SCHOOL HEALTH CARE SERVICES

Introduction
The concern about the health of young people began when some young men were recruited to
serve in the war. They were examined medically and found that 50% of them were suffering
from one medical disease or the other. Then various methods were adopted to improve the
health of the young ones and one of these methods is School Health Service. An important
part of the service is the maintenance of accurate health record about each child. The records
from Infant Welfare Clinic are passed on to the School Health Service when the child starts
schooling this allows for an uninterrupted medical history which is made available. The
record from the General Medical Practitioner may also be made available if necessary.
AIMS OF SCHOOL HEALTH SERVICE
1. To ensure every child is as fit as possible to gain maximum benefits from his/her
education.
2. To pay attention to early diagnosis of any disability so that early treatment can be
started before the child's condition becomes uncontrollable.
3. To improve the children's general health status.
4. To diagnose and treat any handicapped child.
5. To instil principle of healthy living in the school children and members of staff of the
school through the examples from the health personnels demonstration and health
education.
6. To prevent the occurrence and spread of communicable diseases among school
children.
7. To promote high level of sanitary condition in the school.
8. To provide emergency care for school children and if necessary, their teachers.
9. To ensure that physical, social environment of the school is free from dangers.

OBJECTIVES AND SCOPE OF SCHOOL HEALTH PROGRAMME

1. To make certain that every school child is as fit as possible so that each may obtain the
max
2. To pay attention to early diagnosis of any disability so that early treatment can be started
before the child's condition becomes uncontrollable
3. To improve the child’s general health status
4. Health education, it is not sufficient just to check that no disease exists, there must be a
definite programme designed to make every child acquire positive health habit and
knowledge such as personal hygiene, cleaning of environment avoidance of play with sharp
objects
5. Arrange the ascertainment and treatment of various groups of handicapped children (blind,
partially sighted, deaf, partially deaf, physically handicapped, educationally subnormal,
maladjusted, epileptic, speech defect etc)
6. Promote healthy growth and development in school children
7. Detect any physical or mental defects among children that could affect their learning
abilities in school
8. Prevent or control occurrence of and spread of communicable and non communicable
diseases among school children
9. Provide emergency care for school children and if necessary for teachers and other
categories of staff
10. Promote high level sanitary condition in the school
11. Ensure that physical and social environment of the school is free from danger especially
factors that can cause accidents in the playing ground
12. Instil the principles of healthy living among school children, teachers and other categories
of staff in the school
13. Counsel school children, teachers parent/ guardians and other personnels on health and
health related issues The school health programme should cover all the states in the
federation and if possible, globally.
COMPONENTS OF SCHOOL HEALTH PROGRAMME
The Nigerian National School Health Policy (2006) identifies five components of school
health programme including:
 -Healthful School Environment
 -School Feeding Services
 -Skill-based Health Education
 School Health Services (Preventive and Curative)
 School, Home and Community Relationships
CONCEPT OF SCHOOL HEALTH SERVICES
The School Health Service team consist of health workers headed by experienced
Community Health Officer. Others include Public Health Nurses, Dental Hygienist,
Community Health Extension workers etc.
COMPONENTS OF SCHOOL HEALTH SERVICE
(1) Health Education: It is meant to give students opportunities of
early developmental insight into the implication of negative attitudes to issues affecting their
health with this, pupil learn how to promote good health, prevent diseases and seek
immediate medical attention. Its content includes: Personal and environmental hygiene,
hazards of smoking, drug abuse, child abuse, sexuality education especially in relation to
teenage pregnancy and sexually transmitted infections (STIs)
(ii) Nutritional Care: This is aimed at ensuring that every school child is in good nutritional
condition so as to be able to develop and grow normally, maintain resistance to infection and
hence enjoy both physical and mental health. Hence the need of ensuring that every child has
at least a supervised adequate meal in the school daily.
(iii) Environmental Sanitation: Both pupils and teachers are motivated to maintain good
environmental sanitation by keeping their environments free from things that can cause
accidents e.g. uncompleted or dilapidated latrine or buildings, open trenches, uncontrolled
tipping methods of refuse disposal. If the school environment is dirty and consist of
dangerous dilapidated structures then the children stands the risk of being exposed to risks of
infection and accident.
(iv) Immunization Services: This should be offered on continuous basis it is necessary to
identify and immunize those who are yet to be immunized since childhood (within the first
two years). Apart from these, children are being vaccinated against some common diseases
especially during epidemics and boosters of immunizations are given e.g Polio vaccine.
(v) First aids or Emergency Services: Adequate first aid services should be established this,
is to attend to minor illness and injury.
(vi) Eyes, Ear, Nose and Throat Services: This is to detect any of the ailments early and
treat or refer as the case may be. Examination of these parts of the body and education on
methods of preventing problems are given.
(vii) Dental Health Services: This is to prevent dental problems and to treat tooth decay.
Examination of children's teeth and health education on methods of preventing dental
problems.
(viii) Referral Services; While the school is expected to provide functional preventive and
curative health services to its members, there is however likelihood of having cases that are
beyond the expertise or services that the school can provide. As a result, it is vitally important
to ensure that referral arrangements are put in place to ensure that such cases are taken to a
higher service provider or expertise. Every health worker, including those in the school
setting must understand the point that their expertise stops and must never attempt to handle
cases that are beyond their scope and expertise. Referral services are therefore instrumental to
the realization of the objectives of the school health programme. Every school clinic should
have a formal arrangement with a community health setting where cases can be referred.

MANAGEMENT OF SCHOOL HEALTH SERVICE

Medical examination is carried out in the school premises and it is maintained by the LGA.
The first examination takes place after the child might have gained admission into the
primary school. It is the responsibility of the Community Health Worker to carry out this
service with the rest of the health crew that constitute the medical team. General examination
is carried out from the child's head to his feet: Eyes and ears are examined to check for any
defect. Dental examination enables preventive dental treatment to be started early. If
necessary, parents are invited to attend medical examination and a careful medical history is
taken from them plus the child's welfare records and a note of health of the family with a
complete child's health progress before school. All children are examined and parents are
asked to fill a questionnaire about their children's health.
Examination of each child will cover the following Physical Growth: -
Height, Weight, Chest Expansion.
Head: - Look for size and shape of the head, hair distribution, texture and colour of hair,
check for signs of infection such as; ring worm, lice etc
Eyes:
-Test the equity of Vision
-Examine the defect e.g squint
-Examine for disease e.g vitamin A deficiency-Xerophthalmia, ketomalacia
-Examine for Anaemia
Teeth: Look for dental carries, bleeding gums, pyorrhoea etc
Throat: Look for enlarged tonsils, thyroid gland etc.
Ears: Test for hearing, look for discharge
Chest: Auscultate heart and lungs
Abdomen: Palpate for enlargement of spleen or liver, look for enlarged lymph nodes and
tenderness, undescended testes etc.
Limbs: Look for signs of Rickets and defects e.g kyphosis club foot observe gait etc.
Skin and Hair: Look for any hypopigmented patches with loss of
sensation, ulcers, boils, ring worms, scabies, lice, texture of hair and its distributions
etc.
SOME COMMON HEALTH PROBLEMS AMONG PUPILS
Learners are faced with a number of health problems of which common ones include:

1. Visual impairment

2. Hearing impairment

3. Dental disease and defects

4. Diseases due to poor personal hygiene

5. Rheumatic heart disease

6. Malaria

7. Nutrition related diseases

8. Skin diseases

9. Parasitic infections

10. Open/topical wounds

11. Respiratory tract infections, asthma, conjunctivitis

12. Ear and eye infections

13. Accidents

TREATMENT OF MINOR AILMENTS

Minor ailments or injuries such as cough, cuts headache etc. are managed by the school
health worker others are referred to Health Centres.
The health worker is also responsible for regular inspection of the pupils and follow-up.
About 2% of school pupils are found to be having head or body lice tinea capitis, scabies etc
are due to unhygienic standard of living. When this is discovered, the child should be
followed home to inspect and treat other infected members of their family. Importance of
personal and environmental health sanitation should be emphasized to prevent reoccurrence.
At the end of the examination, the health officer will write reports on each child and the
record is kept.
In some areas all children are seen routinely on entering the school and in some, selective
medical examination is carried out. Thereafter further medical examination may be necessary
depending on these children's health condition or they may be referred via the 2-way referral
systems. The medical team is also responsible for prevention, investigation of outbreak of
any communicable disease, treat and prevent its spread in the school and the environment.
For example, if there is an outbreak of a communicable disease e.g. Measles or Typhoid fever
in a school, the health worker will report and mass immunization will be carried out on those
that are not yet infected while the already infected ones will be treated or referred as the case
may be. Health workers are also responsible for giving of booster doses of immunization
when necessary.
CHILD GUIDANCE CLINIC
This is part of School Health Service that is meant to help both children and parents when
there is any emotional maladjustment in a child's relationship with other pupils. A parent who
is in despair over her child's aggressiveness, cruelty, delinquency or nervous manifestations
of some kind is referred here by the school doctor. Here the following group of health
workers are in attendance; Child Psychiatrist, Educational Psychologist and Social welfare
workers. The cause of the behaviour would be investigated and assistance would be rendered
to overcome it or the child is referred to the appropriate facility for further care or assistance.
SOCIAL WELFARE OR EDUCATION WELFARE WORKERS
The social development of the child will be looked into by the health workers from this
department. They look into many areas which have to do with each child's progress in the
school e.g. clothing, uniform, maintenance allowance, school meal.
ADVANTAGES OF SCHOOL HEALTH SERVICE
(i) It helps to identify abnormalities promptly among pupils and to give immediate treatment.
(ii) It enables health workers to monitor growth and development of pupils
(ii) It promotes normal growth and development of the children.
(iv) It helps to check-mate spread of infection among school children.
(v) It enhances learning.
(vi) It reduces congestion in the hospitals as minor ailments such as cough, acute respiratory
infections, cold, fever, malaria, are attended to while immunization is given to prevent the
preventable ones and health education is given to prevent or control others in the school
clinic and only serious cases are referred to the hospital.
ESTABLISHMENT AND MANAGEMENT OF SCHOOL MEAL SERVICE
This is carried out by provision of trained food vendors who are regularly inspected to ensure
that they maintain regular cleanliness and they are periodically screened to ensure that they
are not carrier of diseases such as typhoid fever, cholera est.
ADVANTAGES OF SCHOOL MEAL SERVICES
  It introduces children to adequate diet.
 It relieves hunger and enhances concentration in the school.
 It helps to ensure at least an adequate meal is given to a pupil in a day est.

THE ROLE OF THE COMMANAGEMENT PARENT TEACHERS’ ASSOCIATION

AND OTHER RELEVANT IN MEETING THE NEEDS OF THE SCHOOL CHILD

The school administrators, teachers, parents, community leaders etc, are important people in
the planning and execution of school health programmes because they are in a unique
position to identify the health needs and problems of the children by virtue of their proximity
to the school. Before any administrator can be successful in the provision of healthful school
leaving, certain conditions must be met which includes;

1. Adequate toilet facilities, such as, toilet rolls, soup for washing hands after visiting the
toilets and waste paper basket etc. must be secured by the headmaster or the principal

2. Regular water supply

3. First aid box for emergency situations must be available at all times

4. There should be functional school health services

5. Health record of each child should be intact

6. Provision for health instruction on the time table before the class teacher should have full
confidence to teach

about health

7. The headmaster must have to give both financial and moral support to both children and
the teachers and to make their activities of school health services become successful

Factors that influence the health of school children in developing countries

1. Genetic factors

2. Environmental factors

3. Socioeconomic factors

4. Health service factors

5. Communicable diseases
6. Ignorance of parents etc

SOURCES OF FUNDS FOR SCHOOL HEALTH PROGRAMMES

1. Parent-teachers associations

2. Grant in aid

3. Prize giving day graduation ceremony

4. Interhouse competition

5. Quiz, debate and drama competition

6. Advocacy visit to community leaders

7. Politicians/philanthropists

8. Non governmental organisations