Reorganizing school health services in India


As Schools Reopen, States Need and Have the Opportunity to Consider a Comprehensive Package of Services

As Schools Reopen, States Need and Have the Opportunity to Consider a Comprehensive Package of Services

Children across India are back in school for in-person lessons after an unnecessarily prolonged and arguably unwarranted closure (especially in the past year) following the COVID-19 pandemic. It is time for concrete policy measures and actions that target schoolchildren. On the education front, although there has been some talk of ‘recovery learning’, there is an urgent need to address the health needs of school children. One of the reasons why school health services receive insufficient political attention is that health care needs are often equated with medical care needs. Although school-aged children have a relatively low rate of illness (and therefore limited medical care needs), they have a wide range of age-specific health needs that relate to poor dietary habits, irregular sleep, lack of physical activity, mental and dental disorders. and eye problems, sexual behaviors and use of tobacco and other substances, addiction, etc. Then, the health knowledge acquired and lifestyle adopted during school age is known to carry over into adulthood and lay the foundation for healthy behavior for the rest of their lives. For example, scientific evidence shows that smoking cessation efforts are much more successful if started in school.


The earliest documented record of school health services in India dates back to 1909 when the then Baroda Presidency started the medical examination of school children. Later, the Sir Joseph Bhore Committee, in its 1946 report, observed that school health services in India were underdeveloped and virtually non-existent. In 1953, the Secondary Education Committee of the Government of India recommended comprehensive policy interventions relating to school health and school feeding programmes. The result was programmatic interventions, led by a few select states, that focused primarily on nutrition. However, school health remained largely a token service.

In two and a half years of the COVID-19 pandemic, there has been virtually no serious school health initiative. In the first week of March 2022, the Delhi government opened 20 school health clinics with the promise of more. Although small, this initiative has two messages. First, it recognizes the importance of school health services in the post-pandemic period. Second, the importance of multi-stakeholder partnership for school health services, as these are implemented through corporate social responsibility funding by a donor on the one hand and internal collaboration between health departments and education in government on the other. On the other hand, by the Delhi government’s own assertion, these clinics are curative-oriented services. They also highlight the main problem: what makes school health services comprehensive has not yet been fully understood.

New approach

One of the reasons for poorly designed and often very rudimentary school health services – not only in India but also in most low- and middle-income countries – is arguably a limited understanding and clarity of what constitutes a school that works well and is effective. health services. This situation coexists despite much evidence guided by the international literature. UNESCO, UNICEF, the World Health Organization (WHO) and the World Bank have released an interagency framework called FRESH, an acronym for Focusing Resources on Effective School Health. The FRESH framework and tools propose four main areas and three supporting strategies. The core areas suggest that school health services should focus on school health policies, ie water, sanitation and environment; skills-based health education and school-based health and nutrition services. Supporting strategies include effective partnerships between the education and health sectors, community partnerships, and student engagement.

Additionally, guidelines from the Centers for Disease Control and Prevention in Atlanta, USA, recommend that school health services focus on four main areas of acute and emergency care; family commitment; chronic disease management; and coordination of care. According to the WHO, school health services should be designed based on local needs assessments; should include elements of health promotion, health education, screening leading to care and/or referral and support, as appropriate. The aim of school health services should be the promotion of positive health, disease prevention, early diagnosis, treatment and follow-up, health awareness among children and the establishment of a school environment healthy.

Over the past three decades, many countries (particularly in Europe) have successfully implemented these approaches as part of the health-promoting schools (PHS) initiative. Clearly, there is much to learn in terms of the design of school health services.

Reopening Opportunity

As schools reopen to full capacity, there is a need and opportunity for a proactive approach to having expanded and strengthened school health services.

First, each Indian state must review the statute and then draw up a roadmap to revamp and strengthen school health services, along with a detailed timeline and dedicated budget allocation. The Fifteenth Finance Committee grant for the health sector should and could be taken advantage of.

Second, build on the existing school health infrastructure; the renewed focus must have comprehensive, preventive, promotional and curative services with a functional referral link. Health talks and lifestyle sessions (by visiting teachers and medical and health experts) should be part of the instruction, as should physical activity sessions. Part of the teaching should focus on adolescent sexual health; in addition, topics such as menstrual hygiene, etc. should be incorporated into regular classroom instruction.

Third, school health clinics should be supplemented with online consultations for physical and mental health needs. This could be an important starting point for destigmatizing mental health services.

Fourth, the role and involvement of parents, including through parent-teacher meetings, should be increased. Parents need to be made aware of how school health services are provided in other countries; it can function as an important accountability mechanism to strengthen school health. Innovative approaches offering limited health services to parents, families and even teachers could increase use, acceptance and demand.

Fifth, government initiatives for school health services mostly do not include private schools. Private schools have some health services, which are almost always limited to curative care and emergency care. Clearly, school health services should be designed to care for school children, whether they are in private or public schools.

Sixth, under the Ayushman Bharat program, a school health initiative was launched in early 2020, but its implementation is suboptimal. There is a need to review this initiative, increase the dedicated financial allocation to provide sufficient human resources and monitor performance based on concrete outcome indicators. Otherwise, it will end up being a “missed opportunity”.

Seventh, children are the future of society, but only if they are healthy and educated. Therefore, elected officials, professional public health associations and paediatricians take responsibility – every citizen should raise the issue and work towards improving the school health services present in every state of India.

A few weeks ago, following a review of the implementation of the National Education Policy, the Prime Minister’s Office (PMO) reportedly advised regular health checks and screening of school children. Some letters were reportedly sent to the Department of Health and requests were made to medical interns and post-graduate students to carry out health checks in schools. Such an approach to a question that requires an in-depth approach is akin to “symbolic play”. India’s children need better treatment than this.

For a platform

Every challenge has its silver lining It is incumbent on health policy makers and program managers in every Indian state to do everything in the best interests of children. Indian state departments of education and health should work together to strengthen school health services. This is an opportunity to bring together children, parents, teachers, specialists from the health and education sectors and ministries of health and education on a common platform to ensure a better health and quality education for every child in India. A convergence of the National Health Policy 2017 and the National Education Policy 2020 is expected to result in the provision of comprehensive school health services in every Indian state.

Dr. Chandrakant Lahariya is a primary care physician and public health specialist. He has done extensive work on school health services including the reopening of schools in India. Email: [email protected]


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