Introduction:

School Health programme is a programme for School health service under National Rural Health Mission of India which has been necessitated and launched in fulfilling the vision of NRH Mission to provide effective rural health care to rural population throughout the country with special focus on 18 states which have weak public health educators or weak infrastructure.

Eighteen special focus States are:
1. Arunachal Pradesh
2. Assam
3. Bihar
4. Chattisgharh
5. Himachal Pradesh
6. Jarkhand
7. Jammu & Kashmir
8. Manipur
9. Mizoram
10. Meghalaya
11. Madhya Pradesh
12. Nagaland
13. Orissa,
14. Rajasthan
15. Sikkim
16. Tripura
17. Uttaranchal and
18. Uttar Pradesh.

Thus 8 North eastern sister States are included under this mission. It also focuses on effective integration of health concerns through decentralized management at districts with determinant of health like sanitation, hygiene, nutrition, safe drinking water, gender and social concern. Revitalization of local health traditions, traditional health systems and mainstream AYUSH in public health system.

Improvement of access to health services to rural people especially poor women and children with equitable, affordable, accountable and effective primary health care, convergence of all health components in the State and District level under the said mission, etc.

Effective health care aims at basic affordable equitable health service delivery. In other words, the cost of health care should be within the means of the individual and the State and with the equitable facility where equal degree of health service is rendered to the needy persons irrespective of caste, sex, creed, etc (in our State both urban and rural areas/population are covered under this mission).

Public spending on preventive health services has a low priority over curative health in the country as a whole. In fact, Indian public-spending on health is amongst the lowest in the world whereas its proportion of private spending on health is one of the highest.

More than Rs one lakhs crore is being spent annually as household expenditure on health which is more than 3 times the public expenditure on health. The private sector health care - nursing home, private clinics, hospitals/health institutions is largely unregulated pushing the cost of health care up and making it unaffordable especially for the poor section of the society in both rural and urban areas. It is also accepted that more than 75% of the population in the country go to the private sector, quacks and others.

Health Development Index (HDI) is a good indicator for health assessment. HDI for the year 1999 has been constructed for 174 countries. Canada, Norway, U.S.A are at the tops of HDI ranking and Sierra Leone, Niger and Ethiopia are at the bottom. India’s ranking is at No. 132 with medium human development category which shows that Indian health status needs much improvement. HDI measures average achievement in basic dimensions of human development whereas Human Poverty Index (HPI) measures deprivation in those dimensions.

School Health Service

School health Service is a personal health service which is an economical and powerful means of reaching student community health. It has developed during the past 70 years. It has undergone several changes from the narrow concept of medical examination of school children to the present day broader concept of comprehensive care of the health and wealth being of children throughout the school years.

Historical development

The beginning of school health service in India dates back to 1909 when for the first time medical examination of school children was carried out in Baroda City. The Bhore Committee (1946) reported that school health services were practically non existent in India and where they existed, they were in an under-developed state.

In 1953 the Secondary Education Committee emphasize for the need for medical examination of pupils and school feeding programmes. In 1960 the Government of India constituted a School Health Committee to assess the standard of health and nutrition of school children and suggest ways and means to improve them. The committee submitted its report in 1961 containing many useful recommendations.

During the five years plans many State Governments have provided school health and school feeding programme to the students/pupils. In spite of these efforts to improve school health it must be stated in India as in other developing countries, the school health services provided are hardly more than a token service because of resources restrains and insufficient facilities.

Health problem of school children

Any discussion of a school health service must be based on the local health problem of the school children, the culture of the community and the available resources in terms of money, material, manpower and other factors. Where the health problem of school children varies from one place to another, service carried out in India indicates that the main emphasis will fall in the following categories -
1. Malnutrition, including vitamin deficiencies, etc.
2. Infectious diseases,
3. Intestinal parasites,
4. Diseases of skin, eye and ear and
5. Dental.

Objectives of School Health Service

The objectives of school health programme are as follows:
1. Promotion of positive health,
2. Prevention of diseases: vaccination against six killer diseases - T.B, Polio, Tetanus, Diphtheria, Whooping Cough, and measles.
3. Early diagnosis, treatment and follow-up of defects
4. Awakening health consciousness in children,
5. Provision of healthful environment.

Aspects of School Health service:

The tasks of the school health service are many folds, and vary according to the local priorities. Where resources are plentiful, special school health services may be developed. Some aspects of school health services are summarized as follows:
1. Health appraisal of school children and school personnel.
2. Remedial measures and follow-ups,
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 handicap children
12. Proper maintenance and use of school health records.

School Health programme in Manipur

According to limited sources of information the first delivery of school health services to the pupils in the State was attempted in 1992-93 with the training of school teachers, health staff and others. However, it could not render the desired degree of health service to the needy pupils due to several factors such as lack of financial resources, manpower, communication, etc.

The respective District Health Mission Society in the State under NRH Mission of India (2005-2012) namely Ukhrul District and Imphal East as Pilot project has launched this programme in our State. Ukhrul District first launched this programme in the State on 15th March, 2007 with the Observance of ‘School Health Day’ at ‘Viewland, Phungreitang - Hunphun Primary School’, Ukhrul;

The writer briefly highlighted the School Health programme to staff and children on that occasion. Further Dr. V.S. Yuithingla, Dr. T. Biram and the writer conducted health check-up of 95 students with free distribution of medicines, micro-nutrient and others. Later other districts will also start implementing this School Health Programme.

Basic requirements for an effective implementation of School Health programme

1. The Trained Medical Staff - Specialists, medical officers, Dental Surgeons, Technicians, Optometrists, Eye specialists, and other Specialists, Nurses, Paramedical, Attendants and Trained teachers are required to go to the different schools to cover the respective schools of PHCs, CHCs, PHSCs and different Sub-Divisions.

According to Monthly Reporting Format for School Health Program under National Rural Health Mission, every PHC or CHC or Institution would have weekly school health service programme of School Children Health Check-up. In this connection the number of medical staff posted in different Health Institutions - CHCs, PHCs, PHSCs, etc are not adequate so as to render the said School health service.

Taking Ukhrul district into account every PHC or CHC has 1-3 Medical officers and for coverage of this program maximum 1 or 2 Medical officers can be channelized per weekly school visit.

Calculating/Assuming 1 Doctor examining 50 students per weekly visit, there are 191 Government Primary Schools (Classes I-V) enrolling 14327 students (6-10 years), 38 Government Junior High Schools (Upper Primary Schools - Classes (I-VIII), 2 Government Hr. Sec. Schools + 26 Government High Schools with enrolment of 30594 students, Classes I-VIII (11-14 years) totalling 44921 students, excluding Classes IX-XII, 1 CHC + 6 PHCs = 7 Health Institutions will require on average 44921 students 77 x 50 students = 128 weeks by every PHC or CHC to cover school health check-up in the program.

In other words, one full coverage of the schools will take 2 years by every health Institution. And the second Health Check-up can be taken up only in the 3rd year. This does not include 75 schools (1 JNV + 3 Private Hr. Sec Schools + 30 Private High Schools + others 41 Privates Schools).

Besides this, there is only one Dental Surgeon, no eye specialists, no optometrists (1 ophthalmic assistant posted), no medicine specialist, 2 regular laboratory technicians to examine stool, urine, blood, etc in the whole district.

Thus it is an uphill task for the medical personnel to implement this program. The situation in other hill districts are more or less the same. The involvement of trained teachers is a must. It will also depend much on the dedication, sacrifice of the teachers and others for the successful School health service delivery. In a year a minimum of two health check-ups per institute/schools may be carried out.

2. Recruitment of more staff for the said mission/program is another important factor. Recruitment of more staff for the said mission/program is being done to meet the staff requirement of the mission and to make the program a success.

3. Required availability of medicines, etc. It is hoped that under this mission adequate required fund will be available for the same.

4. Provisions for safe drinking water, proper sanitation and hygiene - separate proper toilets for boys and girls, availability of required nutritional food/nutrition have to be taken care of.

4. Transportation facilities may be provided to the school health program team for their weekly visits to the respective schools especially in the far flung areas.

5. Availability of electricity or alternative arrangements like battery, solar for microscopic examinations by the lab technicians, eye testing for lenses power by the Optometrists/ophthalmic assistants and for health education awareness use of power point demonstration and use of LCD is important.

6. Training of the concerned staff, teachers and others responsible for implementing the program/mission need proper capacity building for proper consolidation of resources, having thorough awareness of the situation, clarity of their roles and responsibilities and optimal use of available resources, timely implementation and for full coverage of the target area and school children with quality.

Suggestions

1. Priority of coverage of schools in the far flung areas be given.

2. Coverage of Schools in District Headquarters, Sub-Divisional Hq Quarters, PHCs/CHCs to be covered later. The trained staff, teachers and others may refer the needy students to the district hospital, CHCs, PHCs for their needful.

3. Fulfilment of the basic requirements.

4. The Application of Child-in-Need Institute (CINI) methodology Kolkata, CINI Methodology for Children Health check-up will be of great advantage.

[CINI Methodology: This methodology involves the Specialists, Medical Officers, Nurses, Pharmacists, Optometrists, Lab Technicians, Para-medical personnel and others like teachers, etc.

On many occasions the team without doctors & specialists, the nurses, Optometrists/ ophthalmic assistants, Lab Technicians, Para-medical personnel and others carry out the Health check-up after giving proper training to them so that they are well equipped to a certain extent for the children health check-up.

Of course serious, needy, deserving cases are referred to the concerned specialists, doctors and hospitals for the needful. The writer had the privilege to expose in the institute in the Year 1987 when he was on one month All India Study Tour under OXFAM ].

** The writer had also participated in the said school health programme in West Bengal in 1992-93 under the All India Institute of Public Health & Hygiene Kolkata with involvement of 5 or more doctors + other concerned persons per school visit. Health is wealth and let our school children enjoy good health with good education, better health with better education and best health with best education.