DR.

MARIAM RAZZAQ
DEMONSTRATOR/PG TRAINEE
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Learning objectives
By the end of the session, students should be able to :
 Define school health and school health services.
 Outline the objectives of SHS.
 Discus various aspects/ functions of SHS.
 Write various features of Healthful school environment.
 Illustrate different types of school desks. Which type of desks
are recommended and why?
 List the components of coordinated School Health Services.
 List different school health problems.
 What is the composition of School Health Team?
 Outline the duties of School health Team(School Health
Officer , School Health Nurse, Attendant and School
Teacher) 2
Background
 An important branch of community health
 SHS are an important means for raising:
 Economical growth
 Community health in current and future
generations
 A personal health service
 Developed over the past 70 years from a narrower
medical examination to a more comprehensive
health care and well being of children through out
the school years.
 Globally, over 2.3 billion school age children spend
one third of their time in schools. (WHO)
 At least 102 countries have either school-based or
school-linked service provision. 3
GSHI-WHO 1995
 The Global School Health Initiative supports countries
to implement the four pillars for Health Promoting
Schools:
1) Health promoting school policies
2) Safe and healthy learning environment
3) Skills-based health education
4) School-based health and nutrition services.

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 School health Services in Pakistan
 Public Sector:
 Recently pilot School Health Programme launched in selected
districts of Punjab, Supported by National Commission of
Human Development(NCHD), WHO and UNICEF.

 UN joint programme of Health and Education at National

and Provincial level. Roles assigned in this programme are:
UNESCO: School health education
UNICEF: Water supply and sanitation
WFP: School nutrition
UNFPA: Reproductive health
WHO: School Health Services

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School health Services in Pakistan…
 Private Sector:
 Since last 2 decades, NGOs are playing key role
 SHS delivered by 2 patterns:
 Snap Shot:
-Annual medical examination by doctor and
nursing staff and reports are given to parents.
- Students are referred to other specialists if
required.
-But no follow up.
 Comprehensive Health Services:
-Setting up of “ School Health Rooms”.
- Eight components of SHS are provided.
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Definition- School health services (SHS)
“School health services (SHS) are services
provided by a health worker to students
enrolled in primary or secondary education,
either within school premises or in a health
service situated outside the school.”
(WHO guidelines-June 2021)
-A branch of Preventive medicine which deals with
preventive, promotive and the curative aspects
of health of school children in a school settings.

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Considerations for planning SHS
A school health service must be based on :

- Local health problems of the school child

- Culture of the community

- Available resources : money, material and manpower.

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Aim and objectives of School
Health Service
School Health Service is an economical and powerful
means of raising community health, and more
important, in future generations.
1. Promotion of positive health
2. Prevention of disease
3. Early diagnosis, treatment and follow up of
diseases/ defects
4. Awakening health consciousness in children
5. Provision of healthful environment
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Health Problems of School Children
1. Malnutrition
2. Infectious diseases
3. Intestinal parasites
4. Diseases of skin, eye & ear.
5. Dental caries
6. Accidents.
7. Behavior problems etc.

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Aspects of SHS
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
contd….. 12
1.Health appraisal : The schedule of Medical Examination :
a. Periodic Medical Examination of students : At entry & then
annual
b. Medical examination of Personnel of school: Teachers and
Staff being a part of school environment
c. Daily morning inspection: By class teachers and the clues
for identifying children who require medical attention are:
1. Unusual flushed face 9. Headache
2. Any rash or spots 10. Chills or fever
3. Symptoms of acute cold 11. Listlessness or sleepy
12. Disinclination to play
4. Coughing and sneezing
13. Diarrhoea
5. Sore throat
14. Body aches
6. Rigid neck 15. Skin conditions like
7. Nausea and vomiting scabies and ringworm
16. Pediculosis etc
8. Red or watery eyes
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 Contd….
2. Remedial measures and follow up
-Follow up at PHC facility( eg BHU)
3. Prevention of communicable diseases:
-Clean environment, sanitary conditions, good
personal hygiene
-Immunization with proper record keeping
-Timely info to parents to prevent spread of CD

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 Contd….

4-Healthful school environment:

a. Location: Fair distance from busy place and
accessible by road
b. Site : on a high land
c. Structure: Heat resistant 10 inches thick
walls and only ground floor for nursery and
Primary schools
d. Classroom: One for every 40 students
e. Desk: Minus desk ideal

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 Contd….
f. Door and Windows : Provision for cross ventilation
25% of floor area
g. Colour: Class Rooms Whitewashed
h. Lighting: Sufficient natural light, possibly
from behind and left
i. Water supply: Continuous supply of safe and
portable water
j. Eating Facilities: No vendors to be allowed inside or
near the school, clean separate
eating place to be provided
k. Lavatories: Separate for Male and Females,
1 urinal for 60 students
1 Latrine for 100 students 16
Type of School desks

 Proper sitting posture is very important.

 Bad sitting arrangement can lead to postural deformities,
( kyphosis, scoliosis), backache, visual problems.
 Chairs should have back rest
 Recommended desk are Minus type , child sits in erect
position keeping a reasonable distance for the eyes.

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????

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 CONTD…
5. Nutritional services:
 Mid day school Meals: may be provided if resources allow.
 Students are encouraged to bring lunch boxes and
where possible mid day meals can be arranged by the
schools on no profit no loss basis
 At least it should provide 1/3rd of daily calorie
requirement and ½ of Protein Requirement.
 Applied Nutritional Programmes: UNICEF is providing
assistance in developing school gardens
 Specific Nutrients: To prevent diseases like Dental caries,
Night blindness, Anemia, Endemic Goiter, Protein Energy
Malnutrition etc in the community to which the student
belongs.
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6. First Aid and Emergency Care: Teachers should be
trained in handling common emergencies.
7. Mental Health: School Teacher has a Preventive role.
Juvenile delinquencies, Drug addiction ,
maladjustments can be identified.
8. Dental Health: teaching of dental hygiene,
Dental caries and periodontal diseases can be
prevented. .
9. Eye Health Services: Basic eye services to be
provided. Refraction, squint, Night blindness ,
Trachoma etc can easily be dealt with.

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10. Health Education: Most important aspect of SHS. School
Teacher is the key figure. It brings about the desirable changes
in health knowledge, in attitudes and in practices and not
merely to teach the children a set of rules of hygiene.
Following areas should be covered:
a. Personal Hygiene: hair, teeth, clothing and posture
b. Environmental Health: Students should be encouraged to
maintain the safe and clean environment in the school
c. Family life: Healthy attitudes towards reproduction
“ Every school child is a health worker”
11. Education of handicapped children: Support to the child and
his family so that he can lead an independent, productive life
to reach his maximum potential.
12. School Health Record: Must be maintained. It should contain:
Identifying Data, Past History, Immunization History, Medical
examination record,etc. Helpful in planning, supervision and
evaluation of a school health programme
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8 x Components of Coordinated School
Health Programme

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School Health Team
 Medical officer
 Nurse
 Attendant
 A School teacher

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 Duties of School Medical Officer
 Responsible for promotive , preventive & curative
components of School Health Programme.
 Conducts daily OPD and where necessary
cases should be referred and follow up maintained.
 Conducts annual or periodical medical inspection of
students
 Immunization and its record
 Counseling of parents and students on Nutrition and
other health issues.
 Health education of parents and students by arranging
seminars and discussions on important health issues.
 Periodic inspection of Physical training of students
and giving exemptions to students as per their condition.
 Health education and training of teachers on first aid
and emergency handling.
CONTD… 27
 Contd…..
 Periodical inspection of water supply, sanitary
conveniences like urinals, latrines etc. ventilation
of building, Inspection of hostels dormitories,
kitchen etc.

 Recommend school Administrator for paint

and white wash at least once in two years.
 Recommend the school administrator for play
grounds, green areas , libraries etc.
 Attend continuous medical education seminars
to update his knowledge.
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Duties of School Health Nurse
 Assist MO in medical inspection planning of children.
 Record Height and weight of students, carry preliminary
vision test
 Assist MO in daily OPD
 Give first aid and issue medicines
 Maintenance of health records
 Supervise the hygiene of school children
 Follow up of cases and keep MO informed.
 Visit homes of school children and gather any additional
information and then convey to MO.
 In the absence of MO, she will take care of minor health
problems.
 Maintain proper record of all her activities.
 Keep herself updated by CME. 29
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 Duties of School Teacher
A key role: prolong contact and influence over children
- Perform daily inspection keeping in mind the various
cues and take action accordingly
- Any change in attention status to be communicated to MO
- First Aid and emergency treatment
- Health education on personal hygiene
- Take part in immunization
- Active participation in school meals
- Supervise sanitation of school environment ( cleanliness,
seating etc)
- Nutritional education
- Periodical reporting on student performance and health
status to parents and attending PTM.
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School Health Program (SHP)-
Department of Community Medine
• For Community-based medical education 4th year
MBBS students of FUMC will work with BHU health
team and School Management at Kotha Kalan
• The School Health Program (SHP) thus aimed at
increasing learning ability of primary
school students through identifying and addressing
the common health problems.
• School children as agent of change in healthy
behaviors of their community.
• Primary Health Care Facility: BHU Kotha Kala, UC-81,
Rawalpindi.
• Target School: Higher Aims School, Kotha Kalan,
UC-81, Rawalpindi
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Few of the Activities
 Periodical Medical examination and health appraisal
 Referral to BHU who will need health care

 Record Keeping of screened students

 Nutritional assessment and counselling
 Health education
 Inspection for Healthful Environment of School etc

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References
 Park’ s Text Book of and Preventive and Social Medicine , 23rd
Edition
 Public Health and Preventive Medicine , Ilyas Ansari, 8th
Edition
 WHO Guidelines School health services 2021
 School Health Programme - UNESCO Islamabad
www.unesco.org.pk
 Eight Components of Coordinated School Health - Warren
...www.warrenschools.com

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CHILDREN MUST BE HEALTHY TO BE EDUCATED
AND
MUST BE EDUCATED TO BE HEALTHY.

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 Lets Recall??
 Definition, objectives and aspects of school health services.
 What are the various features of Healthful school
environment?
 Draw different types of school desks. Which type of desk is
recommended and why?
 List the 8 x components of coordinated School Health
Services.
 What are the different school health problems?
 What is the composition of School Health Team and what
are the duties of School Health Officer ?

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Thank You

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