Daily Editorial Analysis for 21th July 2022

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Revamp India’s school health services

GS Paper 2: Issues Relating to Development and Management of Social Sector/Services relating to Health, Education, Human Resources.
Important For:
Prelims exam: FRESH Approach
Mains exam: Need of school health services reforms
As schools reopen, there is a need and an opportunity for States to look at a comprehensive package of services
Time for concrete policy to target schoolchildren
• Children across India are back to school for in-person classes after an prolonged closure in the wake of the COVID-19 pandemic.
• It is time for concrete policy measures and actions that target schoolchildren.
• On the education front, while there has been some discourse on ‘learning recovery’, there is an urgent need to factor in the health needs of schoolchildren.
Reasons why school health services receive inadequate policy attention
• One of the reasons for wrongly designed, and often very rudimentary, school health services — not only in India but also in most low- and middle-income countries — is, arguably, limited understanding and clarity on what constitutes well-functioning and effective school health services.
• This situation co-exists in spite of much evidence guided by international literature.
• School health services receive inadequate policy attention is because health-care needs are often equated with medical care needs.

What do they need?

• Though school age children have a relatively low sickness rate (and thus limited medical care needs), they do have a wide range and age-specific health needs that are linked to unhealthy dietary habits, irregular sleep, lack of physical activity, mental, dental and eye problems, sexual behaviour, and the use of tobacco and other substances, addiction, etc.
• Then, the health knowledge acquired, and lifestyle adopted in the school-going age are known to stay in adulthood and lay the foundations of healthy behaviour for the rest of their life.
• For example, scientific evidence shows that tobacco cessation efforts are far more successful if started in school.
The Delhi example
• In the first week of March 2022, the government of Delhi began 20 school health clinics with the promise of more.
• Though small, this initiative has two messages.
o One, it recognises the importance of school health services in the post-pandemic period.
o Two, the importance of multi-stakeholder partnership for school health services as these are being set up through corporate social responsibility funding from a donor on the one hand and internal collaboration between health and education departments within government on the other.
• On a flip side, by the Delhi government’s own assertion, these clinics are curative focused services.
• They also highlight the main issue: what makes comprehensive school health services has still not been fully understood.
FRESH approach
• UNESCO, UNICEF, the World Health Organization (WHO) and the World Bank have published an inter-agency framework called FRESH (Focusing Resources on Effective School Health.)
• The FRESH framework and tools propose four core areas and three supporting strategies.
• The core areas suggest that school health services need to focus on school health policies, i.e., water, sanitation and the environment, skills-based health education and school-based health and nutrition services.
• The supporting strategies include effective partnerships between the education and health sectors, community partnership and student participation.
• According to WHO, school health services should be designed based on local need assessment; should have components of health promotion, health education, screening leading to care and/or referral and support as appropriate.
• The objective of school health services has to be the promotion of positive health, prevention of disease, early diagnosis, treatment and follow up, raising health consciousness in children and enabling the provision of a healthy school environment.
Opportunity in reopening
• As schools reopen to full capacity, there is a need and an opportunity for a proactive approach for having expanded and strengthened school health services.
• Every Indian State needs to review the status and then draw up a road map to revamp and strengthen school health services, along with a detailed timeline and dedicated budgetary allocation.
o The Fifteenth Finance Commission grant for the health sector should and could be leveraged.
• Health talks and lifestyle sessions (by schoolteachers and invited medical and health experts) should be a part of teaching just as physical activity sessions are.
• Some of the teaching must look at adolescent sexual health; also, subjects such as menstrual hygiene, etc. should be integrated into regular classroom teaching.
• School health clinics should be supplemented with online consultation for physical and mental health needs. This could be an important starting point to destigmatise mental health services.
• The role and the participation of parents, especially through parent-teacher meetings should be increased.
• Parents need to be sensitised about how school health services are delivered in other countries; this may work as an important accountability mechanism to strengthen school health.
• Innovative approaches that offer limited health services to parents, families and even schoolteachers could increase use, acceptance and demand.
Include Private Schools as well
• The Government’s school health services initiatives do not include private schools most of the time. Private schools do have some health services, which are nearly always restricted to curative care and taking care of emergencies.
o Clearly, school health services should be designed to take care of schoolchildren be they in private or government-run schools.
Review Ayushman Bharat Programme
• Under the Ayushman Bharat programme, a school health initiative was launched in early 2020, but its implementation is sub-optimal.
o There is a need to review this initiative, increase dedicated financial allocation to bring sufficient human resources and monitor performance based on concrete outcome indicators.
o Otherwise, it will end up being a ‘missed opportunity’.

Need of a thorough approach

• A few weeks ago, following a review of the implementation of the National Education Policy, the Prime Minister’s Office (PMO) is said to have advised regular health check-ups and screening schoolchildren.
• Some letters were said to have been sent to the Health Department and requests made to depute medical interns and students in post-graduate courses to conduct a health check-up in schools.
• Such an approach on an issue that needs a thorough approach is akin to ‘tokenism’. India’s children need better handling than this.

A common platform

• Every challenge has a silver lining.
• The onus is on health policy makers and programme managers in every Indian State to do everything in the best interests of children.
• The Departments of Education and Health in every Indian State must work together to strengthen school health services.
• It is an opportunity to bring children, parents, teachers, health and education sector specialists and the Departments of Health and Education on a common platform to ensure better health and quality education for every child in India.
• A convergence of the National Health Policy, 2017 and National Education Policy, 2020 should result in the provision of comprehensive school health services in every Indian State.


Children are the future of society, but only if they are healthy and educated. Therefore, elected representatives, professional associations of public health and paediatricians shoulder the responsibility — every citizen should raise the issue and work towards improved school health services being present in every State of India.

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