Revamp India’s school health services

Source: This post is created based on the article “Revamp India’s school health services” published in The Hindu on 21^st July 2022.

Syllabus: GS Paper 2 – Issues related to education

Context: After the return of normalization post-pandemic, on the education front, there has been some discourse on ‘learning recovery’. However, the health needs of schoolchildren are not getting due attention yet. There is a need for improved school health services.

Government initiatives and past efforts toward School Health Services (SHS)

The first documented record of school health services in India is from 1909. Then presidency of Baroda began the medical examination of schoolchildren.

In its 1946 report, Sir Joseph Bhore committee observed that school health services in India were practically non-existent.

In 1953, the secondary education committee recommended comprehensive policy interventions dealing with school health and school feeding programs.

However, most of the interventions focused on nutrition instead of comprehensive school health.

In March 2022, the government of Delhi began 20 school health clinics, with the following significance. 1) The initiative recognized the importance of school health services. 2) It was based on the multi-stakeholder partnership, i.e. funded through a corporate social responsibility fund and run with collaboration between health and education departments.

This Delhi initiative also suffered from the same issue, i.e. lack of knowledge on what makes comprehensive school health services.

What are the constituents of comprehensive School Health Services (SHS)?

Health-care needs are often equated with medical care needs.

Although school children have limited medical care needs, there are many required health needs. Such as unhealthy dietary habits, irregular sleep, lack of physical activity, mental, dental, and eye problems, sexual behavior, the use of tobacco and other substances, addiction, etc.

The health knowledge acquired, and lifestyle adopted at the school-going age stays in adulthood. They lay the foundations of healthy behavior for the rest of their life. For example, scientific evidence shows that tobacco cessation efforts are far more successful if started in school.

FRESH Framework: UNESCO, UNICEF, the World Health Organization (WHO) and the World Bank have published an inter-agency framework called FRESH — an acronym for Focusing Resources on Effective School Health. It proposes four core areas and three supporting strategies:

The core areas include; 1) focus on school health policies, i.e., water, sanitation, and the environment 2) skills-based health education 3) school-based health 4) school-based nutrition.

The supporting strategies include; 1) effective partnerships between the education and health sectors, 2) community partnership and 3) student participation.

Guidelines by the Centers for Disease Control and Prevention, Atlanta, U.S: School health services should focus on four main areas; 1) Acute and emergency care 2) family engagement 3) chronic disease management 4) care coordination

WHO guidelines: SHS should be designed based on local need assessment, with components; 1) health promotion, 2) health education, 3) screening leading to care and/or referral and support as appropriate.

What India should do?

First, states should draw up a road map to revamp and strengthen school health services, with a timeline and dedicated budgetary allocation.

Second, build upon the existing school health infrastructure. Health talks should be a part of teaching. Adolescent sexual health such as menstrual hygiene, etc. should be integrated into regular classroom teaching.

Third, school health clinics should be supplemented with online consultations for physical and mental health needs.

Fourth, the role and the participation of parents, especially through parent-teacher meetings, should be increased.

Fifth, Government’s school health services initiatives should take care of both private schools and government-run schools.

Sixth, the School Health initiative under the Ayushman Bharat program must be revamped.

Seventh, elected representatives, professionals, pediatricians, and all other influential stakeholders should raise the issue and work towards improved school health services.

Lastly, a convergence of the National Health Policy, 2017 and National Education Policy, 2020 may result in the provision of comprehensive school health services in every Indian State.