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  1. 1. School Health Program Dr. Ramya S
  2. 2. Outline 1. Introduction 2. School Health program 3. School Health Services 4. RBSK 5. Mid Day Meal Scheme 6. Other programs
  3. 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. 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. 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. 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
  7. 7. Health problems of school children Malnutrition Infectious diseases Intestinal parasite Diseases of skin ,eye and ear Dental caries
  8. 8. 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
  9. 9. 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
  10. 10. ASPECTS Mental health Dental health Eye health Health education Education of handicapped children Proper maintenance and use of school health records
  11. 11. 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
  12. 12. 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
  13. 13. 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
  14. 14. PREVENTION OF COMMUNICABLE DISEASES Control through immunization Immunization record should be maintained
  15. 15. HEALTHFUL SCHOOL ENVIRONMENT Location Site Structure Classroom Furniture Doors and windows Color Lighting Water supply Eating facilities Lavatory
  16. 16. 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
  17. 17. 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
  18. 18. 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
  19. 19. 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.
  20. 20. 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
  21. 21. 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.
  22. 22. 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.
  23. 23. DENTAL HEALTH • Common Dental diseases in India : 1. Dental caries 2. Periodontal disease • Examination should be done atleast once a year
  24. 24. 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
  25. 25. HEALTH EDUCATION 1.Personal hygiene: • Hygiene of skin, hair, teeth & clothing • Attention to postures(sitting & standing) 2.Environmental health 3.Family life
  26. 26. 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.
  27. 27. SCHOOL HEALTH RECORDS It Contains 1.Identifying data 2.Past health history 3.Record of findings of physical examination, screening tests & services provided
  28. 28. 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
  29. 29. 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
  30. 30. 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.
  31. 31. 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.
  32. 32. 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
  33. 33. 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
  34. 34. 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
  35. 35. 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
  37. 37. 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
  38. 38. 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
  39. 39. 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
  40. 40. 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
  41. 41. 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
  42. 42. Thank You