This includes content on school health services and program.

1. School Health Program
Dr. Ramya S

2. Outline
1. Introduction
2. School Health program
3. School Health Services
4. RBSK
5. Mid Day Meal Scheme
6. Other programs

3. Introduction
WHO Definition:
School health program encompasses
1. School health services
2. School health education
3. School health environment
4. Health promotion for school personnel
5. School-community projects and outreach
6. Nutrition and food safety
7. Physical education and recreation
8. Mental health, counselling and social support
WHO technical report series

4. School Health – Evolution in India
1909
• Medical examination of school children carried out in Baroda City for
the first time
1946
• Bhore Committee- School health services practically non existent in
India
1960
• Government of India constituted a School Health Committee
1992
• World wide Convention of the rights of the child signed by many
countries
1996
• Government of India launched the School Health Scheme

5. School health program- INDIA
1. Program for school health service under NRHM
2. Integration of health in schools through decentralized
management
3. Implemented in all Government and private aided schools
(12,88,750) covering around 22 Crore students
4. Main focus:
– Nutrition interventions, counselling, education
– Health needs of children – both physical and mental
http://nrhm.gov.in/nrhm-components/rmnch-a/adolescent-health/school-
health-programme-shp/

6. Components of School Health Program
1. Health service provision
a) Screening, health care and referral
b) Immunisation
c) Micronutrient (Vitamin A & IFA) management
d) De-worming
e) Health Promoting Schools
2. Capacity building
3. Monitoring & Evaluation
4. Mid Day Meal

8. Health problems of school
children
Malnutrition
Infectious diseases
Intestinal parasite
Diseases of skin ,eye and ear
Dental caries

9. Objectives of school Health
Promotion of
positive health
Prevention of
diseases
Early diagnosis,
treatment and
follow up of
defects
Awakening
health
consciousness in
children
Provision of
healthful
environment

10. ASPECTS
Health appraisal of school children &personnel
Remedial measures and follow up
Prevention of communicable diseases
Healthful school environment
Nutritional services
First aid and emergency care

11. ASPECTS
Mental health
Dental health
Eye health
Health education
Education of handicapped children
Proper maintenance and use of school health records

12. HEALTH APPRAISAL
1.PERIODIC MEDICAL EXAMINATION
- At the time of entry and thereafter every 4
years.(The school health committee
recommendation, 1961)
- History, physical and clinical examination
2.SCHOOL PERSONNEL

13. HEALTH APPRAISAL
3.DAILY MORNING INSPECTION:
a) Unusually flushed face(any rash or spots)
b) Symptoms of acute cold(coughing, sneezing, sore
throat)
c) Rigid neck
d) Nausea , vomiting
e) Red or watery eyes
f) Headache, chills, fever
g) Listlessness ,sleepiness, disinclination to play
h) Pains in the body
i) Skin conditions like scabies, ringworm, pediculosis

14. REMEDIAL MEASURES AND FOLLOW-UP
• Treatment and follow up
• Special clinics should be conducted exclusively for
children in rural(PHC) and in urban areas(for 5000
children in a selected school)
• Clinics days and time should
be intimated to concerned school

15. PREVENTION OF COMMUNICABLE
DISEASES
Control through immunization
Immunization record should be maintained

16. HEALTHFUL SCHOOL ENVIRONMENT
Location
Site
Structure
Classroom
Furniture
Doors and windows
Color
Lighting
Water supply
Eating facilities
Lavatory

17. SCHOOL ENVIRONMENT
1.LOCATION:
-Properly fenced & kept free from all hazards.
2.SITE:
-On suitable highland
-For higher elementary schools -10 acres
-For primary schools -5 acres
-an additional one acre of land per 100 students
3.STRUCTURE:
-Nursery and secondary schools – single storied
-Exterior wall thickness –min 10 inches & heat resistant

18. SCHOOL ENVIRONMENT
4.CLASSROOM:
- 40 students
- percapita space – 10 sq.feet
5.FURNITURE:
- Desks: minus type
- Chairs: with proper back rests
6.DOORS AND WINDOWS:
- 2’-6” from floor level
- atleast 25% of the floor area
-Cross ventilation

20. SCHOOL ENVIRONMENT
7.COLOR:
-white and periodically white-washed
8.LIGHTING:
-Natural lighting adequate and from left.
9.WATER SUPPLY:
-Independent ,safe, continuous
10.EATING FACILITIES:
-Separate room for mid day meals.
11.LAVATORY:
-one urinal for 60 students &one latrine for 100 students

21. NUTRITIONAL SERVICES
1. Mid day school meal:
-to combat malnutrition
-to provide a good nourishing meal (atleast 1)
-no profit no loss basis
-provides one third of the daily calorie requirement and about
half of the daily protein requirement.

22. NUTRITIONAL SERVICES
2.APPLIED NUTRITION PROGRAMME:
• assisted by UNICEF
• implements, seeds, manure and water supply equipment.
• for developing school gardens
• utilized in school feeding programs

23. FIRST AID & EMERGENCY CARE
In every school a fully equipped first aid post
should be provided.
1. Accidents leading to minor and serious injuries
2. Medical emergencies - gastroenteritis, colic,
epileptic fits , fainting etc.

24. MENTAL HEALTH
• Juvenile delinquency, maladjustment and drug addiction
- common
• The school and the school teacher has a positive and
preventive role.
• The school routine should be planned with enough
relaxation
• No distinction should be made
• Guided by vocational counselors and psychologists.

25. DENTAL HEALTH
• Common Dental diseases in India :
1. Dental caries
2. Periodontal disease
• Examination should be done atleast once a year

26. EYE HEALTH SERVICES
• Early detection of refractive errors
• Treatment of squint
• Detection & treatment of eye infections(trachoma)
• Administration of vitamin A to children at risk

27. HEALTH EDUCATION
1.Personal hygiene:
• Hygiene of skin, hair, teeth & clothing
• Attention to postures(sitting & standing)
2.Environmental health
3.Family life

28. EDUCATION OF HANDICAPPED
CHILDREN
Goal
1. To assist the handicapped child and his family
for reaching his maximum potential
2. To lead as normal a life as possible
3. To become as independent as possible
4. To become a productive and self supporting
member of the society.
Requires the cooperation of health, welfare ,
social and educational agencies.

29. SCHOOL HEALTH RECORDS
It Contains
1.Identifying data
2.Past health history
3.Record of findings of physical
examination, screening tests & services
provided

30. School health Record
• Findings
• Outlook: Lean/ Moderate/ Obese
• Skin & Hair: Boils/ Ulcers/ Scars/ Lice
• Hands & Nails: Ulcer in web of fingers/ Deformity/
• Cleanliness of nails
• Eye: Pallor/ Icterus/ Squint/ Redness/ Watery eyes/
• Eye Sight defects/ Bitot’s spots
• Ear: Discharge/ Pain/ Deformity/ Wax/ Hearing Defects
• Nose: Bleeding/ Running nose/ Irritation
• Mouth: Ulcers/ Dental Caries/ Gum bleeding/ Cleft Lip palate/
Tonsillitis
• Abdomen: Pain/ Worms/ Not eating well
• Neck: Lymph node Swelling/ Thyroid swelling

31. School health record contd..
• Speech: Stammering
• Chest: Wheezing/ Cough/ Pain/ Deformity
• Skeletal System/ Bones: Deformities in shoulder
/ Limb/ Pigeon chest
• Pedal Edema
• Visual Acuity: Lt Eye - Rt Eye -
• Behaviour: Tiredness/ Lack of attention/ Furious/
• Frequent absence
• Any Complaint:
• Diagnosis:
• Advice:
Medical Officer Sign

32. SCHOOL HEALTH ADMINISTRATION
 School health service is administered by the Departments
of Health and Education.
 Integral part of general health services.
 Important function of the PHCs.
 Medical officer to cover 5000 to 6000 children/yr.

33. SCHOOL HEALTH COMMITTEES
• Should mobilize resources and make the program
continuous and self supporting.
•The National school health council will be an
advisory and coordinating body.

35. RBSK…
1. Health screening is expanded to cover all children:
– Birth to 18 years of age
2. Early detection and management of 4D’s prevalent in
children
I. Defects at birth
II. Diseases in children
III. Deficiency conditions
IV. Developmental Delays including Disabilities

37. School Health Program: Puducherry
1. Implemented in all 4 regions under RBSK
2. Under this programme: Puducherry – 4 teams
Karaikal – 3 teams
Mahe – 1 team
Yanam – 1 team
3. Each dedicated team: – 2 Doctors
– 1 Nurse
– 1 Counsellor
4. Of the 66946 students to be covered during 2013-14
– 60077 students were screened for 30 diseases
5. 32208 students – provided IFA
National Programme of Mid Day Meal in School(MDMS)-Annual Work Plan and
Budget, pondicherry,2014–15

38. School Health Program: Puducherry…
1. % of Anaemia and Obesity – more among urban girls in
government schools than in rural areas
2. Low BMI – more among the rural boys
3. Vitamin deficiency – 3% among urban and 2% among
rural school children
4. Skin infections, dental problems and worm infestations
are more among rural school children
http://health.puducherry.gov.in/PSHM

39. MID-DAY MEAL SCHEME
1. National Program of Nutritional Support to Primary Education
2. Launched on 15 August 1995
3. To improve: – School attendance
– Reduce drop out
– Beneficial impact on child nutrition
4. It is the largest school feeding program in the world – covering
10.44 crore children in 12.12 lakh schools
5. Survey – Scheme operational in 87% schools
Around 92% children were beneficiaries
Annual report 2012-13, Ministry of HRD, Govt. of India

40. OTHER PROGRAMS IN SCHOOL AGE
GROUP

41. School Eye Screening Program
1. Integral part of NPCB since 1994
2. Planning of SES - respective District Health Societies
(DHS)
3. Usually carried out during April-September
4. From each school, one teacher is selected for a one-day
training course
5. During the training, teachers are provided with a kit for
screening the children in their schools
6. The teacher’s kit contains – Measuring tape
– Standard vision screening “E”
– Referral card for children with
suspected poor vision
– Educational material

42. School Mental Health Program
1. Included in 11th five year plan: under NMHP
2. District mental health team will facilitate the program
3. Life Skills Approach is used – empowerment of adolescents
a) Critical thinking & creative thinking
b) Decision making & problem solving
c) Communication skills & Interpersonal relations
d) Coping with emotions & stress
e) Self awareness & empathy

43. School Dental Health Program
1. Part of School Health Scheme under National Oral Health
Program
– At least 1 dental surgeon/district to be in charge of
School dental health program
2. Oral health awareness through Dental health education –
private sector involvement
– Colgate-Palmolive India:
Over 4 million school children
(6-12yr) covered

44. School AIDS Education Program
1. Under Adolescence Education Program - NACO
2. To raise the awareness level among school
students
3. Includes training of teachers, peer educators
4. Life Skills – debates, discussions, role play

45. 12 – by – 12
1. Initiative launched by MOHFW, FOGSI, UNICEF, WHO –
2007
2. Aim: Every child – Hb of 12g by age of 12
3. Children (10-14yr) are screened:
– If Hb < 12 : Iron supplements started

46. Thank You