the school health service is defined as

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he school health service is defined as "the school procedures that contribute to the

maintenance and improvement of the health of pupils and school personnel including

ealth services healthful living and health education".

But to speak the truth our school hardly ever has a well defined health programme

ncidentally the teaching about health is done while treating other subjects of the curri-

ulum -such as physiology, hygiene and biology. The approach to these subjects is so

cademic that they are considered to be important from the 'examination point of view'

ave very little effect on actual health practices and attitudes.But in general, health education should be integrated with all the activities in the -

urriculum. It should be a part and parcel of the chili's daily life. It must include the who

fe of the child taking in to consideration his relationship with the school community as

well as the community outside the school.

Objectives of School Health Education:he objectives of the school health education are as follows:

) The promotion of positive health;

i) The prevention of diseases;

ii) Early diagnosis, treatment and follow up of defects;

v) Awakening health consciousness in children:

he objectives of school health service can be achieved through a comprehensive

chool health programme comprising the following activities:) Health appraisal of school children and school personnel;

i) Co-operation with the home and the community;

ii) Healthful school environment;

v) Prevention of communicable diseases;v) Nutritional services;

vi) First aid and emergency care;

vii) Psychological services;

viii) Use of school health records;

x) Remedial measures and follow up;

x) Health instruction;

Health Appraisal:

he health appraisal should cover not only the students but also the teachers and otherchool personnel. Health appraisal consists of periodic medical examinations and

bservation of children by the class teacher.

he School Health Committee (1%1) in India, recommended medical examination of

hildren at the time of entry and thereafter every four years. So one of the most importa

means of taking care of the physical well being of the school children is through

ystematic medical inspection of schools.


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Generally it is seen that most of the students in the school suffer from many preventable

iseases such as defective teeth, bad sight, deafness, anemia etc. but such diseases

dversely affect the learning capacity of the students and cause ill health.

Medical inspection is only the initial step in a great scheme of progress which involves

mprovement of not only the physical but the mental and moral development of the

hildren. Although the system of school medical inspection has been in existence for a

umber of years, yet the outcome of the result have not been satisfactory for the followi

easons as pointed out by Secondary Education commission.) The medical inspection has been done in a perfunctory manner;

i) The defects that have been brought out even by this type of examination have not be

emedied because the remedial measures suggested are often not carried out;

ii) There is no follow-up, even in the case of those who have been declared as defectiv

v) Effective co-operation has not been established between the school authorities and t

arents, either due to ignorance or due to lack of financial resources or reports of the

chool medical officers.

Unless and until the present system is improved considerably, it would be a mere waste

me and money to continue this type of medical inspection in the urban areas in most

chools there is provision for medical inspection of students.

But in rural areas no such provision is available for students. In Western countries, the

medical inspection of children is a regular feature of the school. However for making th

medical inspection meaningful the following factors should be taken in to account:

) A thorough medical examination of all pupils and necessary follow-up and treatment

where necessary, should be carried out in all schools;

i) Pupils with serious defects and those who suffer from severe illness should be

xamined more frequently;ii) Medical examination should be given to teachers and other school personnel as they

orm a part of the environment to which the child is exposed;

v) The teacher is in a unique position to carry out the 'daily inspection' as he is familia

with the children and can detect changes in the child appearance or behavior that sugges

lness or improper growth or development;

he systematic medical examination which has been described above should be

upplemented by daily inspection. This inspection must be made especially on the child

ntry in the school premises in the morning and any lapse from the normal should be nond endeavour should be made to have these corrected. The inspection suggested here c

e made in a few moments, while the pupils assemble in the' morning and in the same

manner matters pertaining to cleanliness and neatness may also be noticed.

What is a health promoting school?

A health promoting school is one that constantly strengthens its capacity as a healthy

etting for living, learning and working.

A health promoting school:

osters health and learning with all the measures at its disposal.


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ngages health and education officials, teachers, teachers' unions, students, parents, hea

roviders and community leaders in efforts to make the school a healthy place.

trives to provide a healthy environment, school health education, and school health

ervices along with school/community projects and outreach, health promotion

rogrammes for staff, nutrition and food safety programmes, opportunities for physical

ducation and recreation, and programmes for counselling, social support and mental

ealth promotion.

mplements policies and practices that respect an individual's well being and dignity,rovide multiple opportunities for success, and acknowledge good efforts and intention

well as personal achievements.

trives to improve the health of school personnel, families and community members as

well as pupils; and works with community leaders to help them understand how the

ommunity contributes to, or undermines, health and education.

Health promoting schools focus on:Caring for oneself and others

Making healthy decisions and taking control over life's circumstances

Creating conditions that are conducive to health (through policies, services, physical /

ocial conditions)

Building capacities for peace, shelter, education, food, income, a stable ecosystem, equi

ocial justice, sustainable development.

reventing leading causes of death, disease and disability: helminths, tobacco use,

HIV/AIDS/STDs, sedentary lifestyle, drugs and alcohol, violence and injuries, unhealth

utrition.

nfluencing health-related behaviours: knowledge, beliefs, skills, attitudes, values, supp

Health ofmothers, newborns, infants and children isimportantfor any society. A

ealthymother gives birth

o healthy infants who grow into adults with sound body andmind, live a productive life

nd contribute to

he family and society. Being the prime caregivers of children,mothers have

hemostsignificant

mpressionable effect on their children in the early development years(Tamis 2001; Lan

000). Theealthy future of a society depends on the health ofthe children oftoday and theirmother

who are

uardians ofthatfuture. If physically andmentally healthy, women can steertheir children

nd the family

owards prosperity and long lasting happiness.UnitedNationsOrganization has

cknowledged womens

ole by declaring thatsustainable development could not be achieved withoutthe full

mpowerment,


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articipation, and contribution of women andmen, in conditions of equality

BeijingDeclaration 1995).

oormaternal health can have significant negative impact on the family and society asiti

major

eterminant ofthe health of children and indirectly affectsthe formation of human capita

According to

esearch,themotherless children diemore frequently; aremore atrisk of

ecomingmalnourished and lesskely to enroll atschool(Ainsworth 1998). The babies ofill or undernourished pregnant

women aremore

kely to have a low birth weight(Reed 1998: 6; Kramer 1987) and impaired developmen

ow birthweight

LBW) children in turn are at greaterrisk of dying and ofsuffering frominfections and

rowth retardation,

ave lowerintelligence and higherrisk of developing chronic diseasesin adulthood (Griv

998). Societies

hat have developed, have always given emphasisto the health care ofmothers, newborn

nd children.

ituation in Pakistan

Government of Pakistan being a signatory to theU.NDeclaration ofHuman

Rightsisresponsible of ensuring

ghtto health for allthemembers of its population including women and children.

hisrightis enshrined in

he 1973 constitution of Pakistan as part ofthe economic,social and culturalrightssection

nd includes:asic necessitiesfor an adequate standard of living including employment, nutrition,shel

ealthcare,

nd education.Ourreligiousteachings highlightthe need oftaking care of health ofmother

nd children.

Our greatleadership always emphasized the importance of women and children in

eveloping a sustainable

ociety and a vibrant Pakistan. Yetthe situation of health ofmothers, newborns and child

s notatisfactory.

hematernalmortality ratio (MMR) in Pakistan according to themostrecent

akistanDemographic and

Health Survey (PDHS)is 276/100,000 live births. The irony isthatmost ofthese deaths ar

reventable and

nly highly underdeveloped countrieslike Ethiopia, Somalia and Rwanda havematernal

eath rates worse


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han ours. The figures of infant and child deaths are evenmore alarming. The

nfantmortality rate (IMR) in

akistan is 78/1000 live births out of which about 2/3rd are contributed by

ewbornmortality. Thismeans

hat out of every 1000 live born babies, 78 infants die before seeing theirfirst birthday

while 58 ofthemdo

otsee the completion of even the firstmonth oftheirlife. Worse,the IMR has actually

eteriorated asitwas 76/1000 according to surveys conducted in 2003. Mortality among children under 5

ears of age is

4/1000 live births and hasimproved frompreviousfigures of 98/1000 in 2003.

he highmaternalmortality in our country isrelated to high number of pregnancies whic

re considered

sthe biggestrisk factorformaternal deaths.Out ofthe 30million women ofreproductive a

bout 5

million become pregnant each year. Most ofthemdo not get proper nutrition and antenat

are. The

mited number of hospitals cannotsustain 5million births, hencemajority (60%80%)

fthemoccur atImproving the Coverage of Maternal,Newborn and ChildHealth in Pakist

Media.

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ome, conducted by untrained and unskilled birth attendants. Like all biological process

ot every

elivery issmooth and 1015% of deliveries become complicated for which

hemothershould be taken to aospital in an emergency condition. Many ofthese pregnancies are unplanned and

nwanted, and the

angerousmethod of abortion is adopted to end this unwanted pregnancy. Majority ofthe

bortions are

nsafe, are conducted by untrained dais, and lead to complicationsincluding deaths but a

otreported.

According to estimates, for 1000 pregnancies ending up in live birthsin Pakistan, 29

regnancies areerminated through abortions. Combined, allthese factors contribute to about

5,000maternal deaths

very yearin our country.

Hospitals in Pakistan whether private or public do not

follow and oblige HCWM guidelines of WHO and do

not practice Pakistan bio-safety rules 2005. The

trainings which we conducted in 10 major hospitals are


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financially feasible to be replicated in other hospitals of

the country. We recommend that:

1. Continuous supervision and monitoring mechanisms

should be developed for effective implementation of

HCWM in hospitals.

2. A dedicated committee on HCWM should be

formulated and regularly meetings should be

organised at facility level.

3. A separate head should be created in hospital for

financial needs in HCWM equipments.

4. Continuous training of Health Care workers need to

be organised for better results in HCWM.

5. A continuous supply of PPE and HCWMconsumables should be provided to the public sector

hospitals on the basis of needs.

6. Evidence based research should be conducted in the

field of HCWM in Pakistan.

7. Dedicated and motivated staff should be deployed for

this activity in each hospital.

8. Remuneration for hospital workers should be given

priority.

9. Catchment area should be declared and proper

transportation mechanism of waste for treatment and

disposal be ensured.

10.Proper segregation should be performed at each

hospital before incineration or treatment of waste.

Health Services

Health Department is the key department entrusted by the people of Punjab

the fundamental responsibility for the health of communities and the entire


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population. Health Department delivers primitive, preventive as well as cura

health care services of Primary Health Care level to Tertiary Health Care lev

The services for Punjab are provided through a well designed infrastructure.

Health Department across the province is divided into:

2,461 Basic Health Units (BHUs)

293 Rural Health Centers (RHCs)

88 Tehsil Headquarters Hospitals (THQs)

34 District Headquarter Hospitals (DHQs)

23 Teaching/ tertiary Care Hospitals

Free of cost consultation, diagnostic facilities and medicines are provided to

patients particularly focusing on the poor and marginalized segments of the

society. Health Department also provides free of cost preventive measures

including immunization 8 vaccine for preventable diseases likePolio

Tuberculosis

Diphtheria

Whooping Cough

Tetanus

Hepatitis-B

H-Influenza

Measles

Besides measures to prevent, treat and control other communicable diseases

Epidemics / Disasters, these vaccines are provided through Expanded Progra

on Immunization (EPI) for children under 2 years and pregnant ladies.

Health Department is producing its own trained and qualified Human Resou

keeping the HR development needs and requirements of Health CareInfrastructure in mind.

Health Care Services

Health care services are the diagnosis, treatment, and prevention of disease,

illness, injury, and other physical and mental impairments in citizens. Health

care services are delivered by specialists in medicine, chiropractic, dentistry

nursing, pharmacy, associated health, and other care providers. The health c


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services represent the efforts put in delivering primary care, secondary care

tertiary care, as well as in public health.

Preventive Care Services

Preventive care refers to measures taken to prevent diseases, (or injuries) rat

than curing them or treating their symptoms.Read more

Promotive Services

These services are defined as "The process of enabling people to increase

control over their health and its determinants, and thereby improve their hea

Read more

Curative Care Services

Curative care is the kind of health care traditionally oriented towards seekin

cure for an existent disease or a medical condition. Read more

Rehabilitation ServicesRehabilitative services can help people, with disabilities, to get gainfully

employed and do away with reliance on others. This includes meeting the

physical, psychosocial, emotional and spiritual needs of patients and their

families while incorporating the nursing and rehabilitative processes. Such

Services should be provided to all patients in both inpatient and outpatient

settings at all levels of care. Read more

Health Care Delivery System

Health sector of Punjab has an extensive network of public and privately

managed health infrastructure throughout the province. The Government is b

far the major provider of hospital services in rural areas, and it is also the ma

provider of preventive care throughout the province. The public sector healt

delivery system is composed of four tiers:

Outreach and community based servicesOutreach and community-based services, which focus on immunization,

sanitation, malaria control, maternal and child health and family planning. R

more

Primary Health Care

The primary care facilities include Basic Health Units (BHUs) and Rural He

enters(RHCs) mainly preventive, outpatient and basic inpatient care. Read m


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Secondary Health Care

Tehsil Headquarters Hospital(THQ) and District Headquarters Hospital(DH

for out patient, inpatient and also specialist care.Read more

Tertiary Care

Tertiary care hospitals located in the major cities for more specialized inpati

care. Read more

General Terms

the school health service is defined as

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