Comprehensive School Health Program Model: A Conceptual Framework for Nepalese Schools

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INTRODUCTION:

Ever since human beings have lived, health has been a great concern of nearly every individual, community, society, and country. The battle to achieve optimal health for everyone has never ceased. During the last century, dramatic strides have been made in the health field. In Nepal health status has been greatly improved in the following aspects: prolonged life expectancy, declining mortality rate, declining infant mortality, and advanced modern biomedicine. But these all are not in enough level for Nepal.

Health education is a profession that stands in the forefront of this centuries old battlefield. Its role has never been so heightened as today. The goal of health education is to provide the individual with the information, skill, and motivation necessary to make intelligent decisions concerning lifestyle and personal health behavior. In any case, health education is working to promote health, prevent disease, disability, and premature death. Within its limited space, this paper intends to introduce the concept of school health education programs, and to suggest a comprehensive school health model that might work in Nepal.

EVOLUTION OF SCHOOL HEALTH PROGRAM:

Health education has an ancient and complex history. Its beginnings can be located within the very foundation of civilization. Much of the early history of the profession closely parallels that of medicine and its associated sciences. In later time, particularly since 1800, the history of health education has taken on a richness and character uniquely its own. History of school health education can be dated back to period of recognition (1850-1880) when people start to recognize that school could be used to educate/screen for disease and solve health problems. From 1880 to 1920, school health education experienced a period of exploration when children's health problems were emphasized and funded studies were done to document these health problems. In 1910, the American Physical Education was renamed American School Hygiene and Physical Education. In 1927, the American School Health Association was founded. Since the  1980s, more sophisticated school health education programs were developed, which brought school health education into a new era. The growing researchers in school health education demonstrated that school health education offers students not only the opportunity for improved health status, but also the opportunity to achieve a life-style that would lead to a satisfying and productive life (Porter, 1987).

Historical School Health Model

From the late 1880s until the late 1990s, school health programs were conceived as having three components: health education, health services, and healthy school environment, which still serve as a base for the school health education program today.

Comprehensive School Health Program (CSHP)

During the 1980s, more sophisticated conceptions of the school health program were proposed. In 1987, Allensworth and Kolbe proposed a model, the Comprehensive School Health Program (CSHP), which extended the classic triad of health education, health services, and healthy school environment to include physical education, counseling and psychological services, nutrition services, health promotion for staff, and parent/community involvement interactive components. This model (Figure 4), broadly adopted in the United States and internationally, is an organized set of policies, procedures and activities designed to protect and promote the health, safety, and well-being of students and school staff (Meek, Heit, & Page, 1996).

The CSHP model requires systematic coordination among eight components to magnify the benefits available in each component. In general, schools by themselves cannot, and should not be expected to address a nation's most serious health and social problems. Collaborative efforts among families, health care workers, the media, religious organizations, and community organizations must be involved to maintain the well being of young people. The glue that could cement each component is health education, for it is the major source of the one element common to all components --- health knowledge.

A SUGGESTED COMPREHENSIVE SCHOOL HEALTH MODEL

FOR NEPAL

Health Education became a required integrated subject in primary and secondary schools in Nepal 2049 BS. To have a comprehensive school health program, with sophisticated curriculum, qualified health educators are needed to promote school health in Nepal and facilitate Nepalese students' health-related knowledge, attitudes, and practices and to have an impact upon their daily lives.

The following Comprehensive School Health Education Model (Figure 6), modified based on existing school health education models. Six components are included in this suggested model. They are school health education, school physical education, nutrition services, health clinics, healthy school environment, and parent/community involvement. An overview of the contents, constructs, and qualifications of each component follows.

1. Health Education:

School health education is a planned, and sequential health instruction for grades 1 through 12, which addresses the physical, mental, emotional, social, spiritual, and environmental dimensions of health. It integrates education as a range of categorical health problems and issues at developmentally appropriate ages. The school health education curriculum should focus on not only improving students' knowledge, but also emphasizing the development of appropriate skills and positive attitudes toward health and healthy lifestyles. The school health education curriculum should give more emphasis on the following content areas:

Personal hygiene

Prevention and control of diseases (infectious and chronic)

Injury prevention and safety

Nutrition

Tobacco prevention

Relationships, sexuality and family planning

Physically active lifestyles

Mental and emotional health

Environmental health

Positive attitudes toward meaningful life and living

The school health education curriculum should have the flexibility to incorporate local or regional health problems as needed. Health instruction should be implemented by qualified, academically trained teachers and certified health educators.To have a dynamic curriculum, it is important to have the programs evaluated by regional government and school administrators so that it could be routinely revised and improved.

1. Physical Education:

School physical education is a planned, sequential grades 1 through 12 curriculum which provides cognitive content and learning experiences in a variety of activity areas such as basic movement skills, physical fitness, rhythms and dance, games, team, dual, and individual sports, tumbling and gymnastics, and aquatics. School physical education should promote, through a variety of planned physical activities, each student's optimum physical, mental, emotional, and social development. School physical education should also promote enjoyable, lifelong physical activity and improve the physical and social environments that encourage and enable physical activity. Schools may develop extracurricular physical activity programs that meet the needs and interests of students and involvement of parents and guardians in physical activity instruction and programs for young people. Schools should hire qualified, trained teachers to teach physical education. Schools need to have a regular evaluation of physical activity instruction, programs, and facilities.

1. Nutrition Services:

Cooperating with health educators, the nutrition staff serving the school should take the opportunity to promote a healthy diet among students. The ultimate purpose of nutrition services is to promote health by emphasizing a balanced and adequate eating habit. Nutrition services should provide student access to a variety of nutritious and appealing

meals that accommodate the health and nutrition needs of all students. The school nutrition services need to offer students a learning laboratory for classroom nutrition and health education, and serve as a resource for linkages with family. Nutrition staff should serve as role models and promote personal hygiene for students. The director of school nutrition services should have educational and professional experiences in nutrition and dietary programs. The director should also routinely provide educational programs for the nutrition services division.

1. Health Clinic:

No comprehensive school health program could be complete without a health clinic. School health clinics should be staffed by qualified professionals including physicians, nurses, dentists, health educators and pharmacists. These health professionals should have experience and expertise in the areas of school health and school aged children. The purpose of having the health clinic is to appraise, protect, and promote student health. These services should ensure access and/or referral to health care services. It should also focus on prevention and controlling communicable diseases as well as emergency care for illness or injury. The responsibilities of the health clinic include cooperation with other school staff in promoting a sanitary and safe school environment for students. The health clinic staff has an important responsibility in the use of the facility for patient education and student counseling to promote and maintain individual, family, and community health.

1. Healthy School Environment:

A healthy school environment includes the physical surroundings, psychosocial climate, and culture of the school. School environment has a significant impact on the health and well being of school age children. Additionally, the school environment influences the success of the curriculum on children's cognitive development. Schools should provide a physical environment free from biological or chemical agents that are detrimental to health. School administrators should provide and promote a positive and healthy environment where students feel safe and happy. Schools should encourage school staff to pursue a healthy lifestyle that contributes to the school's overall coordinated health programs and create positive role modeling for students.

1. Parent/Community/Staff Involvement:

School health programs could not be fully implemented without having staff and parents' cooperation and involvement. Parents, community leaders and teachers often can and do serve as role models for students. Students serve as a linkage with school and family while parents can and should cooperate with schools to help their children. The school health program could impact parents' knowledge, attitudes and practice regarding healthy lifestyles. Through newsletters, correspondences, meetings and volunteering, schools and parents cooperatively, and collaboratively can and should significantly impact the health and well being of students.

Six components in the Comprehensive School Health Model should reflect six aspects of a contemporary school health program in China. Coordination of these six components could have complementary, if not synergistic, effects. All six components need to "work" together as a whole to address a health behavior or health problem, though each of the six components has its own content, constructs and qualifications in the field. Further study is needed to provide empirical evidence for effectiveness and acceptability of this suggested model.

SUMMARY AND CONCLUSION

Professionals in the health education field believe in the power of education and its potential impact on one's health behavior choices. While major leading causes of death are widely linked to unhealthy behaviors, health professionals see the promise through prevention. However, they don't look at the promise through rose colored glasses. On the

Contrary, they do recognize the coexistence of challenges and opportunities. Unhealthy behaviors of adults are usually sewn during their childhood. Since the greatest majority of children go to school, there is no place better than schools to provide health knowledge and skills. Researchers have shown that the most effective school health education programs are those following comprehensive school health program models, theory informed, sequentially designed from kindergarten to the 12th grade, and with family and community involvement.

This paper suggested a comprehensive School health model, which functions under the assumption that it might work in the Nepalese system.

REFERENCES

1. DHS, (2007), Annual Report, Kathmandu, Government of Nepal, MOH and population department of health services.


2. Maharjan, H,(2006), Historical Glimpse of health and health Education ,Kathmandu,  HEPASS , Journal, T.U. , Kirtipur


3. Meeks, L., Heit, P., & Page, P. (1996). Comprehensive School Health Education. Columbus, OH: Meeks Heit Publishing Company.


4. Pate, R. R., Small, M. L., Ross, J. G., Young, J. C., Flint, K. H., & Warren, C. W. (1995). School physical education. Journal of School Health, 65, 312-318.


5. Porter, P. (1987). School health is a place, not a discipline. Journal of School Health, 57(10), 418-420.

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Source by Birat Ghimire