What are schools doing to promote health?

Education

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Although India has made significant progress in educating children, we are far from universal education. 


According to the Family Health Survey (NFHS-4) of 2015-16, the percent of children in the age group of 6-10 attending school in India is 95%, 11-14 it is 88% and drops to 63% from age 15-17. There is almost no difference in school attendance by males and females of age 6-14 but males are more likely to attend school at age 15-17. Urban-rural differentials in school attendance are minimal at age 6-10 but widen at older ages. 

School meals

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Not all children in India are getting free midday meal as required by law.


The National Mid Day Meal (MDM) programme, implemented across all the government and government-aided schools in India aimed to provide nutritional Meal to each and every child (6-14 years) in schools. 

The Mid-day meal program is a scheme sponsored by the Central Government under the Ministry of Health and Family Welfare. It provides for the cost of food and transportation whereas the responsibility of the physical infrastructure lies with the State government. There are strict guidelines regarding the quantity of food per child in Primary (Class I-V) and upper primary (Class VI-VIII). As of 2017, about 100 million children were receiving the mid-day meal in 1.3 million schools. 

Health services in schools

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The implementation of school health services is not consistent across all schools.


The Ministry of Health and Family Welfare under the National Rural Health Mission, has launched the Child Health Screening and Early Intervention Services Program. It is called the RBSK (Rashtriya Bal Swasthya Karyakaram). It aims at the 4Ds prevalent in children. They are the birth defects at birth, diseases in children, deficiency conditions and development delays including disabilities. It includes Immunization, micronutrient management (Vitamin A and Folic Acid) and deworming. 

Health Education

There is minimal focus on health education in Indian schools. 


Although one will find a chapter on health in books on Science, Physical 

education and environmental stiudies,there is is no comprehensive curriculum of books completely devoted to Health Education.  


This is the area that is the weakest regarding implementation. Part of the reason is that the Central Government can only recommend that States and Union Territories adopt a Health Education curriculum. It is upto the State governments to implement the Health Education curriculum in the schools. This is the area where our organization, Tarang Health Alliance, fills the need. This will be discussed in more detail later. 

First, we will review what is being done regarding Health Education in India by various Ministries within government of India and by NGOs. 


A. Govt. Of India Department of Human Resources: Department of Education:

NCERT and CBSE have Policy recommendations on their websites on Health Promoting Schools, which incorporates Health Education.


i) NCERT: NCERT has developed a syllabus on Health and Physical Education for classes I-X. It recommends allocating 10% of school time for health and physical education at primary and upper primary levels and 9% at secondary level.

The syllabus covers topics relating to:

  1. We and our environments: Some aspects of Hygiene, sanitation, cause of diseases, different types of diseases, environmental pollution.
  2. Human body: Physical fitness and health. Includes menstruation, sexual abuse, body image, mental health, growth, emotions, Yoga, sports,
  3. Food and Nutrition including GM foods, insecticides and pesticides.
  4. Social health and relationships with others. This includes self-esteem, gender sensitivity, peer pressure.
  5. Safety and security including injuries, first-aid, sexual harassment, occupational hazards, medical safety.
  6. Consumer health; vocational and leadership aspects. This includes health insurance, patient’s rights, government health services, our rights and responsibilities, role of media and advertising, book banks, governmental agencies promoting sports etc. 

NCERT has a few books that cover some of these topics. It has Teachers Manuals for Classes I-VIII that cover the various topics of health. None of the Teachers Manuals cover a comprehensive Health education syllabus. The topics are scattered among various books. 

NCERT has also set up an AEP (Adolescent Education Program) Centre in coordination with UNFPA (United Nations Population Fund). AEP enables adolescents to articulate their issues, know their rights, counter, shame and fear, build self-esteem and confidence, and develop ability to take on responsibility for self, relationships and (to an extent) the society around them.

This program is for Classes 8-11. NCERT recommends a minimum of 23 hours of instruction on AE including topics of relationships, gender and sexuality, sexual abuse and violation, prevention of substance misuse and HIV/AIDS.


ii) CBSE. CBSE has developed several Teachers Manuals on Health Education for Classes I-XII. As with NCERT publications, none of the books cover Health Education in a comprehensive manner. They have also developed several student textbooks for Classes IX -XII. The health topics are scattered and none of the books cover Health Education comprehensively. The student books and teachers manuals are also not well coordinated. 


B. Govt of India: Ministry of Health and Family Welfare (MHFW): 

It is concerned with the health of the population, including children. Within MHFW, there are three departments that play an important role. 


i) The Central Health Education Bureau (CHEB) collaborates with NCERT in an advisory role. It is helps provide training for teachers, development of health education materials for the masses.  They also provide a Diploma in Health Education. It is a post graduate course of two years and is open to both medical & non-medical gradates with social science background and work experience of one to three years.


ii) National Health Mission: They have a policy document on School Health Programmes. Within it are the programs named Reproductive, maternal, newborn, child and adolescent health (RMNCH+A) and the RKSK (Rashtriya Kishor Swasthya Karyakram). The RMNCHA+A scheme primarily deals with health services to schools. The RKSK deals with Adolescent Health Education and services and targets students of age 10-19, primarily with peer education.

RKSK was launched in 2014. The key principles of this programme is adolescent participation and leadership, Equity and inclusion, Gender Equity. To guide the implementation of this programme, MOHFW has collaborated with UNFPA.

It introduces community-based interventions through peer educators, and is underpinned by collaborations with other ministries and state governments. Its objectives are to improve Nutrition, Sexual and Reproductive Health, enhance Mental Health, prevent injuries and violence and prevent substance misuse

The program RBSK (Rashtriya Bal Swasthya Karyakram) screens children form ages 0-18 for the 4Ds: Defects at birth, Diseases, Deficiencies and Development delays including disabilities. 


iii) NIHFW (National Institute of Health and Family Welfare). It is an autonomous organization acts as a ‘think tank’ for the promotion of health and family welfare programmes by pursuing Education & Training, Research & Evaluation, Consultancy & Advisory services.


C. Govt. of India. Ministry of Water and Sanitation provides guidance on hygiene, sanitation and clean water. The Swach Bharat initiative lies within this ministry.


D. NGOs: 

There are several NGOs that are active in youth health education in India. They include the WHO, Save the Children, Mytri, Fresh/PCD and Hriday. Many of them have developed handbooks and teachers manuals.