Excerpts from a recent study by the Imperial College, London, “Situation Analysis: A Summary of School Health in India in Four States”:
Gujarat State’s health and gender indicators are roughly in line with overall national averages with higher levels of access to electricity, improved drinking water, and toilet facilities compared to the average, but slightly poorer under-5 nutrition. Gujarat’s School Health Programme, started in 1997 by the Department of Health and Family Welfare is the single largest health programme in the State. Gujarat is currently regarded as a State of good practice for School Health and Nutrition (SHN); however, the programme itself is still predominately led by the health sector rather than a partnership between health and education.
As the programme has gone through a number of revisions and as Gujarat State was advised by World Health Organisation (WHO) in 2006 to construct the programme around the pillars of the Focusing Resources on Effective School Health (FRESH) framework, the school health programme has focused on detection, screening and health awareness which is intended to carry over to the community as children return to their homes with improved health information and skills. This may have particular benefits for addressing increased rates of mortality and morbidity in non-school attending months.
The current mechanism for delivery of the school health programme is through a designated ‘School Health Week’ in each school. It is ambitious in that it aims to cover all institutions with 0 to 18 year olds, capturing private, public and out-of-school youth.
Due to this mode of delivery, it does suggest that ongoing and integrated SHN into regular school curriculum is lacking and potentially means those students not captured in the yearly ‘School Health Week’ activities may be missed entirely, especially as a recent snapshot survey in the state suggests approximately 15% of enrolled students are not in attendance on any one day, and this is higher still for children from scheduled castes and tribes (Annual Status of Education Report – ASER 2011).
High coverage and successful implementation is reported by key stakeholders, and although brief programme plans are available precise figures were not obtainable. The programme focuses predominately on screening, often of complex medical conditions requiring referral for surgical procedures including renal and heart disease.
Although basic allocation of roles for teachers and medical officers assigned to the ‘School Health Week’ are available in government guidelines (Government of Gujarat 2012), specific roles and responsibilities for screening and referral processes remain unclear as does the effectiveness of referral mechanisms.
The programme reportedly does have an M&E framework and is reviewed by a consortium of medical colleges on an annual basis. It may be worth considering whether the programme is able to conduct screening and referral for more common ailments such as diarrhoeal disease more than once a year, while less common issues including renal and heart disease remain on an annual basis.
In addition to the State’s school health programme, nutrition interventions including the Midday Meal Scheme (MDMS) and Mamta Taruni Abhiyan (MTA) programmes are ongoing. Financial responsibility for the MDMS is currently divided between National and State Governments and although there appears to be no specific policy on the MDMS, there is an active Memorandum of Understanding between the State Government and several NGOs involved in design and delivery of the Scheme.
MTA aims to assess the prevalence and intensity of nutritional anaemia in 10 to 19 year olds in order to address malnutrition. Notably, this initiative successfully reaches both in- and out-of-school girls. Much of Gujarat’s child nutrition work is concentrated and delivered through early child development (ECD) and even neonatal health platforms including partnerships with the single largest ECD programme globally, Integrated Child Development Services (ICDS) which is attached to Anganwadi Centres and ICDS.
Although crucial, it suggests a potential gap in comprehensive nutrition support for older school-age children. Key informants report deworming and iron folate supplementation does occur, however, were not able to provide information as to which age groups are covered, how often and through which mechanism, i.e. school- or community-based. Additionally, drug stock-outs for supporting nutrition and other health issues are reportedly common.
Efforts to improve Water, Sanitation and Hygiene (WASH) and other elements of safe school environments are being made on the part of the State Government by a multi-agency partnership including the Department of Health and Family Welfare, the Department of Human Resource Development, and the Department of Drinking Water Supply, among others. Both WASH and Safe Structures policies are in place as are standards for ensuring safe school environments and annual testing of a sample of school water supplies is conducted, a potential area of good practice that could be shared with other States and UTs.
Gender and caste discrimination are both actively being prioritised by the Government of Gujarat through a variety of programmes. Mamta Taruni Abhiyan aims to identify and subsequently support healthy nutrition of girls both in- and out-of-school. Adolescent Reproductive and Sexual Health (ARSH) initiatives are in place, though their effectiveness and content could not be assessed here.
Caste discrimination is a known challenge in Gujarat and in response to this the Tribal Development Department’s Tribal Programme has become critical in mainstreaming children from low socioeconomic groups, scheduled castes and tribes into the education system.
Sanjeevani Dudh (a school milk programme), supported jointly by the State Government, Banas Dairy and Ambaji Temple Trust, provides flavoured milk to students attending school in the tribal belt of Gujarat and has proven itself a successful public-private partnership as attendance has significantly improved since the programme’s inception, including among girl children.
SHARP (School Health Annual Report Programme), a Delhi-based NGO with projects across India, has been working with the Department of Education in Anand District to target underprivileged children for health check-ups. Each child’s medical data is captured and stored in an electronic SHARP repository for follow-up and reference for future check-ups.
Additionally, camps are established to provide the children’s mothers with skills-based health education on nutrition, WASH, and other key health issues. (SHARP 2012).