(P7, aid agency: SHNP former chief advisor), Most of the organization and ongoing activities come from the health sector. In the past, students could not understand what they were taught. NewYork: United Nations Children’s Fund; 2012. https://www.unicef.org/publications/files/CFS_WASH_E_web.pdf. It’s because their stomach used to be empty. MOH and MOE were the lead institutions for implementing the program. Basch CE. We adopted a thematic approach for the data analysis. New York: The Guilford Press; 2011. The obvious roles health education teachers play in the community are those that are entrenched within a school setting. 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 2006;3(2):77–101. Factors influencing the National School Health Policy implementation in Lao PDR: a multi-level case study. Horizontal coordination is more difficult than vertical coordination. We have obtained the ethical approval from The Research Ethics Committees of the Graduate School of Medicine at the University of Tokyo and Nepal Health Research Council. J Sch Health. Epilepsy Behav. Some school nurses did not believe that health teaching in the classroom is a nursing role—they viewed health education in the classroom as a role for teachers. Therefore, while evaluating the SHN project, we also aimed to assess the SHN program implementation process in different parts of the country. The role of teachers in education extends past the responsibility of passing along information. When we conducted the program, we had the baseline and end-line data, which showed a huge reduction in anemia. Aid agencies were one of the main sources of funding for the program in the country. In this qualitative study, we conducted 32 in-depth interviews with key informants from September to December 2013. The guide was translated into Nepali and back translated into English by different individuals to ensure the quality of the translated version. This document will assist school and community leaders in efforts that promote the health of young people through schools. Geneva: World Health Organization; 1999. Table 1 shows the number of key informant interviews conducted from different tiers of stakeholders. Moreover, parents and community members can also play a significant role in encouraging children to practice healthy behaviors and keep their school environment clean, safe, and healthy [36]. Tong A, Sainsbury P, Craig J. 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. Policy implementation assessment tool: master interview guide. Each interview lasted for an average of 1 h and was tape-recorded and transcribed. Its purpose is to strengthen efforts to educate young people about the benefits of physical activity and to help schools provide opportunities for students and school personnel to be physically active. Resilience is the ability to cope and thrive in the face of negative events, challenges or adversity. Aid agencies were also playing significant roles in implementing programs in different parts of the country. 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. The key informants were identified through personal network and snowballing procedure. Copenhagen: World Health Organization Regional Office for Europe; 2011. http://www.euro.who.int/__data/assets/pdf_file/0004/134671/e94805.pdf?ua=1. Their perceptions are equally important to provide information on the factors influencing the implementation process and help to identify the gaps in the process. The improved practices included hand washing, using soap while hand washing, and wearing clean school uniforms. When autocomplete results are available use up and down arrows to review and enter to select. 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 … We distributed the 32 transcripts equally between two groups of co-authors. These findings indicate that SHN program has helped to sensitize parents and community members about child health-related issues and promoting healthy behaviors; therefore, they also benefited from the program. Children are changing agents. (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. J Sch Health. At the district level and schools, depending upon the local context and area, the key players involved were District Health Office, District Education Office, schools, Village Development Committee, District Development Committee, local NGOs, health posts, Female Community Health Volunteers (FCHVs), youth clubs, and parents. Accessed 21 Oct 2015. It is their joint role to encourage the student to become an independent learner and member of the classroom, school… Yin R. Qualitative research from start to finish. (P4, aid agency: SHNP senior coordinator), The program will be sustainable if it is integrated into the government system. (P1, aid agency: SHN program coordinator). We had a meeting with parents and teachers and told the parents that we could just give them pipelines. In Nepal, the Ministry of Health (MOH) and the Ministry of Education (MOE) jointly endorsed the National SHN Strategy in 2006 [16]. WHO • An effective school health programme can be one of the most cost effective investments a nation can make to simultaneously improve education and health • WHO promotes school health programmes as a strategic means to prevent important health risks among youth and to engage the education sector in efforts to change the educational, social, economic and political conditions that … 2015;30(2):285–97. Stakeholders from all tiers identified several operational barriers to implementing and expanding the program throughout the country. Strategic Objectives. This document is available in the following languages: This document includes a chapter on national strategies in the ten most populous countries and a chapter on collaborative efforts to strengthen school health promotion in countries with large school-age populations. Sexual Health Education in Schools. We included key informants who were actively involved in the SHN program development and implementation. The authors would also like to thank Editage, Japan, for English language review. Stakeholders at different tiers can play significant roles in the program implementation and its success. Government of Nepal. As soon as he/she gets some training, he/she will be transferred somewhere else due to either personal interest or organizational changes. Besides, many stakeholders are conducting only selective activities [15]. 2018. https://doi.org/10.1093/her/cyy008. Our previous study also showed a positive association between the SHN program and students’ better health outcomes [18]. This study provided a deeper understanding of the linkage between the SHN program implementation, impact, and challenges in Nepal. According to the key informants’ responses from all levels, the major SHN activities could be mainly categorized into four sections, which were based on the four objectives of the SHN strategy [16]. This is one good example of cooperation between school and community. PubMed Google Scholar. Teachers are increasingly being called upon to monitor the mental health and wellbeing of their pupils. 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. Washington (DC): World Bank; 2006. It is not sustainable. Key informants from the schools implemented and self-monitored the SHN program in the schools. 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. (P9, central level: Director, Child Health Division). I have worked in the health training department for 7 years but haven’t received any training related to school health yet and I also don’t know about it. Therefore, key informants’ responses in this study may not represent stakeholders’ perceptions throughout the country. World Health Organization. Switzerland Rai C, Lee S, Rana H, Shrestha B. They further suggested that improved health has a positive impact on students’ academic performance. So we are actively participating in the program. Even tooth brushing was neglected. Masamine Jimba. We have prevented kids from becoming blind after vision screening and referring them for further treatments. 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. Therefore, we conducted a qualitative study to explore (1) the SHN program implementation, (2) its impact, and (3) challenges in Nepal. In the disassembling phase, the first author thoroughly read and reread the transcripts, listened to all the interviews repeatedly, and examined the patterns of interview data. J Sch Health. Starting from elementary school, a teacher plays an important role only next to the parents in molding the children. They also acknowledged that the program significantly improved students’ knowledge, awareness, and practices regarding health and hygiene issues. http://www.who.int/school_youth_health/gshi/en/index.html. Students can be effective advocates for creating a healthy school … Braun V, Clarke V. Using thematic analysis in psychology. (P16, district level: Chief district officer, District Health Office). Despite these challenges, all the stakeholders acknowledged that the SHN program had positive effects on students, schools, and communities and provided some suggestions to improve the implementation of SHN program in the country. Others can help, but it is the teacher who is with the children day after day and hour after hour who is essential to its success. The seven districts were Siraha, Sindhupalchok, Syangja, Kailali, Kathmandu, Lalitpur and Bhaktapur. Many key informants further stated that the program improved students’ health status by reducing problems such as diarrhea, parasitic infections, anemia, blindness, and hearing loss. This document exhibits that HIV prevention programmes are effective in reducing the risk of HIV infection among young people. The first author also sorted and coded all 32 transcripts separately. School health and nutrition program implementation, impact, and challenges in schools of Nepal: stakeholders’ perceptions. Because of insufficient money, some schools even raised funds from parents and community members. Correspondence to The teacher also serves to open and neatly close activities and also give content feedback. However, some key informants mentioned that the MOH and its institutions at the central to local level were more active compared to the MOE. 2 2 ... model of a school health program, consisting of the following basic components: (1) ... trained teachers provide health education. They also gratefully acknowledge the logistic support provided by all the research assistants, particularly Mr. Arun Khanal and Ms. Moe Miyaguchi during the fieldwork. Weiler RM, Pigg RM, McDermott RJ. 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. Majority of key informants from all levels mentioned that they conducted activities such as school cleaning programs, access to safe drinking water, improving toilet and hand washing facilities, waste disposal pits in school, construction of classrooms, toilets, etc. Besides, the government should implement programs to encourage schools to generate resources at the local level and discourage over-dependency on external sources to make the SHN program sustainable. At the end of each interview, the interview notes were reviewed with each key informant to validate what he or she intended to convey. MG, PS, RA, and RD were involved in data analysis and manuscript revision. Health Educ Res. It is published in support of an international partnership that is Focusing Resources on Effective School Health. Shrestha, R.M., Ghimire, M., Shakya, P. et al. The organizations publishing this document offer this publication as a useful tool to help shape a healthy, safe and friendly environment for all who live, learn and work in schools. Some key informants also mentioned that they received support from communities to conduct SHN activities effectively. This suggests that only one sector was actively involved in the implementation of the SHN program in Nepal. © 2020 BioMed Central Ltd unless otherwise stated. ♦ School Health Physician Delineating Roles and Responsibilities for the Safe Delivery of Specialized Health Care . Disease control priorities in developing countries. printable version. Table 2 shows the major themes, codes, and sub-codes deduced from the thematic analysis, showing the linkage between program implementation, impact, and challenges during implementation. When I was looking for a toilet, one of the students from grade 3 showed me the toilet and hand washing soap. Child clubs and extra-curricular activities could have played a significant role in improving students’ health and nutritional knowledge and practices. We conducted the SHN project from Japan International Cooperation Agency's (JICA) support. We followed the consolidated criteria for reporting qualitative research (COREQ) guidelines to conduct the interviews, and analyze and report the data [25]. The central-level key informants were involved in the SHN program development, networking, resource mobilization, and monitoring. 2015;9(11):e0004106. Ideally, the school nurse collaborates with primary care physicians, specialists, and local public health … Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. Manage cookies/Do not sell my data we use in the preference centre. Learning Assessments. There is also a growing expectation for teachers to play an active role in raising awareness of issues central to a child’s wellbeing. However, the key impediments in implementing the program included a lack of coordination between stakeholders, lack of resources, limited training opportunities, and doubts regarding the sustainability of the program. This document was released on the occasion of the first, Report of a meeting, Bangkok, Thailand, 23-25 November 2015. In some areas, communities were mobilized in SHN activities, leading to community awareness. We conducted office visits and had telephone conversations, and formal and informal talks to track key informants. These findings indicate the dearth of trained human resources to conduct the program effectively. 2011;81(10):650–62. Some key informants from the schools even mentioned that they tried to generate funds from local sources. Improving health through schools: national and international strategies. 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. Health Promot Perspect. 2014;4(1):9–17. We do not and cannot do all the activities of the SHN program. So this is about the behavior change among students as well as their parents. The school nurse’s role varies across countries. statement and Furthermore, the seven districts represented three physiographic and four out of five the then developmental regions of the country. They are promoting health and hygiene not only in their schools but also in their homes and communities. (P8, central level: Chief, Nutrition Section at Child Health Division), In our school, we do not have teachers with enough knowledge about health issues. Even if they forget to bring tiffin, their parents bring it to school. This document shows how helminth reduction interventions can have a positive impact on children's health, learning potential and school attendance. Bundy D. Rethinking school health: a key component of education for all. For example, this program has improved students’ knowledge of health and hygiene practices and keeping the school environment clean, etc. 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. PLoS Negl Trop Dis. PLoS One. They suggested that good coordination between the stakeholders might help in generating resources. (P4, aid agency: SHNP senior coordinator). Their health condition is also getting better. After we felt that data saturation was reached, we stopped the data collection procedure [24]. 20 Avenue Appia Furthermore, the program also brought positive changes in students’ nutritional behaviors, hygiene practices, and life skills. Lower numbers of NGOs or INGOs working in the education sector are involved in SHN program implementation. Article  printable version. The authors declare that they have no competing interests. These meetings might be helpful to improve program implementation [38]. All the key informants agreed that training is essential to implement the SHN program effectively. USA and Canada: RoutledgeFalmer; 2002. The refocused programme emphasises nine care pathways with a view to improve pupils’ health and wellbeing. Elementary school teachers play an important role in the education and development of children. However, we interviewed key informants from different tiers including the central and district levels, schools, and aid agencies. Its purpose is to strengthen efforts within the whole school community in favour of malaria prevention and control. A review study also reported that school health promoters required more training to overcome problems while implementing the health-promoting school programs [38]. Fax: + 41 22 791 4832 Many key informants from the aid agencies agreed that they have limited resources and could conduct only selected programs in some target districts. Building capacity for the continuous improvement of health-promoting schools. Palinkas LA, Horwitz SM, Green CA, Wisdom JP, Duan N, Hoagwood K. Purposeful sampling for qualitative data collection and analysis in mixed method implementation research. The training was conducted only once and ended and it was not repeated. Basch C. Healthier students are better learners: a missing link in school reforms to close the achievement gap. All authors read the manuscript and approved for submission. 2nd ed. This document is available in the following languages: This document discusses a range of environmental conditions that exist in a variety of school environments. The School Health Programme under AYUSHMAN BHARAT is a joint collaborative programme between the Ministry of Health and Family Wefare and Ministry of Human Resource ... for students to imbibe from peers and learn from role models, such as teachers and head of school. The organizer can also serve as a demonstrator, this role also allows a teacher to get involved and engaged with learners. 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. BMC Health Serv Res. After the SHN program started, there have been many improvements. 2007;19(6):349–57. (P15, district level: SHN program officer, District Education Office), The tiffin box program would be one of the success stories and good practices. A few studies have also reported a lack of coordination between the two ministries while implementing school health programs [9, 12, 13]. The majority of key informants mentioned that after the implementation of SHN program in the schools, students had better access to different SHN services, better nutrition, safe drinking water, and hygiene and sanitation facilities. Furthermore, MOH and MOE should jointly provide strong leadership and recognize their responsibilities to improve students’ health and academic outcomes. The first author (RMS) then assigned unique code numbers to all the transcripts from the 32 key informants as P1 to P32 (P refers to participant), verified the transcripts with the tape-recorded conversations and written notes. 8 The school is now included as an important … But teachers fill a complex set of roles, which vary from … In the compiling phase, the research assistants transcribed the interviews.