School health services aim to promote the health and well-being of students. There are six key components: 1) Health appraisal and screening to identify health issues early. 2) Preventing communicable diseases through immunizations. 3) Maintaining a healthful school environment with proper sanitation, lighting, and facilities. 4) Providing nutritional services like mid-day meals to ensure students' nutritional needs are met. 5) Offering first aid and emergency care training for teachers to respond to student injuries and illnesses. 6) Implementing comprehensive health education to promote healthy behaviors.

1. School Health Services
Dr/ Eman M. Mortada
Associate professor
In public health and preventive medicine
4th
lecture
Chapter 2: school health services and healthful school environment

2. The guidelines for promoting school health
INTRODUCTION
-Recognize components of coordinated school health program
understand comprehensive School Health Education
Learning objectives
By the end of this lecture the students will be able to:
Identify the 6 categories of risky behaviors in students
Acquire knowledge relating to risk factors for NCDs
Dr. Eman M. Mortada

3.  SCHOOL HEALTH
 PROMOTING HEALTH IN SCHOOLS
 CREATING A SCHOOL HEALTH PROGRAMME
 QUESTIONS WHICH MAY INFORM A SCHOOL HEALTH
PROGRAMME

4. 11
School Health
Services

5.  According to modern concepts, school health service is an
economical and powerful means of raising community health,
and more important, in future generations.
 It has developed during the past 70 years from the narrower
concept of medical examination of children to the present-day
broader concept of comprehensive care of the health and
well-being of children throughout the school years.
Introduction

6.  School health service refers to need based comprehensive
service rendered to pupils, teachers and other personnel in the
school to promote, protect their health, prevent and control
disease and maintain their health
 “It deals with the provision of preventive, promotive, curative
and rehabilitative services to the students and teachers in the
school environment.”
School Health Services

7. PHILOSOPHY OF SCHOOL HEALTH
SERVICES
 1. A healthy child is mentally alert, receptive, will not miss
school due to minor sickness and will have better performance
in his/her studies. 2. Health is not just freedom from sickness
or infirmity but the realization of the full potential of the child
which has physical, mental, social and spiritual components 3.
Prevention is better than cure; interventions when health
breaks down are costly and time consuming

8.  . 4. School health services will help identify any deviations from
normal growth and development, any health problem so that timely,
therapeutic, corrective and rehabilitative actions can be taken to
improve and maintain health and continue studies.
 5.While early diagnosis and prompt and adequate treatment is of
great importance, follow up care is equally important for effective
school health services.
 6. Rehabilitation of physically and mentally handicapped children
can be done and must receive ad-equate attention.
 7. Health knowledge and skills learnt not only will benefit the child
but also it will benefit the school, the parents, family and
community

9. Principles Of School Health Services
 It is based on health needs of school children
 It is planned in co-ordination with school health personnel,
parents and community people.
 It emphasize on health education to promote, protect, improve
and maintain health of children and staff.
 It emphasize on promotive and preventive, aspects.
 It emphasize on learning through active and desirable
participation.
 It is an ongoing and continuous program.
 It has an effective system of record keeping and reporting.

10. The objectives of a school health service
General objective :
To provide comprehensive health care to school students in
order to prepare them physically, mentally & socially
Specific objectives :
1. The promotion of positive health
2. The prevention of diseases
3. Early diagnosis, treatment and follow-up of defects
4. Awakening health consciousness in children
5. The provision of healthful environment.

11. Need For School Health Services
 1. School children constitute a vital and substantial segment of
population.
 2. School children are vulnerable section of and population by
virtue of their physical, mental, emotional and social growth and
development during this period.
 3. School children are exposed to various stressful situation.
 4. Children coming to school belong to different socio- economic
and cultural background which affect their health and nutrition
status and require help and guidance in promoting, protecting and
maintaining their health and nutritional status.
 5. Children in school age are prone to get specific health problems.

12. Emergency care in schools
 Injury or illness emergencies can happen at any time including
during the school day.
 Often the school nurse may be the only health professional in
the building who is formally trained to respond to a medical
crisis.
 In addition, school nurses are also prepared to assist in larger
emergency events or disasters that affect multiple students and
staff, such as weather related events, environmental exposures,
or violent crimes.

13. Chronic Disease Management in Schools
students who have chronic health conditions might have daily
challenges with managing their condition. Examples of chronic
health conditions are asthma, diabetes, food allergies, poor oral
health, epilepsy and other seizure disorders.
Research shows that some students with chronic health conditions
may miss school more often than others. Eventually this may
have an impact on academic performance. Schools can help
students with chronic health conditions by providing services
through a school nurse or at a school-based health center..

14. 13
Aspect of
School Health
services

15. WHO
 An effective school health programmes can be one of the
most cost effective investments a nation can make to
simultaneously improve education and health
 WHO promotes school health programmes as a strategic
means to prevent important health risks among youth and
to engage the education sector in efforts to change the
educational, social, economic and political conditions that
affect risk.

16. 1. Health appraisal of school children and school personnel
2. Prevention of communicable diseases
3. Healthful school environment
4. Nutritional services
5. First aid and emergency care
6. Mental health
7. Dental health
8. Eye health
9. Health education
10. Education of handicap children
11. Proper maintenance and use of school health records
Aspects of School Health Service

17. COMPONENTS OF SCHOOL HEALTH
SERVICES
I) Health Promotive and Protective Services
 1. Wholesome school environment
 2. Maintenance of personal hygiene.
 3. Nutritional services
 4. Physical & recreational activities
 5. Promotion of Mental health
 6. Health Education
 7. Immunization

18.  II) Therapeutic Services
1. Health appraisal
2. 2. Treatment and follow up
3. 3. First aid and emergency care
4. 4. Specialized health services
 III) Rehabilitative Services • Care of the handicapped
 IV) School Health Records

19.  “Health appraisal consists of A routine examination & periodic
medical examinations and observations of children by the class
teacher and the Medical Officer”
 Objective
 Case-finding, specially of unapparent disease
 Assessment of health status of school children
 Baseline for follow-up of health status
 Health education and guidance of students
 A detailed examination of each child in the school by a medical
officer, and should fill the school health card.
 The initial examination should be thorough and should include a careful
history and physical examination of a child, with tests for vision, hearing
and speech.
1. Health Appraisal

20.  Periodic medical examination: A minimum of three examinations
should be carried out as follows:
 On school entry at the age of 5 to 6 years.
 On passing out from primary school at age 10 to 11 years.
 On passing out from middle school at age 13 to 14 years.
 A routine examination of blood and urine should be carried out.
 Clinical examination for nutritional deficiency and examination
of faces for intestinal parasitosis are particularly important.
Daily Morning Inspection:
 The teacher is in a unique position to carry out the “daily
inspection”, as he is familiar with the children and can detect
changes in the child’s appearance or behavior that’s suggest
illness or improper growth and development.
a. Periodic medical examination:

21.  Unusually flushed face
 Any rash or spots
 coughing and sneezing
 Sore throat
 Nausea and vomiting
 Red or watery eyes
 Headache
 Chills or fever
 Listlessness or sleepiness
 Diarrhea
 Pains in the body
 Skin conditions like scabies and ringworm
The clues which help the school teacher in
suspecting children who need medical attention:
Children showing
any such signs or
symptoms
should be referred to
the school medical
officer.

22.  School is the ideal location for basic screening to identify
deviations from normal growth and development and problems
that exert a negative influence on the learning process .
 They are simple tests which can be carried out frequently :
- obesity (BMI)
- visual acuity,
- acuity of hearing,
- IQ testing, and
- dental examination.
b. Screening Tests:

23.  Communicable diseases control through immunization is the most
emphasized school health service function.
 A well planned immunization program should be drawn up against
the common communicable diseases.
 A record of all immunizations should be maintained.
2. Prevention of Communicable diseases

24.  The school building, site and equipment are part of
the environment in which the child grows and
develops.
 Healthful school environment therefore is
necessary for the best emotional, social and personal
health of the pupils.
 Schools should also serve as demonstration centers of
good sanitation to the community. The following
minimum standards for sanitation of the school and its
environs have been suggested.
3. Healthful School Environment

25. Minimum standards for sanitation of the school and its
environs have been suggested.
1. Location
2. Site
3. Structure
4. Classroom
5. Furniture
6. Doors & Windows
7. Color
8. Lightning
9. Water Supply
10. Eating Facilities
11. Lavatory
Minimum standards of Healthful School Environment

26. 1. Location
 The school should normally be centrally situated with proper
approach roads and at a fair distance from busy places and roads,
cinema houses, factories, railway tracks and market places.
 The school premises should be properly fenced and kept free from
all hazards.
 Away from busy places.
 Keep free from all hazards.
2. Site
 Site should be on suitable high land and not subject to inundation
or dampness and can be properly drained.
 In congested areas, the nearest public park or playground should be

27. 3. Structure
 Nursery and secondary schools, as far as possible, be single
storied.
 Exterior walls should have a minimum thickness of 10 inches
and should be heat resistant.
4. Classroom
 Verandahs should be attached to classrooms.
 No class room should accommodate more than 40 students.
 Per capita space for students in a class room should not be less
than 10 sq.ft.

28. 5. Furniture
 Furniture should suit the age group of students.
 It is desirable to provide single desks and chairs.
 Chairs should be provided with proper back-rests, with
facilities for desk-work.
 Desks should be of “minus” type.

29. What is a minus desk?
A vertical line drawn from the edge of the desk -falls on the seat.
What is a zero desk?
A vertical line drawn from the edge of the desk -touches the edge
of the seat.
What is a plus desk?
A vertical line drawn from the edge of the desk - falls outside the
edge of the seat.
desk is recommended for school children
 Minus or zero desks are recommended for school children.
Type Of Desk Is Recommended For School Children

30. 6. Doors & Windows
 The windows should be broad with the bottom sill, at a
height of 2’– 6’ from the floor level;
 combined door and windows are should be at least 25 per
cent of the floor space;
 windows should be placed on different walls for cross
ventilation;
 the ventilators should not be less than 2 per cent of the
floor area.

31. Color
 Color can transform a school’s atmosphere from
depressing and monotonous to:
 Inviting
 Pleasing
 Stimulating
 Inside color of the classroom should be white and
 should be periodically white-washed.

32. 8. Lighting
 Most critical physical characteristic of the classroom
 Classrooms should have sufficient natural light, preferably from
the left, and should not be form the front.
 Adequate artificial lighting arrangements
 No glare on the board
 Key to the well-being of students and teachers who are confined
in a classroom
 Poor lighting can affect students’ attitudes and mood
 Adequate lighting promotes effective academic work,
discourages unsanitary conditions, and encourages high morale

33. Noise control
 Noise can make it difficult for students to learn for several
reasons
 Noise raises stress levels for students and teachers
 Classroom noise can be controlled by using noise absorbing
materials
 Long-term exposure can lead to hearing loss

34. 9. Water Supply
 There should be an independent source of safe and
potable water supply, which should be
 continuous, and
 distributed from the taps
 Periodically tested
10. Eating Facilities
 Vendors other than those approved by the school
authorities should not be allowed inside/outside school
premises;
 there should be a separate room provided for mid-day
meals.

35. 11. Lavatory
 Privies and urinals should be provided –
 One urinal for 60 students and
 one latrine for 100 students.

36.  The diet should contain all the nutrient in proper proportion,
adequate for the maintenance of optimum health. a)
 Mid-day school meal:- -it is recommended that school children
should be assured of at least one nourishing meal.
 school meal should provide at least 1/3rdof calorie and ½ of
protein requirements in school
 Advances in the knowledge of nutrition have revealed that
specific nutrients may be necessary for the prevention of some
nutrient disorders such as- = dental caries = endemic goiter =
night blindness = protein malnutrition = anemia = a host of
other nutrient disorder
4. Nutritional Services

37.  First aid box should be made available.
 The responsibility of given first-aid and emergency care to
pupils who become sick or injured on school premises rests
with the teacher,
 therefore all teachers should receive adequate training during
“Teacher Training Programs” or “In-service Training
Programs” to prepare them to carry out this obligation.
 The emergencies commonly met within schools are
 (a) accidents leading to minor or serious injuries, and
 (b) medical emergencies such as gastroenteritis, colic, epileptic fits,
fainting etc.
 In every school a fully equipped First-Aid-Post should be provided as per
regulations.
5. First-aid and Emergency Care

38.  The teachers should help children in
ttaining a positive mental health among
the learners.
 Suitably modify learning strategies, incentives.- rest,
relaxation between periods of intense work
 Instituting vocational counsellors and psychologists in
schools to guide children into their careers.
 The mental health of the child affects his physical health and
the learning process.
 Juvenile delinquency, maladjustment and drug addiction are
becoming problems among school children.
 The school is the most strategic place for shaping the child’s
behavior and promoting mental health.
6. Mental Health

39.  Children frequently suffer from dental diseases and defects.
 Dental caries and periodontal diseases are the two common
dental diseases in children.
 Educating the children about dental hygiene/ brushing the teeth.
Villages??
 A school health program should have provision for dental
examination, at least once a year
 Dental hygienist & dentist are to be employed.
 During the dental check up should focus on prophylactic
cleansing & dental hygiene
7. Dental Health

40.  Schools should be responsible for the early detection of
refractive errors,treatment of squint and amblyopia and
detection and treatment of eye infections such as trachoma.
 Administration of vitamin A to children at risk, has shown
gratifying results.
 In other words, basic eye health services should be provided in
schools.
 Teachers to be trained to detect…
 reflective errors
 squints and ambylopia
 eye infections….
 …….and refer the child for treatment
 Vit A administration should be done in the schools.
8. Eye Health Services

41.  The development, delivery, and evaluation of a planned curriculum
 Priority health content:
 Alcohol and other drugs, healthy eating, mental and emotional health,
personal health and wellness, physical activity, safety/unintentional injury
prevention, sexual health (abstinence and risk avoidance), tobacco,
violence prevention
 The most important elements of the school health program is health education.
 The goal of health education should be to bring about desirable changes in:
 health knowledge,
 in attitudes and
 in practices,
 and not merely to teach the children a set of rules of hygiene.
1. Personal Hygiene
2. Environmental Health
3. Family life
9. SCHOOL Health Education:

42. Personal hygiene
Care of skin, hair, teeth nails…etc
Attention regarding posture
Environmental health
Encourage to part in health activities
Visits to community health programmes and participation in
community action programmes
Family life
Education regarding reproductive life should be provided from
the very beginning

43. Contrasting 10 traditional HE content
areas with 6 CDC priority areas
10 traditional HE content areas
1. Personal health.
2. Mental & emotional health.
3. Prevention & control of
disease.
4. Nutrition.
5. Substance use & abuse.
6. Accident prevention & safety.
7. Community health.
8. Consumer health.
9. Environmental health.
10. Family life education.
6 CDC priority areas
1. Tobacco use.
2. Poor eating health.
3. Alcohol & other drug risks.
4. Behaviors that result in
intentional and unintentional
injuries.
5. Physical inactivity.
6. Sexual behaviors

44. Education of handicapped children
Ultimate goal is to assist the special child and his family
to…
 Achive maximum potential
 To lead a normal life
 To become as independent as possible
 To become a productive and self- supporting member of society
This is done in a coordinated manner

45.  There should be a school health record on a file for every
elementary and middle level schoolchild. These records should
be kept in an appropriate location that assure confidentiality &
makes them accessible to those who need access to them.
 The record should be large enough to provide space for health
history information, immunization records, the student's
measurements during the school years.
A cumulative health record of each student should be maintained.
 Identifying data – name, date of birth, parent’s name and
address etc.
 Past Health History
 Record of findings of physical examination and screening tests
and record of services provided.
10. School health records

46.  These records will also be useful in analyzing and evaluating
school health programs and providing a useful link between
the home, school and the community
• For reference whenever health data are needed; (e.g.
past medical history to assist diagnosis of existing
disease.)
• Allows follow-up of chronic disease.
• Collecting statistical data and indices of school children,
( for future planning and evaluation of health services).

47. Responsibility for Health is Shared by All
 School personnel
 Teachers
 Administrators
 school nurse
 Students
 Parents
 Community
 Government
Providers of school health services

48.  Health appraisal.
 First aid and emergency service.
 Participation in prevention and control of
communicable diseases.
 Inspection of the school environment.
 Participation in health education.
 Supervising preparation of statistical
 indices and health reports.
Role of School Health Physician :

49.  Can be a valuable help to the classroom teachers by
providing instructional support and serving as a recourse
persons
 Administering first aid instructions.
 Assessing student health complaints.
 Carrying out screening procedures.
 Maintain school health records.
 Provides help to the child who becomes sick or injured
while at school.
 Managing the medical needs of the medically fragile child.
 Managing students' medications during the school day.
 Identifying and referring cases of child abuse and neglect,
and sexual abuse to the proper authorities.
Role of school nurse:

51. The maximum ratio of nurse to student should be: one school
health nurse to no more than 750 students in the general school
population

52.  Using health service activities as an opportunity to educate students.
 Prepares the students for screening and appraising activities through
organized
 Observation: Teachers can observe student's physical, cognitive, social,
emotional, and language performance in comparison to age cohort peers.
 Referral: if the teachers suspect that a health problem may be a learning
impediment, their responsibility extends to making an appropriate
referral .
 Gathering information: about the condition as observed over a period of
time.
 Follow up the referrals: teachers must be patient and persistent in their
follow up activities. This includes continuing observation and
documentation to support the work of intervention specialists who are
working with the child.
Role of classroom teacher:

53.  Spotting suspected cases through supervision of the students in
the classrooms.
 Participation in health education program.
 Supporting mental health promotion.
 First aid
 Daily observations made by the class teacher.
The role of teacher

54. Recommended Reading
 Health services Assessment Tool for Schools (HATS)
54

55. What did you learn today?
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 ___________________________
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56. Questions?

57. Dr. Eman Mortada
Associate Prof. of public health
emmortada@pnu.edu.sa
0118240725

58. Dr. Eman M. Mortada