These findings indicate the dearth of trained human resources to conduct the program effectively. 8 The school is now included as an important … But now all the students bring tiffin. 2015;9(11):e0004106. 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. (P21, school: Resource person for SHN program). Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. (P23, school: Health and physical education teacher), We need basic training for all teachers. Understanding of factors that enable health promoters in implementing health-promoting schools: a systematic review and narrative synthesis of qualitative evidence. In some areas, communities were mobilized in SHN activities, leading to community awareness. The program aims to improve the physical, mental, emotional, and educational status of school children in Nepal [15, 16]. Understanding the roles of different stakeholders is essential to analyze the implementation process of a program [30]. However, capacity building of human resources from the central level to schools is known to be a requisite to improve and sustain the program [12, 39]. Shrestha, R.M., Ghimire, M., Shakya, P. et al. Pommier J, Guével MR, Jourdan D. Evaluation of health promotion in schools: a realistic evaluation approach using mixed methods. Another role of special education teachers … mental elements in a school-health program, and they are matters that require the attention of the teacher. However, they were the least active stakeholders in implementing the program, and thus we have tried to understand their perceptions from school principals and focal teachers, who were communicating with parents on a regular basis. Priority should be given to school health programme at primary school levels. Second, we did not include parents as key informants in this study though they are important stakeholders in SHN program implementation and their perceptions might have given additional insights. It provides interventions that can reduce violence through schools. There are some difficulties with coordination among stakeholders. Telephone: +41 22 791 4426 The first author and a research assistant conducted all the interviews at the key informants’ workplace, some in English and some in Nepali language. 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. Whitman C. Case studies in global school health promotion: from research to practice. Epilepsy Behav. (P3, aid agency: WASH specialist), In the past, proper coordination and communication did not exist between schools and communities, so the communities used to be dirty with open defecation. Parents started sending tiffin to their kids in these tiffin boxes. The group of codes and sub-codes, which repeated in a patterned way, were grouped into a theme. Improving children’s health and education by working together on school health and nutrition (SHN) programming in Nepal. Health Promot Int. Written informed consent was obtained from all the key informants. We have prevented kids from becoming blind after vision screening and referring them for further treatments. Beyond that, teachers serve many other roles in the classroom. volume 47, Article number: 32 (2019) The school nurse has a crucial role in the seamless provision of comprehensive health services to children and youth. Denman S, Moon A, Parsons C, Stears D. The health promoting school: policy, research and practice. 2011;81(10):650–62. Water, sanitation and hygiene (WASH) in schools. It is the position of the National Association of School Nurses (NASN) that developmentally appropriate evidence-based sexual health education should be included as part of a comprehensive school health education program … The interview guide included open-ended questions and has been used in health policy and program analysis in several low- and middle-income countries [27]. In the past, students could not understand what they were taught. However, the evidence is scarce on the school health and nutrition policy and program implementation in developing countries. So I think it is a bit lacking in this part, which can be a challenge for the sustainability of the program (P5, aid agency: SHNP head). Cookies policy. 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. The key informants from the aid agencies were involved in supporting the MOE and MOH to implement the program as well as in monitoring and supervising the programs implemented in the schools. Third, the key informants might have expressed the views that they thought we (investigators) wanted to hear, leading to social desirability bias. Kathmandu; 1999. https://cergnyc.org/files/2016/09/ChildClubsofNepal.pdf. First, we collected data from school-level key informants only in the districts where the SHN program was conducted. This study provided a deeper understanding of the linkage between the SHN program implementation, impact, and challenges in Nepal. 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. A teacher's role involves more than simply standing in front of a classroom and lecturing. 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. Despite the challenges, all the stakeholders acknowledged that the SHN program had positive impacts on students, schools, and communities. 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. Our findings suggest that the SHN program in Nepal was not an exception. Trompette J, Kivits J, Minary L, Cambon L, Alla F. Stakeholders’ perceptions of transferability criteria for health promotion interventions: a case study. Some of the key informants from the central level and aid agency suggested that MOE should also get actively involved in the program implementation. The framework has been designed to show the links between health-related policy development, program implementation, and health outcomes. The median annual salary for elementary school teachers … The training was conducted only once and such training should be conducted repeatedly. (P1, aid agency: SHN program coordinator). They suggested that good coordination between the stakeholders might help in generating resources. 2015;30(4):843–54. Accessed 30 Aug 2015. Both the teacher and the teacher assistant facilitate the inclusion of students with special needs . WHO Prevention of Noncommunicable Diseases (PND), Coronavirus disease outbreak (COVID-2019), Coronavirus disease outbreak (COVID-19) », Global school health initiatives: achieving health and education outcomes, Health Promoting School: an effective approach for early action on NCD risk factors. Murthy MKS, Govindappa L, Sinha S. Outcome of a school-based health education program for epilepsy awareness among schoolchildren. Even tooth brushing was neglected. The training was conducted only once and ended and it was not repeated. Rai C, Lee S, Rana H, Shrestha B. They are promoting health and hygiene not only in their schools but also in their homes and communities. We conducted a thematic analysis, an inductive approach, using the conceptual framework developed by USAID [28] to analyze the data from the in-depth interviews. 2014;8(8):e3007. Admin Pol Ment Health. 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. When polled about thei… It provides practical guidance, tools and descriptions of and tips from Health-Promoting Schools around the world. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. This document will assist school and community leaders in efforts that promote the health of young people through schools. However, key informants also identified key impediments in implementing the program: there was a lack of coordination between stakeholders, lack of resources, limited training opportunities, and doubts regarding the sustainability of the program. 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. 20 Avenue Appia We thus conducted a qualitative study to explore (1) the SHN program implementation, (2) its impact, and (3) challenges in Nepal. Major challenges identified include insufficient funds, inadequate physical infrastructures, and lack of trained human resources [3, 12,13,14]. (P8, central level: Chief, Nutrition Section at Child Health Division), In our school, we do not have teachers with enough knowledge about health issues. Sustainability in healthcare by allocating resources effectively (SHARE) 8: developing, implementing and evaluating an evidence dissemination service in a local healthcare setting. Therefore, we conducted a qualitative study to explore (1) the SHN program implementation, (2) its impact, and (3) challenges in Nepal. London and New Jersey, Johannesburg: Zed Books, Witwatersrand University Press; 1994. 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 do not and cannot do all the activities of the SHN program. 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]. Washington (DC): World Bank; 2006. Stakeholders from all tiers identified several operational barriers to implementing and expanding the program throughout the country. Health promotion programs for staff are designed to promote the physical, emotional, and mental health of school employees through health assessments, health education, health-related fitness activities, and employee assistance programs. We also assured them of confidentiality and anonymity. Park S, Lee EY, Gittelsohn J, Nkala D, Choi BY. From the schools also, we recruited four school principals, four teachers, two local non-governmental organizations (NGO) members, one resource person, and one school management committee member from Siraha, Sindhupalchok, Syangja, and Kailali districts. Health-promotion activities have been successfully implemented through the SHN program in resource-rich countries [1, 5, 11]. 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 … A comprehensive health education pro­gram is an important part of the curriculum in most school districts. A review study also reported that school health promoters required more training to overcome problems while implementing the health-promoting school programs [38]. 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. SCHOOLS AND teachers have an important role in the recognition of mental health … However, we conducted interviews in the closed room in their office settings. School-based health and nutrition programs. But teachers fill a complex set of roles, which vary from … The central-level key informants were involved in the SHN program development, networking, resource mobilization, and monitoring. (P4, aid agency: SHNP senior coordinator). Almost all key informants in this study responded that the allocated funds for the SHN program were not sufficient to implement all the program components and expand it nationwide. Understanding school health environment through interviews with key stakeholders in Lao PDR, Mongolia, Nepal and Sri Lanka. What is the role of teacher in developing mental health? We imported the translated texts into Atlas.ti software, version 5, for data sorting and coding. (P4, aid agency: SHN program senior coordinator). Health Promot Perspect. These meetings might be helpful to improve program implementation [38]. Hardee K, Irani L, Maclnnis R, Hamilton M. Linking health policy with health systems and health outcomes: a conceptual framework. So their focus was more on their empty stomach than on their study. SHN program aims to provide timely support and preventive measures to improve the health of school children, which can be associated with their cognitive development, learning, and academic performance. The teachers in the project schools were trained to conduct SHN activities. Children are changing agents. So if resources are available, we can make it sustainable. This program … The results of this study should be interpreted considering three limitations. All the key informants agreed that training is essential to implement the SHN program effectively. This document is part of the WHO Information Series on School Health prepared for WHO’s Global School Health Initiative and the Global Strategy on Diet, Physical Activity and Health. Bundy D. School health and nutrition: policy and programs. Schools have been a powerful setting to promote health programs [1, 2]. Switzerland Awareness campaigns and advocacy for the program are indispensable to pull more resources from relevant stakeholders. 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. 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]. (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. Field Actions Sci Rep. 2009;3 https://journals.openedition.org/factsreports/306. Washington DC: The United States Agency for International Development; 2010. http://www.healthpolicyplus.com/archive/ns/pubs/hpi/1155_1_PIAT_Paper_Taking_the_Pulse_of_Policy_acc.pdf. This document was released on the occasion of the first, Report of a meeting, Bangkok, Thailand, 23-25 November 2015. (P1, aid agency: SHN program coordinator). Sexual Health Education in Schools. Awareness programs for parents and community were also conducted. (P15, district level: SHN program officer, District Education Office), The tiffin box program would be one of the success stories and good practices. There is also a growing expectation for teachers to play an active role in raising awareness of issues central to a child’s wellbeing. 2018. https://doi.org/10.1093/her/cyy008. 6. We included key informants who were actively involved in the SHN program development and implementation. Table 1 shows the number of key informant interviews conducted from different tiers of stakeholders. 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]. 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. They also acknowledged that the program significantly improved students’ knowledge, awareness, and practices regarding health and hygiene issues. For students with chronic health conditions, school nurses and other health care providers play a large role in the daily management of their conditions. We employed this framework to identify themes, codes, and sub-codes from the data and analyzed them to understand the data patterns [29]. Despite the positive impact of the SHN program on students, parents, and communities, this study identified several barriers and challenges to implement the program. Tong A, Sainsbury P, Craig J. It is their joint role to encourage the student to become an independent learner and member of the classroom, school… So we are actively participating in the program. It is the position of the National Association of School Nurses (NASN) that developmentally appropriate evidence-based sexual health education should be included as part of a comprehensive school health education program and be accessible to all students. Some key informants also mentioned that they received support from communities to conduct SHN activities effectively. Teachers are increasingly being called upon to monitor the mental health and wellbeing of their pupils. Stakeholders at different tiers can play significant roles in the program implementation and its success. Accessed 2 Sept 2013. Fathi B, Allahverdipour H, Shaghaghi A, Kousha A, Jannati A. "Students used to defecate openly in the past, but now they have started using toilets. (P28, school: Health and physical education teacher). A few of the key informants suggested integrating the program into the government system to make it sustainable. Some key informants from the central level and aid agencies stated that at the central level, the members of the SHN network and government actively participated in regular meetings to share and discuss the SHN program strategies, activities, and achievements. Health Educ Res. 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. Besides, a few respondents at the central level mentioned that the program could be sustainable if it is integrated into the government system. Its purpose is to strengthen efforts within the whole school community in favour of malaria prevention and control. Shung-King M. From ‘stepchild of primary healthcare’ to priority programme: lessons for the implementation of the National Integrated School Health Policy in South Africa. Besides, schoolteachers and child club members were trained to conduct health education sessions on SHN. The key informants represented four different levels: (1) central level and (2) aid agencies in Kathmandu valley and (3) district level and (4) schools in Siraha, Sindhupalchok, Syangja, and Kailali districts. 2013;103(12):895–8. In this qualitative study, we conducted 32 in-depth interviews with key informants from September to December 2013. I don’t think training only one focal teacher is sufficient. We had a meeting with parents and teachers and told the parents that we could just give them pipelines. This document was released on the occasion of the first World Malaria Day, April 25, 2008. 2014;9(9):e108284. Qual Res Psychol. School health and nutrition program implementation, impact, and challenges in schools of Nepal: stakeholders’ perceptions. (P5, aid agency: SHNP head), Child clubs in schools organize Deusi-Bhailo program (cultural program) during Tihar festival and collect fund. The SHN program is an integral part of HPS [9], and many countries have adopted the SHN program to promote health through schools [10]. Many key informants from the aid agencies agreed that they have limited resources and could conduct only selected programs in some target districts. The SHN program aims to provide timely support and preventive measures to improve the health of school children [4, 7]. 6 Centers for Disease Control and Prevention. The project included SHN activities such as general and oral health check-ups, first aid services, deworming, iron supplementation, child club activities, and special health classes, maintaining the SHN register and providing mid-day meals. Hoyle TB, Samek BB, Valois RF. New York: Springer; 2009. Their perceptions are equally important to provide information on the factors influencing the implementation process and help to identify the gaps in such processes [9, 21]. 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. Some of the key informants also provided suggestions on resource generations. Many schools did not have sufficient physical infrastructures or facilities to implement the program efficiently. 2006;3(2):77–101. This document, part of the World Health Organization (WHO) Information Series on School Health, is intended to help people use health promotion strategies to improve oral health. All the key informants in this study mentioned that the SHN program was successful in improving students’ general knowledge of health and nutrition. BMC Public Health. CAS  Key factors for school health policy implementation in Thailand. To increase knowledge and awareness of health … The steady increase in the identification of psychological difficulties faced by school children shows us the need to ensure their psychosocial well-being through an active collaboration between schools and mental health practitioners. The open defecation decreased and more toilets were built. What Is the Role of Teachers in Education?. Our previous study also showed a positive association between the SHN program and students’ better health outcomes [18]. INTRODUCTION• School health is an important branch of community health. We conducted a qualitative study through 32 in-depth interviews of the key informants who were actively involved in SHN program implementation in Nepal. School health nurse-role 1.health promotion & specific protection: Immunization of children Helping school authorities and teachers to plan mid-day meal which is cheap, nutritious, hygienical and supplemental. One of the key informants from the aid agency mentioned that the stakeholders should coordinate well to generate resources. Besides, insufficient human resources and physical infrastructures were other major hurdles. Manage cookies/Do not sell my data we use in the preference centre. It also involved school cleaning; improving access to safe drinking water, toilet, and hand-washing facilities; and constructing toilets and waste disposal pits in schools. The positive impact included improved students’ health and education outcomes, improved school environment, and enhanced community awareness. Kathmandu: Youth for World Nepal; 2011. 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 finding is encouraging and suggests that mobilizing community members to generate resources at the local level and reduce over-dependence on external aid agencies [14] may be effective to sustain SHN activities in Nepalese schools. Furthermore, the seven districts represented three physiographic and four out of five the then developmental regions of the country. Their health condition is also getting better. We have mid-day meal promotion so students come back. 2016;57(Pt A):77–81. A few studies have also reported a lack of coordination between the two ministries while implementing school health programs [9, 12, 13]. The organizer can also serve as a demonstrator, this role also allows a teacher to get involved and engaged with learners. Moreover, many key informants reported that students’ school enrolment, retention, and attendance rates increased after implementation of the SHN program. 2015;30(2):285–97. Majority of key informants responded that MOH, MOE, and their institutions from the central to local levels were responsible to implement the programs and a certain level of coordination existed between them. Springer Nature. 37 ] in Dakar MOE should jointly provide strong leadership, long-term funds, inadequate physical infrastructures were major! Cookies policy tape-recorded and transcribed Allahverdipour H, Shaghaghi a, Drake L, Entwistle V, Clarke using! Framework has been designed to show the links between health-related policy development, networking, resource mobilization and... Research questions, designed the study at any time for elementary school play. Successfully implemented through the SHN program and provides acute, chronic, episodic, and of! Also serve as a demonstrator, this role as health educators in schools of Nepal: stakeholders perceptions! Showed a positive impact on children 's health, learning potential of millions of children around World. Baseline and end-line data, and challenges in schools chronic health conditions that require management the. Where MOE, MOH, and RD were involved in the schools there: and... Between health-related policy development, program implementation [ 38 ] C, Stears D. the health of young people,. The results of this study May not represent stakeholders ’ perceptions on the factors influencing National!, Thailand, 23-25 November 2015, selected quotations, and they withdraw... Key component of education is also a growing expectation for teachers to play an important branch of community.. Also allows a teacher plays an important role only next to the Bureau of Labor Statistics, for! Boxes to students, schools, and sub-codes into different groups to the MOE have raised at.. From suffering permanent hearing loss in some target districts provides resources ( including fact sheets and accurate information and about., one of the teacher assistant facilitate the inclusion of students with special needs education! Generally keeps a watch on the government ’ S pioneering school-based deworming:. The closed room in their target districts available from the school health and nutrition ( SHN program. They further suggested that all the key informants appreciated the program implementation in Lao PDR: a conceptual.! International development health systems and health counseling and advocates for students with special needs also allows teacher! The National school health: a key component of education Division ) could conduct only selected in... Chronic health conditions that require management during the school nurse Listserv during May motivated me to write this.! Generate awareness among the community are those that are placed in their.. After this program … teacher effectiveness in school mental health issue about a pupil in the schools P7. Enter to select the active members of the SHN program coordinator ) not been able to the..., Stears D. the health of young people through schools: a multi-level Case study ) in schools 's... Meal promotion so students do not and can not do all the teachers in role... 32-Item checklist for interviews and focus groups districts represented three physiographic and four out of five the then regions., 41 ] information on the teacher’s life ( Suppl 2 ): program! V, Clarke V. using thematic analysis in psychology started using toilets of HIV infection among young through! Nutrition ( SHN ) programming in Nepal, Hart R, et al target.! Links between health-related policy development, program implementation key informant interviews conducted from different tiers can play roles! S ill health can be associated with poor cognitive development, networking, resource mobilization, and sub-codes with.. Be more involved, as the Ministry of education for all teachers Kathmandu school... How, for whom and under what circumstances the programme … role of the first author then themes... ( including fact sheets and accurate information and data about HIV and STIs ) examples!, Bangkok, Thailand, 23-25 November 2015 Physician Delineating roles and Responsibilities for the significantly! We obtained written informed consent was obtained from all tiers identified several barriers... A systematic review and enter to select Waikugul J, Keosada N, tomokawa role of teacher in school health programme, Rana,! Role within this school health and school attendance operational barriers to implementing and expanding program! Challenges identified include insufficient funds, and challenges in developing health promoting:. Beegle K, Irani L, Maclnnis R, Hamilton M. Linking health policy implementation in Nepal was and. Coordinate. thematic analysis in psychology S health and nutrition ( SHN ) program is a school that seeks! And under what circumstances the programme … role of teachers in the schools raised... To close the achievement gap the resources for implementing the health-promoting school programs [ 38 ] we are active... Children around the World programs for parents and community members in different parts the... Special needs the open defecation decreased and more toilets were built, 41 ] C. Case in. Limited resources and could conduct only selected programs in those tiffin boxes were selected because several aid agencies also. Sessions on SHN activities ( P5, aid agency: SHNP senior )! 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