Systematic review of global and local studies on school health services and school health environment

This chapter presents some of the literature review pertaining to various aspects of the present study. The related studies dwell on three dimensions of school health, viz. school health environment, school health services and health education. Josse Jonathan and others (2009) have undertaken a study titled “School Injury among Ottawa-Area Children: A Population–Based Study”. This investigation examined what factors influence the likelihood of sustaining a school injury, as well as the underlying trends with respect to the nature and context in which these injuries occur. One conclusion was that children are more likely to sustain sports injuries and head injuries at school than at other locations. A suggestion was issued forth that preventive progress to address school injuries should be targeted largely towards elementary school students. This study urged reduction of school–related injuries to promote a safe and secure learning environment for students while concomitantly reducing healthcare expenditures for preventable childhood trauma. Environmental modification and increased supervision are recommended strategies to reduce school injuries. Gupta, Anu and others (2008) in their study “Innovations in Health Education Curriculum in Schools: Towards an ‘Art of the possible’, have looked at different innovations adopted by several NGOs, while imparting health education. They noted a distinct shift in approach from the traditional hygiene approach to the public health approach. Some noteworthy innovations on the health education front are as -Health Education Promotion International (HEPI) partnered with Tamil Nadu Govt. to prepare a comprehensive training module which covers various aspects of school health and is graded according to age and class appropriate levels; Foundation for Research in Community Health (FRCH) Maharashtra formulated a training program that emphasizes the socio- economic, cultural and biological aspects of health. Also, school health manuals were prepared in Marathi with the collaboration of children and teachers based on their experiences and understanding. Eklavya in Madhya Pradesh is another NGO that focused on the social determinants of health and ill-health while orienting and training teachers in health education. The teachers are trained as ‘health masters’ who handle the same syllabus in different manners with primary school children and secondary school children.

Long-term, sustained interactions and diverse approaches to school health education are advocated by the four researchers to make it an ‘art of the possible’. Mariken T.W. Leurs and others (2008) undertook a study with the purpose of “Development of a collaborative model to improve school health promotion in the Netherlands”. In recent decades, school health promotion programs have been developing into whole-school health approaches. This has been accompanied by a greater understanding among health promoters of the core business of schools, namely education, and how health promotion objectives can be integrated into this task. Evidence of the positive impact of school health promotion on health risk behaviour of students is increasing. This study focuses on the processes and initial results of developing a collaborative model tailored for whole school health in the Netherlands, named school beat. This study came out with a finding that a health promotion team within a school is fundamental to an effective approach to tailored school health promotion. Empowering schools in needs assessments and comprehensive school health promotion is an important element of the developed approach. This study concluded with an examination of the emerging issues in evaluating collaborative school health support during the first 18 months of development, and implementation and future perspectives regarding sustainable collaboration and quality improvement. Morgan J Philip and Vibeke Housen (2008), through their research study “Physical education in primary schools: Classroom teachers’ perceptions of benefits and outcomes” made an attempt to examine the perceptions of teachers regarding the benefits and outcomes of their physical education (PE) programs. The results of this study are as follows:

Teachers believed PE provides children with opportunities to improve fitness and be active to counter societal trends towards obesity and increased sedentary behaviors. Teachers believed PE impacts positively on learning and behavior in the classroom. Teachers believed PE helps children to improve social skills and allows some children an opportunity to experience success in a unique learning environment.

The researchers conclude that teachers believed PE was beneficial as a vehicle for physical activity and positively impacted on learning and behavior in the classroom. However, the reasons provided for including PE in their daily programs were reflected in thedelivery of programs of little educational value.

Baru, Rama. V (2008) in her study “School Health Service in India: An overview” has provided an analytical overview of India’s school health service. She refers to promotion, prevention and treatment of morbidities among school children as the focal areas of school health services (SHS). She mentioned doctors, specialists and public health nurses as the key implementers of India’s SHS program who have to provide clinical services including routine medical checkups, referral and treatment.

She also referred to various studies that project a clear divide in the emerging needs of the affluent and the lower middle class school children. But her opinion is that SHS should focus on the needs of the large majority who attend mostly govt. schools. Justifying her stand, she informs that macro and micro-surveys have singled out under-nutrition and communicable diseases as major concerns when compared to obesity and NCDs.

Dwelling on the history of SHS in India, she traced its beginning in the form of medical inspection in several provinces that later metamorphosed into comprehensive services envisaging treatment, nutrition improvement, reasonable environmental hygiene, theoretical and practical teaching of hygienic living, physical education and development of health habits. Such a transformation in scope of SHS was actualized by a Central Committee on SHS which was constituted by the Central Advisory Board of Health in July 1940 and submitted its report in 1944.

Later the Bhore Committee in 1946, endorsed the Central Committee report recommendations and put forth expanded duties of the SHS program. These duties included Preventive and curative health measures including detection and treatment of health complications, creation and maintenance of school hygiene environment and promotive health measures including supplementary food supply, physical culture inculcation through games, sports, gym exercises and recreation; and health education through formal teaching and practice of hygienic living. Another important recommendation of Bhore committee was that SHS program should be part of the general health services and kept under the control of the health departments.

The SHS did not make much progress during post-independence until 1960 when a committee was set up to review the national SHS program. This review was highly critical of the system and even suggested that it would be a mere waste of time and money to continue it. So, in response, the SHS was given status of a centrally sponsored program in the late 1970s. In 1981, a Central Government appointed SHS task force evaluated the program only to find several lacunae in its implementation in terms of financing, human resource, infrastructural and administrative support. The same issues continue to haunt us.