Describe the school health services.

School Health Services

• The objectives — to promote positive health; to prevent disease; to detect and treat defects early; to ensure a healthy school environment; and to provide health education that reaches the family through the child
• That last aim deserves emphasis — a child taught handwashing, oral hygiene or the dangers of tobacco carries the message home, and children are frequently more effective health educators of their parents than health workers are
• The components of a school health service:
• 1. Health appraisal (periodic medical examination) — a thorough examination on entry and periodically thereafter, with daily observation by the teacher, who is best placed to notice a change in a child they see every day
• 2. Remedial measures and follow-up — without which screening is pointless
• 3. Prevention of communicable disease — immunisation, notification and exclusion of infectious cases
• 4. Healthy school environment
• 5. Nutritional services — the mid-day meal, with iron and folic acid and deworming
• 6. First aid and emergency care
• 7. Mental health services — counselling and life skills
• 8. Dental and eye health
• 9. Health education
• 10. Education and health care of handicapped children, and proper records maintained in a cumulative health card
• The common health problems found on school screening — dental caries and gingivitis, which are the commonest of all; refractive error; anaemia; malnutrition and, increasingly, overweight; worm infestation; skin conditions including scabies and pediculosis; ear discharge and hearing loss; vitamin deficiencies; and behavioural and learning problems
• Refractive error deserves particular attention because it is cheap to correct and its consequences are disproportionate — an uncorrected child is labelled inattentive or slow, may be moved to the back of the class, and may leave school, so a pair of spectacles is one of the highest-return interventions in school health
• The school environment standards — a site away from noise, dust and heavy traffic; adequate classroom space, roughly 10 square feet per child; adequate light, preferably from the left for right-handed writers, and cross-ventilation; desks of appropriate height; safe drinking water; adequate and clean toilets with separate facilities for girls; handwashing facilities with soap; and a playground
• Separate, functional and private girls’ toilets deserve emphasis, since their absence is a documented cause of adolescent girls dropping out of school after menarche — a sanitation failure with an educational consequence
• The role of the teacher is central and cost-effective — daily observation, first aid, health education, supervision of the mid-day meal, maintaining records, and liaison with parents and health services
• The teacher-to-child ratio makes the teacher a far more available observer than any doctor, which is why teacher training is the most efficient investment in school health
• The INDIAN programmes — the school health programme under RBSK, which screens children 6 to 18 years for the 4 Ds and provides free treatment through District Early Intervention Centres; the ayushman BHARAT school health and wellness programme, in which two teachers per school are designated health and wellness ambassadors and deliver weekly health-promotion sessions; WIFS; the national deworming day; the mid-day meal (PM POSHAN); and SWACHH BHARAT SWACHH vidyalaya for school sanitation
• The practical problems — screening conducted without follow-UP or treatment; irregular visits; poor record-keeping; out-OF-school children, who are the most disadvantaged and are missed entirely; and lack of coordination between the health and education departments
• Screening without follow-up is the standard failure; finding a defect and not treating it wastes everyone time
• Spectacles are among the highest-return interventions, since an uncorrected child is labelled slow and may leave school
• Separate functional toilets keep girls in school after menarche, which is a sanitation failure with educational consequences
• The teacher is the most available observer, seeing the child daily, which no visiting doctor can match
• Teacher training is the efficient investment in school health, ahead of any additional medical staffing
• Children carry health messages home, and are often better educators of their parents than health workers are
• Dental caries is the commonest finding on school screening, ahead of anaemia and refractive error
• Out-of-school children are missed entirely, and are precisely the most disadvantaged group
• Light should come from the left for right-handed writers, with cross-ventilation and about ten square feet per child
• Two teachers become wellness ambassadors under the Ayushman Bharat school programme, delivering weekly sessions
• RBSK screens six to eighteen year olds for the four Ds and provides free treatment through intervention centres
• The school reaches a captive population cheaply, through a system that already exists and already has their attention
• Coordination between health and education is the recurring weakness, and neither department owns the problem