School health

SCHOOL HEALTH
Karthikeyan R
Nursing Officer
IRCH
AIIMS
http://surgicaltechie.com

Meaning of S.H.P.
The school health programme refers to
all school activities that contribute to
initiation, understanding, maintenance
and improvement of the health of pupils
and school personnel, including health
services, health education and healthful
school living.
SCHOOL HEALTH

National association of school
nurses,2001
The school nurses gives care not only to the
children in the school building itself but in
other settings where children are- eg., juvenile
detention centers, in preschools and day-care
centers, during field trips, at sporting events,
and in the children’s home.

Programme relevance
• Sizeable population segment
• Crucial phase of development
• Group-living experience
• Crowded living condition

Program relevance contd…
• Controlled population group
• Impressionable age group
• Willing for a change
• Useful community link
• Valuable national asset

History of school health program
1800s-Metropolitian Association of Nursing,
England, provided medical examination for
school children.
1892- Nurses responsible for checking
nutrition of the school children.
1897- In U.S. nurses identify ill school
children.
-Laws mandating nurses to teach within
the school.

History contd…
1902-Lilian Wald’s Henry street settlement
nurses, in N.Y. began assessing children for
infectious diseases ,in homes and schools .
1910-Teachers college in N.Y. city added
school nursing course to nursing curriculum.
1920s- School nurse teachers employed by
- most municipal health departments.
1940s- Concern over school buildings.

History contd…
1950s-Attention to screening of children,
-Emphasis on school employee health.
1960s- Call higher levels of education for
school nurses-minimum bachelor’s
degree.
1970- 1st
school nurse practitioner program
at University of Colorado.http://surgicaltechie.com

History of S.H.P. - India
1909- Medical examination for school
children
in Baroda.
1946- Bhore committee report- school health
services non-existent.
1953- 2nd
5yr. Plan school health & feeding
programme initiated in many state
govt.
http://surgicaltechie.com

Goals of S.H.P.
To prepare the younger generation to adopt
measures to remain healthy to make use of
educational facilities, utilize lesiure in
productive manner, to enjoy recreation and
develop concern for others.

Goals contd…
To help become healthy and useful citizens
who will be able to perform their role
effectively for the welfare of themselves, their
families, the community at large and country as
a whole.

Objectives of S.H.P.
To increase health awareness in school
children to a level where they can treat health
as a valuable personal, family, community and
national asset.
To educate and guide the school children and
prompt them to adopt health-giving habits and
healthy lifestyle and to give up injurious habits,
practices and urges that can undermine their
health. http://surgicaltechie.com

Objectives contd…
To facilitate early diagnosis and prompt
treatment of diseases in school children and
arrest their propagation if communicable.
To promote the interest of students in
individual and community health activities and
to use them as ‘change agents’ in various areas
of public health significance.

Objectives contd…
To work towards a total personality
development of school children, in all
dimensions- physical, mental, social, moral and
emotional- treating them as valuable national
asset and a useful community resource.

Programme organization
School Health Team
Doctor-in-charge
Trained school teacher/School health nurse
Primary health care functionary

Prog. Org. contd…
School Health Committee
Principal of the school
Selected teachers
Parent representatives
School children representatives
Selected community leaders
Health related departments officers.

Programme operation
School Environment: External
-Location
-Site of the construction
-Ratio between built and open area
- Breeding site close to school premises
-Drainage and waste disposal facilities

Programme operation contd…
School Environment-Internal
Building: layout, construction material
Classroom: accomodation, lighting, ventilation,
blackboard,seating & writing
arrangement, ceiling fans
Facilities: drinking water, waste disposal
Accident and fire proofing arrangements.http://surgicaltechie.com

Programme operation contd…
School Health Service
-Health appraisal: check-ups, health records
-Health care: first aid, health monitoring,
referrals
-School meals
-School athletics

Programme out reach
Parents day
School exhibition
Debates and discussions
Sanitation week
First-aid camps – fairs & festivals
Child-to-Child programme

Initiation of a S.H.P.
Know- administration of the school
Visit- establish rapport, assess resources-3Ms
Collect details- layout, classrooms ,school
strength…
Facilities

Initiation …
Official permission from school management
Fix up the programme
Referrals and follow up
Maintenance of records

Management of S.H.P.
Planning
 A joint endeavor-school health council
 Mission of S.H.P. consistent with health
system
 Start with need assessment.
 Decisions- innovative, economical, keep into
consideration the socio-political forces

Management contd…
Directing
Leadership strengthening at all levels
-verbal communication
-manage--:time, stress, individual decisions
-Motivate and influence others
-Team building

Management contd…
Controlling
 Practice standards serve as useful guide
 Perform program evaluation
 Outcome measures-impact on academic
performance
 Mandate certain services

Barriers to improve S.H.P.
Inadequate understanding and acceptance of
S.H.P.
Inadequate collaboration among the agencies
Inadequate vision and strategic planning

Barriers at different levels
Local barriers
School level: -low priority for S.H.P.
- political and economic
changes

Barriers at different levels contd…
Local barriers contd…
District level:
- Ambiguous delegation or assumption of
authority, responsibility and resources.
- Ambiguous jurisdictional boundaries.

Barriers at different levels
Local barriers contd…
State level:
Poorly developed capacity of state
health and education agencies.

National barriers
Lack of:
Full recognition of importance by officials
Policies and resources
Coordination among various agencies
Knowledgeable and trained personnel

International barriers
Few resources for domestic programmes
Circumstances differ among nations
Constantly changing political and
organizational structure
Economic crises

Strategies to improve S.H.P.
Six crucial strategies:
Identifying responsible organizational staff/units
Developing an evolving strategic plan
Implementing activities to achieve the objectives
Monitoring achievement of the objectives
Establishing an intra-organizational working
group
Establishing an inter-organizational working
group

Education reforms
Mid-day meal scheme
Supreme court rule- Govt. to provide cooked
meals to all school children.
Implementation of school sanitation and
hygiene education
Right to Education bill
Sarva-Siksha Abhiyan
CBSE recommendations

Inter-sectoral coordination
International: UNICEF
collaborates with World Bank,WHO,
UNESCO, & UNFA.
Supports s.h.p.- water, sanitation & hygiene
life skills/ aids
child-to-child
health & nutrition
situation analysis

UNICEF contd…
Four programme principles:
Strengthening partnerships/linkages
Capacity building
Sustainability
Children’s participation

International contd…
WHO: 1996- launched GSHI
Four strategies-
Building capacity
Mobilizing resources
Strengthening national capacities
Research

FAO: Development of nutrition education
materials
for 6-14yrs. Children
UNESCO: -1st
UN organization to undertake
sector work on school health and nutrition.
- Provides technical support for school
feeding programmes- development of manuals,
evaluation of existing programmes.

 UNDP: 1992 –Partnership for Child
Development
Co-sponsor of Micronutrient initiative
Sponsor of research-role of school
health and nutrition in child
development.
 UNFPA: Health programmes for youth and
adolescents.http://surgicaltechie.com

World Bank: Enhances quality of
programmes-
Providing access to expert advice
Developing practical toolkits
Quality information through internet
Building partnerships
Assisting task team –school health components
for projects.

• CIDA: Since 1992 nutrition projects-micro-
nutrients: vit.A, iron, iodine.
• DANIDA: Supports through WASH strategy.
• DFID: Funding for SeHAT programme.
• SIDA: Support basic education and education
reforms.

Non Governmental organizations
o AHRTAG: Supports SeHAT-
Education for all by 2000A.D.
o CARE: Education & health programmes
o CtC: -Child centered approach, health education
-Production of materials, project planning
-Work with children in crises.
-Published- Health promotion in our
schools.

Intersectoral coordination
National
 Naandi foundation Miday-meal programme
-Working in the field of child education,
sustainable livelihoods, mid-day meal and safe
drinking water.
-Automated central mid-day meal kitchens
-Menu consultation-nutritionist from NIN
-Uses GPS to locate schools.

National…
• Akshaya Patra: -ISKCON & secular leaders of B’lore.
-Infosys, Bharti and Jindal- major donors.
- Model successfully replicated in Delhi,
Hyderabad and other cities
• CHETNA: -Childhood Enhancement through training
and Action
-Delhi based NGO working on the issue

National…
• SHARP: School Health Annual Report
Program
-Scientifically planned, professionally managed.
-Currently operational all over the country.
-1st
to computerize and place health records of
school children on internet.
-Programmes- school, community and internet
based

State…
Eureka: Aid Chennai-to improve reading,
maths and pre-primary skills.
SEED: - Society for Economic and
Educational Development
-Runs primary & high school for boys
and girls
ATMG: Association of Tamilnadu Medical
Graduates of U.S.

School Health Records
Should contain:
Basic data
Information about physical examination
Various tests
Immunization
Treatment carried out in sickness
Acts as communication tool

Millennium
Development Goal of
universal primary
education by 2015?

Children of primary school age out of school by sex,
area of residence, and wealth quintile, India 2006

Figure 1: Population of primary school age by sex,
area of residence, and wealth quintile, India 2006

THANK YOU

School health

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