School Health Services In India

Introduction

School health services are an economical and powerful tool for the promotion of child health and community well-being. It focuses on the physical, mental, and social health of school-going children (usually 6–18 years), who represent a large, accessible segment of the population.

Objectives

• Health promotion and disease prevention.
• Early detection, diagnosis, and treatment of ailments.
• Ensuring a healthy environment for learning.
• Developing healthy lifestyle habits and life skills.
• Establishing a link between the school, home, and community health services.

Current Framework: Rashtriya Bal Swasthya Karyakram (RBSK)

The Ministry of Health and Family Welfare (MoHFW) provides school health services primarily through the RBSK program under the National Health Mission (NHM).

The 4Ds Approach

Children are screened for 30 specific health conditions categorized as:

• Defects at Birth: Neural tube defects, congenital heart disease, cleft lip/palate, club foot.
• Deficiencies: Anemia, Vitamin A deficiency, Vitamin D deficiency, Severe Acute Malnutrition (SAM).
• Diseases: Skin conditions, otitis media, rheumatic heart disease, dental caries.
• Developmental Delays and Disabilities: Vision/hearing impairment, ADHD, Autism, Learning disabilities.

Delivery Mechanism

• Mobile Health Teams (MHTs): Consisting of two doctors (one male, one female), one nurse/pharmacist, and one lab technician.
• Frequency: At least once a year for school-aged children.
• Referrals: Children identified with "4Ds" are referred to District Early Intervention Centers (DEIC) for free tertiary care.

Key Components Of School Health Services

1. Health Appraisal And Screening

• Routine periodic medical examinations.
• Continuous observation by teachers for behavioral changes, skin rashes, or vision problems.
• Maintenance of cumulative health records for each child.

2. Nutrition Services (PM POSHAN Scheme)

• Formerly known as the Mid-Day Meal Scheme.
• Provides at least one-third of the daily calorie requirement and half of the protein requirement.
• Primary (Class 1-5): 450 calories and 12g protein.
• Upper Primary (Class 6-8): 700 calories and 20g protein.
• Weekly Iron and Folic Acid Supplementation (WIFS): Blue IFA tablet (60mg elemental iron + 500mcg folic acid) administered every Monday.
• National Deworming Day (NDD): Biannual administration of Tablet Albendazole (400mg) in February and August.

3. Immunization

Administered according to the National Immunization Schedule:

• Age 5–6 years: DPT booster 2 (or Td booster depending on state policy).
• Age 10 years: Td vaccine.
• Age 16 years: Td vaccine.

4. School Health And Wellness Program (SHWP)

Under Ayushman Bharat, this program focuses on health promotion via "Health and Wellness Ambassadors."

• Selection: Two teachers in every school are designated and trained as Ambassadors.
• Activities: 1-hour weekly sessions on 11 themes including Growing up Healthy, Emotional Wellbeing, Gender Equality, and Prevention of Substance Abuse.
• Peer Educators: Two students per class act as Health and Wellness Messengers.

5. Healthful School Environment

• Infrastructure: Safe building, adequate lighting, and cross-ventilation.
• WASH: Provision of safe drinking water and separate, functional toilets for boys and girls.
• Menstrual Hygiene Management (MHM): Provision of sanitary napkins and incinerators for disposal.

6. Mental Health And Adolescent Health

• Counseling services for stress management, exam anxiety, and bullying.
• Life Skills Education (LSE) to improve decision-making and empathy.
• Adolescent Friendly Health Clinics (AFHCs) or 'Saathiya' clinics for reproductive and sexual health issues.

7. Emergency Care And First Aid

• Availability of a standardized first-aid kit.
• Training of teachers and staff in basic life support (BLS) and management of common emergencies (fainting, injuries, seizures).

Role Of The School Teacher

The teacher is the first line of defense in school health:

• Daily inspection of personal hygiene (nails, hair, teeth).
• Identifying children with vision defects (squint, holding books too close).
• Monitoring attendance for signs of chronic illness or outbreaks.
• Assisting MHTs during RBSK screening.

Monitoring And Evaluation

• Monitoring via the RBSK-MIS portal.
• Integration with the UDISE+ (Unified District Information System for Education) database for tracking health outcomes.