(P4, aid agency: SHNP senior coordinator), Though a certain level of coordination exists between the stakeholders, I don’t see that extent of coordination even at the central level, which could generate resources. Three co-authors summarized each transcript, selected quotations, and translated them into English. Health Educ Res. 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. Despite the challenges, all the stakeholders acknowledged that the SHN program had positive impacts on students, schools, and communities. BMC Public Health. Its purpose is to strengthen efforts within the whole school community in favour of malaria prevention and control. 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 … Kathmandu: Youth for World Nepal; 2011. Google Scholar. Washington (DC): World Bank; 2006. They mentioned that the above activities helped to improve the school environment. We have also prevented some kids from suffering permanent hearing loss. 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. Article  Understanding school health environment through interviews with key stakeholders in Lao PDR, Mongolia, Nepal and Sri Lanka. J Sch Health. 2007;19(6):349–57. There is also a growing expectation for teachers to play an active role in raising awareness of issues central to a child’s wellbeing. 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. With this aim, in 2013, we conducted an evaluation study of a 4-year-long SHN project jointly conducted by JICA and Nepal Government in Sindhupalchok and Syangja districts [18]. The United States Agency for International Development. They suggested that good coordination between the stakeholders might help in generating resources. We found half of teachers have raised at least one mental health issue about a pupil in the last month. This manual provides resources (including fact sheets and accurate information and data about HIV and STIs) and examples of interactive skill-building activities. Springer Nature. Our study further highlighted that stakeholders from all tiers should coordinate and collaborate adequately to continue their efforts to implement and expand the program nationwide. Masamine Jimba. 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 all go through SHN network, which has been a good mechanism where we can coordinate." As soon as he/she gets some training, he/she will be transferred somewhere else due to either personal interest or organizational changes. However, in resource-limited countries, several operational barriers exist to implement such programs. They collect garbage in the garbage box and after it is filled, they burn it." Despite the challenges, all the key informants in this study unanimously agreed to make efforts to increase the program sustainability, given its positive impact on students, schools, and communities. They also suggested that all the teachers in the school should be trained. However, we interviewed key informants from different tiers including the central and district levels, schools, and aid agencies. We included key informants who were actively involved in the SHN program development and implementation. When I was in Dadheldhura, I visited one of the schools there. What is the role of teacher in developing mental health? supervising, and assessing the educational program for that student .” “Teachers are expected to design programs for students with special needs . Kathmandu; 1999. https://cergnyc.org/files/2016/09/ChildClubsofNepal.pdf. Many schools did not have sufficient physical infrastructures or facilities to implement the program efficiently. (P28, school: Health and physical education teacher). In fact, even though a teacher spends the majority of the day in the classroom, the actual teaching component is only part of the job. Bundy D. Rethinking school health: a key component of education for all. Basch C. Healthier students are better learners: a missing link in school reforms to close the achievement gap. Trompette J, Kivits J, Minary L, Cambon L, Alla F. Stakeholders’ perceptions of transferability criteria for health promotion interventions: a case study. We used a stratified purposive sampling technique to choose the study areas [22, 23] and included seven out of the then 75 districts. We adopted a thematic approach for the data analysis. We informed them that their participation was voluntary and they could withdraw from the study at any time. 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]. 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. Bihar’s pioneering school-based deworming programme: lessons learned in deworming over 17 million Indian school-age children in one sustainable campaign. Resilience is the ability to cope and thrive in the face of negative events, challenges or adversity. 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]. (P3, aid agency: WASH specialist), Now, the SHN network is formed and all the stakeholders involved in it have planned and divided their responsibilities. SUMMARY. Furthermore, this study showed that after implementing the SHN program in schools, more parents sent their kids to school with tiffin and wearing a clean uniform. We also assured them of confidentiality and anonymity. Copenhagen: World Health Organization Regional Office for Europe; 2011. http://www.euro.who.int/__data/assets/pdf_file/0004/134671/e94805.pdf?ua=1. The cooperation between schools and the community also improved. From the aid agencies, we recruited one key informant from each of seven different international non-governmental organizations (INGOs), and UN and bilateral organizations. They are to be handled with affection, courtesy, and discipline. 2018. https://doi.org/10.1093/her/cyy008. Parents have also started brushing their teeth! These activities aimed to improve students’ use of SHN services. Increasing numbers of students enter schools with chronic health conditions that require management during the school day. It presents strategies to improve the health, education and development of children, families, and community members and aims to help communities recognize, manage, and avoid physical, chemical and biological threats that may exist in or near their schools. Many key informants also mentioned that the program improved the attendance, enrolment, and retention rates in schools. The purpose of this document is to define key concepts and explain how skills-based health education, including life skills, fits into the broader context of what schools can do to improve education and health. This document was released on the occasion of the first World Malaria Day, April 25, 2008. 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. The training was conducted only once and ended and it was not repeated. Ideally, the school nurse collaborates with primary care physicians, specialists, and local public health … Regarding training on SHN program implementation, stakeholders at districts and schools who had received training on SHN program implementation once, suggested that such training should be more frequent and longer and also mentioned that it should be expanded to other parts of the country. Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan, Rachana Manandhar Shrestha, Rakesh Ayer, Rolina Dhital & Masamine Jimba, Department of Health Care Policy and Management, Graduate School of Comprehensive Human Sciences, University of Tsukuba, 1-1-1, Tennodai, Tsukuba, Ibaraki, 301-8577, Japan, Graduate School of International Cooperation Studies, Kyorin University, 5-4-1, Shimorenjaku, Mitaka-shi, Tokyo, 181-8612, Japan, You can also search for this author in School health pomponent of WHO’s Mega Country Network for Health Promotion. This finding may imply that healthy students attend school more regularly and stay longer in schools, which can have a positive impact on their academic performance [34, 35]. BMC Public Health. When autocomplete results are available use up and down arrows to review and enter to select. The group of codes and sub-codes, which repeated in a patterned way, were grouped into a theme. Report of endline survey on school health and nutrition project of Sindhupalchowk and Syangja districts. Eventually, better access to hygiene and sanitation facilities improved students’ hygiene practices, and their improved hygiene practices were associated with positive health outcomes [18]. (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. Sustainability in healthcare by allocating resources effectively (SHARE) 8: developing, implementing and evaluating an evidence dissemination service in a local healthcare setting. 2015;30(4):843–54. USA and Canada: RoutledgeFalmer; 2002. The School Health and Nutrition (SHN) program is a cost-effective intervention for resource-poor countries. A teacher's role involves more than simply standing in front of a classroom and lecturing. Table 1 shows the number of key informant interviews conducted from different tiers of stakeholders. Beyond that, teachers serve many other roles in the classroom. 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 . 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 document shows how helminth reduction interventions can have a positive impact on children's health, learning potential and school attendance. Terms and Conditions, 6 Centers for Disease Control and Prevention. 8 The school is now included as an important … The teacher also serves to open and neatly close activities and also give content feedback. Students can be effective advocates for creating a healthy school … This finding is encouraging and suggests that mobilizing community members to generate resources at the local level and reduce over-dependence on external aid agencies [14] may be effective to sustain SHN activities in Nepalese schools. (P5, aid agency: Country program coordinator, School Feeding Program). There are some difficulties with coordination among stakeholders. 3. Qual Res Psychol. We have prevented kids from becoming blind after vision screening and referring them for further treatments. Teacher effectiveness in school mental health. 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. Some key informants even mentioned that in some schools, communities provided their support and took the initiative to conduct SHN activities, which suggests that communities can play a significant role in making the program sustainable. 2015;30(2):285–97. Correspondence to Fathi B, Allahverdipour H, Shaghaghi A, Kousha A, Jannati A. Written informed consent was obtained from all the key informants. (P4, aid agency: SHNP senior coordinator), The program will be sustainable if it is integrated into the government system. The positive impacts included improved students’ health and school environment and enhanced community awareness. In the interpreting phase, we wrote summaries to interpret the data and discussed important quotations. Subsequently, each group tallied their results with the first author’s results to deduce the final themes, codes, and sub-codes. Some key informants from the schools even mentioned that they tried to generate funds from local sources. Trop Dis. Kathmandu, Lalitpur, and Bhaktapur districts are in the Kathmandu valley, where MOE, MOH, and different aid agencies were located. We have conducted it in two districts but could not expand it to other districts. In the past, students could not understand what they were taught. So their focus was more on their empty stomach than on their study. (P23, school: Health and physical education teacher), We need basic training for all teachers. This document provides an overview of WHO's Global School Health Initiative. Schools have been a powerful setting to promote health programs [1, 2]. Improving health through schools: national and international strategies. The seven districts were Siraha, Sindhupalchok, Syangja, Kailali, Kathmandu, Lalitpur and Bhaktapur. So we are actively participating in the program. At the district level, four key informants from four District Health Office and four District Education Office were recruited from Siraha, Sindhupalchok, Syangja, and Kailali districts. None of the organizations go directly for the implementation of SHN. We particularly focused on health examination, oral health check-ups and camps, tooth brushing and hand washing every day, providing mid-day meals, first aid training, providing first aid box to schools, providing training to school teachers and child clubs in the schools." Though the majority of the key informants from the central level and aid agencies stated that they have received different trainings, mixed responses were obtained from the key informants at the district level and schools. (P1, aid agency: SHNP program coordinator). PubMed Central  The median annual salary for elementary school teachers … This document is available in the following languages: This document discusses a range of environmental conditions that exist in a variety of school environments. Health-promotion activities have been successfully implemented through the SHN program in resource-rich countries [1, 5, 11]. Washington, DC: The World Bank; 2011. Factors influencing the National School Health Policy implementation in Lao PDR: a multi-level case study. 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. Sexual Health Education in Schools. This document is available in the following languages: 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. 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. A few of the key informants suggested integrating the program into the government system to make it sustainable. 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. 41 42. Key factors for school health policy implementation in Thailand. Some of them mentioned that they had received the training once, while some were not even aware of such training. Both the teacher and the teacher assistant facilitate the inclusion of students with special needs . Accessed 2 Sept 2013. Moreover, a few of them identified the turnover of trained staff as a challenge, which is similar to the findings of a study from the Lao PDR [12]. Denman S, Moon A, Parsons C, Stears D. The health promoting school: policy, research and practice. J Sch Health. 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. The central-level key informants were involved in the SHN program development, networking, resource mobilization, and monitoring. Understanding of factors that enable health promoters in implementing health-promoting schools: a systematic review and narrative synthesis of qualitative evidence. Only 11% of teachers felt they should be responsible for improving children’s mental health and yet this is an added responsibility currently placed on teachers. 2008;78(1):1–8. Schools can create environments supportive of students’ efforts to eat healthy and be active by implementing policies and practices that support healthy eating and regular physical activity and by providing opportunities for students to learn about and practice these behaviors. It explains why schools must accept the responsibility to educate their community members and work with them to determine the most appropriate and effective ways to prevent HIV infection among young people. Atlanta, US: Centers for Disease Control and Prevention; 2014. It provides interventions that can reduce violence through schools. After the child club mobilization, the child club members conducted rallies in the villages to generate awareness among the community people. The SHN program is an integral part of HPS [9], and many countries have adopted the SHN program to promote health through schools [10]. Rajbhandary J, Hart R, Khatiwada C. The children’s clubs of Nepal: a democratic experiment. The interview guide included open-ended questions and has been used in health policy and program analysis in several low- and middle-income countries [27]. For adolescents, we have menstrual hygiene management class, which brings them to school. Furthermore, most of the key informants identified insufficient funds and lack of material resources as the major hurdles to implement a comprehensive and nationwide SHN program. Awareness campaigns and advocacy for the program are indispensable to pull more resources from relevant stakeholders. Many key informants from the aid agencies agreed that they have limited resources and could conduct only selected programs in some target districts. Understanding the roles of different stakeholders is essential to analyze the implementation process of a program [30]. National School Health and Nutrition Strategy, Nepal. But now all the students bring tiffin. Despite the positive impact of the SHN program on students, parents, and communities, this study identified several barriers and challenges to implement the program. To increase knowledge and awareness of health promoting behaviours. Drake LJ, Singh S, Mishra CK, Sinha A, Kumar S, Bhushan R, et al. It provides practical guidance, tools and descriptions of and tips from Health-Promoting Schools around the world. Health Promot Perspect. PubMed Google Scholar. It is the position of the National Association of School Nurses (NASN) that developmentally appropriate evidence-based sexual health education should be included as part of a comprehensive school health education program and be accessible to all students. 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. Disease control priorities in developing countries. Google Scholar. 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. 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. RMS conceived the research questions, designed the study, conducted the fieldwork, analyzed the data, and prepared the manuscript draft. Also, we have not been able to use toilets properly and they are smelly because of lack of water facilities. According to many key informants in this study, a broad array of stakeholders was involved from the central level to schools in implementing the SHN programs based on the SHN strategy in the country. Children are changing agents. WHO Prevention of Noncommunicable Diseases (PND) Fax: + 41 22 791 4832 Pommier J, Guével MR, Jourdan D. Evaluation of health promotion in schools: a realistic evaluation approach using mixed methods. Strategic Objectives. Many key informants also mentioned that the program had a positive impact on students’ health status, such as reduced diarrheal diseases, worm infestations, and anemia. Teachers are increasingly being called upon to monitor the mental health and wellbeing of their pupils. This policy statement describes for pediatricians the role of the school … It is the position of the National Association of School Nurses (NASN) that developmentally appropriate evidence-based sexual health education should be included as part of a comprehensive school health education program … Furthermore, MOH and MOE should jointly provide strong leadership and recognize their responsibilities to improve students’ health and academic outcomes. We had a meeting with parents and teachers and told the parents that we could just give them pipelines. Therefore, we conducted a qualitative study to explore (1) the SHN program implementation, (2) its impact, and (3) challenges in Nepal. The guide was translated into Nepali and back translated into English by different individuals to ensure the quality of the translated version. In the present study, many key informants responded that after the project ended, such training was not conducted anymore. (P9, central level: Director, Child Health Division), Human and material resources are insufficient from the central to the district level. In resource-limited countries, a lack of resources has been a crucial operational barrier to conduct the program [3, 12, 13]. Starting in kindergarten and continuing through high school, it pro­vides an introduction to the human body and to factors that prevent illness and promote or damage health. MOH and MOE were the lead institutions for implementing the program. When I was looking for a toilet, one of the students from grade 3 showed me the toilet and hand washing soap. We conducted office visits and had telephone conversations, and formal and informal talks to track key informants. The school nurse’s role varies across countries. (P1, aid agency: SHN program coordinator). This suggests that only one sector was actively involved in the implementation of the SHN program in Nepal. Their participation was voluntarily and their confidentiality and anonymity was maintained. Article  The teachers in the project schools were trained to conduct SHN activities. The school nurse has a critical role within this school health program and provides acute, chronic, episodic, and emergency health care. A comprehensive health education pro­gram is an important part of the curriculum in most school districts. Some of the key informants from the central and aid agency mentioned that horizontal coordination was lacking between the MOH and MOE. In the compiling phase, the research assistants transcribed the interviews. NewYork: United Nations Children’s Fund; 2012. https://www.unicef.org/publications/files/CFS_WASH_E_web.pdf. MG, PS, RA, and RD were involved in data analysis and manuscript revision. The first author also sorted and coded all 32 transcripts separately. In addition, the school nurse provides health education and health counseling and advocates for students with disabilities. (P5, aid agency: SHNP head), Child clubs in schools organize Deusi-Bhailo program (cultural program) during Tihar festival and collect fund. 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. 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. The authors would like to express their sincere gratitude to all the key informants who participated in this study. Furthermore, better access to hygiene and sanitation facilities in schools due to the SHN program could be associated with students’ better hygiene practices. 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. A few studies have also reported a lack of coordination between the two ministries while implementing school health programs [9, 12, 13]. We do not and cannot do all the activities of the SHN program. Parents started sending tiffin to their kids in these tiffin boxes. We have seen many positive changes after this program. Aid agencies were also playing significant roles in implementing programs in different parts of the country. according to modern concept, school health service..• The beginning of school health service in India date back to 1909, in Baroda city.• In 1961 the five year plan, many state provided for school health and school feeding program. They also acknowledged that the program significantly improved students’ knowledge, awareness, and practices regarding health and hygiene issues. 2013;103(12):895–8. A few participants from the central level stated about the SHN network, which was also formed with stakeholders from different tiers and has been actively involved in implementing SHN programs as a campaign. Similar child club activities are known to help students gain knowledge and learn life skills for their personal development in Nepal [31]. (P4, aid agency: SHNP senior coordinator). Finally, in the concluding phase, the first author read the summaries and selected quotations to draw conclusions from the data and discussed them with all co-authors. That horizontal coordination was lacking between the SHN program implementation and its success [ 20 ] major hurdles on! The gaps in the program into the government system episodic, and different aid agencies were of... ) programming in Nepal resource mobilization, and RD were involved in research proposal designing manuscript... School health policy: the United States agency for International development ; 2010.:!: //doi.org/10.1186/s41182-019-0159-4, DOI: https: //www.unicef.org/publications/files/CFS_WASH_E_web.pdf to process and power including... 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