Consolidated criteria for reporting qualitative research, International non-governmental organizations, United States Agency for International Development. Students’ better access to SHN services such as deworming, and iron and vitamin A supplementation might have played a significant role in the improved health outcomes. 6. Then, they did all the labor work to set up the pipelines. Kathmandu: Youth for World Nepal; 2011. statement and 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. 2015;42(5):533–4. The activities aimed at achieving these objectives are listed below. A teacher's role involves more than simply standing in front of a classroom and lecturing. 2006;3(2):77–101. (P4, aid agency: SHN program senior coordinator). J Sch Health. 2014;4(1):9–17. Moreover, many key informants reported that students’ school enrolment, retention, and attendance rates increased after implementation of the SHN program. However, some of the key informants from the central level and aid agencies mentioned that MOH was more active compared to the MOE. We imported the translated texts into Atlas.ti software, version 5, for data sorting and coding. 2010;81(10):593–8. PLoS Negl Trop Dis. School children might have played a role as changing agents and generated awareness about nutrition, personal hygiene, and cleanliness at home and in their communities. At the central level, the ministry of education, ministry of health, national planning commission and different aid agencies are involved, while at grass root level district health office and education office, schools, school management committee, child clubs, parents, students unions, health posts etc. Broadly speaking, the function of teachers is to help students learn by imparting knowledge to them and by setting up a situation in which students can and will learn effectively. (P12, central level: Deputy Director of Education Division). CAS  Besides, insufficient human resources and physical infrastructures were other major hurdles. This document exhibits that HIV prevention programmes are effective in reducing the risk of HIV infection among young people. 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. Sexual Health Education in Schools. This gap could have led to the lack of intensive planning at national level which might be one of the reasons why the program could not be scaled up in other parts of the country as expected [12]. Based on the key informants’ responses, we categorized the impact of the SHN program into two main parts a) impact on students, and b) impact on school environment and community. According to the institutional framework of the SHN strategy, the two ministries were the lead institutions to implement the program in Nepal, and aid agencies were the key implementing partners [16]. In resource-limited countries, a lack of resources has been a crucial operational barrier to conduct the program [3, 12, 13]. (P4, aid agency: SHNP senior coordinator). So this is about the behavior change among students as well as their parents. 2016;11(11):e0166001. It is their joint role to encourage the student to become an independent learner and member of the classroom, school… Health Promot Perspect. School-based health and nutrition programs. The results showed that students in project schools had better access to various school health services, hygiene and sanitation facilities, and more child club activities and special health classes compared to those in comparison schools. We employed this framework to identify themes, codes, and sub-codes from the data and analyzed them to understand the data patterns [29]. The positive impacts included improved students’ health and school environment and enhanced community awareness. MG, PS, RA, and RD were involved in data analysis and manuscript revision. 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. 2014;2(11):1076–87. Bundy D. School health and nutrition: policy and programs. These meetings might be helpful to improve program implementation [38]. The SHN program aims to provide timely support and preventive measures to improve the health of school children [4, 7]. ♦ School Health Physician Delineating Roles and Responsibilities for the Safe Delivery of Specialized Health Care . The training was conducted only once and ended and it was not repeated. The school nurse has a crucial role in the seamless provision of comprehensive health services to children and youth. We all go through SHN network, which has been a good mechanism where we can coordinate." 1211 Geneva 27 We don’t have enough resources. Despite these limitations, this is the first study in Nepal to explore the perceptions of stakeholders from all tiers regarding the SHN program implementation, impact, and challenges. Policy implementation assessment tool: master interview guide. Teachers set the tone of their classrooms, build a warm environment, mentor and nurture students, become role … This document will assist school and community leaders in efforts that promote the health of young people through schools. At the end of each interview, the interview notes were reviewed with each key informant to validate what he or she intended to convey. (P28, school: Health and physical education teacher). Trop Med Health 47, 32 (2019). School health services staff also are responsible for coordinating care by communicating with the student’s family and health care providers so that they can stay healthy and ready to learn. 3. (P23, school: Health and physical education teacher), I am the focal person for the SHN program. volume 47, Article number: 32 (2019) PubMed Google Scholar. Schools have been a powerful setting to promote health programs [1, 2]. School Mental Health Programme. Furthermore, poor coordination and partnerships between stakeholders are also significant hindrances [15]. The Shanghai Declaration on Health Promotion has been endorsed by the participants of the conference. 41 42. In this qualitative study, we conducted 32 in-depth interviews with key informants from September to December 2013. The role of teachers in education extends past the responsibility of passing along information. 6 Centers for Disease Control and Prevention. 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 … The cooperation between schools and the community also improved. The first author then identified the specific data segments, which were related to study objectives, and gave labels to the data segments to develop preliminary themes, codes, and sub-codes based on the conceptual framework by USAID [28]. Teachers are best known for the role of educating the students that are placed in their care. Our previous quantitative study also showed that child clubs and special health classes were positively associated with students’ higher health knowledge scores and identified a positive association between better health and sanitation facilities and students’ improved hygiene practices [18]. It provides interventions that can reduce violence through schools. After the SHN program started, there have been many improvements. 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]. 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. 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]. (P8, central level: Chief, Nutrition Section at Child Health Division), In our school, we do not have teachers with enough knowledge about health issues. Park S, Lee EY, Gittelsohn J, Nkala D, Choi BY. The first author also sorted and coded all 32 transcripts separately. The WSCC model is student-centered and emphasizes the role of the community in supporting the school, the connections between health and academic achievement and the importance of evidence-based school … 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. The obvious roles health education teachers play in the community are those that are entrenched within a school setting. Improving children’s health and education by working together on school health and nutrition (SHN) programming in Nepal. 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. Third, the key informants might have expressed the views that they thought we (investigators) wanted to hear, leading to social desirability bias. Int J Qual Health Care. (P4, aid agency: SHNP senior coordinator), The program will be sustainable if it is integrated into the government system. The authors would also like to thank Editage, Japan, for English language review. The School Health and Nutrition (SHN) program is a cost-effective intervention for resource-poor countries. J Sch Health. Some key informants from the central and aid agencies responded that the lack of trained human resources and turnover of trained staff members were also impediments during program implementation. Key informants from the schools implemented and self-monitored the SHN program in the schools. The school health programme is carried out in schools by the health center staff working together with schools administrators/ teachers, local government, parents and community including both agencies and students.3. Murthy MKS, Govindappa L, Sinha S. Outcome of a school-based health education program for epilepsy awareness among schoolchildren. Giving instructions is vital in this role as well as setting up activities. Our aim was to assess how, for whom and under what circumstances the programme … PubMed Central  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. (P26, school: Chairperson, School Management Committee), By using available funds, we can conduct activities that only meet the indicators proposed by our headquarters. Tropical Medicine and Health Subsequently, each group tallied their results with the first author’s results to deduce the final themes, codes, and sub-codes. Atlanta, US: Centers for Disease Control and Prevention; 2014. Washington DC: The United States Agency for International Development; 2010. http://www.healthpolicyinitiative.com/policyimplementation/files/1155_1_PIAT_Paper_Taking_the_Pulse_of_Policy_acc.pdf. Pommier J, Guével MR, Jourdan D. Evaluation of health promotion in schools: a realistic evaluation approach using mixed methods. Suhrcke M, de Paz Nieves C. The impact of health and health behaviours on educational outcomes in high-income countries: a review of the evidence. Their perceptions are equally important to provide information on the factors influencing the implementation process and help to identify the gaps in the process. 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. 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]. From the aid agencies, we recruited one key informant from each of seven different international non-governmental organizations (INGOs), and UN and bilateral organizations. In some areas, communities were mobilized in SHN activities, leading to community awareness. 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. Washington, DC: The World Bank; 2011. The School Health and Nutrition (SHN) program is a cost-effective intervention for resource-poor countries where more schools and teachers are available than health care institutions and workers [3, 4]. Masamine Jimba. (P1, aid agency: SHN program coordinator). 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. In this study, almost all the key informants appreciated the SHN program implementation in schools and the positive impact it has on students, schools, and communities. 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 WSCC model is student-centered and emphasizes the role of the community in supporting the school, the connections between health and academic achievement and the importance of evidence-based school policies and practices. 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. The positive impact included improved students’ health and education outcomes, improved school environment, and enhanced community awareness. 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]. New York: Springer; 2009. 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. The improved practices included hand washing, using soap while hand washing, and wearing clean school uniforms. These activities aimed to improve students’ use of SHN services. Child clubs and extra-curricular activities could have played a significant role in improving students’ health and nutritional knowledge and practices. 2014;8(8):e3007. We have also prevented some kids from suffering permanent hearing loss. This program … 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. It is published in support of an international partnership that is Focusing Resources on Effective School Health. (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. Furthermore, the program also brought positive changes in students’ nutritional behaviors, hygiene practices, and life skills. It’s because their stomach used to be empty. Taking the pulse of policy: the policy implementation assessment tool. We have not been able to fulfill the demands. They mentioned that the above activities helped to improve the school environment. Tong A, Sainsbury P, Craig J. But now all the students bring tiffin. We obtained written informed consent from all the key informants before the interview. Our previous study also showed a positive association between the SHN program and students’ better health outcomes [18]. Bundy D. Rethinking school health: a key component of education for all. A health promoting school is a school that constantly seeks to strengthen its capacity to promote healthy living, learning and working conditions. Strategic Objectives. The key informants were identified through personal network and snowballing procedure. This document shows how helminth reduction interventions can have a positive impact on children's health, learning potential and school attendance. (P21, school: Resource person for SHN program). 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. At district level and schools, DOH, DOE, schools, health posts, local NGOs, FCHVs, youth clubs, and parents were actively involved. (P16, district level: Chief district officer, District Health Office). 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. This document is available in the following languages: This document discusses a range of environmental conditions that exist in a variety of school environments. This study provided a deeper understanding of the linkage between the SHN program implementation, impact, and challenges in Nepal. Children are changing agents. Two sites were identified to test this new programme. 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. 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