Introduction

Gaza strip with 360 km , it’s population Gaza strip with 360 km , it’s population more than 1.3 millions >4000 inhabitant more than 1.3 millions >4000 inhabitant per kmper km . .

52% of the population under 18 years , 52% of the population under 18 years , 17.2% of the population under 5 years17.2% of the population under 5 years . .

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IntroductionBeing in a state of growth and development, school

children constitute a vulnerable population group which has special educational, health and human development needs that require special attention by health and teaching staff.

The school health service provides an opportunity for promoting the health status of school children, as well as for promoting healthy behavior through targeted life-skill-based

educational activities that ultimately help to transfer knowledge from the classroom into the homes of the pupils and from there to the entire community.

Objectives of the school health programme:

Consistent with the standards set out in the Convention on the Rights of the Child (CRC), the main objectives of the school health programme are:

1. To detect and correct physical impairments, that are amenable to management early before they develop into permanent disabilities, as well as to detect major morbidity conditions that require thorough investigation, treatment and follow-up.

2. To prevent and control communicable diseases that could be transmitted from home to school or vice versa, including vaccine-preventable diseases.

3. To promote health awareness among students in order to avoid self-damaging behavior such as smoking and promote healthy life styles such as proper dietary practices and physical exercise.

4. To maintain a healthy and safe school environment.

5. To promote community participation through participation of students and parents in targeted school health and community-based activities

Organization of school health services:

1. The Departments of Education and Health are jointly responsible for development and implementation of extra curricula health educational programmes and activities that help to promote lifeskill-based education, encourage children to assume responsibility for protecting own health and promoting healthy practices in their communities.

2. A School Health Committee comprising representatives from the Departments of Education and Health will be established at Headquarters level to define the overall policies and strategies relevant to school health activities that need to be implemented through a system-wide approach. The committee will hold meetings, as may be necessary, to pursue such issues in accord with an agreed upon agenda. Representative from the Departments of Relief and Social Services and Operational Technical Services may be invited to participate in such meeting as the need arises.

3) School Health Committees will be established in each school with representatives of teachers and students to undertake activities relevant to promotion of environmental and food safety matters, promote healthy behaviour, encourage participation of children in decision making, and organize special health activities, including health exhibitions and competitions.

4) The Education Department may take advantage of parents’ meetings to raise public awareness and enhance community-participation in health educational/ promotional activities.

Programme activities:

In order to be effective, school health services need to be implemented in closecoordination with teaching staff. The services comprise thorough medical examinationof new entrants, booster immunizations, screening of fourth elementary and firstpreparatory school children for vision and hearing impairments, screening of studentsin the first and third preparatory classes for dental and periodontal disorders,promotion of healthy life-styles, maintaining a healthy school environment andensuring optimal food safety standards.

New entrants’ medical examination

(i) Relevant information on the past medical history and previous Immunizations administered during the pre-school period should be considered as an integral part of the requirements for registration.

(ii) The entrance medical examination should be comprehensive involving all body systems including, in particular, testing for weight, height, vision, squint, hearing, congenital malformations, heart disease, respiratory diseases including bronchial asthma, external genitalia for undescended testicles, iodine deficiency disorders as visible thyroid enlargement, scabies, pediculosis and physical disability. The medical examination should be complemented by dental examination carried out by dental surgeons/mobile dental teams.

(iii) The anthropometric profiles of school children should be assessed based on the body mass index values (BMI) established in the CDC reference table. Children whose body mass index is at two standard deviations above the mean (overweight/obese) or two standard deviations below the mean (stunted) should receive special attention.

(iv) Children who, as a result of this examination, are diagnosed as suffering from vision impairment of ≥ 6/9 or hearing defects should be referred through the appropriate channels for assistance towards the cost of eye glasses/hearing aids.

Screening activities

1.The target groups for screening activities comprise pupils in the fourth elementary and first preparatory classes.

2.Screening for vision and hearing impairments should be carried out according to the following multi-stage process:

(a) Phase I - Teaching staff will carry out preliminary screening by use of simple vision charts to identify children who have vision difficulties. They should prepare lists of children who have/or who are reported by their parents to have hearing problems for subsequent examination by medical personnel

(b) Phase II - Medical officers in charge of school health and school medical officers will use vision charts and audiometers to examine children prescreened by teaching staff to confirm or rule out the need for correction of vision and hearing defects.

(c) Children identified by medical personnel as having ear infection or wax will be treated, followed up and reassessed to confirm or rule out hearing impairment.

(d) Children identified by medical personnel as suffering from vision an/or hearing impairments will be referred by medical personnel to specialists (ophthalmologists or opticians) for establishment of the diagnosis and advice on the management including issue of eye glasses/hearing aids.

3. Head teachers will maintain an effective information and feedback system to/and from parents to ensure that children with physical impairments or morbidity conditions receive the recommended care and follow up.

Immunization:a) Immunizations will be carried out by nursing staff either in health centres or in schools and should be recorded on the School Health Record.

b) Where immunizations are to be carried out in schools, the estimated daily requirements of vaccines and disposal syringes should be obtained from the Field Pharmacy or the nearest health centre, as the case may be, against a Stores Demand Note and should be kept in a vaccine carrier supplied with ice-boxes during transportation and immunization.

c) Children, who for any reason, could not be immunized on schedule should be followed up and vaccinated in due course.

d) First primary vaccinated against Td and oral polio myelitis first

preparatory girls MMR or rubella third preparatory school Td .

Follow-up on children with special health needs

.1 Identification and care of children with special health needs, through out the school cycle, represents an essential component of integrated school health services.

.2 Medical personnel and health tutors must act as focal points for advising concerned teaching staff on the health condition of children suffering from major morbidity conditions and training them on the appropriate measures that should be taken to prevent specific hazards that children might encounter such as, coma, falling, respiratory distress and should provide assistance and counseling to parents on caring for their children.

.3 School medical officer/health centre medical officers should maintain close working relationships with school tutors and teachers for exchange of information on the health condition of children requiring special medical attention and follow-up.

.4 Medical reports on major health problems and treatment/hospitalization provided to children should be attached to the School Health Record.

Emergency preparedness:

.1 First aid kits should be available in each school .

.2 The head teacher of each school should maintain a directory of all nearby medical and civil defense institutions and their telephone numbers to seek prompt assistance in case of emergencies or accidents affecting school premises and/or school children.

.3 Each school should be equipped with an alarm system and teaching staff trained on safe evacuation techniques/places in case of emergencies such

as fire, earthquakes or violent acts.

.4 Each school should be equipped with fire-fighting equipment and teachers/school attendants trained on use of this equipment.

.5 Pupils who suffer from acute or sudden illness or sustain accidents/injuries at

school premises should be referred to the nearest health facility for medical care using the referral forms.

.6 Medical personnel should arrange in-service training for untrained teachers and health tutors should train members of the school health committees on first aid procedures and help them carry out simple first aid procedures at school. At least one teacher in each school should be trained on basic life support techniques.

Oral health services

.1 School oral health services should focus on promoting oral hygiene and prevention and control of dental caries and periodontal diseases. Teachers and tutors can play an important role in health education of students. They should therefore, ensure that school children are made aware of the fact that the majority of dental problems could be prevented by the simple technique of daily brushing of teeth with a paste containing fluoride.

.2 Dental care to school children will be provided by dental surgeons/mobile dental teams who should organize and supervise educational activities to promote oral hygiene, maintain healthy periodontal tissues through scaling and cleaning procedures and treating carious teeth by appropriate restorative/conservative care.

.3 Oral health examination should be carried out by dental surgeons/mobile dental teams for all new entrants either at health centres or in the schools. Dental screening should be carried out on pupils in the first and third preparatory classes (12 and 15 years of age)..4 The results of dental screening should be used for compilation of genderspecific data on the prevalence of decayed, missing and filled teeth (DMFT) among school children 12 and 15 years old as well as for follow up on children who need restorative care .

Health education

1. The school provides the best learning media for upgrading the knowledge and skills of school children as well as for helping them develop positive attitudes leading to healthy behaviour. This is best achieved through direct involvement of the students in self-learning and community-based activities.

2. There is adequate evidence that effective life skill-based education helps to prevent self-damaging behaviour such as smoking and physical violence and that awareness of school children and adolescents on proper dietary habits, physical activity and appropriate family and reproductive health concepts, including ways and means of transmission of HIV/AIDS and sexually transmitted diseases, helps to promote healthy practices later in life. These major issues will continue to receive special emphasis through maintenance and development of appropriate educational material implemented as extra curricula enrichment material.

3. School tutors, counselors and teachers can play a key role in school health educational activities and training programmes. They should also involve the pupils in activities related to current health problems and encourage them to participate in community-based health promotional activities such as health exhibitions and competitions.4. Arrangements should be made by health and teaching staff to ensure wide distribution of the self-learning material on prevention of smoking and prevention of HIV/AIDS and to observe the world health days by organizing appropriate health promotional activities in accord with the globally recognized themes, such as the World Health Day, the World No Tobacco Day etc.5. Teaching and health staff should jointly organize training programmes for school attendants on various health hazards that may result from violence or poor hygienic and safety precautions including miss-handling of detergents, insecticides or pesticides.6. Teaching and health staff in the Fields shall jointly organize training programmes for canteen employees on the types of food items/drinks that should not be allowed on the school premises as well as on safe-handling of food.

School environment

A hygienic and safe school environment is essential for proper learning and working conditions for both pupils and teachers. Daily life at school should give the pupil the example and the opportunity to acquire healthy life skills and adopt positive attitudes conducive to healthy behaviour.

School sanitary facilities:

1) Every school should be provided with adequate hygienic sanitary facilities.

2) Sanitary facilities, playgrounds and surroundings should be maintained, cleaned and kept free from any hazards that could endanger school children or expose them to accidents.

3) The school medical officer/health centre medical officer should complete the inspection form for each school at least once during the school year. Copies of the inspection reports should be submitted to the Field Family Health Officer for subsequent transmittal to the Area Education Officer for action, as may be required, in coordination with concerned staff.

School canteens/cooperatives:1) Medical officers assigned to health centres located within reach of Agency schools and school medical officers will inspect school canteens as part of their visits to schools in order to ensure maintenance of acceptable standards of hygiene and cleanliness as well as compliance with food safety standards and provide feedback to head teachers on any aspects that require corrective action.2) The specifications of food items/drinks that are recommended for sale through school canteens as well as food items/drinks that should not be on sale because they interfere with balanced nutritional requirements or involve risk of disease transmission are provided in annex VIII to this instruction.3) Food handlers in school canteens should be examined at least once yearly to ensure that they are free from and properly treated for infections that could be transmitted to school children.

Other facilities:

a) The Department of Education will ensure that safety precautions are known and implemented in school laboratories especially with regard to proper handling of chemicals.b) Upon their visits to schools, medical personnel should bring to the attention of head teachers any observations relevant to safety such as holes, rubble or harmful objects that could endanger school children.

Special programmes:

There are several programmes implemented through a system-wide approach such as programmes for early detection and management of disabilities and psychosocial welling. Such programmes are currently implemented in certain Fields and will be expanded to all Fields subject to availability of funds. Ongoing programmes at present comprise:

De-worming of school children:Intestinal infestations are highly prevalent in the Agency’s area of

operation especially among children. Consistent with WHO/UNICEF strategy for reducing the burden of intestinal parasites, a programme of de-worming of school children should be implemented in all schools using the single dose highly effective antihelminthic agent administered once yearly for three

consecutive years, starting at entry to school. The supplies will be provided by the Department of Health and the programme implemented in collaboration with teaching staff.

Micronutrient supplements:Micronutrient deficiencies, including iron deficiency anaemia, iodine

deficiencydisorders and vitamin deficiencies, still constitute major health problems thataffect school performance and impair cognitive development.Programmes for supplementation of micronutrients will be implemented asmay be decided by the Agency or the host authorities. The supplies will bemade available to schools by the Health Department and the programmeimplemented under the direct supervision of teaching staff.

Psychosocial wellbeing:A programme is already in place in Gaza Strip and the West Bank forproviding psychological counseling and support to vulenerable groups, inparticular, children. Teaching staff can play an active role in detection ofbehavioral changes among school children and referring them to psychosocialcounsellors, who may provide the necessary support or refer students, whoneed psychotherapy to the appropriate specialized institutions. Trainedmedical and teaching personnel can also play an active role in preventing theadverse consequence of stress-related-trauma on school children byorganization of promotional activities that help them develop appropriatecoping mechanisms to overcome anxiety and distress.

Information system:School Health Quarterly/Annual Report:

This report should be completed by the school medical officer/medical officer in-charge of school health and submitted to field office at the end of each quarter, namely quarters ending November,February and May of the school year. A consolidated Annual Report onschool health activities undertaken during the full school year should becompleted at the Field Office .

Evaluation:Evaluation of school health services will be undertaken by analysis of

statistical data reported from the Fields during the school year or through special health services research, as may be determined by the Departments of Education and Health.

Indicators for evaluation of the health status of school children and outcomes of care will comprise, but not limited to, the following:

1. Percentage of new entrants examined of all new entrants enrolled in schools, by gender.

2. Percentage of school children screened for vision and hearing impairments, by gender.

3. Gender-specific prevalence rates of vision and hearing impairments among school children screened.

4. Gender-specific prevalence rates of profound physical disabilities among students examined/screened.

5. No. of school children assisted towards the cost of eyeglasses and hearing aids.

6. Gender-specific prevalence rates of decayed, missing and filled teeth (DMFT) among children 12 and 15 years of age.

7. Percentage of children who received de-worming medicines.

8. Percentage of children who received booster vaccinations