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CHAPTER ONE

INTRODUCTION.                

The concept of school health services has undergone both evolutionary and revolutionary changes since its inception in the school health programmes. These changes are made possible by advances in medicine and education. The emphasis in school health services has changed from providing only health services for children in our schools to one that is educational in nature and seeks to counsel children and parents in securing their own health services (Igwe, 1996).

 It is universally recognized that the health of school children deserves special attention. In order to derive maximum benefit from the educational programme, the child must be healthy, physically, mentally, and emotionally (Lucas and Giles, 2003). They further assert that children at school are exposed to a variety of hazards ranging from physical injury,   and infection, to emotional problems. School age is a period during which the child is undergoing rapid physical and mental developments. A healthy environment is required to provide the child with appropriate adjustments that are required during this critical period.

The school provides a unique opportunity for health education, a means of establishing a firm foundation for the health habits of the future adult population. By safeguarding the health of the children of today one is ensuring the health of the adults of tomorrow (Lucas and Giles, 2003 ).

School health services   have existed for more than   100 years, beginning with attempts to control the spread of communicable diseases (Dorothy et al , 2002). Increasingly, health services provided by schools have expanded to meet other acute, chronic and preventive health care needs. Basic school health services, usually provided by nurses include screening for medical conditions, administration of prescribed medications, care of children with special health needs; assessment for acute and contagious conditions, administration of first aid, health education and promotion activities, assessment of students’ immunization status and maintenance of school records. Some local boards of education also partner with universities and other institutions of higher learning, providing expanded services for younger students and opportunities for learning through providing service to communities (service learning) and to college students (Fryer and Igoe, 1996).

         The American Academy of Pediatrics recommends that each comprehensive health assessment visit, beginning at age three, includes attention to school health issues (Dorothy et al, 2002) . They further assert that public school districts in the United States provide varying levels of health services to their students, depending on several factors, such as state and federal laws, local boards of education perceptions about the importance of health services; parental and community involvement (Dorothy  et al, 2002). In the United States, the health service phase of school health programme had its conception at the end of the nineteenth century. With the increasing prevalence of disease and illness during this period the value of carrying on health services in the schools, especially medical inspection, began to be realized, in 1872, and because of the prevalence of small pox, a “sanitary superintendent” was employed by the Board of Education in Elmira. In San Antonio, Texas, in the year 1890, a school medical inspection service was established. Following the series of epidemics among school children in 1890, while Dr. Samuel Burgin, Health Commissioner of Boston, established a system of medical inspection in schools (Kenneth, 2001).

         Obionu, ( 2001) and Igwe ( 1996), outlined the scope of school health services to include

•      Health appraisal of the pupils .Health Counseling, guidance and interpretation of the findings. 

•      Emergency care programme for the injured and treatment of ill health among the pupils.

•      The control/prevention of communicable diseases.

•      Health promotion and protection of the school personnel.

•      Educational care and adjustment of pupil with mental health problems in schools.

•      School food services and programme

Ademuwagun and Oduntan(1996), contend that the Nigerian school children do not suffer the very high death rate  of the pre –school children, but they are subjected to multiple diseases which could hinder them from attaining their maximum physical and mental potentialities. Their health problems are numerous; they vary in severity, ranging from minor conditions like ulcers and common cold to severe conditions, such as cancers, tuberculosis and tetanus. They further assert that a high frequency of diseases and disabilities is encountered in apparently healthy children attending schools and for a great proportion of them, no treatment had been sought to correct the abnormalities. Most of the school children are stunted in growth and may exhibit signs of nutritional deficiencies. Practically all school children in the Nigerian community suffer from one type of worm infection or the other.

 School health services care came into existence in 1899 after the Boer war as a result of the defeats the British Soldiers suffered in the hands of the South Americans. Upon the investigation of the cause of the defeat, it was discovered that most of the soldiers used by the British were students that were not medically fit to join the army. This, therefore, prompted the British Government to introduce school health services to help check the status/standards of pupils (Sa’adatu, 2004).  Sofoluwe et al  (1998), advanced that the school health services started in Nigeria in  1929 , and about the same time as in Uganda and ,that the first full time  preventive medical officers were appointed in the two countries to start maternal child and school child health services. They further maintained that late. Dr. Ladipo Oluwale started school health services in Lagos in 1929.

Sa’adatu (2004), maintained that school health services had been dynamic in the western part of the country but the reverse is the case in the northern part of the country. She advanced that school health services were introduced in Enugu state in 1980 and formally established in 1985 with proper transfer of health personnel from Ministry of Health to Ministry of Education. This slow take off of the programme was because most of the health care  services were catered for by the management of schools which was directly run by missionaries. However, due to unexplainable reasons’ the programme had not been on a strong footing in the state, particularly due to lack of funds by the Ministry of Education, to absorb the transferred staff from the Ministry of Health. It is not clear as to what extent school health services were affected by this condition. 

1.2         STATEMENT OF THE PROBLEM

 The school has an obligation to establish a healthy environment, which will help the students maintain optimum fitness adequate for learning, teaching and maintains condition for healthy living, assure optimum health for individual and make intelligent decisions about personal, family, and community health (Igwe, 1996). The emphasis in school health services had changed from providing only health services for children in our schools to one that is educational in nature and seeks to counsel children and parents in securing their own health services.  School health services are the health and related health procedures carried out by the health personnel, teachers and all others connected with school health in order to appraise, protect and promote the health of the child and school personnel (Igwe and Emaharole, 1993).

       Secondary schools in Nigeria provide various levels of health services to the students.

Level of services depends on many factors, like the State and Federal laws, the commitment of the Ministry of Education, perception about the importance of health services and parental and community involvement (Obionu,2001).Basic school health services, usually provided by nurses and health education personnel included screening for medical conditions, administration of prescribed medications, care of students with special health needs, assessment for acute and contagious conditions, administration of the first aid, immunization, health education and promotion activities and maintenance of  school health records. Some schools also partner with medical and local authorities, providing expanded services for students.

Enugu State has about 466 secondary schools. Most students came from Enugu state, mainly from poor families. In addition to pervasive poverty, most schools struggle with two other significant concerns which include academic achievement and students attendance. Most secondary schools can not meet the required academic standard and the attendance rate is less than 75%. If children are healthy, these problems can be minimized, because healthy children are better learners (Igwe, 1996). Unfortunately, the health services provided in the secondary schools appear to be far from adequate.

Perhaps, the negligence of the school health services by the responsible ministries (Health and Education) is attributable to the low level of academic performance and absenteeism in post primary schools in Enugu state. Despite the effort of the government to improve the facilities of school health services, cases of infection remain high among students in post primary schools. It is therefore not clear how adequate the health services in Enugu State are. In view of this state of affairs in the Ministry of Education of Enugu state, it is not clear what kind of health services are provided in secondary schools of Enugu state and to what extent they are maintained and utilized. This study was therefore an attempt to assess the health services provided in secondary schools in Enugu state.

1.3.        RESEARCH QUESTIONS.

This research was conducted to answer the following specific research questions.

1.      Do school health services include appraisal of health status , treatment of common ailments, first aid and emergency care, control of communicable diseases, promotion of sanitary conditions, provision of counseling services, provision of nutritional programme, provision of adequate number of health personnel and encouragement of correction of remedial defects among secondary schools children in Enugu state?.

2.      Is there significant difference between respondents of urban and rural secondary

schools in their assessment of school health services in Enugu State?                                                  

3.      Is there significant difference between respondents in their opinion as influence by their qualification on the health services provided by secondary schools in Enugu State?

4.      Is there significant difference between respondents of boarding and day secondary schools in Enugu state in their assessment of school health services?           

5.      Is there significant difference between male and female respondents in the estimation

of school health services in secondary schools of Enugu State?                                                             

6.      Is there significant difference between respondents from government and private secondary schools in Enugu state in their assessment of school health services? 

1.4         PURPOSE OF THE STUDY.

 This research was concerned primarily with the assessment of school health services in

Enugu State to achieve the following purpose: 

(a)              To identify school health services available in post primary  schools in Enugu State. Health services include counseling services to children, parents and teachers in

Enugu state.

(b)              To find out the adequacy of health services provided in the  secondary schools

of Enugu State.                                                                                                       

(c)              To find out the differences between urban and rural  secondary schools in the

                  provision of health services in            Enugu State.                                               

(d)              To find out the differences between boarding and day secondary schools in

Enugu State in the provision of health services.                                                 

(e)              To find out the differences between Government and Private secondary

schools in Enugu State in the provision of health  services.                                              

(f)               To find out the differences between male and female respondents in the

assessment of health services in secondary schools of Enugu State.

    1.5       BASIC ASSUMPTIONS.

              This study was based on the following assumptions:

         i.          School health services are provided in secondary schools of Enugu state.         ii.          Health services are influenced by the quality of health personnel, teachers and

                        the quality of drugs provided

iii. &n

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