School health services
Over 2.3 billion school age children spend one third of their time in schools. Schools therefore constitute a unique setting to help children and adolescents to develop a positive outlook on life and help them establish healthy lifestyles. Yet global mortality and morbidity estimates in children and adolescents suggest that school aged children have significant needs for health promotion, prevention and health care services.
For many school age children school health services are the first and the most accessible point of contact with health services, with a potential to regularly reach most school-age children with preventive, curative and supportive health interventions. School health services are a very common model of service provision in both high- and middle and low-income countries – at least 102 countries have either school-based or school-linked service provision.
School health services are part of the whole school approach that is promoted by WHO through the Global School Health Initiative launched in 1995. The initiative supports countries to implement the four pillars for Health Promoting Schools: 1) Health promoting school policies 2) Safe and healthy learning environment, 3) Skills-based health education, and 4) School-based health and nutrition services.
Recent guidance from WHO and other UN partners - the Global accelerated action for the health of adolescents (AA-HA!): guidance to support country implementation - gave a new impetus to school health by recommending that “every school should be a health promoting school”.
WHO is working to support Member States in strengthening school health services. This work will support the implementation of the WHO's 13th General Programme of Work, and more specifically its targets of “1 billion more people benefitting from universal health coverage” and “1 billion lives made healthier” by 2023.
Norms, standards and guidelines for school health and school health services
WHO is currently synthesizing evidence to underpin a new WHO guideline on school health services to guide countries on what services have evidence of effectiveness, and what services should be abandoned as there is evidence that they are either not effective or are not cost-effective.
In partnership with UNESCO and other partners, WHO is working to develop Global Standards for Health Promoting Schools as part of the initiative Making Every School a Health Promoting School. Standards for school health services will be part of this guidance.
The European framework for quality standards in school health services and competences for school health professionals aims to support the 53 Member States of the WHO European Region to develop and sustain school health services as part of their national health systems. The framework, which is focused primarily at national- and regional-level policy-makers responsible for school health service standards and service quality, can be adapted by individual countries to enable them to develop services that reflect their specific health priorities and health systems.
Actions for country impact
WHO provides technical assistance to governments and partners to strengthen school health services as part of national school health programmes and initiatives.
The Pan American Health Organization supported Member States to conduct assessments of school health programmes, including school health services. The assessments informed the regional meeting “Improving the health and wellbeing of school-aged children and adolescents in the Americas” that took place on 11-13 June, 2019, in Washington, DC. The purpose of the meeting was to engage stakeholders from 18 LAC and Caribbean countries in a regional dialogue on the current status of school health based on the results of the regional assessment and country experiences, and to jointly identify actions to strengthen school health in the region.
The WHO Regional Office for Africa supported 29 Member States to take stock of progress made in school health in the African Region. Country teams reviewed progress and planned action to strengthen school health programmes during a regional consultation involving government officials, representatives of United Nations agencies, international NGOs, bilateral agencies, civil society organizations and young people’s organizations operating at the global, regional and national level.
The European Network of Health Promoting Schools was launched in 1992 and today Health Promoting Schools exist in 40 Member States of the WHO European Region. The WHO Regional Office for Europe facilitates policy dialogues with countries to introduce the international experience, research evidence and best practices in school health and health-promoting schools, as well as to identify major challenges and key actions towards establishing “every school in the country is a health promoting place”, primarily focusing on prevention of NCDs.
The WHO Regional Office for Europe provides technical assistance to countries for the implementation of the European framework for quality standards in school health services and competences for school health professionals. Based on these standards Kazakhstan, the Republic of Moldova, Uzbekistan and other countries are making progress towards strengthening the contribution of national school health and school health services programmes to adolescents’ positive development.
To support the implementation of the European Framework, the WHO Regional Office for Europe is building institutional capacity in countries for adolescent and school health training. In February 2019, the government of Armenia hosted an intercountry Adolescent Health and Medicine training of trainer’s course that took place in Yerevan, Armenia on 4-8 February 2019. Faculty staff, policy makers and health-care providers from Armenia, Georgia, Kazakhstan, Kyrgyzstan, Russian Federation, Tajikistan and Uzbekistan developed more effective skills in teaching and advocating to improve the quality of health care and preventive services delivered to school-age children and adolescents.
Experiences from countries in school health and school health services
There is a variety of ways that school health services are organized in countries. Countries can learn from each other in this respect, and reflect which model is best suited to their contexts. Five models for the provision of school health services, and experiences from Albania, Republic of Moldova, Tajikistan, United Kingdom, Ukraine and USA were described in the International Handbook on Adolescent Health and Development: The Public Health Response.
- Pairing Children with Health Services: The Changing Role of School Health Services in the Twenty-first Century
- School Health Services in Former Socialist Countries: Case Studies from Albania, Republic of Moldova, Tajikistan, and Ukraine
- School Nursing: Making a Difference in Adolescent Health and Well-Being
- School Health Services to Meet Adolescent Needs in the USA
Case studies on school health services from Morocco, Portugal, Rwanda and USA were included in the Global Accelerated Action for the Health of Adolescents (AA-HA!): guidance to support country implementation, main document and its Annexes.
Evaluation of school health services and school health programmes
WHO and partners are working towards a monitoring and evaluation framework for the Global Standards for Health Promoting Schools. A web-platform will be developed to facilitate students’ and parents’ engagement in monitoring and evaluation of the performance of their school against Global Standards. Key indicators will be aligned with existing global monitoring systems for input, process, outcome and impact indicators, such as the Global School-based Student Health Survey (GSHS), the Health Behaviour in School-aged Children (HBSC) survey, and other surveys.
Global Accelerated Action for the Health of Adolescents (AA-HA!): guidance to support country implementation