SCHOOL HEALTH PROGRAMS IN PAKISTAN

1. RIPHAH INTERNATIONAL UNIVERSITY ISLAMABAD
SCHOOL HEATH PROGRAMS IN PAKISTAN
COURSE: FUNDAMENTALS OF PUBLIC HEALTH
Program: MS HCM
Assignment No: 01
Assignment Topic: School Health Care Program in Pakistan
Submitted ON: May 5, 2019
Submitted TO: Dr. Rao Sanaullah Khan
Submitted By: Group B
Group Members:
Javeria Nisa Mir (29169)
Faiza Javed (28636)
Samreen Afzal (29560)
Amina Tariq (27933)
Muhmmad Akbar Rashid (29381)

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Table of Contents
1.History of School Health Program............................................................................................1
1.1. Definition ..........................................................................................................................1
1.2. History...............................................................................................................................1
1.3. Basic Component of School Health Program....................................................................1
1.4. Importance of School Health Program in Pakistan ...........................................................1
1.5. Evolution of School Health Services in Pakistan..............................................................2
1.5.1School Health Program By NCHD...................................................................................2
1.5.2. School Health Program By PHSRP................................................................................3
1.5.3. UN Support for School Health Programs ......................................................................4
1.5.4. Policy Commitment of Pakistan With Respect To SHP.................................................5
1.5.5. School Health Programs in Private Sectors ....................................................................6
a. Keep Pakistan Smiling
b. Nestlé Healthy Kids Program
c. Safeguard Pakistan School Education Program Empowering Children with
Hygiene Education
2.Comparison of School Health Care System of Pakistan With WHO Standards (Europe) .9
2.1. Global School Health Initiative by WHO .......................................................................10
2.2. Current School Health Program or Services in Pakistan ................................................13
2.3. Objectives of School Health and Nutrition Program 2018 .............................................13
3.Gaps of School Health Program in Pakistan..........................................................................14
3.1. Reasons Behind the Gaps in Pakistan .............................................................................14
3.2. Management of Gaps Identified ......................................................................................17
4.Recommendations for Future School Health Programs in Pakistan...................................18
4.1. School Health Education.................................................................................................18
4.2. Physical Education ..........................................................................................................18
4.3. School Health Services....................................................................................................19
4.4. Nutrition and School Health............................................................................................20
4.5. Health Promotion for Staff & Psychological Services....................................................22
4.6. Healthy Environment & Parents and Community Involvement......................................23
5.Bibliography..............................................................................................................................25

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List of Figures
List of Tables
Table 1 Active components of SHP and supporting agencies 4
S: No Description / Name Page No
Figure 1 Drinking Water Pumps in School Provided By UNICEF 3
Figure 2 Dental Health Month 2012 7
Figure 3 Goals of Nestle Healthy Kids Programs 9
Figure 4 Pakistan School Health Recommended Model 24

4. School Health Care Program
1.1. Definition
Comprehensive school health program is an organized set of policies, procedures and activities
design to protect and promote health and wellbeing of students and staff which has traditionally
included health services, healthful school environment and health education. (Allensworth,
Wyche, Lawson, & Nicholson, 1995).
1.2. History
School health program (SHP) is not a new concept. In most of the developed countries school
health program are important part of their education system. Multiple international and national
organizations are working on school health care program in many countries. It is the responsibility
of the state to facilitate optimal physical and mental growth of children so as they become
productive member of society in future. In Pakistan school health services has been delivered in
fragmented manners (Pakistan, 2010).
1.3. Basic Components of School Health Program
Many factors can affect health and learning process of school children. These factors include
quality of life of their parents, children personal health and hygiene, school environment,
awareness about health promoting activities and availability of health services. Modalities and
delivery form of school health services can be grouped in following categories.
• School Health Environment
• School Health Education
• School health Services
• School Nutrition Program (Pakistan, 2010).
1.4. Importance of SHP In Pakistan
According to WHO report (2014), Pakistan spent only 2.6% of total GDP on its health
expenditure. Pakistan has worst mortality rates among various developing countries due to

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Communicable disease, absence or ineffective and inappropriate delivery of health care services.
Health promotion at school level can contribute in reduction of disease burden (WHO, 2010).
Because 37 million children and 1.3 million teachers are in school. Which represent one fifth of
total population of Pakistan (Farooq as cited in Prasla & Prasla, 2011).
It is hazardous to ignore this population segments because children are future of nation. By
promoting school health care program, we can enhance healthy environment for living, learning
and working (Organization, 1997).
1.5. Evolution of School Health Services in Pakistan
In the early 70’s, school health services were part of health delivery system. In the 1978 WHO
Alma Ata declaration, “Health for All” by year 2000, become base for health promotion. Pakistan
as a signatory of this declaration extended its school health program with new amendments (Prasla
& Prasla, 2011).
In 1980, s school health program was started with the purpose of children health screening and
medical doctors were specially appointed for this purpose. But due to lack of proper monitoring
system this program could not achieved desired results (Pakistan, 2010).
Recently in Punjab, school health program was launched by Punjab Health Sector Reform
Program and National Commission for Human Development (NCHD).
1.5.1. School Health Program By NCHD
NCHD launched school health program in 17 districts of Pakistan with funding from Bill and Melinda
Gates Foundation in June 2005. This program covered 23,266 school of selected district and provide
services to 1.86 million students. This program includes:
• Bi annual screening of students for health problems and referral system for corrective action.
• Screening of 1.86 million student during 2007-2008.
➢ 3.31% were diagnosed with weak eyesight.
➢ 1.31% were diagnosed with eye diseases.
➢ 1.04% were diagnosed with weak hearing and 1.2% with ear diseases.

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➢ 5.2% suffered from dental problems and 2.54% students were suffering
from skin problems.
➢ Free glasses were provided to 53543 students suffering from weak eyesight
(Pakistan, 2010).
1.5.2. School Health Program Launched by Punjab Health Sector Reform Program
(PHSRP):
PHSRP designed and launched school health program (SHP) in 2008 after realizing that there is
a need to provide awareness about health and nutrition in school children of rural areas. Purpose
of this program was to improve student’s health, nutrition and learning ability, to increases school
enrolment and attendance, to introduce and promote better hygiene practices in community.
It was initiated to achieve Millennium Development Goals (MDG’s) in health, education and
child protection. SHP in Punjab has following features and achievements:
I. Appointments: In 22 districts in Basic Health Unit (BHU) level School health (SH) and
Nutrition Supervisors (NS) have been appointed.
II. Training Modules: Preparation and distribution of training material including manual
for SH & N Supervisors and Teachers on school health program with cooperation of
UNICEF.
III. Training of SH & NS: Training has been given to selected SH & NS about their tasks
related to SHP.
IV. Training of Teachers: Training has been given to teachers by SH & NS on common
ailments of students e.g. ENT, Eye, Dental, Skin and general physical problems.
V. Health screening: teachers and SH & NS are
conducting health screening of students.
VI. Referral & Treatment System: if any problem
detected then the students are referred to BHU.
health officers at BHU level examine students and
provide required treatment. If any student required
specialized treatment then he/she referred to
health of children. To improve school
Figure 1:
1
Drinking Water Pump in
School Provided by UNICEF

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specialty available in nearest hospital e.g. RHC, THQ, DHQ & tertiary hospitals. and all
the health services are provided free of cost.
Punjab government has established a steering committee to ensure coordination between health and
education departments, donors and implementation partners and formed working group on SHP. SHP
in Punjab is still at its initial stage. At present, it is mainly focusing on School health services.
UNICEF is also cooperating in improvements of school environment by constructing toilets and water
pumps (Fig. 1) for promoting hygiene education and testing water quality of 46000 schools (Pakistan,
2010).
1.5.3. UN Support for School Health Programs
To improve the quality of life of the peoples United Nation is committed to achieve Millennium
Development Goals (MDGs) by assisting member of states in the Education for All (EFA) and
other international norms and Conventions. Four UN agencies (UNICEF, World Bank, UNESCO
and WHO) signed a framework titled “Focusing Resources for Effective School Health Program’’
(FRESH) on World Education Forum held in Dakar, Senegal in April 2000 to show their dedication
for School Health Program.
S. No. Activity/component of SHP Supporting Agencies
1 Water and Sanitation facilities (provision of water
pumps and toilets etc.) and water quality monitoring
UNICEF
2 Health Screening WHO, UNICEF
3 Hygiene, sanitation and environment education UNICEF, WHO, UNDP,
UNPFA
4 AIDS Prevention Education, Adolescence Education UNESCO, UNAIDS,
UNICEF
5 Life Skills based Education UNICEF, UNESCO, UNFPA
6 Drug Education UNODC, UNESCO
Javeria Nisa Mir
CMS# 29169

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7 Population Education UNFPA, UNESCO
8 Food for education- School Feeding programs WFP
9 Training of teachers on Health Education, training of
teachers
WHO, UNICEF
10 on School Sanitation and Hygiene Education (SSHE) UNESCO, WHO
Table 1: Active components of SHP and supporting agencies
School Health Program and different components associated with this program are being supported
by number of UN agencies (WHO, UNICEF, WFP, UNFPA, UNESCO, UNODC and UNDP).
But still there is lack of holistic approach. School Health Program (SHP) has been envisaged in
the Joint UN Program on Health and Population (2008-09).
Education and health should be working with collaboration for success of School Health Program.
A Holistic approach has been lacking even after number of UN agencies have been supporting
different elements of School Health Program. To form a focused program of school health the
entire individual agency based dissipated interventions can be united and inter-linked.
Govt. of Pakistan can achieve this by increasing coordination with United Nation agencies and by
showing strong interest and focus.
1.5.4. Policy Commitment of Pakistan With Respect To SHP
Following Policy Actions regarding School Health Program and related emerging trends were
provided by The National Education Policy (2009).
“Emerging trends and concepts such as School Health, Prevention Education against HIV/AIDS
and other infectious diseases, Life Skills Based Education, Environmental Education, Population
and Development Education, Human Rights Education, School Safety and Disaster and Risk
Management, Peace Education and inter-faith harmony, detection and prevention of child abuse,
etc. shall be infused in the curricula and awareness and training materials shall be developed for
students and teachers in this context, keeping in view cultural values and sensitivities”.
Above provision of National Education Policy, under the section on Curriculum Reform are
comprehensive. This provision shows commitment of Government of Pakistan to add content on

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health and related issues like AIDS, Human Rights its Prevention Education, Life skilled
Education, Population Education and other important areas in the curriculum.
Another Policy Action is quoted below:
“School Health Education and School Safety shall be infused within the curricula and learning
materials with focus on improving school environment, enriching health education content,
instituting regular mechanism for health screening and health services of students and nutritional
support to needy children in coordination with Departments of Health, Environment and
Population at the Federal, Provincial and District levels”. (Policy Action No 10).
Regular mechanism for health services for schools, nutritional support and health screening to
deserving children in schools is being supported by New National Education Policy action no.10.
On 09 September 2009 new National Education Policy has been approved after the approval
Federal and Provincial Governments stand committed for implementation of above-mentioned
policy actions.
In September 2009 National Drinking Water Policy has envisages that safe and sustainable Water
supply should be provided to entire population of Pakistan. National Sanitation Policy (2006) also
aims to provide sanitation and hygienic facilities to improves the quality of life of people of
Pakistan and provide physical neat and clean environment necessary for healthy life.
Both these Policies support the availability of basic facilities like water and sanitation to all,
necessarily including in schools. Basic facilities like Clean water and sanitation contribute a vital
role towards improving a healthy Environment in schools, which is a very important aspect of
School Health Program. (Ministry of Education, 2010)
1.5.5. School Health Programs in Private Sectors
A. Keep Pakistan Smiling:
In 2016 COLGATE-PALMOLIVEIS worked in partnership with Pakistan Dental Association and
organized free dental check-ups in different cities of Pakistan throughout September 2016 and
make it an ORAL HEALTH MONTH 2016.

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As a global initiative to reach out millions of people and spread smile across countries. Different
dates schedule was provided for different cities across the country.
Following were the facilities provide:
• Free dental check-ups for people from all walks of life, in well-known dental institutes,
clinics, schools and stores.
• Arrangement and working of mobile dental vans in remote areas where dentists access is
limited.
• Awareness of Dental Hygiene as their prime goal.
• Free dental camps in schools for oral hygiene practices.
Figure 2: Dental Health Month 2012
From early 2000s Oral Health Month in Pakistan has gone strength. To reach campaign it has
increased to more cities and to towns and villages, where access was difficult. Colgate believes
that cavity free smile is right of everyone.

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In 2011, free check-ups were provided across 18 cities with the help of 300 leading dental institutes
awareness was provided to 161000 Pakistanis. In 2012 number reached to more than 200000.
Families especially children Schools were targeted for oral hygiene practices.
➢ Launched ‘MY BRIGHT SMILE CALENDAR’ in 2018.
(Colgate-Palmolive, 2016)
b. Nestlé Healthy Kids Program
Nestle launched ‘Nestlé Healthy Kids Program’ in 2010 among school age children keeping in
view the double burden of malnutrition among children in Pakistan.
Key features of the program:
• Nationwide program and covers schools across Punjab.
• Nationwide curriculum-based program i.e. non-branded in nature.
• Works in collaboration with 10 educational partners from development, private and public
sectors and reached Federal Capital, Sindh, KPK and aspires to reach more areas.
• NHK program comprises of 2 books (in both English and Urdu)
• Covering 250 school branches and reaching out 180000 students involving 800 teachers.
• Primary beneficiaries are school children between 6 to 16 years. (Pakistan N. , 2010)

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Figure 3: Goals of Nestle Healthy Kids Programs
C. Safeguard Pakistan School Education Program Empowering Children with Hygiene
Education:
This program has its roots in Karachi Soap Health Study (2002) led by the centers for Disease
Control, Hope and Procter and Gamble. Having a Partnership with Public Sector Health
Organizations to make a difference Health and hygiene programs are carried out in Collaboration
with PAKISTAN MEDICAL ASSOCIATION.
Safeguard School Program has empowered more than 5 million school children between 6 to 11
years with hygiene education over the last four years. Covered more than 10,000 schools in 100
cities of Pakistan.
In Pakistan every year more than 250000 children die from diarrhea this handwashing message
become survival for them.(Pakistan S. , 2002)

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2. Comparison of School Health Care System of Pakistan with WHO standards (Europe)
2.1. Global School Health Initiative By WHO:
• WHO's Global School Health Initiative was launched in 1995.
• Its purpose is to organize and strengthen the health promotion and education activities
at the local, national, regional and global levels.
• The aim of this initiative is to improve the health of students, school teachers, families
and other members of the community through schools.
• WHO and UNESCO are launching a new initiative “Making Every School a Health
Promoting School” through the expansion and advancement of Global Standards for
Health Promoting Schools in collaboration with civil society organizations or other UN
entities. The initiative will aid over 2.3 billion school-age children and will contribute to
the WHO's 13th General Program of Work target of achieving “1 billion lives made
healthier” by 2023.
• WHO's Global School Health Initiative’s concept is adopted by the Ottawa Charter for
Health Promotion (1986).
• A Health-Promoting School can be termed as a school constantly firming up its
dimensions as a healthy site for living, knowledge and working.
2.2. Focus of Health Promoting School According to WHO Is:
• Concerned about oneself and community.
• Making healthy decisions about life’s circumstances and taking control over them.
• Creating environments that are favorable to health (through strategies, physical / social
conditions).
Samreen Afzal
CMS# 29560

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• Building capabilities for food, hygiene, income, education, peace, shelter, a stable
ecosystem, equity, social justice, sustainable development.
• Preventing leading causes of death, disease and disability: tobacco use, sedentary
lifestyle, drugs and alcohol, violence and injuries, unhealthy nutrition.
• Influencing health-related activities: knowledge, beliefs, skills, attitudes, values,
support.
2.3. Components of Health Promoting School According to WHO Are:
2.3 (A). School Health Environment:
1. Safe, clean drinking water (with regular monitoring of quality of water).
2. Proper sanitation, toilets (gender and culturally appropriate).
3. Play grounds, spacious class rooms and child friendly environment.
2.3 (B). School Health Services:
1. Medical checkup of students on regular basis.
2. Proper referral system of students with health issue to medical centres.
2.3 (C). School Health Education About:
School
health
program
School
health
environment
School
health
education
School
nutrition
program
School
health
services

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1. Cleanliness, personal hygiene, sanitation, healthy food and clean drinking water,
physical, sports and environmental education.
2. Information about various communicable, non -communicable diseases.
3. Anti-drug and anti- tobacco education.
4. Teacher’s orientation and life skills education.
2.3 (D). School Nutrition Program:
1. School lunch program.
2. Supplements for malnourished children.
School Health Services in Pakistan:
Pakistan school health services remained part of Health service delivery, being signatory of
Alma-Ata declaration. Khalid, S. T. (2017).
All school health programs initiated in different years by different organizations in Pakistan
were supported by different agencies like WHO, UNICEF, UNESCO etc. For example
School health care programs by:
➢ NCHD (National commission for human development).
➢ PHSPR (Punjab health sector reform program) in collaboration with:
o Health Department
o Education Department
o UNICEF
o District Governments
➢ Program by Ministry of Education, Curriculum Wing in collaboration with UNESCO
(United Nations Educational, Scientific and Cultural Organization) in 2010.
➢ Nestle’ Healthy Kids program in Pakistan in year 2010 launched in 250 schools in
collaboration with local and national government.
The main target or focus of all above mentioned program was quite similar that is:

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➢ Health screening, teachers training, appointments, referral system and treatment of
common ailments but not all the components were included in all programs e.g. Punjab
school health program’s focus was health services only and lacking other components
like nutrition, health education, environment education etc. Similarly nestle’ healthy kid
program’s focus was nutrition and physical activity. Some programs were restricted to
one province only. Initial results of every program were encouraging but almost all were
stopped due to:
o Mismanagement.
o Lack of interest of local and national government.
o Lack of interest of stakeholders and organizations.
o Low replicability in other provinces due to resources constrains.
Current school health program or services in Pakistan:
On December 11, 2018. Punjab Minister for school education and health Minister launched School
Health and Nutrition Program in selected 1,700 public schools of nine districts and in the initial
phase, Initial targets were Rawalpindi, Rahim Yar Khan, Lahore, Jhang, Bhakkar. Khan,
Mianwali, Multan, Sargodha etc. and gradually would be extended to other districts of Punjab in
the second phase.
Objectives of School Health and Nutrition Program 2018:
• Periodic screening of health status of students at school level.
• Assessment of nutritional requirements of students.
• Provision of basic health care facilities including ENT (eyes, nose, throat)
through school health and nutrition supervisors.
• Provision of hygienic and fresh food at affordable prices at cafeterias.
• Installation of 100 water filtration plants in government schools.
• Cleanliness of schools, toilet facilities specially in girls’ schools.
Government also launched an android phone application with the help of PITB (Punjab
Information Technology Board) and secondary healthcare commission to monitor the program.

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3. Gaps of School Health Program (SHP) in Pakistan:
As clarified above, school wellbeing programs contribute in upgrading both wellbeing markers
among youngsters just as improving proficiency of the education system. Undernourishment
because of destitution, absence of education, and absence of basic knowledge about wellbeing and
nutritional values contribute toward disintegration of wellbeing states of the youngsters from lower
socioeconomic groups. In the absence of an extensive school health program, following issues are
still rising in Pakistan
• Learning environment in schools has not improved yet.
• Parents and teachers are not aware of the prevalence of various ailments and disorders
among the children, which affect their learning, & can be treated at early stages.
• Several children still face difficulty in their studies due to physical disorders and may
leave the school without knowing nature of their health problem.
• A considerable proportion of children remain malnourished, particularly from
disadvantaged groups, and their smooth physical and mental growth are inhibited.
• Children and their parents, particularly in rural areas, are more vulnerable to various
diseases and infections.
• Higher dropout rate lead to wastage of resources and negatively affect efficiency of
education system.
• Overall health indicators among next generations remain low.
• Social and economic disparities among different segments of the society are widening
• A ceremony for launching of School Health Programme by NCHD 14 Experts believe
that investment on school health programmed would yield higher social returns, in the
areas of education, productivity of human resources, their health, and environmental
protection in a given country.
By investing on school health Programme, Pakistan can overcome problems, deficiencies,
and gaps referred above.
3.1. What are the reasons for these gaps?
Faiza Javed
CMS# 28636

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Pakistan needs to take concrete steps for launching of a country Programme of School Health, and
then its institutionalization and sustainability. Types of strategic actions that are still not
considered for School Health Programme in Pakistan are listed below.
1) Legislation and policy reforms for provision of health and nutritional support to all children in
schools are still not clearly established and published.
2) Formulation and enforcement of equitable standards of school facilities for all schools are not
in practice.
3) Resource mobilization for School Health Programme (SHP) has not been done.
4) Coordination mechanisms between Health and Education sectors are still lacking
5) Institutional capacity development, i.e. technical and administrative support to the relevant
organizations and institutions at national, provincial, and district level is still just a proposed
strategy.
6) Advocacy and research is not in practice in favor of increased attention to education and health
of school children.
7) Sustainability mechanisms, to ensure that projects launched are consequently integrated into the
regular system are not monitored at any level.
Mostly being contributor subsidized activities; long haul manageability and sustainability of these
programs were flawed. Consequently, school wellbeing advancement program in Pakistan is still
in its outset state. A basic audit on School wellbeing advancement features that little consideration
has been paid to investigate school's job with regards to youngster wellbeing advancement
exercises, even less endeavors are done in systematic recording and documenting the present
status of school wellbeing advancement in Pakistan
In Pakistan, 41.1614 million kids between 3-18 years (pre-nursery to higher secondary level) are
going to schools; and not overlooking 21% of the un-enlisted number of youngsters speak to

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almost one-fourth of the populace. There is a desperate need to plan and uphold evidence-based
initiatives including partners from general society, private areas and civil society to guarantee
sustainable responsibility for program. The tripartite association of training area (proprietor of the
program) with lead specialized job being allocated to health sectors (PMDC and other medical
organizations both at undergrad and post graduate levels) is required to satisfy the social duty.
Solid oversight and feasible help by CSOs and universal bodies, for example, WHO, UNICEF
and UNESCO may offer a path forward to accomplish the hotly anticipated unaccomplished
mission.
Social and cultural perspective assume an important aspect in the development and execution of
any health advancement program (Michaud, 2003). There are instances of numerous projects
which functioned admirably in one piece of the world while, demonstrated ineffective when
administered in different areas without considering social sensitivities.
Tending to a few medical problems in isolation may not deliver attractive results, since it would
have inadequacies in overall implication for child health. Reconciliation with curricular subject
including science and languages could be advantageous, as the message of wellbeing
advancement passed on through numerous stations (Hochbaum, 2010).
Racette (2010) reports a longitudinal investigation of estimating effect of physical exercises
program on overall wellbeing pointers of school age children. This investigation recommended
that educational modules incorporated wellbeing advancement program is bound to succeed on
the off chance that they intercede at different dimensions. Utilization of play roles, dramatization,
theater and different structures performing expressions as an instructive device can possibly
impact person's lives by giving space to self-reflection and commitment with characters. This
incorporated methodology should be executed as a major aspect of organized and coordinated
wellbeing advancement program.
Positive conduct is an extra significant angle for powerful school wellbeing program. Projects
center around wellbeing advancement learning to scattering just information is more averse to
acquire any attractive change conduct, additionally proof incapable in longer run. These sorts of
methodologies typically characterized knowledge into exact areas, and permit little open door for

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holistic methodology, which is fundamental for understanding any phenomenon and prompts
social and behavioral changes. Some High hazard practices, for example, substance misuse are
the results of friends’ pressure, impact from broad communications and the public, numerous
juveniles feel pressurized and discover almost no break to oppose this weight. In these
circumstances, just dispersal of data about negative results isn't enough. Wellbeing experts need
to make any firm move against this (Hochbaum, 2010).
The strong administrative actions required in these circumstances would change, for example,
there would be a need to confer self-administration and social obstruction aptitudes to make
youths positive about their activities and avoiding such motivations (Tall, 2011).
3.2. Management of Gaps:
To manage such sorts of situations there is a need to include youngsters straightforwardly in basic
leadership process for the advancement of wellbeing programs. This would not just make a
proprietorship among pre-adulthood yet additionally helps to recognize genuine requirements of
its recipients.
At last, it isn't enough to present a school wellbeing advancement program which is socially
delicate, it must has coordinated methodology and has capacity to adjust practices. There is an
equivalent need to take a shot at the supportability and long-term sustainability of program. Much
of the time once starting enthusiasm is finished, the program loses its intrigue. In longer keep
running there is having to make approach to make program more rational. As such the
advancement program could accomplish the political consideration that requires promotion at
strategy formalizing level.
Considering everything, to advance Children wellbeing there is a need to fortify school health
advancement programs. Even though, legislature has attempted to work in different approaches
to advance school wellbeing administrations still numerous intercessions are required to achieve
Child wellbeing and advance solid condition in which kid could learn positive practices which
could prompt sound population.

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4. Recommendations
4.1. School Health Education:
According to UNESCO School Health program, the children should be educated about cleanliness,
personal hygiene, sanitation, prevention against various communicable, non-communicable
diseases, HIV, AIDS, healthy food and physical activities (UNESCO, 2010)
Health education and health services are the most neglected part of school education in Pakistan.
The reason behind it is, we made policies, but we don’t implement policies. Lake of political
interest, funds shortage, and low educational or health budget are the main issues to implement
these policies (Parsla & Parsla, 2011).
Opportunities should be provided to primary school students to get accurate health information
about their health, illness and prevention. Information should be provided to the students about
health topics like hand washing, clothing, safety, nutrition, eating disorders and obesity. Develop
awareness about diseases, and hand washing (AAFP: School Health). The most cost-effective
investment of a nation is to promote health education (Afzal et al., 2010).
Who promotes school health program to reduce risks of communicable diseases among children
(UNESCO, 2010). There is a positive relationship between the health conditions of school learners
and learning outcomes (Racette et al., 2010).
On the bases of above arguments, it is recommended that health education should be the part of
Pakistan School Health.
4.2. Physical Education:
Physical education benefits students by increasing physical activity level, improving graded and
help them to remain active physically and mentally in class (CDC Physical education). Childhood
obesity it at epidemic level, proper physical activities prevent, reduce the chance of obesity in
children (Ogden, carroll, Kit, & Flegal, 2014). Schools are considered as important settings for
physical activities. Schools can promote physical activities among children (Trost, Rosenkranz, &
Dzewaltowski, 2008).
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CMS# 27933

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The main goal of each educational system is to promote school physical activities to attain children
skills at optimum level. The growing demands for quality education with short economic resources
are challenging for schools to maintain physical activities (Trost & Van, 2009).
There is a significant positive relationship between child physical activity and academic
performance with the effect of aerobic exercises (Fedewa & Ahn, 2012). There is a positive
relationship among physical activities, fitness, cognition and academic achievements. It was also
concluded that physical activities have positive influence on brain structure, and function. Physical
activities reduction may be harmful for child academic performance (Donnelly et al., 2016). For
the high performance of memory, the physical activities intervention should be greater (Kamijo,
et al. 2011).
On the bases of above arguments, it is recommended that physical education should be included
in Pakistan School program.
4.3. School Health Services:
Children are prone to diseases. In developing countries, health services are very poor. Health
information is very low. Teachers and parents are unable to detect diseases of children. School
health services should include health screening (general health, eye, and ear etc. checkup), student
referral to health centers, and de warming campaigns. Many students can be saved from losing
interest in their studies by screening of health issues (UNESCO, 2010).
School health is the branch of preventive medicine which deals with preventive and curative
aspects of diseases. School health system is a coordinative system, which coordinate with the
school and community health system (Small, et al., 1995).
School is a community basically, where a large population of students and teachers live together.
And communities also have their issues related to health. Health services should be provided to
this community. These services include first aid, prevention from communicable diseases, and
non-communicable disease. Since 1952, school health service was part of government
infrastructure but still does not exist practically. Sindh government rolled back this program due
to lack of doctor’s interest. Health clinics in 3000 to 5000 schools of all provinces of Pakistan are

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provided with the help of UNICEF and Bill Gates Foundation, but their results are yet to be seen
(Ahmad, & Danish, 2013).
It was concluded in a study, which was conducted in Nigeria that school health services were better
in private schools as compared to government schools. Health conditions of children of private
schools were better than government schools. It was recommended that proper schools health
services should be provided to all government and private schools (Kuponiyi, Amoran, &
Kuponiyi, 2016).
On the bases of above arguments, it is recommended that School health services should be included
in Pakistan School Health program.
4.4. Nutrition and School Health:
Nutrition plays main role in overall health. Nutrition also affects the learning capabilities of
children. In Pakistan malnourishment of children is very high. Improvement in food and nutrition
child health can be improved. By improving food chain supply, school attendance can be
improved. Under developed areas are suffering from insufficient nutrition. The nutrition phase of
school nutrition includes: Food supplements for malnourish children, enhancement of food quality,
promotion of iodized salts, and school feeding or school lunch program (UNESCO, 2010)
Consistent health education program and school health nutrition program need to be established in
schools to improve healthy nutrition and dietary habits (Alsubaie, 2017). Healthy nutrition plays
role in good health and unhealthy nutrition leads to chronic diseases. Healthy diet helps to protect
against malnutrition (WHO, 2015).
Nutritional status of school age children impacts their educational status and health status.
Malnutrition is a public health issue among school children in developing countries and non-
developed countries. Nutrition interventions in school age children are needed (Best et al., 2010).
School based nutrition produced a moderate increase in fruit and vegetable intake in children.
These interventions will take part to prevent chronic diseases (Howerton, et al., 2007).
Based on above arguments, it is recommended that nutrition should be included in Pakistan school
health program.

24. 21
4.5. (A) Health promotion for staff:
Staff health promotion program can reduce staff absenteeism and can also increase productive
work among school staff. This may reduce healthcare associated costs and promote school health.
More schools should include comprehensive program to the betterment of their staff. Health
promotion programs for school staff can increase physical mental, social and emotional activities
(Eaton, Marx, & Bowie, 2007).
School mental health includes the mental wellbeing of school children, teaching staff, and
management staff. Significant level of stress is common in work place not only in school but most
of the work places. According to American psychological association most of the United States
residents have work stress. It includes all type of jobs. 33 % Americans have chronic work stress
(APA, 2013).
Individuals working in schools are vulnerable to work stress. According to the data high level of
stress was found in 46 % school teachers (Gallup, 2014). American federation of teachers reported
that 78 % American teachers feel physically mentally exhausted at the end of the day. Educators
stress affects the longevity of the work and professional behavior (AFT, 2015). According to a
survey, 10% teachers leave their job after one year and 17% leave within first five years of their
job due to stress. More teachers in urban areas / districts are leaving their jobs as compared to rural
districts (Gray & Taie, 2015).
Based on above arguments, it is recommended that health promotion for school staff should be
included in Pakistan School Health Program.
4.5. (B) Psychological services:
School psychology is a general practice; this psychological practice is related with school children,
youth, families and learner of all ages. The basic training of school psychologist is to screen,
diagnose, treat and rehabilitation of school child. School psychologists are prepared to check
individuals and can work in a system. School psychologists can make policies about school
psychology. The school psychology varies from area to area. School psychologists are accountable
for their practices. They protect the rights of the school children, families and community (APA;
School Psychology).

25. 22
School psychology is very popular among western countries but the role of school psychologist
among children, parents, teachers and community (Bell, & McKenzie, 2013).
The psychological needs of children vary from country to country or region to region
(Hatzichristou, Lampropoulou, & Lykitsakou, 2006). Chinese culture is very different form
western countries. Chinese children are more obedient towards their teachers as compared to
western children from their childhood. Chinese children psychological level is compared to other
regions (Jia, Way, Ling, Yoshikawa, Chen, Hughes, & Lu, 2009).
Mental health care services are needed to incorporate at primary or community level in Pakistan
(Khalily, 2011).
Based on above arguments, it is stated that school psychological services should be included in
Pakistan school health.
4.6. (A) Healthy Environment:
School environment is one of the major parts of school health. Health school environment plays a
role in physical fitness, mental wellbeing and learning (Healthy School Campaign Organization).
More than 50 million American school children spend their day in school buildings (U.S.
Department of Education, 2010). When school environment is unhealthy, it will affect their mental,
physical and social health status. This may badly affect their health, attendance and academic
performance (National Research Council: US, 2006).
School environment plays a key role in school health. It affects the mental health, physical health
and learning outcomes. Facilities should be provided for healthy school environment. These
facilities should include; filtered water, appropriate sanitation, spacious class rooms, comfortable
seats arrangements, play grounds, child friendly environment, and proper physical activities
(UNESCO, 2010).
Poor health condition is schools are due to poor economic status, poor nutrition, limited physical
activities, homework, non-filtered water and incomplete immunization. Environmental issues are
crowded classrooms, poor ventilation, shortage of clean water, unhygienic clothes, lack of school
greenery, school location near to roads and poor nutrition (Joshi, Pandit, & Kuma, 2005).

26. 23
One the basis of above arguments it is stated that healthy school environment should be included
in Pakistan school health.
4.6. (B) Parents and community involvement:
Children are the future of any nation. Progress of any nation depends upon the quality of
knowledge of their students. That’s why special care should be provided to the children. Parents
and family’s involvement in school education enhance the learning capabilities of children. In this
way national development can be improved (Henderson, & Berla, 1994).
If parents have some concerns about their child performance, they must encourage school
administration to solve that problem. Parents and teachers meeting should be arranged to solve
child issues. Parents involvement helps their child to improve their behavior and learning outcome
(Chaudhry, Khaliq, Agha, & Hassan, 2015).
It is well understood fact that parent involvement in child education makes a positive impact on
children academic performance. The constant parent involvement will also constantly improve
child performance.
The most effective form of parent involvement is to help in learning activities like reading and
writing. Tutoring the child about school work will have positive impact on child. Torturing the
children will have negative impact on their academic performance and mental health (DAWN,
2010).
Based on above arguments, it is stated that parent’s involvement should be included in Pakistan
school health.

27. 24
Figure 4: Pakistan school health recommended model
Muhammad Akbar Rashid
CMS: 29381

28. 25
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