential activities. Government funding does not cover these costs.

Elements embedded into Government’s structure

Existing teachers are trained as School Health Workers, avoiding new payroll costs.
School administrators, also on government payroll, oversee the program daily.
The Ministry of Education created a School Health and Nutrition department to manage the program nationally.
Local Health and Education staff train health teachers and school administrators.
The THINKMD digital platform guides teachers in student health assessments.
School Health Rooms serve as an entry point to healthcare, with schools integrated into the Ministry of Health’s supply chain for medicines and test kits.

Elements that Healthy Learners needed to fundraise for

Setting up health rooms and providing initial equipment.
Salaries for nurses who train teachers.
Supporting the Ministries of Health and Education in training provincial and district staff.
Technical and financial support to train health teachers and school administrators.
Ongoing costs for supplies, equipment maintenance, etc.
Research and development to refine the model.
Advocacy to engage the government and strengthen supportive policies.

Three success factors in securing funding for scale

Designing a low-cost, integrated model

Healthy Learners deliberately designed their programme to have exceptionally low unit costs, around $1.46 per student.

Leveraging credible funders early on

In their early stages, Healthy Learners partnered with funders like Mulago Foundation and Cartier Foundation. This helped establish strong financial systems focused on cost-effectiveness, sustainability, and credibility with potential donors.

Diversification of funding sources:

Most of its funding comes from philanthropy (around 80-85%). However, they have also secured bilateral/multilateral funding, including a $4 million grant from USAID and the UK Medical Research Council for their large-scale RCT.

New report: Securing Nonprofit Funding

Who pays for scale?

Check out the report