School health services

community health nursing

1. School Health Services
By Kunal Soni
Asst. Professor
Community Health Nursing

2. INTRODUCTION
Children between the age of 5-17 years are school age
children.
About 30 percent of the population is comprised of this
age group.
The ultimate aim of the school health is provide well
planned and organized comprehensive health care
services to school going children through school
system to help in attaining their optimum health and
develop wholesome behavior.
Community health nurse plays in important role in
school health.it is essential for her/him to learn about
school health services which are provided to school
children.

3. DEFINITION:
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.
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.

4. SCHOOL HEALTH SERVICES :
Ideally School health services refer to need based comprehensive
services rendered to pupils, teachers and other personnel in the
school to promote and protect their health, prevent and control
diseases and maintain their health. But practically, it refers to
providing need based comprehensive services to pupils to promote and
protect their health, control diseases and maintain their health.

5. SCHOOL HEALTH SERVICES IN INDIA

•Before Independence Era

•Post Independence Era
(Both era are combined here):
•1909, when for the first time medical examination of school
children was done in Baroda city.
•1957 when Child Education -Nutrition Education
Committee and WHO assisted School Health Education
project were set up.
•1979, the National School Health scheme was handed over to
State Governments.

6. •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.
•1988, a proposal for the comprehensive school health service.
•1989, the Central Health Education Bureau, Directorate General of
Health Services, had launched an intensive School Health Education
Project.

7. NEED FOR SCHOOL HEALTH SERVICES

1.School children constitute a vital and substantial segment of
population. They are the future citizens and asset for their
families and nation.
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.These are
school timings, heavy studies, competitive environment, indifferent
behaviour of students, corporal punishment by some teachers
4)Children coming to school belong to difficult socio-economic and cultural
backgrounds which affects their health and nutrition status and require
help and guidance in promoting, protecting and maintaining their health
and nutritional status

8. SCHOOL HEALTH PROBLEMS IN INDIA
Dental problems:
Dental caries, bleeding gums, bad odour, irregular teeth
Malnutrition:
Anaemia, PEM, Vitamin deficiencies.
Gastro-intestinal:
Intestinal parasites, diarrhoeal diseases, constipation
Skin condition:
Scabies,lice,acne,eczema,dermatitis,pigmentation,depigmentation,dryness.
Eye diseases :
Refracting defects, squint,conjuctivitis,dryness.
Respiratory: TB,Pneumonia,asthma

9. Behaviour problem:
1.Antisocial problem: - stealing, lying, gambling, destructiveness,
sexual offence.
2. Habit disorders: - nail biting, thumb sucking, bed wetting
3.Personality disorders: - temper tantrum, shyness, day dreaming, and
jealousy.
4.Educational difficulties: - backwardness in study, school fear,
school failure, etc
Other problems:
Tiredness, defective postures, inattentiveness, headache, congenital heart
problems. Urinary infection, HIV infection

10. PHILOSOPHY OF SCHOOL HEALTH
SERVICES

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.

11. 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 ad-equate 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

12. AIMS AND OBJECTIVES OF
SCHOOL HEALTH SERVICES
Aims:
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 services:
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

13. PRINCIPLES OF SCHOOL HEALTH
SERVICES
•Be based on health needs of school children.
•Be planned in coordination with 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.
•Emphasize on learning through active and desirable participation.
•Be ongoing and continuous programme.
•Have an effective system of record keeping and reporting

14. COMPONENTS OF SCHOOL
HEALTH SERVICES
•The components of school health services include all those aspects which
help achieve its aim and objectives.
•The components are enlisted as under :
I)Health Promotive and Protective Services:
1.Wholesome school environment
2.Maintenance of personal hygiene.
3.Nutritional services
4.Physical & recreational activities
5.Promotion of Mental health
6.Health Education
7.Immunization

15. II) Therapeutic Services:
1. Health appraisal
2.Treatment and follow up
3.First aid and emergency care
4.Specialized health services
III) Rehabilitative Services:
•Care of the handicapped
IV) School Health Records

16. I)Health Promotive and Protective Services:

1.Wholesome school environment:
•School should be away from railway station, railway lines,bus-stand
,market place, cinema
•There should be proper arrangement of ventilation and light
•Heights of rooms should not be less than 12 feet.
•Every student should get minimum 10-15 sq. feet of area
•Floor should be clean but not slippery
•There should be proper railing on the staircase and roofs.
•For every 100 students there should be minimum one toilet and two urinals
•There should be safe and separate arrangement for drinking water,wash
basin and school kitchen.
•There should not more than 40 students in classroom.

17. •Classroom should be a veranda in front of every classroom.
•School sanitation and hygiene education(SSHE): This programme is being
implemented in school under the total sanitation campaign : i) one toilet
and 3-4 urinals for 100-150 students
•ii) separate blocks for boys and girls
•iii) safe water supply
•iv) Hand washing facilities
•v) Garbage pits and soak- pits.

18. 2.Maintenance of personal hygiene:
•Maintenance of personal hygiene is very essential for promotion of
health of children.
•Personal hygiene includes care of the whole body starting from head
to toe.
•It require proper cleanliness and care of head, eye, mouth and teeth,
hands and nails, body folds. Private parts, feet and bowel habit.
•It also include behavior related diet,sleep,exercise,clothings,smokings
drugs, relationship with parents, peer groups, siblings, friends.
•Teachers are play important role for maintaining personal hygiene of
the students.

19. 3. Nutrition services:
•The objectives of this aspects is to protect children against malnutrition.
Mid-day meal:
According to the recommendations of school health committee, Minimum
one nutritious meal should be given to children in the school.
Committee believes that one third of the total calories required by a child in
the day ,should be acquired by him through mid-day school meal .
To make the mid-day school meal. Attractive and utilize the surplus storage
of wheat,Ghoongari(boiled wheat, sweetened with sugar or gur) is being
supplied in many states to school going children. Use of POHA or local
foods are also encouraged to include in this programme.
According to local condition, menu of midday school meal should be
different on every day.

20. Mid-day meal programme was launched on 15 august 1995. At present, it is
the biggest school meal programme in the world.
Recommended menu for Mid-day school meal:

Food stuff Qty: gm/day/Child
Cereals 75
Pulses 30
Oil(Fats) 8
Green leafy veg. 30
Other Vegetables 30

21. 4.Physical & recreational activities:
•Physical and recreational activities in the school promote
musculoskeletal development, inculcate team spirit and help release
physical and mental stress.
5.Promotion of Mental health:
•Wholesome mental health and behavior of a child is very
essential for making sound adjustment with the overall
environment around him/her in the school and with the studies
expected.
•Maladjustment may lead to various type of problem such as
truancy, juvenile delinquency, drug addiction.
•For promotion of mental health school authority and school
teachers can play a significant role.

22. •Teachers and health personnel can play vital role for guidance and
counselling for specific academic and health related problems of students.
6.Health Education:
•School health education should also include gender awareness and
family life education.
•It will be better to make these topics a part of course and teachers
should provide health education along with regular curriculum.
•Vocational education also helpful for the handicapped children
•It is the felt need that sex education should be included in the
school curriculum

23. 7.Immunization:
•All school children should be immunized according to the national
immunization schedule.
II) Therapeutic Services:
1.Health appraisal:
•Regular periodical appraisal of health of school children is very
necessary to identify the deviation from normal condition of body
parts and system.
•A minimum of three health appraisal are carried out:
i) on school entry at the age of 5-6 years
ii) on passing out from primary school at age of 10-11 years
iii) on passing out from middle school at age of 13-14 years.

24. •Physical examination includes observation of the child from head to toe of
general normal characteristics; measurement of height,weight,arm and
chest circumference.
•Testing of vision, hearing, teeth,eyes,speech, general test of blood and urine
is also necessary. Stool test can be done to diagnose parasites. This test is
conducted by doctor/ community health nurse.
2.First aid &Emergency services:
•The school must have an arrangement for providing First Aid& Emergency
care to children who get injured or become sick at the school.
•Teacher who are available at the spot can provide such care.

25. 3.Treatment and follow up:
•In rural areas it should be at primary health centre.
•In urban areas school health clinics can be at the selected school or at a
local dispensaries.
4.Specialized health services:
•Special clinics should be provided exclusively for school children or
specialities should be invited on specific days to hold these clinics in school
health clinics for examination and treatment of disorders.

26. III.Rehabilitative Services:
•These for children who are born with or/ and acquire any disability or
handicap due to road accident/infection/some special care.
•Disability or handicap may be physical &mental or both. Children with
marked physical abnormalities such as blindness, deafness, mutism,
marked mental retardation etc. should be trained in special institution and
rehabilitated.
•So teachers and health worker needs to be more attention on these section
of group

27. IV.)School Health Records


Health records should include information on :
I.Identification and personal aspects
II.Personal and family health history
III.Findings of physical and medical examination
IV.Findings of routine investigation and screening
V.Service rendered and prognosis

28. SCHOOL HEALTH TEAM
The major possible function of team members are as under:
1.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

29. 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.

30. 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

31. 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
behavior.
3.Through "Parents- Teachers Association" the parents can be
involved in planning, organizing and implementation of school
health programme

32. 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.

33. 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

34. 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 objective
and activities.

35. THE SCHOOL HEALTH NURSE OR
ROLE OF NURSE IN SCHOOL HEALTH SERVICES OR
RESPONSIBILITIES OF SCHOOL HEALTH NURSE

Health promotion and specific protection: (primary level prevention)
The community health nurse in the school setting include:
•Immunization of children
•Helping school authority and teachers to plan mid-day meal for students
which is cheap but nutritious ,hygienically and supplemental
•Health education of children, their parents regarding maintenance of
personal hygiene, growth and development, prevention of communicable
diseases, balanced diet and good nutrition, mental health and hygiene
•Helping students, their parents and teachers develop attitude and health
behaviour by demonstrating healthful behaviour and by providing health
experiences.

36. •Providing counselling regarding problem solving skills to students, their
parents and teachers.
•Helping school authority and teachers to design health education to
teachers on health education topics
Early diagnosis and treatment: (secondary level prevention)
•Regular and periodical health appraisal of school of school children.
•Notifying the parents about health appraisal result.
•Making referrals for further investigation or specialist as needed
•Follow up referred cases
•Home visit of certain selected children to ensure implementation of
corrective measures
•Counselling of students ,their parents and teachers regarding personal
problem, to make informed decision to solve problem.

37. •Teaching family members, auxiliary nurse midwife/multi-purpose health
worker (F) to perform special treatment or procedures.
•Providing first aid and emergency services.
Prevention of complications and rehabilitation:
This is tertiary level of prevention. these are:
•Helping in prevention of recurrence of acute condition by
i) Eliminating risk responsible for particular condition.
ii) health education to the students and parents
•Prevention of complication and promotion of adjustments to chronic and
handicapping condition.
•Help in prevention of adverse effects of learning disabilities by counselling
of children

38. Other functions:
•Maintenance of health records and preparing reports of health appraisal and
medical examination, episode of any illness any defect,treatment,corrective
measure and follow up care given
•Assisting, supervision and guidance of ANM/MPW(F) in carrying school
health services.
•Management of school health clinics
•Holding the conference with teachers, parents, students to discuss related
health issues