[Editorial] School Health Services

Following the prolonged school closure in the wake of the pandemic, students have returned to schools for in-person classes. The recent times call for policy measures and actions to address the needs of the school-children. On the academic front, there have been discussions on topics like ‘learning recovery’. However, the children’s health needs aren’t getting as much attention.

Why are school health services important?

  • Health-care needs are frequently equated with medical needs. This is one of the reasons why school healthcare services receive so little policy attention.
  • Schoolchildren have a relatively low sickness rate and hence the requirement for medical care is limited. However, they have a wide-range of age-specific health needs, linked to:
    • unhealthy dietary habits
    • irregular sleep
    • lack of physical activity
    • mental health problems
    • dental and eye problems
    • sexual behaviour
    • tobacco use
    • substance abuse, etc.
  • The health knowledge and the lifestyle acquired during the school years are known to stick in adulthood.
  • These gains lay the foundation for life-long healthy behaviour.
  • For instance, evidence shows that efforts to stop tobacco use are especially effective if started at the school-level.
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How has these services evolved in India?

  • India’s first record of school health services goes back to 1909, when presidency of Baroda started medical examination of school students.
  • In 1946, the Sir Joseph Bhore committee made observations on the under-developed status of the Indian school health services.
  • The Secondary Education Committee, in 1953, called for comprehensive policy interventions with regards to school health and feeding programs.
  • Following this, few states undertook programmatic interventions that primarily focused on nutrition. However, the school health services part largely remained a ‘token’ service.

Has the pandemic changed things?

  • In these 2.5 years of pandemic, there hasn’t been any serious initiatives towards school health.

Aam Aadmi School Clinics Project

  • In March 2022, the Delhi government started 20 school health clinics and has promised more.
  • These are being funded through Corporate Social Responsibility route and is also supported by collaboration between the government’s health and education departments.
  • These clinics focus on providing curative services.

Learnings:

  • This initiative, though small, shows a recognition of:
    1. Importance of school health services in post-pandemic period
    2. Importance of multi-stakeholder partnership in school health services
  • School health services still aren’t comprehensive enough.

How can things be improved?

  • The limited understanding of what constitutes an effective and well-functioning school health service is one of the main reasons for such programs being wrongly designed and rudimentary in most of the low and middle income nations.

FRESH Framework:

  • FRESH or ‘Focusing Resources on Effective School Health’ is a framework given by UNICEF, WHO and the World Bank.
  • It proposes 4 core areas of focus:
    1. School health policies
    2. Water, sanitation and the environment
    3. Skills-based health education
    4. School-based health and nutrition services
  • It also gives supporting strategies:
    1. Effective partnerships between teachers and healthcare workers
    2. Effective partnership between education and health sectors
    3. Effective community partnerships
    4. Pupil awareness and participation

Other Guidelines:

  • The US Centers for Disease Control and Prevention suggest that school health services focus on 4 main areas:
    1. Acute and emergency care
    2. Family engagement
    3. Chronic disease management
    4. Care coordination
  • According to the WHO, such health services must be designed on the basis of local need assessment. It should include components of:
    1. Health promotion
    2. Health education
    3. Screening- followed by appropriate care, referral and support
  • The services’ objectives should be:
    1. Promotion of positive health
    2. Prevention of diseases
    3. Early diagnosis
    4. Treatment and follow up
    5. Developing health consciousness among children
    6. A healthy school environment
  • Over the last 30 years, many countries, especially the European ones, have successfully made use of these approaches under their HPS (Health-promoting Schools) initiative.

What is the way ahead?

  • As schools reopen, there is an opportunity to adopt a proactive approach towards a strengthened and expanded school health services system.
  • For this, certain steps need to be taken:

Review Status

  • All the states need to review the status of their school health services.
  • Then a roadmap needs to be drawn up for revamping and strengthening these services. The roadmap should have detailed timeline.
  • Dedicated budgetary allocation is a must. The 15th Finance Commission’s health sector grant can be leveraged here.

Services

  • Building upon the existing infrastructure, the renewed focus should be, not only on curative services, but also on preventive and promotive services. A functioning referral linkage is also vital.
  • Teachers, medical experts and health experts should give health talks and organize lifestyle sessions.
  • Teaching of subjects, like adolescent sexual health, menstrual hygiene, etc., must be integrated into regular classroom teaching.

Online Consultations

  • School health clinics must be supplemented with online consultation service to address physical and mental health needs.
  • Such consultations are important in destigmatizing mental health services.

Parents’ Role

  • There is a need to increase the parents’ role and participation, especially via parent-teacher meetings.
  • They need to be sensitized about how school health services work in other countries. This will help improve accountability in the services offered by the schools, domestically.
  • Innovative approaches could be adopted to offer limited health services to parents, families and teachers. This would increase acceptance and demand for these services.

Private Schools

  • In general, government school health service initiatives don’t cover private schools.
  • Though private schools have some form of health services, they are almost always restricted to taking care of emergencies and curative treatment.
  • School health services must be designed to address the needs of children in both private schools and government-run schools.

Ayushman Bharat

  • A school health initiative was started under the Ayushman Bharat program in 2020. However, its implementation hasn’t been satisfactory. This needs to be reviewed.
  • Dedicated financial allocation for this initiative must be increased to provide for sufficient human resources.
  • Its performance must be monitored based on appropriate outcome indicators.

Public Responsibility

  • Elected representatives, professional public health associations and paediatricians must take up the responsibility of raising this issue on the public forum.
  • Even the citizenry should raise the issue and work towards an improved school health service system in every state.
  • The states’ departments of health and education must work to strengthen health services in schools.
  • A convergence of the 2017 National Health Policy and the 2020 National Education Policy should result in a comprehensive school health service across India.

Conclusion:

The children are the society’s future- but only if they are healthy and educated. The onus is on policy makers and program managers to do everything in the children’s best interest. Working on a comprehensive school health service system would bring together parents, teachers, education and health specialists, state departments, etc. onto a common platform towards a healthier future.

Practice Question for Mains

Examine the condition of school health services in India. What can be done to improve it? (250 words)

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