Landmark school health programme delivers major gains, highlights urgent need for sustained care

Dili; Timor-Leste has recorded important gains in school health systems under the Say No to 5S (SN5S) project, with endline findings from one of the country’s most far-reaching school health programmes showing both the progress achieved and the need for stronger follow-up care, community engagement and sustained government investment.

The findings were shared on Friday at the Endline Results Dissemination Workshop for the SN5S Project, jointly implemented by the World Health Organization and the World Food Programme in collaboration with the Ministry of Health and Ministry of Education, with funding from KOICA. Over 4.5 years, SN5S targeted five priority health risks among school-aged children across all 14 municipalities of Timor-Leste.

“It is not often that we have genuinely new evidence about the health of our school-age children,” said Dr Arvind Mathur, WHO Representative. Calling the findings “groundbreaking”, he said they should shape how Timor-Leste invests in school health going forward.

The endline evaluation survey, conducted between February and May 2026, was led by researchers from Universitas Gadjah Mada (UGM) in Indonesia through two components: a school-based survey covering more than 2,100 students and 270 teachers across 65 schools; and consultations with over 200 government officials, health workers, teachers, students and community members.

Presentation of the Endline Results. (WHO Timor-Leste)

“What stood out most clearly was the strong willingness among school authorities to sustain the positive changes in health practices introduced through the programme and ensure that these gains continue,” said Dr Bagas Suryo Bintoro and Ms Shita Listya Dewi, Principal and Co-Principal Investigators from UGM.

The results point to a major strengthening of school health systems. The proportion of schools with trained health staff more than doubled, from 31% to 76%. Schools providing health services both on campus and through nearby health facilities rose from 12% to 27%. Schools with functional piped drinking water nearly tripled, from 14% to 38%. Eighty-five percent of sampled schools reported that tobacco and alcohol prevention had been integrated into the curriculum.

Dr. Elizabeth Leto Mau, Director General of Primary Health Care, delivering her address at the endline results workshop. (WHO Timor-Leste)

“The key outcome of the programme has been the deeper collaboration between health and education sectors,” said Dr Elisabeth Leto Mau, DG Primary Health Care. “Schools are now better connected with Community Health Centres when students require additional care. The programme is now more comprehensive, covering eye, skin, ear and oral health, and national coverage has improved. Healthy children concentrate better in class and achieve better academic results,” she added.

Attendees review the project's key findings. (WHO Timor-Leste)

"Almost 2,000 teachers have been part of this programme, helping turn schools into places that promote not only learning but also health and well-being," said Mr Fernando Soares, Director-General of the Ministry of Education. “This assessment will help us identify what should continue, and the Ministry of Education remains committed to working with partners so that support reaches every child, especially in remote areas.”

Stronger systems, however, have yet to fully translate into sustained health outcomes. Serious intestinal worm infections declined by the end of the project but remained higher than at the start, rising from nearly 6% at baseline to 16% at midline before falling to close to 9% at endline. This points to the need for stronger prevention between treatment rounds to reduce reinfection.

Tobacco use declined only modestly, while alcohol use remained stable, underlining that school-based education must be supported by stronger family and community engagement.

“SN5S has laid an important foundation for school health, including trained personnel and national data to guide future decisions,” said Ms Suji Lee, Deputy Director for KOICA. “This evidence helps us understand the impact of our joint work; guide future strategies and investments in school health.”

WHO Representative Dr. Arvind Mathur alongside key stakeholders at the endline results dissemination workshop. (WHO Timor-Leste)

Dr Mathur underlined that the findings now point to clear priorities for the next phase: ensuring that children receive the care, follow-up and support they need, especially in hard-to-reach schools and communities.