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Give detailed notes only K PARK CONTENT HANDWRITTEN NOTES TOPIC SCHL HEALTH PRGRM nd services

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📚 SCHOOL HEALTH PROGRAMME & SERVICES

K. Park's Textbook of Preventive and Social Medicine

DEFINITION & CONCEPT

School health is an important branch of community health. According to modern concepts, school health service is:
  • An economical and powerful means of raising community health
  • More importantly, it builds health for future generations
  • It is a personal health service
  • It has evolved from narrow concept (only medical examination) → broad concept of comprehensive care of children throughout school years

HISTORICAL DEVELOPMENT (India)

YearEvent
1909First medical examination of school children - Baroda city
1946Bhore Committee - reported school health services practically non-existent
1953Secondary Education Committee - emphasized medical examination and school feeding
1960Govt. of India constituted School Health Committee
1961School Health Committee submitted its report with key recommendations
Five Year PlansMany State Governments provided for school health & feeding programmes
Note: Despite efforts, school health services in India remain mostly a "token service" due to shortage of resources and insufficient facilities.

HEALTH PROBLEMS OF THE SCHOOL CHILD

Surveys in India indicate main health problems in school children fall in 5 categories:
  1. Malnutrition
  2. Infectious diseases
  3. Intestinal parasites
  4. Diseases of skin, eye and ear
  5. Dental caries

OBJECTIVES OF SCHOOL HEALTH SERVICE

  1. Promotion of positive health
  2. Prevention of diseases
  3. Early diagnosis, treatment and follow-up of defects
  4. Awakening health consciousness in children
  5. Provision of healthful environment

ASPECTS OF SCHOOL HEALTH SERVICE (12 aspects)

  1. Health appraisal of school children and school personnel
  2. Remedial measures and follow-up
  3. Prevention of communicable diseases
  4. Healthful school environment
  5. Nutritional services
  6. First-aid and emergency care
  7. Mental health services
  8. Dental health
  9. Eye health
  10. Health education
  11. Education of handicapped children
  12. Proper maintenance and use of school health records

DETAILED ASPECTS

1. HEALTH APPRAISAL

(a) Periodic Medical Examination:
  • School Health Committee (1961) recommended examination at time of entry and thereafter every 4 years
  • Initial examination should be thorough:
    • Careful history + physical examination
    • Tests for vision, hearing, and speech
    • Routine blood and urine examination
    • Clinical exam for nutritional deficiency
    • Examination of faeces for intestinal parasitosis
    • Tuberculin testing or mass screening
  • Parents should be present at examinations
(b) School Personnel:
  • Teachers and other staff must also receive medical examination (they form part of the child's environment)
(c) Daily Morning Inspection (by class teacher): The teacher can detect changes in appearance/behavior. Clues to refer for medical attention:
  1. Unusually flushed face
  2. Any rash or spots
  3. Symptoms of acute cold
  4. Coughing and sneezing
  5. Sore throat
  6. Rigid neck
  7. Nausea and vomiting
  8. Red or watery eyes
  9. Headache
  10. Chills or fever
  11. Listlessness or sleepiness
  12. Disinclination to play
  13. Diarrhoea
  14. Pains in the body
  15. Skin conditions - scabies and ringworm
  16. Pediculosis
Teachers must be trained during Teacher Training Courses and In-service Training Courses for this work.

2. REMEDIAL MEASURES AND FOLLOW-UP

  • Medical examinations are NOT an end in themselves - must be followed by treatment and follow-up
  • Special clinics for school children:
    • At PHCs in rural areas
    • In selected schools or dispensaries for groups of ~5,000 children (urban)
  • Special clinics for dental, eye, ENT defects
  • In big cities - specialists employed in School Health Service
  • Provision for beds in referral hospitals for children needing admission

3. PREVENTION OF COMMUNICABLE DISEASES

  • Immunization is the most emphasized function
  • A well-planned immunization programme against common communicable diseases
  • Records of all immunizations maintained in school health records
  • When child leaves school, health record must accompany him/her

4. HEALTHFUL SCHOOL ENVIRONMENT

Minimum standards for school sanitation (India):
ParameterStandard
(1) LocationCentrally situated; away from busy roads, cinema houses, factories, railway tracks, market places; premises fenced
(2) SiteHigh land; not subject to flooding; properly drained. 10 acres for higher elementary; 5 acres for primary + 1 additional acre per 100 students
(3) StructureNursery/secondary schools - single storied; exterior walls min 10 inches thick; heat resistant
(4) ClassroomMax 40 students per classroom; per capita space not less than 10 sq. ft.
(5) FurnitureAge-appropriate; single desks and chairs; desks of "minus" type; chairs with back-rests
(6) Doors & WindowsBottom sill at 2'6" from floor; combined door+window = at least 25% of floor space; cross-ventilation; ventilators ≥ 2% of floor area
(7) ColourInside colour: white; periodically white-washed
(8) LightingSufficient natural light, preferably from the left (not from front)
(9) Water SupplyIndependent source of safe, potable, continuous water supply
(10) Eating FacilitiesOnly school-approved vendors; separate room for mid-day meals
(11) Lavatory1 urinal per 60 students; 1 latrine per 100 students; separate for boys and girls

5. NUTRITIONAL SERVICES

  • A physically weak child will be mentally weak
  • Studies in India - widespread nutritional disorders: deficiencies of proteins, Vitamins A, C, thiamine, riboflavin, calcium, and iron
Mid-day School Meal:
  • Accepted procedure to provide nourishing mid-day meal
  • In India: Mid-Day Meal Scheme (MDMS) - hot cooked meal to primary school children
  • Nutritional content per child per day: ≥ 450 calories, ≥ 12g protein (primary); ≥ 700 calories, ≥ 20g protein (upper primary)
Weekly Iron Folic Acid Supplementation (WIFS):
Age GroupDose
6-10 yearsTablets of 45 mg elemental iron + 400 mcg folic acid
10-19 yearsTablets of 60 mg elemental iron + 500 mcg folic acid
  • Delivered through school teachers

6. FIRST AID AND EMERGENCY CARE

  • Children spend considerable time in school - school responsible for safety
  • Teachers and students should know basic first aid
  • First aid box in each school (mandatory)
  • Awareness of emergency services: ambulance, fire brigade, police, nearest health facility
  • Linkage with local disaster response team
  • Build capacity of teachers and children to respond to emergencies

7. HEALTH EDUCATION

  • Health education is a major function of school health service
  • School is an ideal setting for health education (captive audience of impressionable children)
  • Topics include personal hygiene, nutrition, communicable diseases, mental health, etc.

8. DENTAL HEALTH, 9. EYE HEALTH

  • Special attention given to dental and eye defects (very prevalent in India)
  • Dedicated clinics and specialists involved

10. SCHOOL HEALTH PROMOTION ACTIVITIES

Age-appropriate health education framework:
Primary School:
  • Health, growth and development
  • Personal safety
  • Nutrition and physical activity
  • Hygiene practices
  • Prevention of malaria, dengue, TB, worms, diarrhoea, vaccine-preventable diseases
Middle School:
  • Puberty and related changes
  • Eye care, oral hygiene
  • Nutrition
  • Bullying prevention
  • Meditation and yoga
  • Internet safety and media literacy
  • Prevention of substance abuse
  • HIV/AIDS
  • Mental health
High School:
  • Prevention of substance abuse
  • Sexual and reproductive health
  • Violence prevention
  • Unintentional injury, Road safety
  • Nutrition
  • Meditation and Yoga

11. HEALTH SCREENING - RBSK

Rashtriya Bal Swasthya Karyakram (RBSK):
  • Aims at early identification and early intervention for children birth to 18 years
  • Covers 4 Ds:
    • Defects at birth
    • Deficiencies
    • Diseases
    • Development delays including disability
  • 0-6 years: managed at District Early Intervention Centre (DEIC)
  • 6-18 years: managed through existing public health facilities
  • Treatment/intervention at zero cost to the family

12. SCHOOL HEALTH RECORDS

  • Maintained for all students
  • Include: medical history, immunization records, periodic examination findings, height/weight records
  • Records should accompany the child when leaving school

HEALTH & WELLNESS AMBASSADORS

Students trained as Health & Wellness Ambassadors to:
  • Facilitate linkages with school-based programmes: WIFS, NDD (National Deworming Day), MHS, RBSK
  • Coordinate referral to Adolescent Friendly Health Centres
  • Refer to Adolescent Friendly Health Resource Centres at district level

SCHOOL HEALTH ADMINISTRATION

Responsibility: Parents + Teachers + Health Administrators + Community
In India: Administered by departments of Health and Education (varies by state)
School Health Committee (1960) Recommendation: School health service should be an integral part of general health services

(a) Primary Health Centres (PHCs)

  • Charged with responsibility of school health service within their jurisdiction
  • Requires full-time medical officer to cover 5,000-6,000 children/year
  • PHC staff should be augmented with additional staff

(b) School Health Committees (1961 Recommendation)

Formation recommended at:
  • Village level
  • Block level
  • District level
  • State level
  • National level (National School Health Council = advisory and coordinating body)
Functions: Mobilize community resources; make school health programme continuous and self-supporting

SUMMARY MNEMONIC for 12 ASPECTS

"H R C E N F M D E H E R"
Health appraisal, Remedial measures, Communicable disease prevention, Environment, Nutrition, First aid, Mental health, Dental health, Eye health, Health education, Education of handicapped, Records
Source: Park's Textbook of Preventive and Social Medicine (K. Park), Chapter on School Health Service, pp. 670-674
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