Dr.Abhimod.

R
 Contents
• Introduction
• Basic considerations
• Historical background
• School health
• Rationale and Significance
• Basic components or pillars of SHP
• Proposed Strategic Actions
• Conclusion
• References
 School
• School is defined as an educational institution where groups of
pupils pursue defined studies at defined levels, receive
instructions from one or more teachers, frequently interact
with other officers and employees such as principal, various
supervisors/ instructors, and maintenance staff etc., usually
housed in a single building.
 HEALTH
• Health is a state of complete physical, mental and social
wellbeing and not merely the absence of disease or infirmity.

(WHO 1948)

• Amplified to include the ability to lead a “socially and

economically productive life”

(WHO 1978)
 School health
• School health 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.
 What is a Health Promoting
School(HPS)?
• A health promoting school is one that constantly strengthens
its capacity as a healthy setting for living, learning and
working.

(World Health Organization)

• Fosters health and learning with all the measures at its disposal.

• Engages health and education officials, teachers, teachers'unions,

students, parents, health providers and community leaders in efforts
to make the school a healthy place.
• Strives to provide a healthy environment, school health education,
and school health services along with school/community projects
and outreach, health promotion programmes for staff, nutrition and
food safety programmes, opportunities for physical education and
recreation, and programmes for counselling, social support and
mental health promotion.
• Implements policies and practices that respect an individual's well
being and dignity, provide multiple opportunities for success, and
acknowledge good efforts and intentions as well as personal
achievements.

• Strives to improve the health of school personnel, families and

community members as well as pupils; and works with community
leaders to help them understand how the community contributes to,
or undermines, health and education.
 Incremental

Vs Health care

Comprehensive
• A comprehensive SCHOOL HEALTH PROGRAM is an
integrated set of planned, sequential, school-affiliated strategies,
activities, and services designed to promote the optimal physical,
emotional, social, and educational development of students. The
program involves and is supportive of families and is determined by
the local community, based on community needs, resources,
standards, and requirements. It is coordinated by multidisciplinary
team and is accountable to the community for program quality and
effectiveness.
 Models
• There are a variety of models that have been used to describe the
components of a school health program.
• 1. The Three-Component Model:

Originating in the early 1900s and evolving through the 1980s,

the three-component model is considered the traditional model of a
school health program, consisting of the following basic
components:

• Health education

• Health services

• A healthful environment.
• 2. The Eight-Component Model: In the 1980s, the three-
component model was expanded into an eight-component model—
traditionally referred to as a “comprehensive school health
program”—consisting of the following components:

• Health education

• Health services

• Healthy school environment

• Physical education

• Nutrition services

• Health promotion for school staff

• Counseling, psychological, and social services

• Parent and community involvement.

• Full-Service Schools: In recent years, additional models,
definitions, and descriptions have emerged that build on previous
models, including the full-service school model. In addition to
quality education, a full-service school model involves a one-stop,
seamless institution, where the school is the center for providing a
wide range of health, mental health, social, and/or family services.
 School Health Through the Early
Twentieth Century
• During the colonial period, only limited attention was paid to any
aspect of school health.

• Benjamin Franklin advocated a "healthful situation" and promoted

physical exercise as one of the primary subjects in the schools that
were developing during his time.
• Samuel Moody, headmaster of the Dummer Grammar School, which
opened in 1763 as the first private boarding school, taught the
value of exercise and participated in it himself.
• Prior to the mid-1800s, however, public education was still in a
formative stage and efforts to introduce health into the schools were
isolated and sparse.

• School health professionals often state that the ''modern school

health era" began in 1850.

• In that year, the Sanitary Commission of Massachusetts, headed by

Lemuel Shattuck, produced a report that had a significant impact on
school health.
 Lemuel Shattuck: Architect of
American Public Health
• On the 100th anniversary of Lemuel Shattuck's 1850s Report of the
Sanitary Commission of Massachusetts, Winslow praised the
Report as “the most outstanding single ‘Book of Prophesy’ in
the history of public health.”

• Most of the recommendations of the Shattuck Report are now

standard components of American public health practice.
Shattuck was not just a “prophet” of American public health, but its
most influential architect.
• The report stated
• Every child should be taught early in life, that, to preserve his own life
and his own health and the lives and health of others, is one of the most
important and constantly abiding duties. By obeying certain laws or
performing certain acts, his life and health may be preserved; by
disobedience, or performing certain other acts, they will both be
destroyed. By knowing and avoiding the causes of disease, disease itself
will be avoided, and he may enjoy health and live; by ignorance of these
causes and exposure to them, he may contract disease, ruin his health,
and die. Everything connected with wealth, happiness and long life
depends upon health; and even the great duties of morals and religion
are performed more acceptably in a healthy than a sickly condition.
• When New York City was faced with an outbreak of smallpox in
the 1860s, no mechanism was in place to provide free
vaccinations to those who needed them, so the Board of Health
turned to the schools. Education officials agreed to permit
inspection of school children to determine whether or not they had
been vaccinated, and in 1870, smallpox vaccination became
a prerequisite to school attendance
• In 1902,

 New York City provided for the routine inspection of all

students to detect contagious eye and skin diseases, and
employed school nurses to help the students' families seek and follow
through with treatment.

 Lillian Wald demonstrated in New York City that nurses working in

schools could reduce absenteeism due to contagious diseases by 50
percent in a matter of weeks.
• In 1906, Massachusetts made medical inspection compulsory in
all public schools, a step that ushered in broad-based programs
of medical inspections in which school nurses and physicians
participated.

• By 1911, there were 102 cities employing cadres of school

nurses.

• In 1913, New York City alone had 176 school nurses.

• As late as 1914, school inspectors were not allowed to touch
children, and inspections were done with children fully clothed.

• In 1915, the New York Board of Education introduced a new

requirement that all children entering school must undergo a
physical examination without clothing. This requirement met some
resistance, with critics declaring it immoral to strip children for
medical purposes.
• The prevalence of tuberculosis in the United States had a
significant impact on school health during the early part of the
century. Particularly notable was the development and spread in
"open-air classrooms“ — wide open to the outside air, even in
the middle of winter
• In 1915, the National Tuberculosis Association enlisted school

children in the Christmas Seal drive. A child who bought or sold 10

cents worth of seals was enrolled as a "Modern Health Crusader"
and received a certificate with "health rules."
 11 daily ͞health chores͟ for Modern
Health Crusaders
1. Wash hands before each meal; clean fingernails.

2. Brush teeth after breakfast and the evening meal.

3. Carry handkerchief and use it to protect others when coughing or

sneezing.

4. Avoid accidents; look both ways when crossing the street.

5. Drink four glasses of water, but no tea, coffee, or any harmful drink.

6. Eat three wholesome meals; drink milk.

7. Eat some cereal or bread, green (watery) vegetable and fruit, but

no candy or "sweets" unless at the end of the meal.

8. Go to the toilet at regular times.

9. Sit and stand straight.

10. Spend 11 hours in bed, with windows open.

11. Have a complete bath and rub yourself dry.

 School Health from World War
I(1914) to the 1960s
• World War I marked a turning point in the history of school
health programs. Prior to this period, programs had a narrow focus
emphasizing inspection, hygiene, negative messages, and didactic
instruction about anatomy and physiology
• However, the advent of the war made the problems of poverty more
visible: malnutrition, poor physical condition, and the abysmal
state of the health and welfare of many of the country's
children.

• New health promotion philosophies and movements began to

spring up to replace the outmoded methods; these new
approaches were based on using motivational psychology and an
understanding of behavior.
• The Child Health Organization was one of the most active groups
devoted to the health of children, and the organization conducted a
nationwide campaign to raise the health standard of the American
School Child.

• In 1922, in collaboration with the U.S Department of the Interior

and the Bureau of Education, the organization published and widely
distributed…..

”The Rules of the Health Game”

• In the 1920s, more than 73 percent of the surveyed schools taught
health directly under the name of "health" or "hygiene,'‘ while 108
cities reported correlating content in their health curriculum to such
other subjects as language, civics, reading, physical education,
general science, and art.

• During the following decades, the health education curriculum

included topics such as nutrition, personal health habits, diseases,
exercise, alcohol and tobacco, family health, and sex education.
• In 1936, New York City Board of Education set aside a day as
Health Day, during which teachers checked children's height,
weight, vision, hearing, and teeth. Teachers then had the
responsibility for trying to get any defects corrected.
• The 1948 National School Health Bill, which was designed to
provide federal aid to school health, was defeated partly because of
the opposition of the medical profession whose members feared that
funds would be provided for services to students who would
otherwise have paid private practitioners.
 National School Lunch Act
• When many World War II draftees were found to suffer from
nutritional deficiencies, the federal government in 1946 passed the
National School Lunch Act to provide funds and surplus
agricultural commodities to assist schools in serving nutritious hot
lunches to school children. It was not until 1966, however, that a
pilot school breakfast program was established, and the program
was not made permanent until 1975.
“In the long view, no nation is healthier than its children, or more prosperous
than its farmers.”
– Harry Truman
President of the United States of America (On signing the 1946 NSLA)
 India
• In ancient India, schools were in the form of Gurukuls.
Gurukuls were traditional Hindu residential schools of
learning; typically the teacher's house or a monastery.

• During the Mughal rule, Madrasa’s were introduced in India

to educate the children of Muslim parents.
• Under the British rule in India, Christian missionaries from
England, USA and other countries established missionary and
boarding schools throughout the country. Later as these
schools gained in popularity, more were started and some
gained prestige. These schools marked the beginning of
modern schooling in India and the syllabus and calendar they
followed became the benchmark for schools in modern India. Today
most of the schools follow the missionary school model in terms of
tutoring, subject / syllabus, governance etc.with minor changes.
 1875, Amritsar
Sikh girls enrolled in a school run by the Church Missionary School
• School health is an important branch of community health.

• An Economical and powerful means of raising community health.

• Developed over past 70 years.......

Narrower concept of medical examination

Broader concept of comprehensive care

• The beginning of school health services in India dates back to 1909,
when for the first time medical examination of the school
children was carried out in Baroda(Vadodara) city.
• The Bhore committee (1946) reported that school health services
were practically non-existent in INDIA, and where they existed,
they were in an under-developed state.
• 1953 – the secondary education committee emphasized the need
for medical examination of pupils and school feeding programmes.

• 1960 – The government of India constituted a School Health

Committee to assess the standards of health and nutrition of school
children and suggest ways and means to improve them.

• 1961 – The committee submitted its report, which contains many

useful recommendations.
• 1977 when a Centrally Sponsored National School Health Scheme
was started.
• 1979, the National School Health scheme was handed over to State
Governments.
• 1981, a Task Force was established by the Government of India,
Ministry of Health and Family Welfare to study the progress of
School Health programme functioning in various states of the
country.
• 1984-85.Delhi had its own comprehensive school Health Scheme
which is continuing.
 AIM OF SCHOOL HEALTH
PROGRAMS
• The ultimate aim of School Health Services is to promote, protect
and maintain health of school children and reduce morbidity and
mortality in them
OBJECTIVES OF SCHOOL HEALTH
PROGRAMS
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

 GOALS OF SCHOOL HEALTH
PROGRAMS
1) To prepare the younger generation to adopt measures to remain
healthy so as to help them to make the best use of educational
facilities, to utilize leisure in productive and constructive manner, to
enjoy recreation and to develop concern for others
2) To help the younger generation become healthy and useful citizens
who will be able to perform their role effectively for the welfare of
themselves, their families, and the community at large and country
as a whole.
 Why School Health Programme?:
Rationale and Significance
• Education sector not only trains or prepares human resources needed
for the economy; it also produces leadership for various spheres of
life. The leadership coming out of the educational institutions
influences social and political dynamics in the country. Teachers,
professors, and education managers enjoy respect in the community,
and they have the potential to contribute significantly as catalysts of
social change and development.
 Need for a school health program
1. School children constitute a vital and substantial segment of
population.

2. School children are vulnerable section of population by virtue of

their physical, mental, emotional and social growth and
development during this period.

3. School children are exposed to various stressful situations.

4. Children coming to school belong to different socioeconomic and
cultural backgrounds 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

 ADVANTAGES
1. Can bring comprehensive health care to school children

2. Students can be accessed during their formative years

3. School clinics are less threatening

4. Children’s daily contact with Health personnel

5. Makes it easy to maintain General health in adult life

6. Regular Healthcare attendance pattern can be instilled

7. Expenses and time involved in transportation to clinics can be saved

8. Parents don’t have to lose the working day

9. Cost-effective

10. Health of school staff, families and community members can be

enhanced.
 PHILOSOPHY OF SCHOOL
HEALTH PROGRAMS
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.

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 adequate 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.
PRINCIPLES OF SCHOOL HEALTH
PROGRAMS
1. Be based on health needs of school children.

2. Be planned in coordination with school health personnel, parents and

community people.

3. Be part of community health services.

4. Emphasize on promotive and preventive aspects

5. Emphasize on health education to promote, protect, improve and
maintain health of children and Staff.

6. Emphasize on learning through active and desirable participation.

7. Be ongoing and continuous programme.

8. Have an effective system of record keeping and reporting.

 Basic components or pillars of SHP
• A number of factors influence the physical and mental health of
school children, and their learning process. These factors include
health conditions of the children themselves, physical and social
environment in their school, quality of life of their parents, their
own knowledge about health promoting practices, and availability of
health services around them. Modalities and delivery forms of
school health related interventions can be grouped into following
categories:
 SCHOOL HEALTH PROBLEMS
• Health problems:-

1. Malnutrition

2. Infectious diseases

3. Intestinal parasites

4. Diseases of skin, eye and ear

5. Dental caries.
 School Health Environment
• School environment plays a pivotal role in the retention and learning
outcomes of students. Availability of proper facilities is a pre-
requisite for creating a healthy environment in a school. Provision of
following facilities contributes in creating a conducive environment
for the children in the school
• Safe clean drinking water (with regular water quality monitoring)

• Gender and culturally appropriate sanitation/toilet facilities

• Adequately spacious class rooms

• Comfortable seating arrangements,Play grounds etc.

• A child friendly environment

• Access for disabled and physically challenged

 School Health Education
• Young children are at a greater risk of various infections and
diseases. Schools have the responsibility to educate their students
and foster among them healthy and hygienic behaviour. They need
to warn their students about various health risks, and guide them
how to protect themselves and others against diseases and other
forms of ill-health by adopting health and hygiene promoting habits
and practices.
• Education of students on health and hygiene issues, through
integration of health and hygiene information messages into the
curriculum, and training of teachers on following themes form part
of the School Health programmes
• Education about cleanliness, personal hygiene, and sanitation

• Preventive information against various non- communicable common

diseases

• Prevention against communicable diseases, including H1N1 and

Hepatitis, HIV and AIDS Prevention Education

• Guidance and Counseling for adolescent students on puberty issues

• Anti-drugs and anti tobacco education

• Healthy food (balanced diet) and clean drinking water

• Sports and Physical education

• Population education and Adolescence Education

• Environment education

• Life skills based education

• Orientation of teachers and PTAs/SMCs to stop Corporal

Punishment in schools
• Provision of information, knowledge, and skills to the children on
above subjects enable them to develop healthy behaviour and
protect themselves from diseases and practices which can make
them vulnerable to various hazards in their life.
• In the absence of above facilities, overall health and mental
concentration of students will be negatively affected. Many children
are likely to leave the school due to its uncomfortable and
unattractive environment
 School Health Services
• Young children are prone to many diseases. In the developing
countries, where health services for the general public are poor and
overall knowledge about health care is low, parents and teachers are
unable to detect health problem of children which impede their
learning as well. Provision of health services to the children and
young students in following forms fall under this category:
• Health screening (medical check up) of students on regular basis

• Referral of students with health problems to medical centres for

treatment or rehabilitation

• De-worming campaigns.

• A number of children can be saved from loosing interest in their

studies and dropping out of school when their learning difficulties
or disorders are detected through health screening and addressed
at early stages. Collaboration between health and education
sectors is crucial for this component of school health programme.
 School Nutrition Programmes
• Nutritional level affects overall health, and consequently the pace of
learning among the children. A substantial ratio of children is
malnourished, particularly in underdeveloped areas, and among the
disadvantaged groups. Nutritional inputs can increase both
attendance and quality of education. Provision of following inputs to
schools can be grouped under nutrition component of school health
programme.
• Good supplements for malnourished children

• Food as incentive to enhance enrolment and attendance

• Promotion of use of iodized salt

• School feeding or school lunch programme for all students in

schools

• In the developed countries, school lunch or school feeding

programmes are widely supported. In a number of neighbouring
countries, school feeding programmes are in being implemented.
 Good practices of SHP: Recent
examples
• School Health Programme has been institutionalized in most of the
developed countries. In the recent past, a number of developing
countries have also come forward to launch some form of health
related interventions for their schools.
 Iran
• Ministry of Health and Medical Education, in collaboration with Ministry
of Education and Training has launched National Integrated School Health
Screening Program in Iran. This program aims to identify children who
have early signs of health problems. For example, during 2007-08,
screening of 3.1 million students was completed. Out of these 12.48% had
weight disorders, 4.77% had visual disorders, 3.95% had head lice, 2.24%
had behavioral disorders, and 0.6% had hearing disorders. Students with
health problems are referred to outpatient clinics or hospitals and all
services are offered free of charge.
 ‘CHERISH’ in Singapore
• The CHERISH (Championing Efforts Resulting in Improved
School Health) Award was launched in August 2000 to give
recognition to and encourage schools to establish comprehensive
health promotion programs for students and staff through the
fostering of good physical, social and emotional health for optimal
learning.
• Modeled following the recommendations of the WHO's Health
Promoting School initiative, it uses a whole school
approach towards health promotion. The Health Promotion Board
introduced the School Health Promotion (SHP) Grant in 2003 to
encourage more schools to establish comprehensive school health
promotion programs.
• The grant can be used to partially fund health promotion programs
targeted at students and/or staff in schools. HPB will reimburse the
school 50% of the total amount spent by the school for health
promotion activities, up to a maximum of $5,000. Schools must co-
fund the project by contributing an equal or higher amount.
‘Fit for School’ program in Philippines
• Since 2003, ‘Fit for School’ program is being implemented in
Philippines. Interventions at school level include, daily supervised
hand washing with soap prior to recess, daily supervised tooth
brushing with fluoride toothpaste, and biannual de-worming of all
children. The costs are comparatively low but benefits are high.
Selected evaluation of the program have confirmed following
impacts:
• Infectious diseases including diarrhea and respiratory infections are
reduced by 30 to 50% .

• The progression of (dental) caries is reduced by 40 to 50%.

• The prevalence of helminth (parasitic worm) infections sinks by

80% .

• The number of children with below-normal height and weight is

reduced by 20% School attendance rises by 20 to 25%
• Currently the program is implemented by Philippines Department of
Education in close cooperation with 20 different units of local
government. The Department of Education has also launched a new
school health program which seeks to address both malnutrition and
academic performance of elementary pupils in selected schools
nation wide. Program is focusing on Pre-school and Grades I pupils
Each recipient child is given a ration of one kilo of rice on each
school day. In 2007, about 2.7 million children were benefitting
from this program.
India - School Health Program through
NRHM
• National Rural Health Mission (NRHM), Ministry of Health, in
collaboration with Education sector and States has launched a
School Health Program, which is comprehensive in its scope and
nation wide in its coverage. It intends to cover 1.288 million
schools, benefiting 220 million school children. SHP in India
consists of following components and interventions:
 Health Screening and Remedial
Measures
• At least annual health screening covering general health and
personal hygiene, clinical assessment of anemia, eye examination,
ear discharge and hearing problems, common dental conditions,
common skin diseases and infestations, heart defects, disabilities,
learning disorders. Remedial measures include remedial actions at
school level and referral to laboratories and hospitals. Student
Health Cards and transport facility for referral are provided. For
documentation purposes, School Health Register is maintained.
Bigger schools are provided necessary (basic) equipment by the
Health Department for health screening.
Health and Nutrition Education:
• Health and nutrition education messages are transmitted using
multiple approaches, including infusion into curriculum, extra
curriculum activities, physical education and sports, and health
counseling etc.
 Nutritional Interventions
• An important component of nutritional interventions in Mid-day
meal program. This program has led to improvement in enrolment,
retention, and learning achievement. Second intervention is
provision of Micronutrients, including weekly provision of Iron
Folate tablets, and administration of Vitamin-A in needy cases. De-
worming interventions are provided as per national guidelines, with
biannually supervised schedule. Siblings of students are also
covered.
Safe and Supportive Environment in
School
• Under this component provision of sanitary facilities in schools are
ensured. This means schools must be able to provide sanitary
environment, functionary sanitary latrines, facility for hand washing,
supply of potable water.
 Capacity building for Health
Screening
• This includes training of heath department staff to be involved in
health screening, training of nodal teachers, and provision of a tool
kit to schools consisting of training and resource manuals, audio-
visual aids, and guidebooks etc.

• School Health Program in being implemented in most of the States

in India. Framework and Guidelines for SHP have been developed
by the central government, whereas implementation is undertaken
by the States.
Examples of school health programs in India
 SeHET (School Health Action and
Training):
• The SeHAT project was implemented as a pilot program in the
schools run by the municipal corporations of Mumbai and Delhi.
The core strategy of the program was inclusion of health education
in the curriculum. The topics covered included communicable
diseases, personal hygiene, sanitation, nutrition and pollution.
 Improved Mid Day Meal Program
(Gujarat):
• In 1994, government of Gujarat integrated six monthly de-worming,
vitamin A and iron supplementation with the mid day meal program.
Every child in the school is provided twice a year with one dose of
400 mg of albendazole, a capsule of 200,000 IU of vitamin A and a
course of 60 tablets of 200 mg of iron.
 Andhra Pradesh School Health Project
(APSHP)
• The government of Andhra Pradesh initiated the APSHP in 1992
with the funding support of DFID. The program aimed at
augmentation of the existing school health services by improved
screening and referral activities. The project was implemented for
five years and covered the entire state in a phased manner
Human Capacity Development (HCD)
Project
• Catholic Relief Service (CRS) implemented this program from 1997
to 2001 in the sponsored schools in rural areas. The program
adopted cluster-wise strategy of mid-day meal and capacity building
of parents to address constraints to the education of girls and
disadvantaged groups.
 School Water and Sanitation towards
Health and Hygiene (SWASTHH)
• SWASTHH, a joint project of government of India and UNICEF
with a funding support from the USAID, is being implemented in
Chhattisgarh and Karnataka. The key strategy of the project is to
improve the water and sanitation facilities in the schools and provide
health education to the children.
 Adolescent Girls’ Health Project
• Introduced in Jabalpur City, Madhya Pradesh with a focus on
addressing reproductive health needs of adolescent girls. Although
the target population of the project included slum community,
schools were used as platform for peer education.
YUVA School Adolescence Education
Program
• The government of Delhi and Delhi state AIDS control society
launched the YUVA in 2006. The program is centered at capacity
building of school teachers and students through life skills
education. The program effectively covers a wide range of
adolescent health issues.
 Aarogya keralam
• The seed for renovating the School Health program in the State was
sown with the starting of a School Health Clinic in 2007 December
in the largest girl’s school in India, the Cotton Hill Girls Higher
Secondary School in the capital city Thiruvananthapuram. A full
time Doctor, a staff Nurse and an attendant was appointed. The
clinic proved to be a great success with 30-40 out patients
(students), who were given appropriate treatment either with
medicines or proper advice
• Health education was approached in a multi pronged manner. Along
with the conventional class room method, an year long standing
exhibition, quiz competitions, demonstration on preparation of easy
to prepare nutritious food etc were conducted. In 2008, realizing a
need for extending health activities in all schools of the state
planning was undertaken which culminated in implementation of
the Special School Health program.
Child-to-child School Health Program
• This program was implemented by the community health
department of St. Stephen’s Hospital, Delhi, covering 25000
children of government schools. The program is strategy was based
on child-to-child approach. A school based team comprising of a
health coordinator (a teacher), health leaders and health scouts
(students) was trained to screen common ailments and create health
and environment awareness among school children. The hospital
organized annual health checkup and periodic follow-up clinics.
 SHP in other countries
• In Asia, A number of other countries, including Sri Lanka,
Bangladesh, Thailand, and Malaysia are implementing some
components of School Health Programme. Sri Lanka has School
Health and Nutrition Brach established as part of Ministry of
Education. In Malaysia School Health Programme is implementing
through Health Promoting Schools
 SOME SCHOOL ORAL HEALTH
PROGRAMS
1. “Learning about your oral health” – prevention oriented school
programme
2. “TATTLETOOTH PROGRAM" - TEXAS STATEWIDE
PREVENTIVE DENTISTRY PROGRAM
3. ASKOV DENTAL DEMONSTRATION
4. NORTH CAROLINA STATEWIDE PREVENTIVE DENTAL
HEALTH PROGRAM
5. SCHOOL HEALTH ADDITIONAL REFERRAL PROGRAMME
(SHARP)
6. TEENAGE HEALTH EDUCATION TEACHING ASSISTANTS
PROGRAM (THETA Program)
7. WORLD HEALTH ORGANIZATION’S (WHO’S) GLOBAL
SCHOOL HEALTH INITIATIVE
 “Learning about your oral health” –
prevention oriented school programme
• This program was developed by the 'American Dental Association'
(ADA) and their consultants in coordination with the 1971 ADA
House of delegates and is presently available to school systems
throughout the United States of America. "Learning about Your Oral
Health" is a comprehensive program covering current dental
concepts.
• The primary goal of this program is to develop the knowledge,
skills and attitudes needed for prevention of dental diseases among
school children.

• Implementation of the program: The program fs divided into five

levels, each level having its own defined specific content The five
different levels are:
• The core material for each of the five levels is self-contained in a
teaching packet that allows the classroom teacher to adapt the
presentation to the needs of the students. Each teaching packet
includes.

• A teacher's self-contained guide on "dental health facts" with a

section on handicapped children

• A glossary of dental health terms

• A curriculum guide featuring content, goals, behavioral objectives
and suggested activities for other classes

• Five lesson plans for the preschool level and seven or more lesson
plans for each of the other levels

• Four overhead transparencies

• Twelve spirit masters (for copying)

• Methods and activities for parental involvement

 “TATTLETOOTH PROGRAM" - TEXAS STATEWIDE
PREVENTIVE DENTISTRY PROGRAM

• The Tattletooth Program was developed in 1974-1976 as a

cooperative effort between Texas Dental health professional
organizations, the Texas Department of Health and the Texas
Education Agency through a grant from the Department of Health
and Human Services to the Bureau of Dental Health.
• The program was pilot tested inl975 and field tested in spring I97£in
schools within the state of Texas. In l989, the Bureau of dental
health developed a new program to replace the existing Tattletooth
Program. This was called Tattletooth II - A New Generation for
Grades K – 6
• Three videotapes were produced as part of the teacher-training
package.
• The first videotape familiarizes the teachers with the lesson format
and content.
• A second videotape, "Brushing and Flossing" was developed for the
dual purpose of teacher training and as an educational unit to be
used by the teacher with the students.
• A third videotape provides teachers with additional background
information as a means of preparing them to teach the lessons.
• The program embraces the six elements of effective lesson design;
anticipatory set, setting the objective, input modelling, checking for
understanding, guided practice and independent practice.

• The basic goal of the program is to reduce dental disease and

develop positive dental habits to last a lifetime.

• The major thrust of Tattle tooth is to convince students that

preventing dental disease is important and that they can do it.
• The Texas Department of Health employs 16 hygienists in the eight
public health regions to implement the Tattle tooth Program. The
hygienists instruct teachers using videotapes designed for teacher
training and provide them with a copy of the curriculum. Health
promotion activities are encouraged and publicized within the
school community. Teachers are encouraged to invite a dental
professional to demonstrate brushing and flossing in the classroom.
• A field trip to a dental office is strongly recommended for
kindergarten children.

• Bulletin board suggestions, a book list, films and videotapes are

available on a free loan for appropriate grade levels.

• Other resources used are a list of companies providing

supplementary classroom resources and a comprehensive glossary of
vocabulary words written for the teacher in English or Spanish that
are used in all grade levels.
 ASKOV DENTAL DEMONSTRATION

• Askov is a small farming community with a population mostly of

Danish extraction. It showed very high dental caries in the Initial
surveys made in 1943 and 1946.

• During the period from 1949 to 1957, the Section on Dental Health
of the Minnesota Department of Health supervised a demonstration
school dental health program in Askov, including caries prevention
and control, dental health education and dental care
• All recognized methods for preventing dental caries were used in the
demonstration with the exception of communal water fluoridation
since until 1955 Askov had no communal water supply.

• Dental care was rendered by a group of five dentists from nearby

communities employed by the Minnesota Department of Health.
These dentists also gave topical fluoride treatments.
 NORTH CAROLINA STATEWIDE PREVENTIVE
DENTAL HEALTH PROGRAM

• This program is a unique public and private partnership dedicated to

the mission of assuring conditions in which North Carolina citizens
can achieve optimal oral health. The program activities include
preventive and educational components to modify the behavior
patterns of individuals to improve their oral health habits through
dietary changes, tooth brushing and flossing
 Objectives that will facilitate
attainment of the goals includ
• Appropriate use of fluoride

• Health education in schools and communities

• Availability of public health dental staff in all counties

 SCHOOL HEALTH ADDITIONAL REFERRAL
PROGRAMME (SHARP)

• This program was instituted in Philadelphia with the purpose of

motivating parents into initiating action for correction of defects in
their children through effective utilization of community resources.
The project was carried out by district nurses with the cooperation
of school personnel. The nurses made daytime visits to families in
which the mothers were at home. Working parents were contacted
by phone. The one-to-one basis of health guidance between parent
and health worker established better rapport between school and
home.
 TEENAGE HEALTH EDUCATION
TEACHING ASSISTANTS PROGRAM
(THETA Program)
• Developed by the National Foundation for the prevention of oral
disease for the Department of Health and Welfare, Division of
Dental Health.

• Philosophy: Dental personnel train high school children to teach

preventive dentistry to elementary school children.

• Goals : To give knowledge & skills to young children. Allows high

school children to develop understanding of young children.
Introduces them to career opportunities.
 WORLD HEALTH ORGANIZATION’S (WHO’S)
GLOBAL SCHOOL HEALTH INITIATIVE

• WHO's Global School Health Initiative, launched in 1995, seeks to

mobilize and strengthen health promotion and education activities at
the local, national, regional and global levels. The Initiative is
designed to improve the health of students, school personnel,
families and other members of the community through schools
 COLGATE’S BRIGHT SMILES,
BRIGHT FUTURES
• The Colgate Bright Smiles, Bright Futures" oral health educational
program worldwide was developed to teach children positive oral
health habits of basic hygiene, diet and physical activity. This
program also encourages dental professionals, public health
officials, civic leaders and most importantly, parents and educators
to come together to emphasize the importance of oral health as part
of a child's overall physical and emotional development
"Neev" School Oral Health Program
• The School Dental Program "Neev" would be initiated across
Government Schools run by Govt. of NCT of Delhi in Delhi State as
a Pilot Project. The Dental Team along with the Mobile Dental
Clinic would draw a district plan which would cover different
schools round the year.
• The primary intention is to

• Promote oral health through Dental Health Education and organize

dental check up/ Screening.

• Provide Primary and Secondary Dental care through Mobile Dental

Clinic in the Schools.

• Make necessary referrals for advanced care available at Maulana

Azad Institute of Dental Sciences
• Target group:
• The Program would be run for one year during which it would cover
all the Public funded schools in any one District, Delhi State (at
least 50 schools) and include all children from Class 6th to Class
10th.
• Training and involving Teachers, School authorities and Parents as
team members.
• Collaborating ultimately into the existing Health Care system at the
school level.
• Financial details:
• The total expected annual expenditure for the program is Rs. 2, 00,
00,000/-covering more than 80,000 School Children in the One
District of the State.
 SCHOOL HEALTH TEAM
1. The school principal

2. The school teacher

3. The parents

4. The community

5. The children

6. The medical officer

7. The school health nurse/community health nurse

 THE SCHOOL PRINCIPAL
1. Ensure that school health programme has the approval and support of
school administrative authority.

2. Setup a school health committee/school health council to work out

the school health plan and plan for its implementation.

3. Ensure that teachers are adequately trained for health care of school-
children.
4. Provide facilities for implementation of school health activities.

5. Make sure that proper health records are maintained.

6. Ensure that parents are involved and follow up of children is done.

 THE SCHOOL TEACHER
1. Daily inspection of children for personal hygiene and cleanliness;

2. Daily observation of children for detecting any evidence of any

deviation from normal health, behavior, any communicable disease,
malnutrition etc;

3. Help in control of communicable diseases;

4.Referral of child having any problem to school health clinic for
further action;

5. Informing the parents and maintaining follow up;

6. Maintaining record of anthropometric measurements and other

health record of children;

7. Help in providing safe environmental sanitation;

8. Giving First Aid and Emergency care to children

9. Imparting of health education on healthful living habits and behavior
etc;

10.Participate in investigation of epidemic or any communicable

disease etc.
 THE PARENTS
1. They can help in correction of defects if any and follow up of
children found sick.

2. They can help in formation of good healthful living habits and

behaviour.

3. Through "Parents- Teachers Association" the parents can be involved

in planning, organizing and implementation of school health
programm
 THE COMMUNITY
1. Providing suitable land for school building;

2. Providing funds and labour in building proper school;

3. Participation in school health committees or councils and contribute

in formulation of school health policies and plan;

4. Participation in implementation of programme activities.

5. Motivating parents to send their children to school and take care of

their health etc
 THE CHILDREN
1. Learn values of medical and health examinations, personal hygiene,
good nutrition, environmental sanitation etc.;

2. Co-operate in various aspects of school health programme;

3. Develop positive habits and healthful living activities as educated

upon;

4. Extend this knowledge to other members of the family,

neighborhood etc.
 THE MEDICAL OFFICER
1. Medical examination of the students.

2. Making diagnosis.

3. Prescribing treatment.

4. Making referral to specialists.

5. Ensuring follow up of children.

6. Initiating promotive and preventive programme.

7.Inspection of school environment and sanitation

8. Holding meetings with parents and teachers.

9. Ensuring maintenance of records and reports.

10.Evaluation of the programme and redefining programme objectives

and activities.
 THE SCHOOL HEALTH NURSE
• Is responsible for comprehensive health of the child. She takes care
of all the factors which influence the health of the child such as:-

1. Biological aspects of the child,

2. School and family environment,

3. Health knowledge and health attitude of the child and families

4. Living activities,

5. Personal habits,

6. Health behavior followed by the child and his/ her family members;

7. Family and individual health history;

8. Family and community resources and their utilization etc.

 SCHOOL HEALTH POLICY
1. Health center staff is responsible for implementation of school health
programme.

2. The school health programme is carried out in schools by the health

center staff working together with schools administrators/ teachers,
local government, parents and community including both agencies
and students.

3. Priority should be given to school health programme at primary

school levels.
 ASPECTS OF SCHOOL HEALTH
PROGRAM
• Health appraisal

• Health counselling

• Emergency care ad first aid

• School health education

• Maintenance of school health records

• Curative services
 Implications of not launching School
Health Program (SHP)
• Learning environment in schools will not improve.

• Parents and teachers will not be aware of the prevalence of various

ailments and disorders among the children, which affect their learning, &
can be treated at early stages.

• A number of children will face difficulty in their studies due to physical

disorders, and may leave the school without knowing nature of their health
problem.

• A considerable proportion of children will remain malnourished,

particularly from disadvantaged groups, and their smooth physical and
mental growth will be inhibited.
• Children and their parents, particularly in rural areas, will be more
vulnerable to various diseases and infections.

• Higher drop out rate will lead to wastage of resources and will
negatively affect efficiency of education system .

• Overall health indicators among next generations will remain low.

• Social and economic disparities among different segments of the

society will widen.
 UN Support for School Health
Program
• UN is committed to assist member states in the achievement of
Millennium Development Goals (MDGs), Education For All (EFA),
and other international norms and Conventions aimed to improve
quality of life of the people. On the occasion of World Education
Forum in Dakar (Senegal), in April 2000, four UN agencies (WHO,
UNICEF, UNESCO and World Bank) signed a framework titled
“Focusing Resources for Effective School Health Program (FRESH)
to affirm their commitment for the School Health Programs.
• A number of UN agencies have been supporting different
components of School Health Programme, although a holistic
approach has been lacking. Agencies contributing towards this
programme include WHO, UNICEF, WFP, UNFPA, UNESCO,
UNODC and UNDP.
 What needs to be done? Proposed
Strategic Actions
1) Legislation and policy reforms for provision of health and nutritional
support to all children in schools.

2) Formulation and enforcement of equitable standards of school

facilities for all schools

3) Resource mobilization for School Health Program (SHP)

4) Coordination mechanisms between Health and Education sectors

5) Institutional capacity development, i.e. technical and administrative
support to the relevant organizations and institutions at national,
provincial, and district level.

6) Advocacy and research in favor of increased attention to education

and health of school children.

7) Sustainability mechanisms, to ensure that projects launched are

consequently integrated into the regular system.
 Desired Actions at National level
• Units on SHP: Separate units or sections on School Health Program
may be established at the federal level, in both relevant Ministries
i.e. Ministry of Education and Ministry of Health

• Advocacy: Policy dialogue with Ministry of Education, Ministry of

Health and Environment including orientation of key officials on the
concept and rationale of SHP. Decision makers should be convinced
to invest on different components of school health programe.
• Material Development: Preparation and production of advocacy
and teaching-learning material on school health programe, for the
officials, educators, school heads and teachers.

• Students Curricula: Integration of new and more explicit messages

relating to health, nutrition, HIV and AIDS Prevention education
and Population Education in the textbooks for students.
• Teacher Training Curricula: Inclusion/enrichment of health
education or school based health related activities and approaches in
the teacher training curriculum

• Research work: Studies (e.g. pilot surveys) on pertinent issues and

indicators relating to health status of school children, and building a
data base.
 Desired Actions at Provincial level
• Coordination Mechanisms: Provinces should constitute Steering
Committees or Task Forces for policy level work on School Health
Programme. These Committees should include representatives from
both Health and Education sectors.
• SHP Units: Provincial Departments of Education and Health should
establish School Health Units to plan, implement, and monitor
interventions relating to School Health Programme
• Consultation: Policy dialogue with provincial departments of
education for launching of a pilot project of school health.
• Pilot Projects: Provincial governments should formulate and launch
pilot projects, either focusing on selected districts, or few
interventions for the whole province, e.g. School Feeding or Health
Screening etc. Lessons learnt and experience gained from pilot
phase may lead to the replication and up scaling.

• Networking: Identification, mapping and networking of relevant

provincial level institutes and organizations which can extend
technical support (in the area of school health) at the district level
• Roles and responsibilities of various departments and officials at
different levels may be spelled out along with allocation of
necessary budget required for this programme. Relevant focal point
organizations at provincial level should also undertake the tasks of
material development, training, and research in this important area.
 Desired Actions at District level
• District governments and public sector offices at district and sub
district level play a pivotal role in the implementation of
interventions relating to School Health Programe.
• Orientation: District education authorities, District level Health
staff need to be provided orientation about the concept and rationale
of school health programes, including roles and responsibilities of
different departments.
• Visits of Health staff: Periodical visits of medical doctors to the
schools for undertaking following tasks:
• Annual/or six-monthly Medical check up of all students, particularly their
eyesight, weight, and other indicators of fitness

• Informative lectures on health, hygiene, and nutrition etc. for the students
Special lessons in Secondary/higher secondary schools on issues and
diseases related to adolescence (e.g. STIs, AIDS Prevention etc)

• Capacity building: Orientation of school heads for organizing school-

based health and nutritional interventions and provision of necessary
financial and administrative support to the schools for this purpose.
• Teacher Training: Organization of short courses for training of
school teachers in methodologies for communication of key
messages on health and population to the students in the class
rooms. Training may also cover basic steps for health screening of
students in the absence of medical staff.

• Informative Material: Provision of resource material on population

and health issues to the teachers and students
• Community Involvement: Sensitization of Parent Teacher
Associations (PTAs) and/or School Management Committees
(SMCs) on school health programmes for mobilization of support of
local communities for the programme
• School level interventions: Possible interventions at the school
level may include:

• De-worming campaigns

• Anti-smoking drive

• Drug education

• Sports and physical education etc.

• Food as incentive to enhance enrolment and attendance

• Special food supplements for malnourished children

• Promotion of use of iodized salt

• Provision of water and sanitation/toilet facilities and promotion of
hygiene education

• Training of teachers to undertake screening

• Health screening by teachers themselves in the absence of medical

staff

• Role of Civil Society: Partnership with civil society organizations

and CBOs to promote school health and population education etc.
 Political will and partnership building
for School Health Programme
• Success of any future country wide School Health Programme will
largely depend on two factors. Firstly, the will and determination of
political leadership to invest on this important area which will affect
health and education of next generations. Secondly, interest and
willingness of various stakeholder organizations at national and
international levels to join hands to collectively plan and implement
this unique programme, which can not be implemented by one
Ministry or Department alone.
• International community, including donors, UN agencies, and
professional institutions to come forward to build a partnership for
School Health Programme.
 CONCLUSION
• Childhood is the age of learning and it is the time when a child start
developing practices and attitude towards health. It is very important
to target the children for health awareness and demonstration of
correct methods for a healthy life style. At the global level,
approximately 80% of children attend primary schools and 60%
complete at least four years of education, with wide variation
between countries and gender. They can be nurtured well for their
general and oral health and can very well be implemented
effectively
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 Previous year questions
• Components of school health program (AUG 2005) – 5 marks

• Objectives of school health program (AUG 2007)- 5 marks

• Define school health program . Explain in detail the planning,

implementation and evaluation of various school health
programs (AUG 2001) – 10 marks