Relevance: GS-2: Issues Relating to Development and Management of Social Sector/Services relating to Health, Education, Human Resources.

Key Phrases: School health services, FRESH framework, Adolescent sexual health, Health talks and lifestyle sessions, School health clinics, Destigmatise mental health services, National Health Policy, 2017.

Context:

• Children across India are back to school for offline regular classes after prolonged closure in the wake of the COVID-19 pandemic.
• It is time for concrete policy measures and actions that target schoolchildren.
• On the education front there is an urgent need to factor in the health needs of schoolchildren.

Need for school health services:

• One of the reasons school health services receive inadequate policy attention is because health care needs are often equated with medical care needs.
• Though school-age children have a relatively low sickness rate (and thus limited medical care needs), they do have a wide range and age specific health needs that are linked to unhealthy dietary habits, irregular sleep, lack of physical activity, mental, dental and eye problems, sexual behaviour, and the use of tobacco and other substances, addiction, etc.
• The health knowledge acquired and lifestyle adopted in the school going age are known to stay in adulthood and lay the foundations of healthy behaviour for the rest of their life. For example, scientific evidence shows that tobacco cessation efforts are far more successful if started in school.

The evolution:

• The first documented record of school health services in India goes back to 1909 when the then presidency of Baroda began the medical examination of schoolchildren.
• Later, the Sir Joseph Bhore committee, in its 1946 report, observed that school health services in India were underdeveloped and practically non-existent.
• In 1953, the Secondary education committee of the Government of India recommended comprehensive policy interventions dealing with school health and school feeding programmes.
• The result was programmatic interventions, led by a few selected States that mostly focused on nutrition. However, school health has largely remained a token service.

FRESH approach

• One of the reasons for wrongly designed, and often very rudimentary, school health services is limited understanding and clarity on what constitutes well-functioning and effective school health services.
• UNESCO, UNICEF, the World Health Organization (WHO) and the World Bank have published an inter-agency framework called FRESH — an acronym for Focusing Resources on Effective School Health.
• FRESH is a combination of activities in four core areas:
  • School health policies
  • Water, sanitation and the environment
  • Skills-based health education
  • School-based health and nutrition services
• There are three supporting strategies:
  • Effective partnerships between the education and health sectors
  • Community partnership
  • Student participation
• The supporting strategies include effective partnerships between the education and health sectors, community partnership and student participation.

Guidelines by the Centres for Disease Control and Prevention, Atlanta, U.S.:

• It advises that school health services should focus on four main areas:
  • Acute and emergency care;
  • Family engagement;
  • Chronic disease management; and
  • Care coordination.

WHO Guidelines:

• School health services should be designed based on local need assessment.
• It should have components of health promotion, health education, screening leading to care and/or referral and support as appropriate.

Suggestions:

• Every Indian State needs to review the status and then draw up a road map to revamp and strengthen school health services, along with a detailed timeline and dedicated budgetary allocation.
  • The Fifteenth Finance Commission grant for the health sector should and could be leveraged.
• Build upon the existing school health infrastructure; the renewed focus has to have comprehensive, preventive, promotive and curative services with a functioning referral linkage.
  • Health talks and lifestyle sessions should be a part of teaching just as physical activity sessions are.
  • Some of the teachings must look at adolescent sexual health; also, subjects such as menstrual hygiene etc., should be integrated into regular classroom teaching.
• School health clinics should be supplemented with online consultation for physical and mental health needs.
  • This could be an important starting point to destigmatise mental health services.
• The role and the participation of parents, especially through parent-teacher meetings should be increased.
  • Parents need to be sensitised about how school health services are delivered in other countries; this may work as an important accountability mechanism to strengthen school health.
  • Innovative approaches that offer limited health services to parents, families and even school teachers could increase use, acceptance and demand.
• The Government’s school health services initiatives do not include private schools most of the time.
  • Private schools do have some health services, which are nearly always restricted to curative care and taking care of emergencies.
  • Clearly, school health services should be designed to take care of schoolchildren be they in private or government run schools.
• Under the Ayushman Bharat Programme, a school health initiative was launched in early 2020, but its implementation is sub-optimal.
  • There is a need to review this initiative, increase dedicated financial allocation to bring sufficient human resources and monitor performance based on concrete outcome indicators. Otherwise, it will end up being a ‘missed opportunity’.
• Elected representatives, professional associations of public health and paediatricians shoulder the responsibility — every citizen should raise the issue and work towards improved school health services present in every State of India.

Conclusion:

• Every challenge has a silver lining and the onus is on health policymakers and programme managers in every Indian State to do everything in the best interests of children.
• The Departments of Education and Health in every Indian State must work together to strengthen school health services.
• It is an opportunity to bring children, parents, teachers, health and education sector specialists and the Departments of Health and Education on a common platform to ensure better health and quality education for every child in India.
• A convergence of the National Health Policy, 2017 and National Education Policy, 2020 should result in the provision of comprehensive school health services in every Indian State.

Source: The Hindu

Mains Question:

Q. There is urgent need to factor in the health needs of schoolchildren in India and strengthen school health services. Discuss.