World Health Organization. MJ was involved in research proposal designing, manuscript revision, and supervision of the whole process. SUMMARY. This manual provides resources (including fact sheets and accurate information and data about HIV and STIs) and examples of interactive skill-building activities. It is a skill that can be developed through: 1. positive social connections 2. safe environments 3. life skills such as positive coping and problem solving skills 4. pro-social values 5. positive self-regard 6. and a sense … Teachers’ role in the school mental health initiatives cannot be overemphasized. The group of codes and sub-codes, which repeated in a patterned way, were grouped into a theme. The role of teachers in education extends past the responsibility of passing along information. In Scotland, the Chief Nursing Officer recommended that the role should be refocused. SCHOOLS AND teachers have an important role in the recognition of mental health … (P8, central level: Chief, Nutrition Section at Child Health Division), In our school, we do not have teachers with enough knowledge about health issues. 2007;19(6):349–57. Fathi B, Allahverdipour H, Shaghaghi A, Kousha A, Jannati A. Sustainability in healthcare by allocating resources effectively (SHARE) 8: developing, implementing and evaluating an evidence dissemination service in a local healthcare setting. (P1, aid agency: SHNP program coordinator). For students with chronic health conditions, school nurses and other health care providers play a large role in the daily management of their conditions. (P3, aid agency: WASH specialist), Now, the SHN network is formed and all the stakeholders involved in it have planned and divided their responsibilities. Google Scholar. From the schools also, we recruited four school principals, four teachers, two local non-governmental organizations (NGO) members, one resource person, and one school management committee member from Siraha, Sindhupalchok, Syangja, and Kailali districts. Washington DC: The United States Agency for International Development; 2010. http://www.healthpolicyinitiative.com/policyimplementation/files/1155_1_PIAT_Paper_Taking_the_Pulse_of_Policy_acc.pdf. The training was conducted only once and ended and it was not repeated. Article  We all go through SHN network, which has been a good mechanism where we can coordinate." The four major challenges identified by the stakeholders were lack of coordination between stakeholders, lack of resources, lack of training opportunities, and low sustainability of the program. J Sch Health. E-mail: [email protected]. Field Actions Sci Rep. 2009;3 https://journals.openedition.org/factsreports/306. First, we collected data from school-level key informants only in the districts where the SHN program was conducted. (P3, aid agency: WASH specialist), In the past, proper coordination and communication did not exist between schools and communities, so the communities used to be dirty with open defecation. This document provides an overview of WHO's Global School Health Initiative. The cooperation between schools and the community also improved. The majority of key informants mentioned that after the implementation of SHN program in the schools, students had better access to different SHN services, better nutrition, safe drinking water, and hygiene and sanitation facilities. It provides practical guidance, tools and descriptions of and tips from Health-Promoting Schools around the world. (P3, aid agency: WASH specialist), Water facility was not available in the schools in Pyuthan district. This document is part of the WHO Information Series on School Health prepared for WHO’s Global School Health Initiative and the Global Strategy on Diet, Physical Activity and Health. But we are facing difficulties to expand the program because of financial problems. It’s because their stomach used to be empty. In my opinion, the coordination between the stakeholders should also act on pulling up the resources for implementing the program. NewYork: United Nations Children’s Fund; 2012. https://www.unicef.org/publications/files/CFS_WASH_E_web.pdf. Second, we did not include parents as key informants in this study though they are important stakeholders in SHN program implementation and their perceptions might have given additional insights. Switzerland Article  Challenges in developing health promoting schools’ project: application of global traits in local realm. Am J Educ Res. It is their joint role to encourage the student to become an independent learner and member of the classroom, school… Bihar’s pioneering school-based deworming programme: lessons learned in deworming over 17 million Indian school-age children in one sustainable campaign. We distributed the 32 transcripts equally between two groups of co-authors. We used a modified interview guide based on the Policy Implementation Assessment Tool for program implementers and other stakeholders, developed by the United States Agency for International Development (USAID) [26]. Besides, many stakeholders are conducting only selective activities [15]. However, some of the key informants from the central level and aid agencies mentioned that MOH was more active compared to the MOE. Teachers are best known for the role of educating the students that are placed in their care. Shung-King M. From ‘stepchild of primary healthcare’ to priority programme: lessons for the implementation of the National Integrated School Health Policy in South Africa. However, capacity building of human resources from the central level to schools is known to be a requisite to improve and sustain the program [12, 39]. As soon as he/she gets some training, he/she will be transferred somewhere else due to either personal interest or organizational changes. The organizer can also serve as a demonstrator, this role also allows a teacher to get involved and engaged with learners. (P4, aid agency: SHNP senior coordinator). 2010;81(10):593–8. BMC Public Health. Others can help, but it is the teacher who is with the children day after day and hour after hour who is essential to its success. To improve the quality of the SHN program, generating evidence is essential. Child clubs and extra-curricular activities could have played a significant role in improving students’ health and nutritional knowledge and practices. Teachers are increasingly being called upon to monitor the mental health and wellbeing of their pupils. © 2020 BioMed Central Ltd unless otherwise stated. For example, this program has improved students’ knowledge of health and hygiene practices and keeping the school environment clean, etc. The project included SHN activities such as general and oral health check-ups, first aid services, deworming, iron supplementation, child club activities, and special health classes, maintaining the SHN register and providing mid-day meals. Similar child club activities are known to help students gain knowledge and learn life skills for their personal development in Nepal [31]. The Shanghai Declaration on Health Promotion has been endorsed by the participants of the conference. Schools have been a powerful setting to promote health programs [1, 2]. Some key informants from the central level and aid agencies stated that at the central level, the members of the SHN network and government actively participated in regular meetings to share and discuss the SHN program strategies, activities, and achievements. 3. mental elements in a school-health program, and they are matters that require the attention of the teacher. However, we conducted interviews in the closed room in their office settings. Majority of key informants responded that MOH, MOE, and their institutions from the central to local levels were responsible to implement the programs and a certain level of coordination existed between them. (P4, aid agency: SHNP senior coordinator). We thus conducted a qualitative study to explore (1) the SHN program implementation, (2) its impact, and (3) challenges in Nepal. Therefore, our findings warrant the need for regular and refresher training, and the establishment of training centers to generate trained manpower to implement the SHN program effectively and sustainably. In the SHN project evaluation study, we only collected data from the school students but did not include other stakeholders, who were actively involved in the SHN program implementation. (P5, aid agency: SHNP head), Child clubs in schools organize Deusi-Bhailo program (cultural program) during Tihar festival and collect fund. Some of the key informants from the central level and aid agency suggested that MOE should also get actively involved in the program implementation. So students do not run away from their schools. Another role of special education teachers … Kathmandu: Youth for World Nepal; 2011. Sexual Health Education in Schools. Even if they forget to bring tiffin, their parents bring it to school. The WSCC model is student-centered and emphasizes the role of the community in supporting the school, the connections between health and academic achievement and the importance of evidence-based school … 2015;30(2):285–97. What is an adequate sample size? Lower numbers of NGOs or INGOs working in the education sector are involved in SHN program implementation. Kathmandu; 1999. https://cergnyc.org/files/2016/09/ChildClubsofNepal.pdf. We have seen many positive changes after this program. This document is part of the WHO Information Series on School Health prepared for WHO’s Global School Health Initiative and the Global Strategy on Diet, Physical Activity and Health. The school nurse’s role varies across countries. There are some difficulties with coordination among stakeholders. Despite several challenges identified by the stakeholders during the implementation of SHN programs, all of them acknowledged that efforts should be made to make the program sustainable, because of its positive impact on students, schools, and communities. This study showed that the sustainability of the SHN program was a challenge because of insufficient material and human resources, and lack of strong leadership. We obtained written informed consent from all the key informants before the interview. Building capacity for the continuous improvement of health-promoting schools. The refocused programme emphasises nine care pathways with a view to improve pupils’ health and wellbeing. To increase knowledge and awareness of health … J Sch Health. Based on the key informants’ responses, we categorized the impact of the SHN program into two main parts a) impact on students, and b) impact on school environment and community. During the 4-year SHN project in Sindhupalchok and Syangja districts, teachers and staff from the District Education Office and District Health Office were trained once to conduct SHN program activities [37]. Learning Assessments. Understanding of factors that enable health promoters in implementing health-promoting schools: a systematic review and narrative synthesis of qualitative evidence. Almost half of the key informants from different levels were positive regarding the sustainability of the program, while others were doubtful due to lack of resources. This document is part of the WHO Information Series on School Health prepared for WHO's Global School Health Initiative and the Roll Back Malaria Partnership. School health pomponent of WHO’s Mega Country Network for Health Promotion. In resource-limited countries, a lack of resources has been a crucial operational barrier to conduct the program [3, 12, 13]. It also involved school cleaning; improving access to safe drinking water, toilet, and hand-washing facilities; and constructing toilets and waste disposal pits in schools. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Some key informants also mentioned that they received support from communities to conduct SHN activities effectively. Braun V, Clarke V. Using thematic analysis in psychology. We conducted office visits and had telephone conversations, and formal and informal talks to track key informants. However, the key impediments in implementing the program included a lack of coordination between stakeholders, lack of resources, limited training opportunities, and doubts regarding the sustainability of the program. I have worked in the health training department for 7 years but haven’t received any training related to school health yet and I also don’t know about it. Global School Health Initiative. When polled about thei… Basch CE. 2008;78(1):1–8. 2014;4(1):9–17. PLoS Negl Trop Dis. We included key informants who were actively involved in the SHN program development and implementation. After the child club mobilization, the child club members conducted rallies in the villages to generate awareness among the community people. Position Statement. Atlanta, US: Centers for Disease Control and Prevention; 2014. The school nurse has a central management role in the implementation of the school health services program for all children and youth in the school. The School Health and Nutrition (SHN) program is a cost-effective intervention for resource-poor countries. Harris C, Garrubba M, Melder A, Voutier C, Waller C, King R, et al. Besides, the government should implement programs to encourage schools to generate resources at the local level and discourage over-dependency on external sources to make the SHN program sustainable. Although most of the key informants from the central level and aid agencies received and provided training to implement the SHN program, only some key informants from the district level and schools received the training. Some key informants from the schools even mentioned that they tried to generate funds from local sources. Basch C. Healthier students are better learners: a missing link in school reforms to close the achievement gap. Healthy eating patterns in childhood and adolescence promote optimal childhood health, growth, and intellectual development; prevent immediate health problems, such as iron deficiency anemia, obesity, eating disorders, and dental caries; and may prevent long-term health problems, such as coronary heart … Some of them mentioned that they had received the training once, while some were not even aware of such training. The authors declare that they have no competing interests. Then, they did all the labor work to set up the pipelines. The School Health Program has helped to establish a link between professionals within the Family Health Strategy Program and teachers, who must be involved in work with teenagers given that the health education process requires an exchange of experiences and knowledge that must be shared among all the actors mentioned, including the family. Schools can play an important role in promoting positive mental health, reducing stigma, raising awareness among teachers, parents and children about mental health issues as well as identifying and supporting youth experiencing mental health difficulties. BMC Health Serv Res. (P1, aid agency: SHN program coordinator). 1. We don’t have enough resources. They may be teaching a classroom about topics related to … In: Jamison D, Berman J, Measham A, Alleyne G, Claeson M, Evans D, et al., editors. The teachers in the project schools were trained to conduct SHN activities. SUMMARY. The steady increase in the identification of psychological difficulties faced by school children shows us the need to ensure their psychosocial well-being through an active collaboration between schools and mental health practitioners. A few of them were not even aware of such training programs on SHN activities. Increasing numbers of students enter schools with chronic health conditions that require management during the school day. Health instruction and role of teacher in school health program Ask for details ; Follow Report by Ishan1794 20.02.2019 Log in to add a comment Bundy D. Rethinking school health: a key component of education for all. By using this website, you agree to our The SHN program aims to provide timely support and preventive measures to improve the health of school children [4, 7]. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. INTRODUCTION• School health is an important branch of community health. Awareness campaigns and advocacy for the program are indispensable to pull more resources from relevant stakeholders. Water, sanitation and hygiene (WASH) in schools. Tong A, Sainsbury P, Craig J. Schools and teachers play a vital role in recognising and supporting students with mental health problems. This paper demonstrates that tobacco use prevention programmes have a positive impact on the health of children and adolescents and that comprehensive tobacco use prevention programmes in schools work and effectively reduce tobacco consumption. Improving children’s health and education by working together on school health and nutrition (SHN) programming in Nepal. (P27, school: School principal). Table 2 shows the major themes, codes, and sub-codes deduced from the thematic analysis, showing the linkage between program implementation, impact, and challenges during implementation. Third, the key informants might have expressed the views that they thought we (investigators) wanted to hear, leading to social desirability bias. Int J Qual Health Care. Notes were also taken while interviewing. Horizontal coordination is more difficult than vertical coordination. They are to be handled with affection, courtesy, and discipline. We categorized interview data into three broad themes: (1) SHN program implementation, (2) its impact, and (3) challenges during implementation. Bundy D. School health and nutrition: policy and programs. Awareness campaigns and advocacy for the program are indispensable to pull more resources from relevant stakeholders. Health Promotion aims to create a healthy school environment by promoting the general health and wellbeing of learners and educators, and by addressing key health and social barriers to learning in order to promote effective teaching and learning. Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. Many school-aged children in these countries are affected by treatable and preventable illnesses [3, 4]. Furthermore, the overall coordination between these two sectors was limited, which therefore led to a lack of planning for the sustainability and scaling up of the program. One of the key informants from the aid agency mentioned that the stakeholders should coordinate well to generate resources. Stakeholders at different tiers can play significant roles in the program implementation and its success. No study has yet explored stakeholders’ perceptions on the SHN program implementation process in low-income countries, including Nepal. Using his extensive network of connections and a snowballing procedure, we identified key informants from different organizations who had in-depth knowledge and were actively involved in the program. The first author also sorted and coded all 32 transcripts separately. 2013;103(12):895–8. We recruited the key informants through the personal network of a key person who was also actively involved in the SHN program development and implementation. (P7, aid agency: SHNP former chief advisor), Most of the organization and ongoing activities come from the health sector. 2014;14:1134. Furthermore, MOH and MOE should jointly provide strong leadership and recognize their responsibilities to improve students’ health and academic outcomes. WHO Prevention of Noncommunicable Diseases (PND) 6 Centers for Disease Control and Prevention. A few of the key informants suggested integrating the program into the government system to make it sustainable. Springer Nature. All the key informants agreed that training is essential to implement the SHN program effectively. Because of insufficient money, some schools even raised funds from parents and community members. A few studies have also reported a lack of coordination between the two ministries while implementing school health programs [9, 12, 13]. Shrestha, R.M., Ghimire, M., Shakya, P. et al. RMS conceived the research questions, designed the study, conducted the fieldwork, analyzed the data, and prepared the manuscript draft. Our findings highlighted that stakeholders from all tiers should coordinate, collaborate, and continue their efforts to effectively implement and expand the program nationwide. According to a few key informants, physical screening could have also prevented blindness and hearing loss in some students. This study provided a deeper understanding of the linkage between the SHN program implementation, impact, and challenges in Nepal. The district level key informants were involved in planning, coordination, resource mobilization, and monitoring of the SHN program in the schools. So this is about the behavior change among students as well as their parents. However, the evidence is scarce on the school health and nutrition policy and program implementation in developing countries. There is also a growing expectation for teachers to play an active role in raising awareness of issues central to a child’s wellbeing. Despite the challenges, all the stakeholders acknowledged that the SHN program had positive impacts on students, schools, and communities. These findings indicate that SHN program has helped to sensitize parents and community members about child health-related issues and promoting healthy behaviors; therefore, they also benefited from the program. So I think it is a bit lacking in this part, which can be a challenge for the sustainability of the program (P5, aid agency: SHNP head). In 1995, the World Health Organization (WHO) launched the Global School Health Initiative and introduced the concept of Health-Promoting Schools (HPS) [8], which can be characterized as schools seeking to strengthen their capacity and enable a healthy environment in the schools [8]. Our previous quantitative study also showed that child clubs and special health classes were positively associated with students’ higher health knowledge scores and identified a positive association between better health and sanitation facilities and students’ improved hygiene practices [18]. Kathmandu: Government of Nepal; 2006. Parents have also started brushing their teeth! We used a stratified purposive sampling technique to choose the study areas [22, 23] and included seven out of the then 75 districts. At district level and schools, DOH, DOE, schools, health posts, local NGOs, FCHVs, youth clubs, and parents were actively involved. We adopted a thematic approach for the data analysis. The framework has been designed to show the links between health-related policy development, program implementation, and health outcomes. The evidence is scarce on the SHN program implementation process in resource-limited countries [9, 12, 19], and no study has yet explored stakeholders’ perceptions on the SHN program implementation process in low-income countries, including Nepal. "Students used to defecate openly in the past, but now they have started using toilets. The SHN program is an integral part of HPS [9], and many countries have adopted the SHN program to promote health through schools [10]. BMC Public Health. Major challenges identified include insufficient funds, inadequate physical infrastructures, and lack of trained human resources [3, 12,13,14]. Teachers may play a central role in the implementation of strategies and interventions rooted in the RTI framework, but their effective role in the implementation of RTI and mental health … Park S, Lee EY, Gittelsohn J, Nkala D, Choi BY. The results of this study should be interpreted considering three limitations. MG, PS, RA, and RD were involved in data analysis and manuscript revision. They collect garbage in the garbage box and after it is filled, they burn it." Traditionally, the role of the teacher in the school-health program is that of providing health instruction. Both the teacher and the teacher assistant facilitate the inclusion of students with special needs . ♦ School Health Physician Delineating Roles and Responsibilities for the Safe Delivery of Specialized Health Care . According to the key informants from aid agencies, district level, and schools, they conducted activities such as health education classes, child clubs, and extra-curricular activities to improve students’ health-related knowledge and behaviors. Health Promot Perspect. None of the organizations go directly for the implementation of SHN. Washington, DC: The World Bank; 2011. The key informants from the aid agencies were involved in supporting the MOE and MOH to implement the program as well as in monitoring and supervising the programs implemented in the schools. Three co-authors summarized each transcript, selected quotations, and translated them into English. We had a meeting with parents and teachers and told the parents that we could just give them pipelines. Many key informants also mentioned that the program improved the attendance, enrolment, and retention rates in schools. 8 The school is now included as an important … Majority of key informants mentioned that the SHN program brought positive changes in the school environment and community. We also assured them about the confidentiality of the information they provided and the anonymity of their identity. It provides interventions that can reduce violence through schools. However, the coverage of the program activities has not reached many districts in the country [15, 17], and most of the support has been limited to the students of government schools [15, 17]. Terms and Conditions, We followed the consolidated criteria for reporting qualitative research (COREQ) guidelines to conduct the interviews, and analyze and report the data [25]. Even tooth brushing was neglected. In this study, almost all the key informants appreciated the SHN program implementation in schools and the positive impact it has on students, schools, and communities. The results showed that students in project schools had better access to various school health services, hygiene and sanitation facilities, and more child club activities and special health classes compared to those in comparison schools. Majority of key informants responded that they conducted activities such as general and oral health check-ups, first aid services, deworming, iron supplementation, child club activities, maintaining the SHN register, and providing mid-day meals. Hung TT, Chiang VC, Dawson A, Lee RL. (P29, school: SHN program coordinator, local NGO), We have qualitative data and reports, which showed students now want to come to school and don’t go back in a break. Majority of the participants from the central, aid agencies, and district level mentioned that there is a structural network from top to down, which included Department of Health Services (MOH), Department of Education (MOE), and different aid agencies at the national level, which were involved in program implementation. Francis JJ, Johnston M, Robertson C, Glidewell L, Entwistle V, Eccles MP, et al. Teachers’ assistants play a key role in many programs for students with special needs, performing functions which range from personal care to assisting the teacher with instructional programs . Health promotion programs for staff are designed to promote the physical, emotional, and mental health of school employees through health assessments, health education, health-related fitness activities, and employee assistance programs. Beyond that, teachers serve many other roles in the classroom. United Nations Children’s Fund. According to the key informants’ responses from all levels, the major SHN activities could be mainly categorized into four sections, which were based on the four objectives of the SHN strategy [16]. PubMed  SHN program aims to provide timely support and preventive measures to improve the health of school children, which can be associated with their cognitive development, learning, and academic performance. In the disassembling phase, the first author thoroughly read and reread the transcripts, listened to all the interviews repeatedly, and examined the patterns of interview data. A similar situation was reported in the Lao People’s Democratic Republic (PDR), where the education sector had a leading role in implementing the National School Health Policy in the country [12]. The positive impact included improved students’ health and education outcomes, improved school environment, and enhanced community awareness. PubMed Google Scholar. https://doi.org/10.1186/s41182-019-0159-4, DOI: https://doi.org/10.1186/s41182-019-0159-4. Students can be effective advocates for creating a healthy school … We then analyzed the data following the 5-phase cycle proposed by Yin [23], which includes (1) compiling, (2) disassembling, (3) reassembling, (4) interpreting, and (5) concluding. Furthermore, the program also brought positive changes in students’ nutritional behaviors, hygiene practices, and life skills. WHO Prevention of Noncommunicable Diseases (PND), Coronavirus disease outbreak (COVID-2019), Coronavirus disease outbreak (COVID-19) », Global school health initiatives: achieving health and education outcomes, Health Promoting School: an effective approach for early action on NCD risk factors. Yin R. Qualitative research from start to finish. (P1, aid agency: SHN program coordinator). Committee of the linkage between the SHN program effectively a few respondents at the level. 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