Minimum package of school health and nutrition program.

Research Report.

SUMMARY: Schools are the places where most school-age children spend six or seven hours a day and around 200 days a year. School students require physically safe environment, clean school complex and health education in order to protect and promote their health. The Government of Nepal has already developed a National School Health and Nutrition Strategy (GoN, 2006) to implement School Health and Nutrition Program (SHNP) in the country. Despite this, SHNP has not been implemented in all the schools of the country in order to address the health problems of students. Currently there are several external development partners and I/NGOs implementing school health and nutrition programs in some schools of the selected districts. This minimum package of SHNP has been developed based on NSHN Strategy 2006 that aims to develop physical, mental, emotional and educational status of the school children. This goal is supported by four strategic objectives: to improve the use of SHN services by school children, improve healthy school environment, improve health and nutritional behavior and habits and improve and strengthen community support system and policy environment. Objectives of the Minimum Package for SHN program are as follows:  To increase the access of school children to minimum health and nutrition services  To create a safe and healthful school environment by providing minimum physical and sanitary facilities.  To promote practical and skill oriented teaching-learning approaches to health education.  To promote joint efforts of schools, health institutions and other stakeholders in school health and nutrition program.  To implement National School Health and Nutrition Strategy making conducive policy environment. The minimum package of School Health and Nutrition Program includes the following four components:  School-Based Health and Nutrition Services  Healthful School Environment  Life Skill-Based Health, Hygiene and Nutrition Education  Coordinated and Collaborative Efforts for the Minimum SHN Program School Based Health and Nutrition Services, one of the main components of the package include several activities like, general health checkup, screening, first aid, de-worming, v management of school feeding program and micronutrient supplement (iron tablets), counseling/advising, referral and follow-up services of the school. The second component, health school environment intends to create safe and healthful school environment by providing minimum physical facilities. It includes the provision of safe drinking water and adequate water supply for hand washing and cleaning toilets with separate toilets with urinals for girls and boys, management of solid waste, maintenance of ventilation and light in classroom, safe and clean school premises and play ground. One of the strategic objectives of the School Health and Nutrition Program is to improve health and nutrition behavior among students through life skill-based teaching. Health, hygiene and nutrition behaviors of students can be formed and changed through the application of practical, child centered and life skill-based teaching approach in health education. It emphasizes on the use of participatory and practical teaching approach to health, sanitation and nutrition education, inclusion of local contents in health education, production, distribution and use of low cost teaching/pictorial materials, establishment of IEC Corner in school, daily and weekly checking of personal health and hygiene using the attendance register with daily checklist, extra-curricular activities and celebration of SHN week. Being joint efforts of Education and Health Sectors, the SHNP requires coordinated efforts of the concerned Ministries and Departments as well as other concerned stakeholders from national to local level in order to develop the technical, managerial and financial aspects of the programs. The coordinated and collaborative efforts can be achieved and maintained through formation of District School Health and Nutrition Coordination Committee (DSHNCC), recruitment or assignment of District School Health and Nutrition Coordinator (DSHNC), formation of School Health and Nutrition Committee (SHNC) at the school level, assignment of Focal Teacher as well as Health Education Teacher in each school, preparation of annual action plans of Child Club and SHNP, partnership between the school and local health institutions, coordination between school and community including PTA, CBOs and clubs, and collaboration between the school and local governing bodies (VDC, Municipality, DDC). School Health and Nutrition Committee (SHNC), Child Club, PTA, SMC, Teachers, VDC/Municipality, PHC/HP/SHP and health workers will work at the school and community level under the DSHNCC. The provision of the institutional framework is the key for effective implementation of the Minimum SHNP package in the country. Capacity building and resource management are essential to implement the minimum package effectively and sustainably. The capacity of the workforce and stakeholders can be enhanced through the orientation workshops at the district level; formation of District SHNCC and vi orientation to the members of SHNCC; assignment/recruitment and training of District Focal Person/District School Health and Nutrition Coordinator in DEO; orientation training to health personnel, RP and School Supervisors; orientation training to the school headmaster, teachers and members of SMC, SHNC, PTA and Child Clubs; and training to Focal Teachers (short intensive training) on student health issues, first aid, screening, counseling, referral and follow up procedure, record maintaining, using checklist, participatory teaching approach, management of school feeding/tiffin and school environment. Each school can create funds for sustainability and effective implementation of the SHNP. Likewise, there should be legal provision for the mandatory implementation of the minimum package of SHNP by all schools in the country. Monitoring, supervision, evaluation/operational research, documentation and reporting are essential to ensure the uniform implementation, to measure progress made in achieving SHN goals and objectives, determine the impact of Minimum SHNP on students' health and improvement of school environment and modify the SHNP periodically based on past experiences. There should be regular reporting, monitoring and supervision, and periodic evaluation of the SHNPs. The following specific recommendations are made for the implementation of the minimum package of SHNPs in the country:  The government must develop legal framework and institutional provision and network.  Develop national guidelines for implementing the SHNP package.  Make the mandatory implementation of the minimum package of SHNP in each school of the country by law and acts.  Produce and distribute the IEC/pictorial materials, Health Record Forms, Checklist, weighing machine and measuring instrument, Snellen (E) Chart and other materials required for the effective implementation of the package.  Create a position and recruit District School Health and Nutrition Coordinator for coordinating and implementing overall SHNP in the district under DSHNCC.  Create a position for Health Education Teacher in school for effective implementation of SHNP at the school level.  Provide financial and technical supports to those schools that lack access to separate latrines with urinals for girls and boys.  Identify a focal school health teacher to coordinate SHNP in the school.  Provide training to the School Headmasters, Focal Teacher, and In-Charge of HP/SHP on SHNP  Form the SHN Committee and Child Club for mobilization of students and teachers and other local resources for SHNP at the school level