Ajith J: How school based health services can improve child health in India

ajithSchool children constitute over 25% of India’s population of 1.21 billion people. School health in India is limited to sporadic screening in public schools. Private schools, where 30 million urban children (66%) go, are ignored. There are 197,541 schools in urban India, mostly catering to low and middle income groups. School aged children in urban India face a variety of health challenges—40% are undernourished and 15% are overweight or obese, reflecting the dual burden of nutrition. 20% of children have refractory errors, half of which go uncorrected. 1 in 8 children have psycho-social issues, almost all of which go unaddressed. 50% of children have dental caries—a much ignored chronic disease of childhood. Compounding the problem is the episodic care-seeking behaviour fuelled by out-of pocket expenditure for services delivered by fragmented private providers. The average school-aged child spends 28% of the day and 14% of his or her total annual hours in school.

A comprehensive health check service at a younger age would lead to much better preventive care which could lead to a reduction in the overall disease burden. Conducting or introducing comprehensive health checks and health education in schools would be the first and most important step in detecting and addressing several of these very preventable issues.

The objectives of the programme should ideally be:
● To partner with the school in providing a positive school environment that promotes the physical, mental and social dimensions of health.
● To build the capacity of the school to address major determinants of health.
● To reduce morbidity amongst school children through health promotion, prevention, early detection of health related problems and proper management through referral.

A potential way of implementing better school based health checks, would be to have annual health checks and follow-ups. This would include comprehensive health screening, health checks, and follow up consultations with parents by a multidisciplinary team that goes beyond mandatory requirements. All records and reports should be maintained electronically for easy reference and analysis. Cloud based electronic health records help to keep track of the health records of each child. It also makes it possible to compare different schools data and analyse trends over time.

It works on the same concept as sarva shiksha abhiyan, a government funded programme aimed at providing universal health coverage in school levels. But this programme has not been effective because of a lack of trained people to do the work and unrealistically low funding. Another option is privately funded programmes, However with these programmes the issue is that they work mainly in urban areas rather than with rural populations where it is more critical and needed. This gap could be bridged if government funding was increased to realistic values so that healthcare workers could be trained to do the work, or through a Public Private Partnership (PPP) model.

The programme that I am currently part of shows a year on year decrease in disease prevalence amongst school children in the target group. The number varies between 20-40% (depending on varying socio economic background of that particular community/demography). Though the numbers are not very high, it could still be considered a positive trend considering most of these numbers would have gone unnoticed or worse untreated thanks to our general lethargy towards overall health and wellbeing (mostly due to lack of awareness) of this particular target group. By not only addressing the primary health needs at an early stage, but also bringing in a positive behavioural modification through health education, we could assure a healthier future for our children.

Competing interests: Ajith Jnair is an employee of Addresshealth a social enterprise/organisation providing comprehensive school health services in Bangalore.

Ajith J is a student of elearning in Public Health Management(ePHM) course by Institute of Public Health, Bangalore.