Integrated School health Programme Early Childhood Development Conference. East London. Dr N Dlamini 28 March 2012

Component of (Primary Health Care) PHC re-engineering Ward based PHC (Primary Health Care) teams School Health services District Clinical Specialist Teams – The new Integrated School Health Policy replaces the 2003 School Health Policy.

Joint initiative Integrated school health program: Dept of Health Dept of Basic Education Dept of Social Development

Package of services 1.Individual learner assessments (screening) – In foundation phase focus is on barriers to learning e.g. vision, hearing, speech oral health, fine & gross motor assessment, nutrition, chronic disease, TB screening – psychosocial vulnerability – Increasing focus on SRH and mental health in later phases.

Package of services 2.On-site services Checking the road-to-health cards Missed immunisations are administered especially the 6 year Td and the 12 year Td deworming Treatment of minor ailments “Know your body” Age appropriate language is very important.

Package of services 2.2 SRH for the older age group: Face to face information, counseling and referral for services (menstruation, STIs, pregnancy testing, antenatal care) 3.Referrals and follow-up: Mobiles Health facility 4.Health promotion (complements life skills/orientation): Support the life skills program in each of the 4 educational phases

Educational phases EDUCATIONAL PHASESGRADES Foundation PhaseGrade R – 3 Intermediate PhaseGrade 4 – 6 Senior PhaseGrade 7 – 9 FET PhaseGrade 10 – 12

Composition of teams Professional nurse Auxiliary nurse or enrolled nurse Oral hygienist Health promoter (will be shared with the PHC ward based team).

Source of nursing staff Existing school health nurses Retired nurses (385 on data base). Redeployment recruitment

Formula for Nurse :Learner Ratio A nurse is allocated 5hours/day in each school (Primary and High Schools) Estimated time for consultation per learner is 30 minutes. 2 learners to be seen in 1 hr 10 learners to be seen in 5 hrs/day 50 learners to be seen in 1 week 200 learners to be seen in 1 month In total 2000 learners will be seen in 10 months (The 10 months excludes school holidays)

Role of the school nurse School health team led by professional nurse Co ordinates implementation Conducts individual learner assessments Provision of on-site services Source other services – dental, optometry where need arises Ensures that referrals are effected & follows up learners Recording & Storage of information Submission of collated data to PHC

Role of enrolled nurse or auxiliary nurse Weighing of children Heights Visual screen – While the professional nurse conducts the more complex tasks such as the hearing test using the audiometer. Home visits to deliver medicines where instructions must be given to the caregiver eg calamine lotion. For topical application & not for drinking

Linkage with ECD centres Where the ECD centre is attached to a formal school, children will be assessed with the rest of the foundation learners. Most ECD centres are attached to a school and this therefore improves access and impacts on coverage.

ECD For those that are not attached, the school health team will liaise with ward-based PHC out-reach teams to render services to ECD centres e.g. during school holidays, campaigns and disease outbreaks. For children not at an ECD centre, the PHC team will identify children that need to be seen and referred appropriately.

Phased implementation Year 1Year 2Year 3Year 4Year 5 Quintile INDIVIDUAL LEARNER ASSESSMENT Foundation Intermediate Senior FET HEALTH PROMOTION/EDUCATION Intermediate Senior FET

Implementation Full service package Phased approach starting with quintile 1 and 2 schools Over 5 years to reach coverage of all schools.

Mobile health units. Support from NDOH Mobile cars to be purchased for school health to take services to the schools. 1.Fully equipped for PHC services and has an operating theatre 2.Fully equipped for dental care 3.Fully equipped for ophthalmology (eye) services

Mobiles Staffing: Professional nurse Enrolled nurse Oral hygienist Ophthalmic nurse Drivers Extra staff depending on specific needs at the school

Mobiles During school holidays mobiles will provide services to ECD centres not attached to schools During events During campaigns To rehab centres

Monitoring and Evaluation A set of National Indicators will be used to monitor the school health programme. Focus is on: – Coverage of services ie schools reached – Coverage of learners – The impact of the service on the access to schooling, retention and achievement of learners. – Sustainability of school health services in all districts

Support system at national level Task Team co-chaired by DOH and DBE and meets every 2 weeks. Drives development of the policy and guides implementation. Officials from DOH, DBE and development partners assigned to specific provinces to guide and support implementation. Regular telecommunication and provincial visits.

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