CHAPTER ONE

                                                              INTRODUCTION

BACKGROUNG OF STUDY

Globally, even though school - aged children do not suffer from the high mortality of pre-school children, there exists a high burden of morbidity among them. Varying in prevalence from one country to another, the health problems in this group of children include infectious diseases, accidents and injuries, nutritional and mental disorders including substance abuse.

School Health Services refers to the procedures that are carried out by physicians, nurses, dentists, teachers and other personnel to appraise, protect and promote the health of school children and school personnel.7, 8 It includes health appraisals, treatment of common ailments, including the provision of emergency care, supervision of the health of children (normal and handicapped) and personnel, control of communicable diseases, record keeping, and the school nutrition programme. School health Services is therefore an essential component of the School Health Programme.

A historical review shows that the awareness of the need for a health service for school- aged children started quite early and has spread all over the world. Thus, most countries have initiated some form of School Health Programme. The state of such programmes, however, varies from country to country, depending on certain characteristics of each country such as level of economic development, educational resources, and disease prevalence. In Nigeria; many authors have observed that generally, the School Health Programme is a neglected aspect of the Health and Education sectors of the country. From the review of the programme in Nigeria, it appears that the programme was functional at the onset but then started to decline in the late seventies. 10 This may be due to the economic downturn and political instability in the country in the last three decades.  There is paucity of data on evaluation of school health services in Nigeria, especially in the West. The objective of this study was to evaluate the status of the School Health Services in public and private  schools in ogun state, Nigeria.

Generally in the whole world, particularly in Nigeria, education has been considered to be the corner - stone for development. It forms the basis for literacy, skill acquisition, technological advancement and ability to harness human and material resources towards the achievement of societal goal, (FRN, 2004). Education is very important in any given society. It is a process by which abilities and capabilities of individual are developed. These abilities might be physical abilities, emotional abilities, social abilities and intellectual abilities. It is the actualizing of human potential so that the individual can become something more than what he was before. According to Ugwuanyi (2003) education is the process by which society establishes to assist the young to learn and understand the heritage of the past, participate productively in the society and contribute meaningfully for the development of the society. Emeka (2008) citing Kneller (2000) sees education as a process by which any society through schools, colleges, universities and other institutions deliberately transmit knowledge, values and skills from one person to another. As a result of deregulation in Nigerian education, the system of education has two main interest groups – public education and private education.  Public education is the pillar or backbone of society which opens the door of equal educational opportunity to all citizens. It is a public owned property which attracts public attention constantly. According to Ukeje in Akpa, Udoh and Faghamiye (2005): Public school is concerned with the acquisition of appropriate skills, abilities and competencies of both mental and physical nature as equipment for the individual to live in this society, and acquisition of a relevant and balanced knowledge of facts about local and world phenomena. (P. 12-13) Public schools can also be seen as those schools controlled neither by individuals nor by private interest or agencies but by those who represent the society as a whole. In other words public schools are those schools which are supported and controlled by the government of the state or nation. Private schools are those schools that are not administered by local, state or national government, which retain the right to select their student body and are founded in whole or part by charging their students tuition rather than with public funds. This means that the school established by the missionaries, individuals and voluntary organizations belong to this group. According to Hernes (2001) United Nations Educational, Scientific and Cultural Organization (UNESCO) and the world Bank, private educational institutions are those that are not operated by a public authority, but are controlled and managed by a 3 private body or board of governors not selected by a public agency on selected by public vote. The institution may be run by or operated by non governmental organizations (NGOS) or business enterprise. Secondary school is the stage of education following primary school. It is generally the final stage of compulsory education. Webster (2009) sees secondary school as a school intermediate between elementary school and collage usually offering general technical, vocational or college- preparatory course, while Collins (2003) refers to it as a school for young people, usually between the ages of eleven and eighteen. As for the National policy on education (FRN, 2004) it is the form of education children receive after primary education and before the tertiary stage. Environment can be defined as a system within which living organisms interacts with the physical element while education environment is a learning place where the learner learn and interact with learning facilities in order to be socialized and face the challenges in the society. Agusiegbe (2004) sees environments as consisting of all elements existing around man and which exert some influence on him. These include physical, biological and social attributes. Environment can also be seen as aggregate of all the external condition and influence affecting the life and development of an organism.  In this study,school health environment includes all the external condition and influences in the school that affect the academic achievement of the student such as first aid box, clinic, immunization, nutritionist, school location among others. Environment for the purpose of this work can be divided into two parts,home environment and school environment. School environment is the thread that connects the multitude of activities on the school. In many respects, this thread is almost invisible, yet everyone experiences its influence. Dudek (2000) opined that it could be said to be the external influences in the school that can influence academic achievement of students irrespective of their intelligent quotient. School environment can also be considered as the second teacher since space has the power to organize and promote pleasant relationships between people of different ages, to provide changes, to promote choices and activities and for its potential for sparking different types of social and affective learning (Okeke 2001). It has been generally accepted that environment and heredity can hardly be separated from education in influencing achievement, hence a child’s life and ability is influenced by nature and nurture. Heredity provides the natural disposition while a healthy environment makes available a window of opportunities to the learner (Ohuche 2001). The environmental variable of the setting helps to a large extent in ensuring attainability of the goals of such setting. The environmental differences and the differences in the quality of instruction from one school to another can create differences in the level of knowledge acquisition of the students. School health services deal with health appraisals, control of communicable diseases, record keeping and supervision of the health of school children and personnel. It is the aspect that concerns itself with the evaluating the health of an individual objectively. Health appraisals afford the school authorities the opportunity to detect signs and symptoms of common diseases as well as signs of emotional disturbances that could impede the learning activities of children . School health services are both preventive and curative services and it helps in providing information to parents and school personnel on the health status of school children . It also provides advisory and counselling services for the school community and parents. It include pre-entry medical screening, routine health screening/examination, school health records, sick bay, first aid and referral services. Other services rendered include health observation (which involves physical inspection of the physiology and behaviours of children), health examinations (screening tests and medical diagnosis) and health records (keeping of records of the health histories of children) . A National study of the school health system in Nigeria by the Federal Ministries of Health and Education revealed that only 14  % of head teachers indicated that pre-enrolment medical examination was mandatory in their schools and 30 % of the students had low body mass index (BMI). It further indicated that 30  % of students have low BMI and the common health conditions that contribute to absenteeism include fever (56 %), headache (43  %), stomach ache (29  %), cough/catarrh (38  %) and malaria (40  %)  There is a dearth of school health clinics in Nigeria and where they exist, the services are not comprehensive enough or not organized to meet the needs of the pupils [5]. Studies have shown that primary school children in Nigeria were not provided with basic health examination services and pre-entrance medical examinations thus baseline health information about them was absent. There is also a lack of routine medical examination which would have picked up deviations from normal which make early referrals impossible and children vulnerable to preventable diseases . School health has been described as the neglected component of Primary Health Care in Africa. Since almost every small community has a primary school, in those communities without health centres, it should be possible to use the primary school as a centre for primary health care delivery not just for the pupils but also for the community . A well organized and properly executed school health programme can be used to create safe environment for school children . School health programme can become one of the strategies for promoting primary health care services . All efforts at addressing the school health programme in Nigeria have remained largely at policy level, with minimal implementation. Where implementation has been attempted the emphasis has been on outside rather than within the schools . This study was therefore designed to determine the school health services available and its practices in primary schools in Ogun state Nigeria. This has implications in the primary health care of the school children and reduction in incidence of preventable diseases early in life.

STATEMENT OF PROBLEM

The gruesome picture of the health of our children especially in the area of reproductive health in Nigeria can be  attributed to poorly developed school health services. According to Fajewonyomi and Afolabi (1999) school health   services had been solely limited to posting a few nurses to a few urban secondary schools with their roles not  properly defined. The above situation has not improved over the years and similarly gives a true picture of the   current situation in Cross River and Akwa Ibom States, thus calling for a new direction for school health  programme. For such direction, pertinent questions need to be answered culminating into the study aimed at

identifying the problems and challenges of school health service in Ogun state, with attention on  what should be the focus in the resolution of identified problems.

RESEARCH OBJECTIVES:

1) Determine the current coverage of school health programmes within the two states;

2) Determine the services rendered by the school nurses in their various schools;

3) Determine the respondents' assessment of adequacy of equipments and supplies provided for school health programmes;

4) Identify other professionals that were performing school health duties;

5) Ascertain the problems encountered by the nurses in the practice of school health programmes;

6) Determine if there was significant relationship between nurses' knowledge of roles for school health   programmes and health services rendered by them;

7) Ascertain the relationship between nurses' level of satisfaction with equipments and supplies provided  for school health programmes and the services rendered by them.

SIGNIFICANCE OF THE STUDY

This study will help to identify the current state of school health services and areas that require interventions, so that  the expected goals of school health programmes will be achieved. The findings will assist in providing guidance on  needed policies; directions that planning should go and strategies to be put in place for successful provision of  school health services.

RESEARCH QUESTIONS

The study provided answers to the following research questions:

1 . What is the current coverage of school health programme?

2. What are the services rendered by the school nurses in their various schools?

3. What are the respondents' assessment of adequacy of equipments and supplies provided for school health service programmes?

4. Who are the other professionals performing school health services in schools?

5. What are the problems encountered by the nurses in the practice of school health?

6. What is the relationship between nurses' knowledge of roles for school health programmes and

services rendered by them?

7. What is the relationship between nurses' level of satisfaction with equipments and supplies provided

for school health programmes and the services rendered by them?

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