Why should we target and develop special programs for schools?

Schools and the basic education system in many countries provide a rather unique opportunity to reach and provide for better health to a great number of children. In addition the basic education system can be effectively used as an agent of change for improved child health practices.

School Population

School population, even among the developing countries, constitute a considerable percentage of the total number of children between age 6 to 15 years. Depending on the level of development and priorities for basic education, the proportion of children at school vary from one country to another. Using Uganda as an example the Ministerial budget for Education was 16% of which 51% went to just first seven (7) years of education. Enrolment in first year Primary (1990) 78% while completion Primary education (1990) was 32%. At any one time about 50% of the children aged 6-15 years are at school.

Proportion of Time Spent at School

On average children spend more time at school, in a year than in their homes. Roughly between 6-9 months each year is spent at school. Therefore children health needs have to be provide for during school time.

The Ease to Reach and Influence Change

Children in school are easier to reach than those out of school and as children, they are more anirable to change than adults. So they can be positively influenced to adopt health practices. School children and their teachers can be utilized as a resource and agents of change in the communities.

Schools Infrastructure

The infrastructure for basic education is relatively well developed. In Uganda, it is much more developed than the health system infrastructure. Even in the remotest village, one is more likely to find a school than a health facility. Thus in such circumstances, school infrastructure can be used much more effectively to reach grass root communities.

Previously non-optimal utilization of schools and the basic education system for provison of health has lead to a need to examine policies and strategies to promote institutional change and build organisational capacities whithin the education system. Such policies and strategies should empower and enable actual participation of basic education institutions in realizing better health for the school children. Specifically there is need to enhance their capacities to effectively be involved in planning, managing and monitoring progress towards child health objectives. There is need to identify the roles to be played by children, parents, schools and government.

Programs directed to children in schools could be influenced at several levels and calls for policies and strategies to support such programs at these levels if they are to become effective and viable. For the purpose of this discussion I would suggest that the following levels and institutions be considered:-

i) Central level: Ministries concerned with Basic Education,

ii) Schools, Teacher training colleges.

iii) Community and Faamily

Community and Family

Policies and strategies directed at Community and Family level. Policies and strategies to mobilize communities in active participation of school health programs would positively compliment ongoing efforts for child health interventions and would facilitate increased sustainability for such health interventions within the education sector and the country at large.

Example:

Concurrent Health Education of parents of the children in schools. This could extremely be a useful strategy to facilitate ongoing school health education as it was demonstrated in Malawi (Darfoor). In Uganda we have PTA organizations which have been very instrumental to cost-sharing efforts in schools. As a strategy these could be made more involved in developing more relevant Heath Education circular for schools as well as providing fora for parallel learning/training of parents for identified specific learning gaps such as sex education and family life to the children.

Changes Required in National Policies and Government Institutions in the Ministry of Education in Collaboration with that of Health.

Policy formulation and development for child health intervention is an essential element in the process of improving health status of the children in every country but is of particular significance in developing countries. A systematic approach to development of policies supporting the development and implementation of strategies and programs directed to children in schools, need to be recognized at national level. Efforts should be taken to minimize the haphazard fashion of policy formulation but to develop sound policies based on societal goals for human development, political commitment of the goals, sound scientific evidence, resource availability and social considerations.

The donors could play an important role in enabling the government and nationals to develop these professional and technical capacities required.

In order to achieve this at central level there is a need to develop technical capacities for the whole process of health policy development including the burden of disease, the effectiveness of interventions (in this case directed to children at school) together with the costs and appropriate policy and planning process for every level of the health system, from the family to national government. Other capacities required at this national level is to appreciate the role of research and quality of the evidence concerning the effectiveness of the interventions as well as the importance of political commitment and good management at every level ensure implementation of policies, strategies and programs developed. The role of intersectoral be very clear and adhered to.

Policies and Strategies Directed at the School and Teacher Training Colleges

Required at these levels are policies and strategies for health provision to the school children as well as optimal utilization of schools and school children to promote IEC strategies for child health interventions.

For ease of catering for the different health needs at different ages. It may prove useful to group the school children into 6-10 years (Children); and 10 - 15 years (adolescents).

Areas of Concern to 6 - 10 years of Age Group

1. Nutrition and school feeding.

2. Dental health

3. Disability and vulnerable child. To identify the problems, assist to cope with and ensure equity in education opportunities.

4. Health Education policies and strategies to give the appropriate Health information to this age group and prepare them to receive more advanced Health Education and sex and family education later on. Strategies so far include development and implementation of the School Health Education Program (SHEP) in Uganda. A primary and secondary school syllabi have been developed and these HE has been an examinable subject at Primary level for two years now. To implement such syllabi it has been necessary to develop appropriate teaching aids, orientet the school teachers to the sysllabi, implement parallel program in Teacher Training Colleges and develop an extra curricular component. The extra circular component has involved teachers and school children in more active participation in community health activities through music and drama and sports and community health leadership such sitting on community health committees.

Child-to-child programs - as a strategy, health messages through music and drama, poems etc., have been effectively passed on among school children.

10-15 Year Areas Of Concern

1. HE need to be intensified giving more skills and knowledge to enable individuals to practice and promote health practices.

2. Sex and Family life education needs become more specific and provision of knowledge and skills with the right attitudes is required. Examples are abilities to negotiate relationships that delay sex; explore cultural values about their bodies and appreciate simple anatomy and function so their reproductive system;

3. Gender equity in terms of continuing with education becomes a bigger issue and girls drop out of schools at this stage. Strategies and policies supporting education of females is vital.

4. Counselling which is usually little or none existing to school need to be strengthened. Appropriate counselling to these children at the time to great changes both mentally and physiologically. Many developing countries do have conflicts between their culture and modern ways. Strategies can be useful include peer-counselling to be taken of advantage as positively as possible, as adolescents break away from parents and associate more with their own age-mates.

5. Career guidance should be more realistic within the context of each country taking into consideration the stage of development and should be linked to important or large scale health issues going on in each county, eg., AIDS. pandemic.

6. Learning should be problem solving and analytical and relevant to available resources so as to move away from rote memorization. Strategies changing this should be targeted to the Teacher Training programmes as well.

7. School children should be prepared for community participation/involvement for promotion and provision of health strategies creating awareness of their roles as individuals or collectively as communities; awareness of environment issues; development of leadership and responsible citizenship; and concept of development and appropriate technology.

KEYWORDS[ education, child care, counselling,