SCHOOL HEALTH SERVICES

PRESENTEDBY:
Ms. Sameeksha Bhardwaj
Asstt. Professor
Deptt. Of Community
Health Nursing

INTRODUCTION
Children between the age of 5-17 years are school age children.
They spent most of their time of the day in the school under the
direct supervision and guidance of their teachers. They are also
exposed to various epidemiological factors in the school which
influence their present and future state of health.
Hence, school is the best place for giving health education and
make a strong foundation to the healthy nation. School Health
Services are primarily meant for preserving and promoting
health of the students.

DEFINITIONS
SCHOOL HEALTH
It refers to a state of complete
physical, mental, social and
spiritual well being and not merely
the absence of disease or infirmity
among pupils, teachers and other
school personnel.

SCHOOL HEALTH SERVICES
It refers to need based
comprehensive services
rendered to pupils, teachers and
other personnel in the school to
promote and protect their
health, prevent and control
diseases and maintain their
health.

HEALTH PROBLEMS OF SCHOOL CHILDREN
There are some health problems which are common in school
children. These are:
1. Malnutrition

4. Disease of skin, eye and ear

NEED FOR SCHOOL HEALTH SERVICES
These are necessary and important because of the following reasons.
Students are:
Vital and substantial segment of population and the future citizens.
Exposed to various stressful situations .it can cause mental health
problems, negative attitudes, affect growth and development, disturb
appetite and dietary habits resulting in malnutrition.
Vulnerable section of population, exposed to various environmental
factors.

Belongs to different socio economic and cultural
backgrounds which affect their health and nutrition
status .
Prone to specific health problems like diarrhoea,
constipation, dental caries, bleeding gums, PEM, worm
infestation, hepatitis, anaemia, scabies, acne, influenza,
measles, mumps, chickenpox, UTI, eye and ear infection,
cardiac problems etc.

AIM OF SCHOOL HEALTH SERVICES
The ultimate aim of
school health service is
to promote, protect and
maintain health of
school children and
reduce morbidity and
mortality among them.

The specific objectives are to:
• Create health consciousness among school children, their
parent and teachers.
• Provide healthy and safe environment which is conducive
to comprehensive development of children.
• Impart health information and conduct health education
on various aspects of healthful living in school, home and
community.
• Prevent communicable and non communicable diseases.

• Identify and treat the abnormality and defect as
early as possible and do the necessary referral
and follow up.
• Involve teacher, student and their parents in
management of health aspects of children.
• Help teachers and children make constructive
and productive use of co-curricular and
extracurricular activities.

PRINCIPLES OF SCHOOL HEALTH SERVICES
School health services should:
Planned in coordination with schools, health personnel, parents and community
people. A school health council needs to be set up.
Be based on health needs of school children.
Emphasize on preventive and promotive aspect.
Be a part of community health services.

• .Emphasize on health education to promote, protect, improve
and maintain health of children and staff.
Emphasize on learning through active and desirable
participation.
Be ongoing and continuous program.
Have an effective system of recording and reporting.

COMPONENTS OF SCHOOL HEALTH SERVICES
It includes all those aspects which can help to achieve
the aim and objectives.
(A)Health promotive and protective services
i)Wholesome school environment:
It is essential for holistic development of school
children coming from varying socio economic and
cultural backgrounds.

• Location and site:
away from the nuisance, traffic, dust etc.
easily approachable
proper drainage system
play ground
• The building structure:
heat proof single storied building
Classrooms should be spacious, well ventilated and
attached to verandas
inside colour of the classrooms should be white.
Minimum space of 10sq. feet should be provided to
each child
 proper trees and plantation.

• Furnishing of classroom:
single desk with chair along with the back rest.
desks should be of ‘minus’ type.
each classroom should have adequate teaching
learning facilities according to the students and
resources available.

• Sanitary and other facilities: These facilities includes-
Water supply: There should be continuous, potable and
safe water supplies from the tap or well and should
be chlorinated properly. Use of common glass for
water should be avoided.
Lavotary: There should be sanitary urinals and latrines
with adequate water supply. There should be
separate arrangements for boys and girls. One
urinal for 60 students and one latrine for 100
students is advocated.

• Disposal of waste water and refuse:
proper system of drainage of waste water.
In urban areas it should be underground drainage
system.
 The refuse should be collected in dust bins kept in
each classroom and other strategic areas. They
should be emptied into compost pit or burnt in one
of the corners away from class room especially in
the rural areas.
 In urban areas the refuse is collected at one place
and removed to collecting areas assigned by
municipality for further processing.

• Canteen and eating facilities:
own sanitary canteen facility on subsidized basis
approved vendors in the school premises.
A separate room should be there for taking mid day
meals.
Facility for washing hands

ii)Maintenance of personal hygiene:
very essential for the promotion of health of children.
Teachers are the role model by following good
personal hygiene.
Educate children to follow good personal hygiene and
should do the inspection to assess the personal
hygiene.
It includes the care of whole body starting from head
to toe. It requires of proper cleanliness, care of head,
eyes, mouth and teeth, hands and nails, body folds,
private parts, feet, bowel habits.
 It also includes behaviour related to diet, sleep,
exercise, clothing, drug, smoking, relation with
parents, peer group, sibling, friends etc.

iii)Good nutrition:
Very essential, not only for optimal health, growth
and development of the child but also for his
educational achievement.
A nutritious mid day meal for children in school is
considered as a practical solution to combat
malnutrition in children.
School meal should provide about one third of
daily calorie requirements and half of daily
protein requirement.

iv)Physical and recreational activities:
promote musculoskeletal development
inculcate team spirit
help in releasing physical and mental stress
promotes mental health, growth and development
of scholastic achievements
The school health team takes active interest and
efforts to ensure that school authority organizes a
regular program of physical and recreational
activities in the school.

vi)Health education:
o very important for school children
o It creates awareness, makes them knowledgeable
regarding health matters
o develops motivation and promotes changes in
health behaviour and attitude
AIM
Its main aim is helping students to develop self
reliance and civic sense, take social responsibility and
have better quality of life throughout the life span.

Health education areas includes
• personal hygiene
• environmental health nutrition
• prevention and control of communicable and non
communicable diseases
• first aid and emergency care
• home nursing
• family life and reproductive health
• prevention and control of psychosocial problems
etc.

Interactive
methods
and
approaches
•Different type of
discussion
•Demonstration
•Problem solving
•Issue based learning
•Role plays
•Competitions
•Group projects etc.

vii)Immunization:
• Necessary to prevent the occurrence of such
communicable diseases.
• The immunization schedule is completed by the age
of 5-6 years.
• It is necessary to find out at the time of admission
whether the child has completed the immunization
schedule or not.
• A proper record of immunization should be
maintained which should be handed over to the child
at the time of leaving school.
Tuberculosis, Diphtheria, Tetanus,
Measles, Polio, Hepatitis, Pertusis.

(B) Therapeutic services:
i)Health appraisal:
 very essential to identify the deviation from normal
conditions of body parts and systems.
 It requires complete physical and medical check up.
 The school health team recommended initial health
appraisal at the time of entry in the school and
thereafter at four year interval.
 The initial appraisal need to be thorough which
requires complete health history taking, physical
and medical examination.

A minimum of 3 health appraisals are carried out:
On passing out from middle school at
the age of 13-14 years.
On passing out from primary school
at the age of 10-11 years.
On school entry at the age of 5-6
years

In addition to health appraisal, recording of
weight and height at an interval of 3 months
should be done at the school by class teachers.
They should also do daily inspection of personal
hygiene and make observation to detect any
deviation in normal behaviour or any change in
appearance which may suggest any abnormality.

ii)Treatment and follow up:
 Essential for children having any illness or defect.
 In urban area the school health clinics can be at
selected schools or at local dispensaries.
 There should be fixed days and timings which
should be known to teachers and parents.
 The parents should be informed and explained
about any kind of major illness or defect.
 Follow up of such children should be done by
school health nurse to make sure that regular
treatment is taken up and proper care is given to
the children.

iii)First aid and emergency care:
o Arrangement for providing First aid and emergency
care to injured children.
o Teachers who are available at the spot can provide
such care.
o They need to be prepared and should be trained for
providing first aid & emergency care.
o The basic facilities for providing First aid and
emergency care should be in accordance with the
standards laid down by St. Johns Ambulance
Association of India.
o Senior students can also be involved and get trained
for the same.

iv)Specialized health services:
School children often suffer from dental problems
especially caries teeth and periodontal diseases, eye
problems such as defective vision, squint, eye
infection etc. problem of ear, nose and throat. All
these conditions requires specialized services of
specialists in these areas.
Special clinics should be provided exclusively for
school children.
specialists should be invited on specific days to hold
these clinics in schools for examination and
treatment of such disorder and defects.

(C) Rehabilitative services:
Required for children who are born with or
acquire any disability or handicap due to road
accident/serious disease/burn injury etc.
These children require special care.
Those with minor physical or mental defects can
be kept in normal schools.
Teachers and workers need to give more attention
and care to them.
The children with marked physical abnormalities
such as blindness, deafness, mutism, marked
mental retardation etc. should be trained in
special institution and should be rehabilitated.

(D) School health records:
essential to maintain complete, accurate and
continuous health record of school children
useful in providing need based health care and
guidance to children
evaluate the school health services
assist in future development
improvement of health services rendered to school
children.

Health record should include information on:
Identification and
personal aspect
Personal and
family history
Findings of routine
investigations and
screening
Services rendered
and the prognosis
Findings of physical
and medical
examinations

Various dimensions of school health
services
Health problems are not just physical, they can be
mental and emotional as well. There are three levels
of health services for schools.
A)First level of prevention

1. Actions to promote good practices in Hygiene.

2. Action to make sure that children and their
family are immunization against certain diseases.

• If there is no clear history of previous immunization
with DPT then two doses of DT need to be given at
an interval of 4 weeks at the age of 5-6 years, two
doses of TT at one month interval at the age of 10
years and again at 16 years need to be repeated.
• If immunization is done completely then one dose
of DT need to be given at 5-6 years, one dose of TT
at the age of 10 years and again at 16 years of age.

3. Action to improve the mental health of the school
children
o The mental health of the child affects his physical
health and learning process.
o Juvenile delinquency, maladjustment, untoward
behaviour etc. are becoming problems among
school children.
o The school is the most strategic place for shaping
the child’s behaviour and promoting mental health.
o The school teachers should be concerned with
helping all children attain mental health, so that
they may develop into mature, responsible and well
adjusted adults.

• The school routine should be planned that there is
enough relaxation between periods of intense
work.
• No distinction should be made between race,
religion, caste or community, between rich and
poor and between clever and dull.
• There is a need to have guidance & counseling
facilities for students.
• Teacher and health personnel can also play
important role in guidance and counseling for
specific academic and health related problem of
students.

B)The second level of prevention and action
1. Checking the physical health of children in school so as to
detect health problem early.
Physical examination from head to toe
Measurement of height, weight, arm and chest
circumference
Testing of vision, hearing and speech
Observation of vital signs such as pulse, respiratory rate and
temperature
Examination of blood, urine and stool
Screening for tuberculosis

Medical examination includes complete and
thorough check up of all the systems of body.
Vital signs
Vital signs are the visual signs that tell us the
condition of the victim. They are:
Breathing
rate
Temperature
Pulse rate

Normal breathing rate
Age Respiration/minute
2-6 years 24
6-12 years 20
12- 15 years 18
15- 21 years 16-20

• Normal pulse rate of a child aged 6-12 year is
60-95/minute.
• In a healthy individual, the body temperature may
vary between 970 F. ( 36.10 To 37.20 C)
• Fever is defined as a rise in the body temperature
above 990 F.
• Fever is not a disease but it is a sign of infection.
Children showing any serious signs and
symptoms should be referred to medical officer.

2. Provision of First Aids and emergency care
Definition of first aid
First aid is the temporary and immediate treatment
given to a person who is injured or suddenly becomes
ill, using facilities or materials available at that time
before regular medical help is imparted.

Who is the first aider?
The first aider is just a common person who may
have learnt a standard method at application of first
aid best suited to his skill.

When the responsibility end?
The responsibility of the first aider ends when the
causality is handed over the care of doctor, a nurse or
other appropriate person. Later on, he may assist the
doctor.

3. Follow up programmes
• It is necessary to ensure that the child complies
with the advised health interventions.
• The efficient follow up programme begin with
careful planning.
• Once the defect is discovered, the parents should
be informed.
• Notice to the parents, notifying from the suspected
difficulty.
• The clinics days and time should be initiated to all
the consumed schools.

4. Training of teachers
The objectives of the teachers training should be to
equip the teachers to observe the children under
their care for:
• Such defects or deviation from normal health
• Help children to develop clean personal habits
• Educate the teachers, parents and children about
healthful school environment
• Ensure a healthful school environment
• Provide first aid in emergencies

C) The third level of prevention and action
Often children who attend school have health
problems which will not go away quickly. There are 4
main categories:
• Long term medical problem such as Asthma or
Epilepsy
• Disabilities
• Poverty, which often leads to under- nourishment
• Long term emotional problems at home such as
those which affect children whose parents are very
ill.

SCHOOL HEALTH TEAM
The members are as follows:
1.The school principal:
Responsibilities are:
• Ensure that school health program has the approval
and support of school administrative authority.
• Set up a school health committee to work out the
school health plan and plan for its implementation.
• Ensure that teachers are adequately trained for
health care of school children.
• Make sure that proper health records are maintained.
• Ensure that parents are involved and follow up of the
children is done.

2.The school teacher:
Teacher is a key person because she is in continuous
contact with the students in a position to make
observation of their health.
Functions are as follows:
• Daily inspection of children for personal hygiene and
cleanliness
• Daily observation of children for detecting any
evidence from deviation from normal health,
behaviour, any communicable disease, malnutrition
etc.
• Help in control of communicable disease
• Referral of child having any problem to school health
clinic for further action

• Informing the parents and maintaining follow up
• Maintaining record of anthropometric
measurement and other health record of children
• Giving first aid and emergency care to children
• Imparting health education on healthful living
habits and behaviour etc.
• Participate in investigation of epidemic or any
communicable disease etc.

3. The parents:
• They can help in making assessment of health of
children providing information regarding past and
present history of medical problems not only of the
child but also of other members of the family.
• They can participate and cooperate in physical and
medical examination and immunization of children.
• They can help in correction of defects if any and
follow up of the children if found sick.
• They can help in foundation of good healthful living
habits and behaviour.

• Through parent ‘teacher association’ the parent can
be involved in planning, organizing and
implementation of school health programme.
• Above all the parent must relieve the child’s work
pressure at home so that the child can take
advantages of school.
• They need to be prepared for such participation in
school health programme, they can be educated
while having Parent Teacher Association meetings.

4. The community
The community can contribute by supporting school
health program by:
• Providing suitable land for school building.
• Providing funds and labour in building proper school.
• Participation in school health committees or councils
and contribute in formulation of school health
policies and plans.
• Participation in implementation of programme
activities e.g. Conduct of medical examination,
immunization of children, maintenance of
environmental sanitation, health education activities.
• Motivating parents to send their children to school
and take care of their health.

5. The children
The child has the responsibility to:
• Learn values of medical and health examinations,
personal hygiene, good nutrition, environmental
sanitation etc.
• Cooperate in various aspects of school health
programme.
• Develop positive habits and healthful living
activities as educated upon
• Extends this knowledge to other members of the
family, neighbourhood etc.

6. The medical officer
As being one the member of the
team he is responsible for:
• Medical examination of the students
• Making diagnosis
• Prescribing treatment
• Making referral to services
• Ensuring follow up of children

• Initiating promotive and preventive programme
• Inspection of school environment and sanitation
• Holding meetings with parents and teachers
• Ensuring maintenance of records and reports
• Evaluation of the programme and redefining
programme objectives and activities

7.The school health nurse/community health nurse
• The community health nurse working in school
health setting is responsible for comprehensive
health of the child.

• She takes care of all the factors which influence
health of the child such as biological aspect of the
child, school and family environment, living
activities, personal habits, health behaviour
followed by the child and his family members,
family and individual health history, family and
community resources and their utilization etc.

CONCLUSION
School health services are offered to the students
so that they can attain a healthy living including
physical examination, treatment of minor ailment
and common diseases. It is the responsibility of
the teachers and other school staff to find out any
deviation from the normal condition and take
appropriate steps in this direction.

SCHOOL HEALTH SERVICES

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