School Health Service/School Health Programme

School health is an essential part of community health. Today, school health services are recognized as one of the most effective and economical ways to improve the health status of the community, particularly the health of upcoming generations.

These services focus on providing personal health care to school children. Over the past several decades, the concept has grown from a limited approach mainly the medical examination of students to a much broader and more comprehensive programme. The modern school health programme aims to support the complete physical, mental, emotional, and social well-being of children throughout their school years.

Health problems of the school child

Planning any school health service must begin with an understanding of the common health issues faced by school-age children, along with the cultural background of the community and the resources available in terms of manpower, materials, and finance. Although the pattern of health problems differs from place to place, studies have shown that school children commonly experience the following major categories:

1. Malnutrition
2. Infectious diseases
3. Intestinal parasitic infections
4. Diseases of the skin, eyes, and ears
5. Dental caries

Objectives of School Health Service

The objectives of the programme of a school health service are as follows:

1. the promotion of positive health
2. the prevention of diseases
3. early diagnosis, treatment and follow-up of defects
4. awakening health consciousness in children the provision of healthful environment

The responsibilities of a school health service are wide-ranging and differ based on the needs and priorities of each community. In areas with adequate resources, schools may be able to develop more specialized and comprehensive health services for students.

Some aspects of a school health service are as follows:

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
8. Dental health
9. Eye health
10. Health education
11. Education of handicapped children
12. Proper maintenance and use of school health records.

1. Health appraisal

The health appraisal should cover not only the students but also the teachers and other school personnel. Health appraisal consists of periodic medical examinations and observation of children by the class teacher.

1. Periodic Medical Examination: According to the school‑health committee’s (India, 1967) recommendation, a medical examination of children should be done when they first enter school, and thereafter every four years. In large urban areas where medical facilities are available, these examinations may be done more frequently. The initial examination should be comprehensive and unhurried, including a detailed medical history and a full physical examination. It should also include screening for vision, hearing, and speech. Routine blood and urine tests should be carried out. In settings with high prevalence of nutritional deficiencies or parasitic infections, clinical examination for nutritional status and examination of stool for intestinal parasites are especially important. Testing for tuberculosis (for example, tuberculin testing) or mass screening should not be withheld if conditions warrant. Parents should be encouraged to attend these examinations. Teachers should assist the medical inspection by:

• taking and recording the child’s medical history;
• measuring and recording height and weight regularly (e.g. quarterly)
• conducting annual screening of vision;
• preparing children in advance for the medical examination by explaining to them the purpose and the procedure the “how” and “why” of health appraisal.

ii. School Personnel: Teachers and other school staff should also undergo periodic medical examinations, as they are an integral part of the environment to which children are exposed. Ensuring the health of school personnel contributes to a safer and healthier learning environment for students.

iii. Daily Morning Inspection: Teachers are in a unique position to conduct a “daily inspection” of students, as they are familiar with the children and can notice any changes in appearance, behaviour, or overall well-being that may indicate illness, poor growth, or developmental issues.

The following clues will help the school teacher in suspecting children who need medical attention:

• unusually flushed face
• any rash or spots
• symptoms of acute cold
• coughing and sneezing
• sore throat
• rigid neck
• nausea and vomiting
• red or watery eyes
• headache
• chills or fever
• listlessness or sleepiness
• disinclination to play
• diarrhea
• pains in the body
• skin conditions like scabies and ringworm
• pediculosis.

Children who show any signs or symptoms of illness should be promptly referred to the school medical officer for further assessment. In India, teacher observation is especially crucial due to the limited number of trained professionals available for school health services. To ensure effective monitoring, teachers should receive proper training on child health during their formal Teacher Training Courses, and their skills should be reinforced periodically through short in-service training programs.

2. Remedial measures and follow-up

Medical examinations of school children are not an end in themselves; they must be followed by appropriate treatment measures and continuous follow-up. In rural areas, special clinics should be organized exclusively for school children at primary health centres, providing treatment, counseling, and health education tailored to their needs. In urban areas, similar clinics should be established in selected schools or dispensaries to serve groups of approximately 5,000 children, with the dates and timings communicated in advance to ensure maximum participation.

Considering the high prevalence of dental, eye, ear, nose, and throat problems among school children in India, dedicated clinics should focus on the examination and treatment of these common defects. In large cities, the School Health Service should employ the required number of specialists, such as dentists, ophthalmologists, and ENT experts, to adequately meet the health needs of children. Additionally, arrangements should be made for hospital beds in existing referral hospitals so that children requiring further investigation or treatment can be admitted promptly.

3. Prevention of communicable diseases

Communicable diseases control through immunization is the most emphasized school health service function. A well planned immunization programme should be drawn up against the common communicable diseases.

A record of all immunizations should be maintained as part of the school health records. When the child leaves school, the health record should accompany him.

4. Healthful school environment

The school building, its site, and the equipment provided are important components of the environment in which a child grows and develops. A healthy and well-maintained school environment is therefore essential for promoting the emotional, social, and personal well-being of students. Schools should also act as models of good sanitation practices for the surrounding community.

1. Location: Schools should ideally be centrally located, with proper access roads, and situated at a safe distance from busy streets, industrial areas, railway tracks, cinemas, and marketplaces. The school premises should be securely fenced and kept free from potential hazards.
2. Site: The school should be built on suitable elevated land that is not prone to flooding or dampness and allows for proper drainage. In areas where space is limited, students should be provided access to nearby public parks or playgrounds.
3. Structure: Whenever possible, nursery and secondary schools should be single-storied. Exterior walls should have a minimum thickness of 10 inches and be resistant to heat to ensure safety and comfort.
4. Classrooms: Each classroom should have an attached verandah. Classrooms should not accommodate more than 40 students, and the per-student space should be no less than 10 square feet.
5. Furniture: School furniture should be appropriate for the age group of the students. It is preferable to provide individual desks and chairs. Desks should be of the “minus” type, and chairs should have proper back support to facilitate comfortable desk work.
6. Doors and windows: Windows should be wide, with the bottom sill at a height of approximately 2 feet 6 inches from the floor. The total combined area of doors and windows should be at least 25% of the floor space, and windows should be placed on different walls to allow for cross-ventilation. Ventilators should cover at least 2% of the floor area.
7. Colour: Classroom interiors should be painted white and periodically refreshed with whitewash to maintain brightness and cleanliness.
8. Lighting: Classrooms should receive adequate natural light, preferably from the left side, and not directly from the front, to reduce eye strain.
9. Water Supply: There should be a reliable and safe source of potable water, continuously available, and accessible through taps.
10. Eating Facilities: Only food vendors approved by school authorities should be allowed on the premises. A separate area should be provided for mid-day meals to maintain hygiene and proper nutrition for students.
11. Lavatory: Privies and urinals should be provided one urinal for 60 students and one latrine for 100 students. Arrangements should be separately made for boys and girls.

5. Nutritional services

A physically weak child is often mentally weak and unable to fully benefit from schooling; therefore, proper nutrition is essential. The diet of school children should provide all necessary nutrients in appropriate proportions to maintain optimal health. Studies in India show that nutritional deficiencies particularly of protein, vitamins A and C, thiamine, riboflavin, calcium, and iron are widespread among school children.

Mid-day School Meal: To combat malnutrition, it is recommended that school children receive at least one nourishing meal daily. Children who can afford it may bring lunch from home, while schools should arrange mid-day meals through their own cafeteria on a ‘no profit, no loss’ basis. In India, these meals should ideally provide at least one-third of the daily calorie requirement and about half of the daily protein requirement.

Applied Nutrition Programme: UNICEF supports the implementation of school nutrition programs by providing tools, seeds, manure, and water supply equipment. Available land can be used for school gardens, whose produce may contribute to school feeding programs and nutrition education.

Specific Nutrients: Knowledge of nutrition shows that certain nutrients prevent specific disorders. Dental caries, endemic goitre, night blindness, protein malnutrition, and anaemia are largely preventable with targeted nutrient intake. Schools should ensure the use of such nutrients where deficiencies are prevalent in the community.

6. First-aid and emergency care

The responsibility of providing first-aid and emergency care to pupils who become sick or injured on school premises rests with the teachers. Therefore, all teachers should receive adequate training through “Teacher Training Programmes” or “In-service Training Programmes” to equip them to handle such situations effectively. Common emergencies encountered in schools include (a) accidents resulting in minor or serious injuries, and (b) medical emergencies such as gastroenteritis, colic, epileptic seizures, fainting, and similar conditions.

7. Mental health

The mental health of a child directly influences physical well-being and overall learning. Issues such as juvenile delinquency, emotional maladjustment, and drug misuse are increasingly observed among school-aged children. Since the school environment plays a central role in shaping behavior, it is one of the most effective settings for promoting mental health. Teachers have both preventive and supportive responsibilities; they should work toward helping every child achieve positive mental health so they can grow into mature, responsible, and well-adjusted adults. School routines should be designed to include adequate breaks between periods of intense academic activity, and efforts should be made to reduce classroom monotony. There should be no discrimination based on race, religion, caste, community, socioeconomic status, or academic ability. Growing awareness has highlighted the need for vocational counsellors and school psychologists who can guide students toward suitable career paths and support their emotional development.

8. Dental health

Children often suffer from different dental problems, and the most common among them are dental caries and periodontal diseases. Therefore, a well-organized school health programme should ensure that every child receives a dental check-up at least once a year. In many developed nations, schools appoint dental hygienists who work alongside school dentists to carry out oral health assessments. These hygienists perform preliminary examinations of the teeth and provide prophylactic cleaning, which helps prevent gum problems and improves overall appearance. They also play an important role in promoting oral hygiene by educating children about proper dental care practices as part of their routine responsibilities.

9. Eye health services

Schools have an important role in identifying eye problems early, such as refractive errors, squint, and amblyopia. They should also help in detecting and managing eye infections like trachoma. Providing vitamin A supplements to children who are at risk has been shown to give very positive results. Therefore, it is essential that schools offer basic eye health services as part of their regular health activities.

10. Health education

The most vital component of a school health programme is health education. Its purpose is not just to teach children a list of hygiene rules, but to bring meaningful improvements in their health knowledge, attitudes, and everyday practices.

Health education in schools should include the following key areas:

1. Personal hygiene: Health education should be engaging, practical, and connected to the daily lives and interests of children. They should be taught the importance of keeping their skin, hair, teeth, and clothes clean. Good posture should also be emphasized, as many children develop poor habits while sitting or standing. Since many adult degenerative diseases are linked to unhealthy habits formed during childhood, schools must address these issues early. For example, cigarette smoking is a major public health concern that should be discouraged from the school level.
2. Environmental Health: Schools should motivate students to participate in activities that promote a clean and healthy environment. Organizing visits to observe community health programmes or even better, involving students directly in community actions such as vaccination drives, fly control campaigns, or building sanitary wells and latrines provides excellent practical learning experiences.
3. Family life: Family life education is now considered essential in both developed and developing countries. The school health programme should focus not only on helping students grow into healthy individuals but also on shaping responsible attitudes toward human reproduction and family relationships.

Health education in schools is primarily the responsibility of the school teacher. Although the health officer and public health nurse or health worker can provide teaching materials and guidance, the teacher plays the central role in delivering health information to students. For the teacher to carry out this important task effectively, they must be well-trained in health education methods and genuinely committed to the well-being of their students.

The health lessons children learn in school do not remain with them alone they often share this knowledge with their parents. Later in life, as adults, they apply these same practices within their own families. In developing countries, where health problems are widespread, the idea that “every school child is a health worker” highlights the powerful impact of school-based health education on communities.

11. Education of handicapped children

The main aim of educating children with disabilities is to support both the child and the family so that the child can develop to their fullest potential. The goal is to help them live as normal a life as possible, become independent, and eventually grow into productive, self-sufficient members of society.

The services available for supporting handicapped children differ from one country to another, but effective management always requires teamwork. Health services, social welfare agencies, educational institutions, and community support systems must work together to meet the needs of these children.

12. School health records

A cumulative health record should be maintained for every student. This record should include:

1. Identifying information – name, date of birth, parents’ names, address, and other basic details.
2. Past health history- any previous illnesses or medical conditions.
3. Findings from physical examinations and screening tests, along with a record of any health services provided to the child.

The purpose of keeping these school health records is to maintain continuous and comprehensive information about each child’s health, allowing for ongoing and well-planned health supervision. These records also help in monitoring and evaluating the effectiveness of school health programmes and serve as an important link between the home, school, and the wider community.

School health administration

The health of the school child is the responsibility of the parents, teachers, health administrators and the community. The success or efficiency of school health service depends largely on effective coordination between the participating agencies. There is no uniform pattern of school health administration, both here and abroad. In England, school health service is part of the Education service of the country. In India, school health service is administered by different departments in different States – these are usually the departments of Health and Education. The School Health Committee set up by the Government of India in 1960 recommended that school health service should be an integral part of the general health services. The general health services in India are administered largely through the primary health centres in the rural areas, where the bulk of India’s population lives. School health service is therefore an important function of the primary health centres.

 (a) Primary Health Centres:  The Primary Health Centres are charged with the responsibility of administering school health service within their jurisdiction. It requires a whole-time, medical officer to cover 5,000 to 6,000 children a year. The School Health Committee (1961) has therefore recommended that the staff of the primary health centres should be augmented by additional staff to carry out effectively the school health programme.

(b) School Health Committees: The School Health Committee (1961) in India recommended the formation of school health committees at the village level, block level, district level, state level and national level. These Committees should mobilize community resources and make the school health programme continuous and self-supporting. The National School Health Council will be an advisory and coordinating body.

References

1. Park, K. (2024). Park’s Textbook of Preventive and Social Medicine (27th ed.). M/s Banarsidas Bhanot Publishers.
2. World Health Organization. (2021). WHO guideline on school health services. WHO Press.