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Indian Journal of Community Medicine

School Health

Author(s): K. Raghava Prasad

Vol. 30, No. 4 (2005-10 - 2005-12)

The health of children and youth is a fundamental value. Health services for school children are a must for building a Healthy Young India.

Over one fifth of our population comprises of children, aged 5-14 i.e., the age group covering primary and secondary education. Only about 80% of these children are enrolled in schools, the rest remaining out of school . Of those enrolled 65-85% are regularly attending school, on average in 200 days in a year. Thus the bulk of the school age children are in schools on majority of days in a year and are very easy to reach.

Health services for school children apart from catering to a easy to reach but a significant segment of the whole population have other benefits too. School age being an age of learning for which purpose children attend schools, they also learn about health and healthy practices along with subjects like languages, mathematics, sciences, etc. What is instructed, observed and practised at this age will result in long lasting effect which are most likely to continue into and influence their adult life. Appreciation of this fact is very important health and education go together. In another way good health of the child is a sine qua non for good learning. Sickness is a major cause of school absenteeism and scholastic backwardness. It is estimated that every third child has some sign of ill-health. Numerous studies have described the types and frequencies of sickness found in school children.The common morbidities found are nutritional deficiencies, dental, visual and hearing problems, respiratory infections, skin conditions, locomotor disabilities and congenital heart and other problems. The fact is that most of these conditions are preventable or avoidable and curable especially in early stages. Another benefit of school health is that the school child acts as a transmission agent i.e., it acts as a change agent by transmitting the desired message to members of his family and community ; this is particularly important as a considerable proportion of school children in our society happen to be first generation school-goers and their family members, relatives and neighbours are influenced by their thoughts and actions. This concept is the basis of child-to-child and child-to-community activities and programmes. On the whole a comprehensive school health service remains one of the most cost-effective public health measures.

School health services in India have a long history. Since independence a number of committees were set up on topics in relation to school health. In 1961 the Rennuka Ray School Health Committee laid the foundations for a comprehensive school health programme. Notable in the context of school health are the project on Nutrition, Health Education and Environmental Sanitation (NHEES) and the efforts of bodies like National Council of Educational Research and Training (NCERT). Both the national policies on health (1983) and education (1986) strongly suppor ted school health programmes, particularly school health education (SHE). Different states have their own schemes, e.g., Andhra Pradesh School Health Project (1991-99), an externally aided project covering primary schools. It is to be noted that school health services remained and remain a state responsibility as are the main public health measures, the private sector playing little or no role. Further it is and has to be a joint responsibility of the departments of health and education, a very good example of sectoral approach.

School health programmes consist of three related components; school health services, school environment and health education.

The school health services comprise immunization, screening, surveillance, counselling, early detection and treatment and referral services.These are well known and need no elaboration. However referral services have to be emphasized because without a good functioning referral system school health services cannot be successful in their objectives. The two-way referral system, school-health worker-medical officer at health centre/school health clinic-specialist shall be established and be working. Teachers will be trained and equipped for recognition of sickness/danger signals, for giving first aid/on the spot treatment and for referring the children needing further care. For this purpose training programmes have to be designed, ideally jointly with health functionaries (of appropriate levels) for present teachers and suitable changes made in the training curricula for future teachers.

The school environment includes the school building and its environs, class rooms, lighting and ventilation, furniture; water supply, meals, waste disposal, abatement of pollution if any, etc. The environment should be health promoting and also save the educational purpose in that appropriate ideas and habits are promoted in the users as they are greatly influenced by their interactions in the school environment. Needless to say a healthful school environment needs multisectoral cooperation.

The most impor tant component, in the context of the enumerated benefits of school health programmes-as a measure for health promotion in the truest and broadest sense­is school health education. Here one has to recall the definition of health education, i.e., the process of producing desirable change in health behaviour and in the knowledge and attitudes required for such a change. Schools form ideal settings for health education in more than one way. SHE assumes greater importance in changing the life styles and behaviour which play chief role in many of the current health problems. Many programmes and projects in SHE, sometimes using the child-to-child approach in order to promote health among younger children/siblings, members of family and community at large, making use of a variety of methods and media including classroom sessions and community projects have been implemented successfully. In short, schools are the most fruitful and rewarding venues for health education. As far as the curriculum is concerned, it is generally agreed that health education, instead of being a separate subject, should be integrated with other subjects forming a hidden curriculum; health topics should form part of sciences, arts, environmental studies and even languages and mathematics. Suitable changes are to be made in the curricula concerned. Health education fits well into the present concept of child-centred and activity-based learning in education. The out-of-school activities of school children also can cover health topics. Teachers also influence students through the examples, set by them.

There have been several innovative projects and programmes in the area of school health. School health is recognized as a routine public health function to be carried out by the network of primary health centres and subcentres. But almost all projects and special programmes, through successful in themselves, lack either sustainability, replicabilities or both. As for routine public health services, this area is given low priority and is generally neglected and not executed systematically in a planned manner.

It is desirable that the school health component of routine health services should be strengthened.The minimum action that could be done are: joint (health and education) training; joint visits by supervisors of both departments; visiting of every school in his/her area by every rural health worker for at least one half day every month for conducting school health activities jointly with teacher(s); providing required drugs and material in every school; establishing a working referral system. The third activity is not very difficult as every worker usually has about 5-6 schools in his/her area and he/she can visit every school once a month on his/her tour days.The job charts of the health functionaries have to be he written accordingly. During their visit a session should be devoted extensively for health educational activity on common problems of the area or any topical problems. In the urban areas school health clinics in large towns and municipal health organizations/urban health centres in other towns may be responsible for providing school health services on a systematic basis.

It is to be remembered to extend the school health activities to children staying in hostels or residential homes.

Regarding school age children not attending schools i.e., out of school children, they have to be covered by special programmes. Special programmes for dropouts, etc. have to incorporate health activities; similarly, programmes of special institutions, homes or schools for child workers, street children, etc. have to have appropriate health component.

It is hoped that school health or health of school age children will be given the place it deserves in the health services and thus contribute to the achievement of our health policy goals.

(The author was Director, Andhra Pradesh School Health Project during 1991-93)

Department of Community Medicine, Narayana Medical College, Nellore, Andhra Pradesh.

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