I spent a year working and living on a tea estate outside of Darjeeling, India in 2006. This was my first trip to India and it quickly became apparent that it would certainly not be my last. It was during this time that the Darjeeling Hills became a second home to me and with that was born a life-long relationship with Darjeeling.

As part of my training at Harvard Medical School, I spent another year living and working in Darjeeling, this time as an AIF Fellow and cofounder of Broadleaf Health and Education Alliance. After realizing the harsh realities related to the mortality and morbidity of children in the Darjeeling Hills, my wife and I worked alongside a local NGO in Darjeeling to develop an innovative model for school health. My background in health and her background in Elementary Education was the perfect collaboration to develop CHHIP, the Comprehensive Health and Hygiene Improvement Program.

CHHIP is aimed at school-aged children in the Darjeeling Himalaya who are burdened by unmet health needs that threaten their ability to develop and thrive. Their poor health status is reflected in high rates of stunting, anemia, and preventable infectious diseases, all of which contribute to poor academic achievement.

Our team recognized that a key barrier to effective school health is human resource constraints. We believe that the key to unlocking school health is the identification of effective delivery agents. Traditional delivery agents for school health programs include teachers, mid-level health providers, and physicians. However, in many communities, there is a shortage of medical professionals and teachers are overburdened with competing responsibilities.

In contrast to these limitations, we also saw passionate individuals committed to the education and development of the children in their communities. Our approach was to develop a novel task-shifting model in which lay community members are trained to deliver comprehensive school health programs in rural primary schools. We termed these community members School Health Activists (SHAs).

Joyful health education empowers children to be agents of change in the health of their communities

For the past seven years we have rigorously tested this innovation. The results, which have been recently published in Pediatrics, are exciting. We observed that the SHAs could successfully deliver health education and basic primary health services. Teachers held positive perceptions of the SHAs and parents trusted their role in promoting the health of their children. Ultimately this program resulted in a 33% reduction in the incidence of diarrhea, 13% increase in health knowledge, and improved the students’ growth and development.

We believe that within every community there are dedicated individuals that can be empowered to deliver school health. This model could be crucial in achieving India’s public health goals. As the work continues, my relationship with Darjeeling continues to deepen, bringing me back to India several times a year to further expand upon our work and relationships within the region.


– Michael Matergia MD, Executive Director, Broadleaf Health and Education Alliance and AIF Clinton Fellow, 2011-12

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