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Paper text:
international policy frameworks for school health , particularly the unesco - led fresh approach ( 12 ) and the who health promoting school concept ( 13 ) provide the conceptual context for the innovative fit for school action framework , which is the basis of operation for the fit approach ( see fig .
1 ) . the core of the fit for school action framework are the three 
simple : interventions in school health must be based on best possible evidence , should be cost - effective and are more likely to achieve high impact if only a few key diseases are at focus and the interventions are packaged to make implementation as easy as possible.scalable : the fit approach shows that large - scale implementation is possible if interventions follow a modular structure and are based on uniform templates .
using existing structures and resources is an essential part of scalability , such as relying on a few simple interventions implemented by teachers , rather than health professionals.sustainable : any programme will only be successful in the long run if it is not donor - dependent .
the fit approach is based on the principle of sustained government funding after an initial start - up phase .
it also actively involves actively communities and parents in the programme through a participative monitoring and evaluation ( m&e ) process or through the construction of required group washing facilities . a supporting policy framework that addresses macro- and micro - management issues alike is key in ensuring sustainability .
effective and appropriate research and monitoring complement and inform the programme management as well as political decision makers .
simple : interventions in school health must be based on best possible evidence , should be cost - effective and are more likely to achieve high impact if only a few key diseases are at focus and the interventions are packaged to make implementation as easy as possible .
scalable : the fit approach shows that large - scale implementation is possible if interventions follow a modular structure and are based on uniform templates .
using existing structures and resources is an essential part of scalability , such as relying on a few simple interventions implemented by teachers , rather than health professionals .
sustainable : any programme will only be successful in the long run if it is not donor - dependent .
the fit approach is based on the principle of sustained government funding after an initial start - up phase .
it also actively involves actively communities and parents in the programme through a participative monitoring and evaluation ( m&e ) process or through the construction of required group washing facilities . a supporting policy framework that addresses macro- and micro - management issues alike is key in ensuring sustainability .
effective and appropriate research and monitoring complement and inform the programme management as well as political decision makers .
a set of simple enabling principles is helping to pragmatically bridge the gap between well - intended policy and real - life implementation : clear agreements between stakeholders on vision and values of the programme , a formalised intersectoral collaboration and advocacy at the different levels of the health and education system , addressing the broad range of stakeholders on local , regional and national levels . in this context
it helps to demonstrate that effective school health contributes to different sectors of the overall development agenda .
effective school health , embedded in a community context , driven by the education sector and supported by the health and sanitation sectors produces benefits across many areas , makes schools healthier places and thus tackles determinants of health and contributes to greater health equity  all of this at exceptionally low cost . preventing diseases at an early age and promoting healthy life - skills promises huge long - term returns . 
the question now is not whether school health programs are necessary (  ) , but how they can be implemented at meaningful scale in the poorest countries , which need them the most .
we could not agree more with this statement from donald bundy , the world bank 's leading expert on school health .
the inclusion of school health in the declaration of the un high - level meeting on non - communicable diseases ( ncds ) is a step in the right direction to address the growing tide of ncds and puts effective school health back on political agendas worldwide ( 15 ) .
the philippines and the successful fit for school approach are at the forefront of intensified efforts to revitalise school health as a platform for concerted intersectoral public health action addressing health and education , but also key determinants of development progress .
school health programmes as a platform to deliver high - impact health interventions are currently underrated by decision makers and do not get adequate attention from the international public health community . 
 we describe the award - winning fit for school approach from the philippines as an example of a large - scale , integrated , cost - effective and evidence - based programme that bridges the gap between sectors , and between evidence and practice . in view of the challenges to achieve the health and education related millennium development goals ( mdgs ) in many countries , 
 intensified efforts are required . 
 we present the fit for school action framework as a realistic and tested approach that helps to make schools places of public health for children and wider communities .