School health services

SCHOOL HEALTH
SERVICES
Ms. NAMITA BATRA
Associate Professor, Community Health
Nursing

INTRODUCTION
• School going children comprise of at least
30% of the total population.
• Health care services to this section can be
rendered through school system.
• School system provides the oppurtunity for
influencing knowledge benefits, attitudes
and practices of children for present and
future.
• Children are exposed to various
epidemiological factors which influence their
health.

INTRODUCTION
• Ultimate aim of the school health is to
provide well planned and organized
comprehensive health care services to school
going children throgh school system.
• It is important for the community health
nurse to know about the school health as it is
the continuation of the services.

INTRODUCTION
• SCHOOL HEALTH: refers to the state of
complete physical, mental, social and
spiritual well being and not merely absence
of disease or infirmity among pupils, teachers
and other school personnel.
• SCHOOL HEALTH SERVICES: Refers to need
based comprehensive services rendered to
pupil, teachers and other personnel in the
school to promote and protect their health,
prevent and control diseases and maintain
their health.

NEED FOR SCHOOL HEALTH SERVICES
• School children constitute a vital and
substantial segmment of population. Their
health status affect the health status of the
community. Future of the nation.
• School children are vulnerable section of
population by virtue of their physical, mental,
emotional and social growth and
development.
• They are exposed to stressful situations
• They belong to different socio-economic
sections, which affect their health status.

NEED FOR SCHOOL HEALTH SERVICES
• School children are prone to get specific
healh problems, e.g. dental caries, worm
infestation, hepatitis, anemia etc.

AIM AND OBJECTIVES OF
SCHOOL HEALTH SERVICES
• Ultimate aim of the school health
services is to promote, protect and
maintain health of school children and
reduce morbidity and mortality in
them.

• Specific objectives are:
– Create health conciousness among school
children, parents and teachers.
– Provide healthy and safe environment
which is conducive to comprehensive
development of children
– Impart health information and conduct
health education on various aspects.
– Prevent communicable and non-
communicable diseases.

• Specific objectives are:
– Identify and treat any abnormalities/
defects/ diseases as early as possible and
do necessary referrals and follow up.
– Involve teachers, students and their
parents in management of health aspects
of children.
– Help teachers and children make
constructive and productive use of co-
curricular and extra-curricular activities.

PRINCIPLES OF SCHOOL HEALTH SERVICES
• Should be based on health needs of the school
children.
• Be planned in coordination with the school, health
personnel, parents and community people.
• Be part of community health services.
• Emphasize on promotive and preventive aspects.
• Emphasize on health education to promote, protect,
improve and maintain health of children and staff.
• Be ongoing and continuous program.
• Have an effective system of record keeping and
reporting.

COMPONENTS OF SCHOOL HEALTH SERVICES
• HEALTH PROMOTIVE AND PROTECTIVE SERVICES
– Wholesome School environment
– Maintenance of Personal Hygiene
– Nutritional services.
– Physical and recreational activities
– Promotion of mental health
– Health education
– Immunization.
• THERAPEUTIC SERVICES
– Health Appraisal
– Treatment and follow up
– First aid and emergency care
– Specialised health services.

COMPONENTS OF SCHOOL HEALTH SERVICES
• REHABILITATIVE SERVICES
– Care of handicapped
• SCHOOL HEALTH RECORDS

Health promotive and protective services
• Wholesome environment: essential for holistic
development of children. It comprises of site,
location, building structure and its surroundings,
sanitary and other facilities.
• General sanitation: General cleanliness should be
maintained. Play grounds should be free of stones.
School should have proper drainge system.

Wholesome environment
 Location & site:
 should be away from noise, traffic, dust etc.
 Easily approachable.
 Raised with proper drainage system
 Provision of playground

 Building structure
 Preferably single storied fire proof building.
 Should be heat proof, well ventilated and class rooms
attached to verandhas.
 Area covered by doors and windows should be 25% of
floor space.
 Class room should provide minimum space of 10sq.
Feet space to each student.
 Plantation and proper trees to keep surroundings clean
and fresh.

 Furnishing of classroom
 Desirable to have single desk with chair.
 Chair should be with proper back rest.
 Desk should be of ‘minus type’.
 Ceiling should be with dull finish and pastel wall to
prevent glare.
 Dark green chalk boards with dull finish can be used as
they doesnot absorb as much light as black.


 Sanitary and other facilities
 Water supply: continuous, potable and safe water
supply from tap. Water should be chlorinated
periodically. It should be covered and tumbler with long
handle should be used to take out water. Common
drinking water cup should never be used.
 Lavatory: separate arrangements for boys and girls. One
urinal for 60 students is advocated. Provide a container
of water near urinals for handwashing. Arrange for the
supply of soap. Teach the children to air dry the hands
rather than use a common towel.
 Disposal of waste water and refuse: in rural areas
waste water can be drained in soak pit or garden or into
nearby agriculture field. In urban areas, underground
drainage system should be available. Dustbins should
be kept in each classroom.

 Sanitary and other facilities
 Canteen and eating facilities: if feasible school should
have its own sanitary canteen facility on subsidized
basis or else approved vendors should be allowed in
the school premises. Facility to wash hands and
separate room for mid day meal should be there.

Maintenance of personal hygiene
• Teachers play important role in maintenance of
personal hygiene.
• They should encourage and educate the children to
follow good personal hygiene.
• Daily inspection of children to assess their personal
hygiene.

Good Nutrition
• Essential for optimal health, growth and
development of school children.
• Mid day meal should be provided as it is helpful in
combating malnutrition in children.
• It is necessary to improve nutritional status and
scholastic performance of children.

Physical and recreational activities
• To promote musculo-skeletal development,
recreational activities should be inculcated in the
extra-curriculum.
• It help in releasing physical and mental stress and
promote optimal health, growth and development
and scholastic achievements.
• The recreational programs should be organised at
regular intervals.

Promotion of mental health
• Mental health is essential for making sound
adjustments with the overall environment.
• Maladjustment can lead to untoward behaviour such
as: truancy, juvenile delinquency, drug addiction etc.
• Guidance and counselling facilities should be
available for students at school.
• Teachers and health personnel play important role in
promoting mental health among school children.

Health Education
• It creates awareness, develops motivation and
promotes change in health behaviour and attitude.
• Crucial and key element of school health services.
• Ultimate aim is to help students develop self
reliance, civic sense, take social reponsibility and
have quality of life through their life span.
• Content includes areas such as: personal hygiene,
environmental health, nutrition, prevention and
control of communicable and non-communicable
diseases etc.

Health Education
• Methods and approaches used to educate students
regarding health can be: discussions,
demonstrations, problem solving or issue based
learning, role play, competitions, group projects etc.
• These methods should be used considering their
maturity, level and variation in pace of learning.

Immunization
• It is necessary to find out at the time of admission
whether child has completed immunization schedule
or not.
• If no clear history of previous immunization with DPT
then two doses of DT can be given at an interval of
4weeks at age of 5-6yrs., two doses of TT at one
month interval at age of 10 yrs and 16yrs
respectively.

THERAPEUTIC SERVICES
• Health Appraisal
– It is necessary to identify the deviation from normal
conditions of body parts and systems.
– Includes complete physical and medical checkups.
– The health appraisal is done initially at the entry in the
school and thereafter at four year interval.
– Physical examination includes head to toe examination of
general normal characteristics.
– It also includes: ht., wt., chest circumference, vision test,
hearing and speech, vital signs, routine examination of
urine, blood and stool.
– Medical examination includes thorough checkup of all
systems of body, which is done by a medical officer.

• Health Appraisal
– A minimum of 3 appraisals should be done i.e –
• On school entry t age of 5-6years
• On passing out from primary school at the age of 10-11 years
• On passing out from middle school at the age of 13-14years
– In addition to the health appraisal, recording of weight and
height at 3months interval should be done.
– Daily inspection of personal hygiene, dental hygiene and
deviation from normal behavior can be done by the class
teachers.

• Treatment and follow up
– It is important for the school to have arrangements
exclusively for school children.
– In rural areas the treatment may be provided at PHC, while
in urban areas in school health clinics at selected school or
local dispensary.
– After the treatment, the follow up should be done by
school health nurse to make sure that regular treatment is
taken and proper care is given.

• First Aid and Emergency care
– Arrangements for providing First Aid and emergency care
to children in case of sudden injuries or falls should be
made.
– Basic facilities should be as per the standards laid down by
St. John Ambulance Association of India.
– The school health nurse must be trained in that and in case
of her absence teachers should be able to provide first aid.

• Specialised Health Services
– Specialized services like: dental, eye, ENT etc can be
provided by the specialists.
– Special clinics may be organized or specialists may be
invited on specific days to hold clinics for examination and
treatment of disorders related to eye, ENT, teeth etc.

REHABILITATIVE SERVICES
– It is required for those children who are born with or
acquire any disability or handicap due to road
accident/disease etc.
– The disability or handicap may be physical and mental or
both.
– Children with marked disabilities like blindness, deafness
etc, should be trained in special institution.
– Children with minor defects may be kept in normal
schools.
– However, teachers and health workers need to give
increasing attention and care to them.

SCHOOL HEALTH RECORDS
– Should be complete, accurate and continuous health
records of school children.
– It helps to evaluate the school health services and assist in
further development and improvement of health services
rendered to the school children
– They should include: identification data, personal and
family health history, findings of physical and medical
examination, findings of routine investigation and
screening, services rendered and the prognosis.
– School health records are important documents for
providing of need based services but also for legal and
administrative purposes.

SCHOOL HEALTH PROGRAM
• School health program refers to all school
activities/procedures that contribute to initiation,
understanding, maintenance and improvement of
health of pupil and school personnel, including
health services- health education and healthful
school living.

PRINCIPLES OF SCHOOL HEALTH PROGRAM
• It is based on the health needs of school children
• It is an ongoing and continuous program
• It emphasizes on learning through active and
desirable participation.
• It emphasizes on promotive and preventive aspects.
• It should be well planned in coordination with
school, health personnel, parents and community
people.
• It should have an effective system of record keeping
and reporting.

SCHOOL HEALTH NURSE
• She is responsible for comprehensive services
including preventive, promotive and personal care of
the child, health education of children, parents,
teachers and community.
• She helps and asserts early diagnosis, treatment,
prevention of complications and rehabilitation.
• She also performs managerial and supervisory
functions.

RESPONSIBILITIES OF SCHOOL HEALTH NURSE
• Health promotion and specific protection: includes
immunization, nutritional supplementation, health
education etc.
• Early diagnosis and treatment: includes regular and
periodical health appraisals, making referrals, follow-
up of referred cases, counseling.
• Prevention of complications and rehabilitation:
includes eliminating risk factors responsible for a
particular condition, health education of students
etc.
• Other functions: Maintenance of health records,
collaboration with the physician, participate in health
committee, inservice education etc.

ROLES OF SCHOOL HEALTH NURSE
• NURSE PRACTITIONER: identifying children at risk for specific
health problems for the management of certain chronic
diseases and acute health concerns.
• NURSE TEACHER: Teaches the health concepts and identifies
ways to transmit knowledge that supports change in
behaviour.
• CONSULTANT: she can be consultant to children, parents and
teachers to identify health problems and guide for good
health practices.
• ADVOCATE: represents the interest of the individual student,
special need group etc.
• FUNCTIONAL ROLE: fulfills the functions of screening, follow
ups, immunization etc.

ROLES OF SCHOOL HEALTH NURSE
• PRIMARY ROLE: it includes direct health services like: caring
of sick children, control of communicable diseases and health
education.
• TEAM MEMBER: she is a member of multidisciplinary team.
She may act as a coordinator in the team, who will convey the
health information about problem areas.

SCHOOL HEALTH TEAM
• It comprises of: school health officer, school health nurse,
auxiliary health worker, teachers, parents and students
representatives from community.
• Each member on the tam has important role in promoting
health of school children.
• Team needs to work in group and follow group dynamics in
assessing school health needs, planning, organizing and
implementing school health activities by delegating specific
responsibilities to team members.
• Functions of the tam members are as follows:

SCHOOL PRINCIPAL
• To ensure that school health program has the approval and
support of school administrative authority
• To set up a school health committee/school health council to
work out the school health plan and plan for its
implementation.
• To ensure that teachers are adequately trained for health care
of school- children.
• To provide facilities for implementation of school health
activities.
• To make sure that proper health records are maintained.
• To ensure that parents are involved and follow up of the
children is done.

SCHOOL TEACHER
• She is the key person as she is in continuous contact with the
students. Some of the specific functions are:
• Daily inspection of children for personal hygiene and
cleanliness.
• Daily observation of children for detecting any evidence of
any deviation from normal health, behaviour, any
communicable disease, malnutrition etc.
• Help in control of communicable disease.
• Referral of child having any problem to school health clinic for
further action.
• Informing the parents and maintaining follow up.
• Maintaining record of anthropometric measurements and
other health records of children.
• Help in providing safe environment sanitation.

SCHOOL TEACHER
• Giving first aid and emergency care to the children
• Imparting of health education on healthful living habits and
behaviour etc.
• Participate in investigation of epidemic or any communicable
disease.

PARENTS
• They can help in making assessment of health of children by
providing information.
• They can participate and cooperate in physical and medical
examination of children.
• They can help in correction of defects if any and follow up of
children found sick.
• Through Parents- teachers association, parents can be
involved in planning, organizing and implementation.
• They must relieve the child of work pressure at home.

COMMUNITY
• Provides land for school building
• Provides funds and labour in building proper school
• Participates in school health committees or councils and
contributes in formulation of school health policies and plan.
• Participates in implementation of program activities e.g
conducting medical examination, immunization etc.
• Motivating parents to send their children to school and take
care of their health.

CHILDREN
• Learns values of medical and health examinations, personal
hygiene, good nutrition etc.
• Cooperates in various aspects of school health program
• Develop positive habits and healthful living activities as
educated upon
• Extend this knowledge to other members of family and
neighbourhood.

MEDICAL OFFICER
• The medical officer is responsible for:
• Medical examination of the students
• Making diagnosis
• Prescribing treatment
• Making referrals to specialists
• Ensuring follow up of the children
• Initiating promotive and preventing program
• Inspection of school environment and sanitation
• Holding meetings with parents and teachers.
• Ensuring maintenance of records and reports.
• Evaluation of the program and redefining program objectives
and activities.

School health services

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