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WPRO - 28

SEMINAR ON CillLD HZALTH AND THE SCHOOL

Sponsored by the

HORLD HEALTH ORGANIZATION REGIONAL OFFICE FOR THE lV-ESTERN PACIFIC

and the

UNITED NATIONS EDUCATICNAL, SCIENTIFIC, AND CULTURAL ORGANIZATION

WPR/292/62

MANIIA, PillLIPPINES

27 November - 8 December 1961

FINAL REPORT

NO!' FOR SALE

PRINTED AND DISTRIBUTED

by the

REGIONAL OFFICE FOR TH8 WESTERN PACIFIC of the 1ior1d Health Organization

Manila, Philippines June 1962

NOT E

The views expressed in this report are those of the

advisers and participants at the Meeting and do not neces-

sarily reflect the policy of the ·World Health Organization.

This report has been prepared by the Western Pacific Regional Office of the .~-orld Health Organization for govern-ments of Member States and for all who participated in the Seminar on the Child Health and the School, Manila, November-December 1961.

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ANNEX.

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TABLE OF CONTENTS

UST OF PARTICIPANTS ..................................

INTRODUCTI ON ............. -.............................................................. .. ORGANI ZATI ON .. ........ ..

AUSTRALIA

CHINA (TAIWAN)

FRENCH POLYNESIA

HONG KCNG

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LIST OF PARTICIPANTS

PARTI CI PANTS

Mr. R. E. HALLIDAY Superintendent of Youth, Physical

and Health Education Division Education Department of ~estern

Australia

Professor ThOOlas srAPLErON Director Institute of Child Health Royal Alexandra Hospital

for Children

Miss Shu AI-CHU Director Provincial Junior College of Nursing

Dr. Lee SHU-PEl Head Professor of Health Education Department and Chief of

University Health Center

M. Robert MEDARD Inspecteur de l'Enseignement Primaire Adjoint au Chef du Service de

l'Enseignement de Polynesie Francaise

Miss Clara KO c/o The Director of Medical

& Health Services Medical and Health Department

Mr. Choy KWOK-BING Health Education Officer Education Office

• JAPAN

KOREA

MALAYA

NETHERLANDS NEW GUINEA

NI!lr1 ZEALAND

PHIUPPINES

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Dr. YasatGru SUGIURA Assistant Professor University of Saitama

Dr. Yawara YAMANAKA Assistant Chief, Tuberculosis Prevention Section Public Health Bureau

Dr. Kim Choo SUNG Director School Health Centre

Mr. Hyun \'[00 YOUNG Health and Physical Education

Teacher

Dr. H. K. VIRIK Paediatric Consultant General Hospital

Dr. H. J. F. Van ITERSCN Deputy Director Department of Education

Dr. H. W. A. VOORHOEVE Head of MCH Division Department of Health Central HOEpital

Dr. D. R. WILLS Superintendent of Physical Education Department of Education

Mrs. Luisa A. ALVAREZ Chief, Health Section General Education II Bureau of Public Schools

Dr. Josefina B. BALEA Chief, ill vision of MCH Bureau of Health Services

TERRITORY OF PAPUA AND NEW GUINEA

SINGAPORE

VIEl' NAM

UNITED NATIONS CHILDREN'S FUND (UNICEF)

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Mr. V. BANDONI 11 Sanitary Engineer Department of Health Region I, Dagupan City

Mr. Honorio PAm: ON General Office Supervisor

of Health Education Bureau of Public Schools

Dr. Joan J. B. REFSHAUGE Assistant Director Infant, Child and Maternal Health Department of Public Health

Major Fam Foong HEE Inspector of Schools Ministry of Education

Dr. Lai Kuen YEE Health Officer, Rural Medical Department Ministry of Health

Dr. Pham Hinh CHAU Medecin du Service de Medecin Scolair de Saigon

Mme Trinh Thuy NGA. Professeur, Lycee Trung-Vuong

OBSERVERS

Mr. Paul B. EI1NARDS Resident Representative UNICEF Country Office Manila, Philippines

Dr. Amansia MANGAY (alternate) UNICEF Country Office Manila, Philippines

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lNTEI/NATI aNAL UN! ON FOR ) HEALTH EDUCATION (IUHE) )

WORLD CCNFEDERflTlON OF ORGANI Zi,TIONS OF THE TEIl.CHING PROFESS[ ON (WCOrP)

CATHOLl C INTERNATIONAL EDUCATION OFFICE (crEO)

Dr. E. M. ALEXANDER

Miss M. ARGO

Dr. F. MORT1\.RA

Dr. P. ORAT1\.

Mr. B. T. PIERCE

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Mrs. Cristina MAMURI Bureau of Public Schools Department of Education Manila, Philippines

Dr. Joaquin QUINTOS Catholic Educational Association

of the Philippines Manila

SECRETARIAT

Regional Adviser on Maternal and Child Health

WHO/WPRO, Manila (Secretary)

Public Health Nurse (School Health) San Diego, California, U .• S.A. (Consultant - WHO)

Medical Officer, Maternal and Child Health WHO Headquarters, Geneva (Consultant - WHO, Rapporteur)

Dean of Graduate Studies Philippine Nonnal College Manila (Consultant - UNESCO)

Head, Regional Centre for Educational Information and studies

UNESCO, Bangkok ( Secretary)

Miss E. SCHNEJ:DER

Miss L. M. TURNBULL

Dr. G. R. WADg,[ORTH

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Specialist Health, Physical Education, Recreation and Safety

Department of Health, Education and ~lelfare

Office of Education ~iashington, D.C., U.S.A. (Consultant - \-THO, Seminar Director)

Regional Adviser on Nursing 'I1HO!I'1PRO, Manila

Regional Adviser on Nutrition WHOjwPRO, Manila

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1. INTRODUCTI ON

The first proposal for a Seminar on School Health to be convened by the World Health Organization (vJHO) in the Western Pacific Region was put forward in 1956. It lias felt that while most countries and territories in the Region were giving attention to sane fonn of school health programme, in many instances more emphasis ..,BS being given to the detection of physical defects than to health education and the provision of a healthy school environment. There was indication thnt health and education authorities were becoming increasingly altl':lre of thei.r responsibility for protecting and improving the health of school childrGn; therefore it seemed timely to convene a Seminar for healt hand eudcation personnel to discuss improvement:. s of the total school health progr~mme which includes health services, healthy living, ~.nd health oducation.

The Seminar was approved by the WHO Regional Committee for the Western Pacific in 1959 at its tenth session, ~nd included in the vJHO Regu1:>.r Progr3llll!le a.nd Budget for 1961 (Official Records No. 97, p:lge 285).

Following exploratory discussions, the Director-General of UNESCO early in 1961 accepted the invitation of the Director-General of WHO for joint-sponsorship of the Seminar by the two Organizations, and offered to provide the services of a consultant from one of the interested countries in the Region and the p.:lrticipation of a UNESCO representative •

Plans for the Seminar IV'ere discussed with Dr. A.F.lVi.K. Rahman, Director, UNESCO Regional Office for Educat ion in Asia, Bangkok, during his vim t to Manila in May 1961; advantage was also taken of the presence of Miss E. Schneider who visited the Regional Office en route to N~N Delhi in July 1961, to allow for more detailed prelinunary planning for the Seminar. (Miss Schneider had been invited to act as a temporary advisor to the WHO r(egional Office for 60 days beginning the middle of October. She later WGS named Seminar Director.)

Letters of invi tati on :rcrc sent by ;'iHO and UNESCO to Ministries of Health and of Education infonnine them of the Seminar on Child Health and the School to be held in Manila 27 November to 8 Decanber 1961, and stating the objectives of tho Seminar as follows:

(a) to identify some of the most import:mt health problems of the school-age children and youth in the ~'Jestern Pa.m.fic . .Region;

( b) to consider ways in \-1hich the school can contribute to meeting the health needs of the school children through its own resources and in co-opereticn with parents, health 9.guncies :1nd other organizations;

(c) to indicate various methods, possibilities anQ resources for improving and oxtending health programmes for schoo1-age children and youth in the countries and territories of the Hegion.

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It was proposed that the participants should include both health personnel and educators. It was pointed out that while nomination of candidates was entirely a matter for the Governments to decide, it would be very helpful if the health \-lorker nanina ted were an individual wi th administrative responsibility for the planning and development of health programmes for school-age children, and if the educator Were an administrator with responsibility for assisting in the development of policies relating to the health of children in school or to the health instructional progranune.

Prior to the Seminar, participants were requested to supply country informaticn on &:hool health and for this purpose two outline guides were prepared, one far health and one for education personnel. It was suggested that where possible the participants co-opemte in preparing this informati on.

Arrangements were made for the Seminar Director to make a number of field trips in Malaya, Singapore and Viet Nam in October and early November.

2. ORGANI Zf.TION

The first Seminar on Child Health in the School, jointly sponsored by the World Health Organization C-iHO) in the #estern PacifiC and the United Nations Educational, Scientific, and Cultural Organization (UNESCO), was held at the WHO Building in Manila fran 27 November to 8 December 1961.

A reference library of beoks and periodicals on various aspects of the school health programme was ph ced at the di~osal of the participants. Available also .rere samples of rna terials brought by t he participants. The working lanb'llages of the Seminar l-lere English ond French.

There were twenty-four participants from twelve countries in the Region and three observers, one representing the United Nations Children's Fund (UNICEF), one for both the International Union for Health Education (IUHE) and thevlorld Confederation of Organizaticns of the Teaching Profession (vJCarp), and one for the Catholic International Education Office (erEO). As for participants, observers, and staff, see List of PartiCipants (p. ii-vi).

The Nedical, Educational, and Public Health Nurse Consultants each contributed a \-lorking p3.per. The Seminar Director prepared a fourth paper consisting of extracts from selected Expert Committee Reports and a synthesis of the country reports. All of these dccuments were used as references throughout the discussions.

In the week precedine the Seminar detailed plans were discussed and outlined by a working party ccnsisting of the Consultants, the Operational Officer, several members of the w~O Regional Office staff, and the Seminar Director. DurinG the Seminar, day-to-day arrangements were

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made by a Co-ordinating Committee consisting of the same staff who had attended the pre-seminar conference, plus the UNESCO representative and two persons nominated by the participants.

Evaluation qURstionnaires were distributed twice during the Seminar.

3. CONDUCT OF THE SEMINAR

The programme of the Seminar included plenary sessions, STlall group meetings, a field visit to the Philippine Community School Training Centre at Bayambang, opportunities to view films and slides, and to examine reference materials, including those brought by participants.

Several methods were used for discussing the subject matter of the Seminar. Certain topics were presented in plenary sessions by a speaker, followed by panel and group dlscussions. Opportunities for several kinds of small group discussions were proVided. Host of trese groups brcught together health and education personnel; sometimes groups were made up of personnel with similar problems or of personnel with like professional responsibilities. In each instance the group selected a chainnan and a rapporteur. The informality of too discussions made it possible to explore problems, agreements, am differences of opinion objectivel¥. Everyone had an opportunity to enter the discussions. The Seminar staff served as resources to all groups. The reports of these working groups were then considered and discussed in the plenary sessions.

4.1 Opening Session

The Seminar was fonnally opened on 27 November 1961 by Dr. I.C. Fang, WHO llegional Director, who stated that this was an especially significant meeting since it is universally reccgnized that manls future depends largely upon the health and well-being of the world's children and youth. He emphasized the uniqueness 01 the group in that it represented many different backgrounds in the fields of health and education. This diversity, indicated Dr. Fang, illustrated a growing appreciation of the prinCiple that co-operative and co-ordinated action is essential to the solution of child health problems. He pointed out that some inescapable factors must be faced such as the shortages, which exist in most countries, of personnel, money, facilities, and equipnent, and that the Seminar could be of definite help to c~untries in the liegion by making practical and realistic suggestions for meeting these shortages and related problems.

In concluding, the wHO Regional Director expressed the belief that increaSingly children will have opportunities to achieve their full health potential, in keeping wi th the philosophies, values, customs and cultures

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of a particular country. He wished the participants well and h?pe~ that the Seminar W'culd be an enriching experience for all who took part l.n l.t.

Speaking for UNESCO, Mr. Benjamin T. Pierce said t ~ t his . Organization took great pleasure in participating in the Seml.nar and l.n collaborating with the ~'Iorld Health Organization in bringing it to pass. He described the establishment in Thailand, under UNESCOls sponsorship of the International Institute for Child ~tudy, :md disclosed that the Institute I s research in T~i villages had shown the health problems of children to be one important elanent among. the causes of school failures. UNESCO, said Mr. Pierce, places great faith in the Seminar as a tool for coping with what may at this time appear to be difficult problems.

4,2 Technical Discussions

4.2.1 These were opened with a talk by Dr. F. Mortara calling attention first to the title of the Seminar. He said that l.hat made it particularly interesting was the implication it carried of an intimate relationship between what happens in school and the health of the child. This was not a new concept but one which had received very little attentim in many countries. As for the membership of the Seminar, its inclusion of health personnel and educators working in many different capacities within the total school health programne was a significant develop11ent. It could be thought to represent in itself the accomplishment of one of the aims of the Seminar. Certainly, said the speaker, educators and health personnel had met before, in certain countries more often than in others. As a rule, however, opportunities such as this one for a joint study of the problems involved had been far too few .•

Dr .. Nortara turned then to his W'orking paper w-hich had been distributed to participants in advance of the Seminar, and underlined certain points which deserved particular attention. funong these, he mentioned the planning of the school health programme in which school health committees at various levels can playa very important role. These committees can be particularly useful in assisting school authorities in establishing pricrities and in enlisting all available help. Another area which needs scrutiny is the role of the school health services. The speaker expressed particular concern .::lbout what happens after the medical examination. He pointed out that unless facilities are available and used for the treat-ment of illnesses and defects discovered, the periodic medical examination of school children is of ve~ little use.

Dr. Mortara stated that health education and the adequate preparation of teachers for health education had been the object of much study in ma qy countries. There are innumerable books and articles on this subject, including the recent report by the Joint WHO/UNESCO Expert Committee on Teacher Preparation far Health Education. 1 it useful contribution of this Seminar would be to consider ways of applying some of the suggestions made

1wJ.d. Hlth. erg. techno Hep. Series, 193.

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under the different circumstances prevailing in the various countries of the Region.

The provision for healthful school living is often a mtlch neglected area. It is an unfortunate and not unconunon experience tlnt the school does not practice what it teaches. The speaker saw in this situation an area for possible fruitful discussion at the Seminar.

Finally, Dr. Mortara mentioned the need for continuous evaluation of the school health programme and the many opportunities for research.

4..2,.2 Dr. P. Orata also spoke to the parti~ipants in a plenary session. He forwarded the concept that health is a way of life. He stated that health education is commonly taught as a subject, often with unsatisfactory results. For the teaching to be effective, he indicated tlnt theory learned should be integrated With life and applied in actual healthful practices and habits. This 'may call for a re-orientation in the actual meaning of health education.

The speaker called attention to the importance of establishing scientific bases to support health education. In rural areas such practices as compo sting and the growing of vegetables and fruits by the pupils may effectively integrate health teaching.

Dr. Orata suggested simplification of health education metrods in the school. In his opinion the subject should be taught as casually as possible so that pupils get used to it as a natural practice. One of the objects would be to lead children to the formulation of simple principles in their O'Wnwords. Application of these prinCiples should not be left to chance. Demonstration by the teacher is useful and should be followed by guided practice. A logical outcome of this method would be the carryover of these practices by the pupils to their homes. Thi s could help bridge the gap between good health practices and less healthful practices.

In speaking about the services given them by such health personnel as the nurse, physician, dentist, and nutritionist, Dr. Orata suggested that the teacher should encourage and educate the children and, through them the parents, to appreciate such services and do their utmost to co-operate with the health personnel before, during, and after the service is rendered.

In the discussion which followed these presentations, several points were made:

(a) Health education in school

The problem is much less one of limited funds and facilities than of re-orientation of teaching. Demonstration and guided practice are far more effective as teaching methods than theory alone. Recognition of wmt is already good and effectively practiced by the people one works with is important.

Several points of view were expressed regarding health teaching in primary/elementary schools and some believed it advantageous to integrate health and science; some felt that health teaching should not

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be a separate subject but should permeate the entire school curriculum.

(b) Health education in the community

Several persons thought it possible to reach the parents through the children. It was suggested that one should try to get away fram the practice of telling people what to do, how and when; . ODe shou~d instead, as far as possible, get people to ask the reason behind pract~ces and thus develop their interest in health matters.

(c) School health services

The follCMing suggestions were made:

(1) Better use could be made of existing health facilities through co-ordination of services and continuous co-operation of personnel providing them.

(2) The voluntary assistance of local physicians can often be enlisted and can be valuable.

(3) The family has definite responsibility and should be encouraged to look after the health of the children.

(d) Role of teachers

It was stated that the teachers should not be expected to shoulder the entire responsibility for the health of pupils but should share i t with families and conununity. Conunonly, tea chers ara not valued for their interest in health. Only public demand will get the school to act in the field of health as effectively as in other areas. Populations with a high level of information on health problems are more likely to demand increased efforts in health education.

4 .. 2.4 Haw countries in the Region are meeting the challenge -Two plenary sessicns were dedicated to brief, extemporaneous

reports by each participant on conditions in his country. These reports, highlighting conditions, problems, and advances in the various countries, gave the participants insight into the characteristics of the Region.

Synthesis of reports

At another plenary session the Seminar Director gave a synthesis of too informati on provided by the participants through the questionnaires distributed to them in advance of the meeting. This presentation was followed by discussion.

Miss Schneider reported that the information supplied by the partiCipants on the school health programme reflected the ver,rwide range of conditions existing in the Region. Some problems and conditions seemed

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to be common in most countries, such as:

(a) Shortage of physicians and nurses

In most countries there is a shortage of trained school health personnel. Contributing causes appeared to be budgetary limitations, lack of training facilities and lack of willingness of physiCians, in particUlar, to join the health services in view of the greater financial rewards of private practice.

(b) Lack of dental services

(c) Shortage of facilities for providing a healthy school environment

(d) Lack of co-operation on the part of the children's families

(e) Lack of interest in health education on the part of teachers

(f) Lack of co~ordination between education and health authonties

On the positive side, various measures of success were reported in meeting sane of the most serious problems, for instance:

(a) Health education councils or school health committees have been instrumental in L~proving health teaching in schools •

(b) Educat ion of parents has resulted in great improvement in health practices by the children. Nany reports emphasized the vital importance of health education programmes for adults.

4.2.6 The role of the school nurse

The subject was introduced by the nurse consultant, Miss Argo, who reviewed the functions of the school nurse in all areas of the school health progr9JlllTle. A discussion followed, first by a panel and later by the entire group.

Miss Argo remarked that much had already been said about the needs of children and the various difficulties encountered by schools in their attempts to meet these needs. Nurses can make a particularly important contribution to the health programme, as they often are part of the health team which is in close contact with the children I s families. She invited the panel and all the partiCipants to give particular consideration in the discussims to: the administrative plans for the nursing service as a part of the school health services; the function of the school nurse and her preparation; and the skills essential for too implementation of nursing services •

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In the discussion that followed, various points of view were , expressed in amplification of the Nurse Consultgnt's outline of the funct~ons of the school nurse. It was thouCht by some participants that the nurse should be present and actively participate in the planning of the school health programme.

Her role in Z1.v1.ng in-service tr2.ining to teachers to improve their participation in the health programme was also emphasized. Different,views were expressed concerninG the availability to the teachers of the pup1.1sl health records. Hhile some participants recoenized the advantage of the teachers having access to this information, others felt that it is the duty of physicians to keep all medical records confidential, disclosing to the teachers only that information considered important for them to have. It was agreed, however, that in any case the child's health and educational records should follow the child throughout his school attendance so that complete information may always be available.

(a) Administrative considerations relative to school nurse functions

lihere policy makinG bodies at administrative level exist, appropriate health personnel (e.g., doctors, nurses, sanitarians, dentists, teachers and school administrators) should be included to help formulate policies affecting their respective disciplines in school health programmes. The lines of authority, responsibility, and communication should be clearly defined, whether nurses are employed by the schoel or outside organizations. This applies to all health personnel.

In making policies, the following subjects should be taken into account: leave (annual, sick and maternity), duties, responsibilities, qualifications, uniforms, transportation allo:lances, tenure of office, standing orders by doctors, control of canmunic~ble disease, referral defect correction, health records and reports. If nurses are required to teach formally, then they should be prepared for thn t purpo se.

(b) Co-ordination and co-operation for tho implEmentation and improvEment of the total school health pr9grarmue

Co-ordination of work is essential at the different levels: national, provincial, local and school.

The nursine group recognized that child health in the school is only one part of the family health servico in the community. The nurse has an important rOle to play in being the liaison officer inteerating the health of the family into the school and vice versa.

The follow-up after the health inspection and t he medical examination is to facilitate the correction of defects found in the child. In order to assure effective on-going programmes, the administration should be responsible for making studies, for example, of annual weighing and measuring procedures, the periodical medical examinations, record keeping, etc. Nurses should be involved in these evaluations.

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Nutrition and the school

The subject was introduced by Dr. G.R. Wadsworth, WHO Regional Nutrition Advis0r, and was subsequently taken up by a panel. Later the discussion was opened to the entire group •

Dr. Wadsworth stated that nutrition refers to a state of the body; foods and diet can be considered as a separate topic. School teachers may be concerned both with the nutritional status of their pupils and also with instructing them about foods and dietary habits.

In some places children do not get enough to eat. This in itself is not conducive to their taking part in systematic scmol activities. The situation is made worse when even the youngest children use up energy in walking many miles to school from their homes. Gross malnutrition would not be expected to occur in children of school age to the same degree as in childrEn aged one to five years. However, in areas where children are poorly fed, the school may lave to undertake feeding programme" designed simply to alleviate under-nutrition. These progranmes may involve the issue of skimmed milk or the provision of a full school meal. In some places the children are obliged to prepare their own meals Wi. th little or no supervision. In others, "snack bars" or "tuck-shopsn may be nearby where children can purchase snaIl amounts of food. These shops are usually not supervised as to hygienic conditione or the kinds of foods they sell.

Certain dangers should be recognized in school meals services. In sane places when school meals have been ,;iven to children to improve their nutrition, parents lave correspondingly decreased the foods given the child at home. Close school-home co-operation would reduce this danger.

The potential effects of nutrition activities in schools must not be ignored. There are instances in which the diet of communities has been changed within a few years as a direct outcome of new dietary labi ts learned through children receiving a school lunch. In another instance a school garden established by a school teacher was copied by the local community Which, for the first time, became an exporter of vegetables to surrounding places. An example of a different sort was the increased sale to the public of a relatively expensive milk preparation following its use as a routine diet supplement for schocl children.

In many pla ces in this region children aged from about one to five years are particularly liable to develop malnutrition. Not only are nutritional requirements highly critical at this stage of life, but these children are most often neglected by parents. It is not generally appreciated that the young child needs a better quality diet than \he adnlt. Mothers with large families who help in farm work may often neglect the child as an individual. Much good can be expected from inculcating the habit of proper attention to the feeding of each member of the family. This can be done at school by orgam.z:Lng a IIfamilyll system of school feeding. In some schools, feeding is organized so that children are fed in snail groups,

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one of the older girls acting as a "mott~r.

Inclusion of agricultural subjects in school cur:icu~a is hi~hly desirable in communities in which adults spend much of thell' hfe groWing just enough foods to keep alive. Children should be taught about such . . things as crop rotation, mixed farming, irrigation, and the use. of fert~l~zer. School gardening should be associated ~th teaching about t~ s~mple economics of food Production, and the use of garden produce ~n home economics classes.' At all etages simple lessons in hygiene should be given, such as the need to wear shoes when fanning to prevent hcokwonn and other infestati ens.

Turning to the objectives of nutrition education, Dr. Wadsworth said that as a result of the wide application of food technology the foods people eat nowadays may be different in a number of ways from those available previously. Owing to the use of insecticides, and drugs in modern agriculture and food processinG, harmful chemicals may be present in foods. As for the world food supplies, the production of protective foods does not seem to increase at the same rate as the population so that the over-all situation may be said to be worsening, but with appropriate application of present lmowledge this could be remedied. Children should be made aware of these food and nutrition problems in ways understandable to them, as part of their general education.

It is extremely difficult to judge the state of nutrition of children on general appearances; much reliance is placed on how children are growing, and this emphasizes the importance of keeping accurate records of height and Weight. Such records, however, are useless if they are not analyzed. From the point of ViEM of an individual child, a temporary sloWing down of Growth rate may be a sensitive index of faulty nutrition, which in turn may have resulted, for example, from trouble in the home. In any group of children, especially near adolescence, great variability of size is found. In one survey girls varied in weight from about twenty-five kilogrammes to as much as eighty kilogrammes, although all were of the same chronological age. Moreover, size was dir8ctly related on the average to the stage of development. I t might be questioned whether it is sui table to teach such a varied colle ction of inm vi duals as a hcmogenous group. It is important to realize at least in more advanced communitias, that nowadays children seem to be grcwing bigger and maturing sooner than in previous generations, and this may have something to do with school feeding programmes. This change is not necessarily good and seems to be leading to the development of sociological problems.

Dental disease is a serious problem in many countries. Schools may help preven.t such condi tions by encouraging children to eat foods which need chewing such as corn-cobs, by planting citrus and other fruit trees near the school and encouraging chHdren to eat too fruit, and by teaching children to avoid eating sugary preparations.

Much useful research could be done in schools. For example, although very large amounts of milk are b~ing given to school children throughout the Region there suems to be little objective information on whether it is doing any good. There is a naed to observe Whether food

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supplements, school feeding programmes, and nutrition education lead to the lowering of sickness rates and improved scholastic achievement •

We are now moving rapidly, concluded Dr. Wadswroth, into a new era of human disease patterns. 'fJhereas until recently common diseases could often be successfully treated whep they began to produce symptoms; in advanced communities the dominant and killine diseases are those which can no longer be successfully cured once symptoms have developed. Such conditions include diabetes, cancer, heart diseases, and chronic rheumatism. Therefore, it is becoming increasingly important to discover the essential causes of these abnormalities so that prev£ntive measures can be devised. But essential causes may already be operating in childhood or even earlier in life. It is SUCgcsted tm t observations of height and '.eight, of dietary habits, and other circumstances if carefully made could be passed on to health aut ho ritie s when the child leaves school. Individuals with such records could be observed during adult life to find out whether childhood characteristics have anything to do with adult disease.

After Dr. ifadsworth's speech, a nurse participant reported on the successful use of volunteers in her country to relieve teachers in milk distribution to school children. She also emphasized the importance of parental attitude. Not infrequently parents are primarily responsible for negative attitudes of children towards certain foods.

Another participant gave an account, illustrated by the projection of slides, of a situation where the government has adopted a policy which gives to nutrition teaching an important place within the school curriculum. School gardens were developed and a school feeding programme implemented.

One physician discussed the nature of the nutritional problems existing in the area in which she works and outlined the school feeding and nutriticn education programme. A great deal of useful information about nutrition and the preparation of foods is given to boys and girls in such courses as home economics or domestic science.

In the discussion that followed there was an exchanEe of views concerning the value of measuring periodically the height and weight of the children in order to detennine thmr rate of growth, and indirectly, their nutrition status. It was thought that taking these measurements twice a year may give the desired information, wi. thout unduly taxing the teachers.

It was pointed out that teachers are likely to become enthusiastic about school feeding programmes once they see the improvement in children1s learning which often follows. A situation was reported in which the school feeding programme is not administered by the school, but by an association of parents; this scheme has the advantage that parents feel the responsibility for feeding their o~. It was reported that occasionally in countries where economic conditions are good and the population well fed, milk distribution to school children does not seem justified and may even lead to over-nutrition and excess weight.

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Public information and public relatioo.s in the scrvice of the school health programme

Mr. J. Milwertz, WHO Regional Public Infonnation Of~cer, introduced the subject. He said that public information a~d public rel~tl.ons form pa:-t of the emerging science of ccrnmunications. Basl.cally, technical co-~peratl.on is a ccrnmunicatioo. process, the ccnveying of knowledge in the most s:unpl~, practical and effective ways so that people may act upon that knowledge l.D order to improve their lot.

Informaticn is dissGIni.nated in many ways, through the written and spoken words and the visual image presented in a variety of forms. The press, radio film, and television are now used to reach people on a mass scale. The m~jor purpose served by the information media is to keep people informed of the world in which they live. A second function of the mass media, as an instrument of education, is of growing importance especially in the developing countries.

Haiever, if the media of mass communication are to be effective in education, as well as in inforna tion, then facts must be presented in a learning situation whicn provides opportunity for individuals to consider, question, discuss and explore. Hence, close co-operation is necessary betwcen the mass communications specialist, or the information officer, and the educator. In a recent UNESCO report to the United Nations (Mass Media in the Developing Countries, 1961), mass media were said to offer in the developing countries "the greatest possibilities for effective action" in mass educati on. After discussing the characteristics of good audio-visual programmes, the speaker illustrated SOlIE of tre points he had made wi th audio-visual demonstratione.

Relating the topic of his presentation with the subject matter of the Seminar, Hr. Milwertz concluded that public information properly used in connection with the introduction or expansion of school health programmes can help to create public interest, sympathy, and eventually, participation. It can be particularly useful in helping to influence those sections of society from which leaders arc drawn am which influence the decision of authorities. The media of mass communication may also prove to be effective tools in health education of the community.

During the discussion that followed, many participants confirmed that the mass cooonunication media, especially radio, cen be usefUl in health education. It was felt tmt this medium may be particularly welcome by people who live in isolation. The possible uses of tape recorders and of drama were also mentioned.

Regarding the use of printed materials, it was pointed out that frequently adults who have learned to read with considerable effort have no opportunity to employ this recently acquired skill owing to the lack of reading materials. Their eaeerness to read creates an excellent opportunity for providing health education.

A word of caution was expressed against using audio-visual aids to prusent situations which could be reproduced easily in real life for demonstration

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purposes. The view was also expressed that a continuous evaluation of all media of communication is necessary in order to make sure that results justify the effort.

The subject of environmental sanitation as part of a healthy school environment was introduced by Mr. J. Blaeske, ~lHO Sanitarian. The speaker outlined the various components of a well-rounded programme of environmental health in the scheol. He pointed out that such a procramme ebould take into consideration not only the immediate environs of the school, but also prevailing conditions in the area, one of the objectives of the programme being to bring about improvement in the community by way of the child. He stressed that it is possible to solve many environmental sanitation problems by practical and relatively inexpensive means in the interim until the ideal method can be afforded. Another point emphasized was th3.t the facilities must not only be adequate and available but must also be used. He illustrated important concepts by giving sevGral examples of correct and wrong approaches.

Many of these pOints were further stressed in the ensuing discussion. The need was mentioned for instructing children in handwashing, using a minimum amount of water when it is in limited supply. Towels are not indispensable and if in short supply, children may be taught to dry their hands in the air. The use of the same towel by many children may carry some danger of spreading infection. In all areas of 6nvironmental sanitation, teacher-parent or school-home co-operation is essential. Economical solutions to problems are often available.

4.3 field vim t

On 4 December 1961, the p~rticipants Visited the Philippine-UNESCO National Community Training Centre at Bayambang, Pangasinan. The train trip through the interesting cc·untryl!lida gave the conferees an opportunity to become further acquainted with the land and its people. The Superintendent of the Centre and the staff gave warm greetings to the group as they arrived.

The Assistant Superintendent and other members of the staff officially welcomed the Group in the assembly h.3.ll of the Centre. A group of prospective teachers with a leader presented choral numbers representative of the Philippines.

The Superintendent described the Training Centre. He highlighted the general objective of the Centre which is to provide le9.dership in developing the community as an effective means of improving living conditions in the rural communities of the Philippines.

He explained the central purposes of the Centre as they were expressed in the original agreement between UNESCO and the Philippine Government on April 5, 19511

(a) the preparation of teachers and other leaders of communit,y schools;

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(b) the demonstration of too use of methods and techniques, which lave been tried in community school work and found productive of

good results;

(c) the development. of new methods and techniques;

(d) the demonstration of new methods and techniques;

(e) the preparation and printing of materials for adult education am community school;

(f) the evaluation of community school practices;

(g) too publication and distribution of reports and bulletinc on the community school;

(h) the development and demonstration of good school practices for the normal school, high school and elementary school, which includes adult education (also out-of-school youth).

The group then toured too Nonnal School classrooms, libraryl laboratories, and outdoor experimental projects. This was followed by a visi t to the laboratory school Where there was an opportunity to observe teachers and children at work and play. AlthouGh the time was short, trere was opportunity also to become acquainted with the Bayambang Community High School, the Bayambang Central Elementary School and several Barrio Schools and projects.

To most observers the experiences were rewarding and enlight-ening. The participants were impressed with the earnestness with wbich the future teachers participated in their teacher training activities, the quality of leaderShip in all the schools observed, the warmth arnmg human beings which existed in the classrooms, involvement of the Barrio (village) residents, and the ideals and values upon which the community school concept builds.

Upon returning to Manila, there was discussion of the visit. As was to be expected, there were differences of opinion regarding certain aspects of the programme, but in the main, tribute was paid to the excellent work being accomplished at the Centre.

4.4 Closing session

Before the closing of the Seminar by the WH) Regional Director, Dr. Fang, a participant selected by the group expressed appreCiation to WHO and UNESCO for h3ving organized the Seminar. He indicated that for the most, the Seminar had provided a welcome opportunity for reviewing all phases of the school health programme in varying ~ircumataoceB. Particularly useful had been the presence of education and health personnel which permitted approaching problems from a uniquely broad point of view.

In his concluding remarks, Dr. Fang expressed the hope that the exchmge of information and experience which took place during the Seminar would continue beyond the closing of the SEminar. He assured all participants

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that in the months and years ahead, the World Health Organization would be ready to be of assistance to governments to the best of its ability.

5. CCNCLUSIONS AND SUGGESITCNS FOR ACTI,,)N

·5.1 Identification of major health needs

The Seminar considered the following health needs of a school child to be of special significance:

(a) protection from diseases;

(b) appropriate medical and dental care;

(c) healthful environment;

(d) adequate nutrition;

(e) sufficient rest and sleep;

(f) sui table physi cal activity;

(g) sense of security arising from the feeling of being wanted, understood, accepted and respected as a person and as a member of his family, school, and community;

(h) assurance that the challenges he will be expected to meet are realistic and consistent with his capacity •

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5.2.1

Meeting the health needs of children

Planning the school health programme - _--.''''-Effective co-ordination of the activities of the Ministries of

Health and Ministries of Education to improve all aspects of school health work is vital. The group considers it important that Joint School Health Committees be set up at Ministerial level. These committees should be widely representative and should enlist the co-operation of all groups interustod in SChool h(alth. ~J.rt of the work of the Joint Ccrn.mittee should be aimed at securing co-ordinative action at all levels in connection with the health of school children. It might be advisable to have comparable committees at other levels.

Plans should be made to establish priorities through systematic studies or surveys of existing problems, noeds, and available personnel, facilities, ani equipment.

In planning health education, healthful living and health services in schools, local and national authorities should draw up a list of priorities according to sound and workable criteria. When this is done, responsibility for discharging obligations can be clearly established so that needs are met by the designated agency or department, separately or co-operatively.

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5.2.2 Health protection

Daily classroom observation of school watch for poor health habits, personal hygiene, signs of illness and diseases is essential.

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children by the teacher to abnormal conditions, or for

The school should have policies regarding procedures to be followed in cases of illness, accidBDt, or emergency.

* * * The education of family members in detecting early signs of

illness is a primary responsibility of the community health programme; desirably the school co-operates with the health authority.

* * * There should be continuity of maternal and child health, pre-

school and sChool health services.

* * * Wherever possible, the child's health record should be brought

to the attention of the doctor who is exarrrl.ning the child in a school medical examination. These records can either be kept by the parents, the school, or/and the agencies concerned.

* i~ * Certain eye conditians of school children, e.g. faulty vision,

infection, Vitamin A deficiency, may result in serious damage to the eye-Sight. PreVentive measures are therefore important and early detection and treatment of these conditions is essential.

Medical services

The functions of medical services include the following:

(a) rendering medical advice and consultation on health programmes, health education, health problems and preventive measures;

(b) periodical physical examination or inspection of school children;

(c) follow-up and correction of physical defects and attention to other health problems;

(d) diagnosis and treatment of diseases in children referred by school teachers or nurses.

Prevention of communicable diseases

An awareness of the common communicable diseases of school-age children in the respective countries is essential for the development of suitable preventive programmes.

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Agreement on policies regarding measures for the control of comrmmi cable diseases should be established jointly by the .health and education authorities.

* * * Formulation of specific regulations on immunizations for schoel

children against communicable diseasqs is the responsibility of individual countries.

Immunizations in schools should be a part of the total community programme.

Attention am encouragement should be given to families and children to receive immunizaticn. Explanation of reasons for specific immunizations should be given in conjunction with the services; whenever possible, family members should be involved.

{~ * * In areas where other health services are non-existent, the school

should make its facilities and services available to the community for immunization programmes. Since tetanus is a hazard to children everywhere, and especially to those in farming communities. immunization of all children is justifiable if the east can be met •

* * * The spread of communicable diseases in schools can be reduced if

there is early detection of abnormal conditions by family members and the ailing child is kept at home and referred to a physician for early diagnosis and attention.

Nutrition

The school health programme should give particular attention to the nutritional status of children. Teachers can help to detect mal-nutrition and doctors, nurses and teachers share responsibility for giving advice on food habits.

By and large, efforts to improve the diet ought to concentrate on the improvement of local products rather than on the importation of foreign products since emphasis on the latter may cause economic problems.

* * ~~ There should be co-ordination at the planning level as well as at

the action level among such departments as agriculture, health, education, and public works.

* * * Attempts should be made to control food advertisements and childrm·

should be educated to develop a critical attitude towards advertising.

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It is desirable that food vendors in schools be licensed and supervised. In school oanteeNI careful attenti en should be given to the storage, handling, preparation and serving of food.

* * * When appropriate, it is advisable to include in the school

curriculwn agriculture and animal husbandry in relation to nutrition. Parents should albo have access to the school to improve treir knew-ledge and techniques in these fields.

* * * Nutrition education can be made more meaningful through the use of

such devices as flannelgraphs, market expeditions, wax models, film strips, bringing samples of food to the school, school gardens and so forth.

Height and weight records, a useful means for assessing the nutritional status of children, also offer an opportunity for teaching about growth and development.

Additional suggestions for nutri ti en education include:

(a) providing information which will make children increasingly able to select the correct foods;

(b) hOOle gardens;

urging boys and girls to produce more food, e.g. school and

(c) encouraging the use of inexpensive nutritious foods, e.g. peanuts, undermilled rice, soya bean;

(d) pointing out that foods, in addition to being nutritious, should be prepared so that they are attractive and tasty.

5 .. t.6 Dental health

Because the high rate of dental caries in school children is one of the major health problems in the countries of the Region, it is essential that the school, the home, and the canmunity make every effort to help children improve their dental health.

The school should take a major part in dental health education. Among the points to be stressed are:

(a) the importance of detection and treatment of dental caries and abnormal oral conditions;

(b) the use of individual and clean toothbrushes;

(c) the provision of adequate time for practice of oral hygiene, both at home and in the school;

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(d) the value of including hard foods in the diet;

(e) discouragement of excessive use of SW'eet foods and drinks;

(f) the need for proper diet in pregnancy as an important measure for building healthy teeth in the formation period, e.g. in mothercraft classes, motrers' clubs and adult education.

* * * For effective implementation of dental health programmes, the

following suggestions may be of importance to sane countries:

(a) appropriate dental hygiene practices and proper nutrition should be anphasized in health educationJ

(b) training of dental nurses, to give appropriate dental treat-ment and health education, under the supervision of dentists, may be indicated.

(c) fiouridation of water where such is needed (WHO Technical Report Series No. 146).

* * * . In order to secure data which might be useful for the prevention of

dental caries among school children in developiI"€ countries, it is suggested that expert technical studies be made of dental conditions among certain populations where the incidence of dental caries is low.

* * * Environmental health

Within the means available and with ccnsideration for the habits, customs and beliefs of people, the school must be a model of a clean and healthy environment which sets an example in the coITllTlUllity. A minimum of realistic sta.rds and follow-up seem necessary for the improvement of the school premises and surrounding areas; in addition, persuasion campaigns can help bring about desirable changes in attitudes and habits.

* * * Planning for the improvement and proper maintenance of health and

sanitary facilities in the schools is a constant responsibility of the school administration. The implementation of these plans will require the joint co-operation of teachers, other staff and children, as well as the cOJlllllUllity.

* * * As far as possible, school buildings should be expected to meet

certain standards developed by health and education authorities. Arrangemente need to be made in all instances to provide safe drinking water, sanitary handwashing faCilities, and waste and refuse disposal.

* * i~ Scientific information should be sought for a safe method of using

human excreta as a fertilizer. Tre "two-stove latrine" idea might be investigated further.

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In some areas water seal toilets of the squatting type are more acceptable than others. The structures should comply wi th local customs and resources.

Handwashing facilities should be adjacent to toilets. Where there is no piped water, children can be educated to take turns in co.rrying water from the source of supply and to improvise suitable methods for using the available water to best advantage.

Garbage and refuse may be used for camposting.

* -~ * The basic elements of envirormental health must be included in the

school curriculum.

* * * Children, particularly the older ones, may help keep the classrooms

clean as part of their education in healthful living.

Students, especially in rural areas, can be taught to help in the improvement of sanitation in the villages, e.g. constructing drains, building sanitary latrines, etcetera.

School children should assist in maintainini a healthful school environment, e.g. they should lGarn habitually to follo',; clean tojlet practices, where necessary by means of danonstrati. m, guided practice, a nd follow-up until

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the correct habits are formed. ~

The influence of healthy living can extend to the hanes and the comrrrunity from the schools, e.g.

(a) parents may be invited to the school to see how toilet facilities are kept clean so that they can apply comparable procedures in the home;

(b) together, parents and students can clean up am beautify the school premises;

(c) as a community service, st.udents may even help to clean the village or roads near the school.

5.2.8 Safety

Safety education is a part of health education, and should be under-taken by teachers Vlho need to be adequately prepared for this work.

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The following examples illustrate what might be included in safety education:

(a) emphasizing accident prevention, in relation to falls, poisons, drowning, fire, suffocation, road aCCidents, work hazards, and other potential dangers;

(b) inviting traffic police and representatives of voluntary safety organizations to the schools to give lectures and demonstrations;

(c) utilizing activities, such as a traffic game in which a piece of ground is laid out with miniature roads, signs, traffic lights, etc., children go about these roads on bicycles and pedal cars with "traffic police-men" around to guide traffic and give advice. In this ;yay children learn to observe traffic laws, to be courteous on the road, and to gain traffic sense,

(d) conducting a safety week in co-operation with other community agencies,;

(e) utilizing safety pamphlets and posters in the school and in the community.

Other traffic safety measures: a system of traffic control may be provided by school personnel, children or responsible persons outside the schools where children have to cross the road going to and from school. In sane countries, it has been found helpful for children going to and from school to wear clothing such as yellow caps, which make them conspicuous in traffic •

5.2.9 lIiental and emotional health

Organized community effort should be encouraged and developed for improvement of the emotional and social environment in hanes and in the school, and for the promotion of mental health as a whole.

* * * There must be love, affection, and a sense of security in the home

and in the classroom. While scholastic success is important in a teacher, a real affection for children is essential. In assessing teachers, this quali ty should be taken into consi derati on. The recruitment of teachers wi th unsuitable temperaments should be avoided.

Shortage of personnel, overload in teaching and other responsibilities may affect the interest, emotional stability, vitality, energy, and health of the teacher. This in turn affects the relationship between teachers and the children. It is recommended that the number of teachers be increased in proportion to increases in the number of school children.

* * * Good relationships between supervisors, teachers, and school children

should be fostered through mutual understanding and democratic practices in teaching and supervision.

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Multiple sessicns in schools may interfere with the regular pattern of meals at home, decrease opaortunities for classroom ventilation and cleaning-up, disturb the life pattern of school children, reduce e~ra-c~ricular activities, over-tax the teachers' vitality and energy (wlll.ch nll affect the quality of teaching) and may also provide extra leisure time in which school children engage in undesirable activities. While multiple sessions in schools appear to be unavoidable as a temporary measure in some countries, the effects of such school organization upon the health of children and teachers need further study".

* * * Pressure for high academic achievement, and emphasis on excessive

competition, may add mental burd~ns and stresses on children, parents, and teachers which create undue anxieties, conflicts, and emotional upsets. The effects of examination systems on the health of children needs further stuqy. The curriculum should be sufficiently adaptable to provide far the differences in children's capacities.

* * * The home environment may affect the child adversely, e.g. parental

neglect, lack of love and affection, heavy work at home, noise from mah-jong or radio, etcetera.

In certain circumstances, the use of a Simple school uniform may help lessen the effects of wide differences in social and economic status.

* * * Sufficient and suitable physical exercise and rest in schools not

only ,romote physi cal development in children, but also promote social and emotional well-being.

S.3 Health education

Preferably, health education in primary/elementary schools should not be tr~ated as a separate subject. In secondary schools, it may be desirable to provide health education as a separate subject. In the training of teachers, however, it should be treated as a separate subject which includes first aid. In the teaching of other subjects, health implications Should be brought in wherever possible.

Health education can be given formally or informally, directly or ~ndirectly. It should be taught as a living subject whenever possible, not ~n the abstract. The real success of health teaclnng can in part be judged by the health practices the children habitually follow, and by the status of health of the school children.

Health education is most likely to be effective when~

(a) instruction is based on scientific facts which Will help overcome superstition, taboos, and ignorance;

(b) emphasis is placed upon motivating children to apply what they learned in supervised and unsupervised situations;

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(c) the programme extends into the homes and neighbourhood in which the children live.

* * * Continuous assessmmt and evaluation of teaching metlxlds and

materials is essential, to ensure effective health education •

5.3.1 Personnel

5.3.1.1 Teachers

In primary and elementary schools, every teacher should be a teacher of health, not only through instruction and the provision of an environment which encourages healthful living in the classroan, rut also through example and action. '.fuen teacher education is oriented to this concept, teachers are more likely to participate in the school health programme with efficiency and enthusiaSlll. Methods should be devised for including practical aspects of anticipated teaching situations in the curriculum of teacher training so that prospective teachers may become familiar with, and able to meet, conditions that may face them later on, e.g. how to keep the school and the premises clean; various ways of making unsafe water safer; haN to store and use water conservatively; how to recognize the common diseases of children in an area; and hew to work with a variety of health personnel.

The use of itinerant specialists for valuable contribution to the teachers in the schools through pilot projects. school Visits, refresher courses, and similar techniques is suggested •

* * * Pre-service and in-service preparation of t1achers for health

education is discussed in an Expert Committee Report; this report might well be studied by those concerned wi. th teacher education.

5.;3.1..2 Nurses

The contributions of the nurse to the school health progr'l.!llIlIe are many. One of her most important functions is to act as a liaison between home and school. The versatility of her contributions make it necessary that the content of her training be wide and varied.

The shortage of nurses makes it advisable to utilize their time and skills to best advantage. It is recommended that the reports of two Expert Committees be consulted: (1) Expert Committee on SOCial Health Services,2 and (2) Expert Committee on Training of Health Personnel in Health Education of the Public. 3 These publications are valuable references which deserve wider distribution to those planning school health programmes.

IWHo TeChnical Report Series No. 193. 2wHO Technical Report Series No. 30.

%mO Technical Report Series No. 156.

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5.3.1.3 Resource persons

Personnel who are reasonably accessible to the school can make valuable ccntributions to the school programme, e.g. sanitarians, local health officers, nutritionists, agricultural specialists, etc. ·:c .•

5.3.1.4 Auxiliary personnel

In areas where there is a shortage of professional health staff, it may be necessary to train auxiliary personnel according to the particular needs of the country.

5.3.1.5 ~~~ary services

Appropriate partiCipations of individuals 3.nd voluntary organizations, e.g. parents, Red Cross, Child Welfare Associations, etc., in the school health progrrumme should be encouraged. Such voluntary assistance can make great contributions not orily to the improvement of healthful living, but also in carrying out tasks in school which may allow richer use of professional and auxiliary workers. The use of voluntary aid sll"luld be explored and stimulated insofar as the developnent of the community permits. In some instances, having adults work i'lith the school might be a first educational step towards greater participation in community activities.

5.3.2 Recruitment

In some countries, differences in salary between teachers, nurses and other professional personnel result in poor recruitment and high staff losses. Hea Ith personnel and teachers should have terms and conditions of employment which attract the highest calibre of recruits and are consistent with the dignity, duties and leneth of training of these professions.

* * * The recruitment of health and education personnel needs more

study in terms of local customs, and salaries; the study of these problems should be conducted by competent committees at various levels.

5.3.3 Facilities

Attention should be given to the full use of existing facilities and equipment. Often, improvisations can be made which contribute to the health needs of children, as, for example:

(a) (b) ( c) (d) ( e)

rebuilding desks or altering chairs to suit growing children; painting wood to serve as blackboards; using banana leaves in absence of toilet paper; utilizing loc~l materials for toilet construction; using bamboo tubes for drip-washing facilities~

It is likely that many countries in the Region have information on such improvisations and it would be useful if it were disseminated through such agencies as WHO, UNESCO or other international agencies.

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Every school should have a properly equipped multi-purpose Health Room which could be used by all health personnel and for first-aid treatment, demonstrations, rest, etc. Ivhere this is not possible, efforts should be made to improvise a suitable facility.

* * i~ Physical education equipment, either purchased or improvised,

should be supplied to the full extent of local possibilities.

* * * School facilities should be made available during out-of-school

hours, including week-ends and vacations, for youth and adult activities, e.gs

(a) equipment;

school workshops for community use, such as repairing farm

(b) home economics buildings for teaching of nutrition and mothercraft to out-of-school girls;

(c) school grounds for demonstration of improved agricultural techniques;

(d) school buildings and grounds as recreation centres.

!5.3.4 Health education materials

There is a dearth of health education reading material at the child! s level. Textbooks in reading, languages, general science, and arithmetic should nave a health bias. Such an emphasis can also be extended to books read for enjoyment. All such books should be prepared by qualified persons who have had special training. In some countries the central Ministries of Education produce written materials including periodicals for children. It would be advantageous if persons responsible for these publications were encouraged to include materials and articles on health education.

Given the important strides which have been made in the use of radio in school programmes, it wruld be advantageous if fuller use were made of this medium to reach the comllnmi ty as well. Health campaigns should be well planned with the help of the best specialists available and care should be taken to assure that only one subject is treated at a time. In such campaigns it is also essential that there be co-ordination of all media, such as mobile cinema, television, talks and demonstrations, plays, marionettes, posters, and film strips.

5_4 International action

There are many ways in which international agencies can assist individual countries. Thos e recognized as particularly appropriate for the Region at this time include:

(a) dissemination of infannation on health and health education which has been found useful in the various countries;

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(b) helping countries, at th:Jir request, in the implementaticn of actittl programmes;

(c) convening furthbr international meetings for the purpose of exchanging ideas and experiences as has been made possible in this Seminar;

(d) grantiIl6 fellolfships and scholarships for training of personnel and providing experts to assist in local training programmes;

(e) facilitatinL exchange visits of professionally qualified personnel.

References has been made to certain concti. tions and problems which merit further stu~ (internationally, nationally, locally). It is suggested that the following studies be conducted:

(a) the effect of multiple-session programmes upon the health of children am teachers;

(b) the effect of child labour on child health and learning;

(c) the prevalence of emotional problems arnmg children in highly developed countries and in developing countries;

(d) the effects of examina ti m systems upon t m health of children;

(e) the effects of food supplements, school feeding programmes and nutrition education on sickness r3tes and scholastic achievemmt of scheol children;

(f) factors cmtributing to the low incidence of dental caries in certain populations.

The Seminar gives its fullest support to tm proposed project for the training of teacher educators in the Philippines by UNESCO, and urges that adequate health education be included in their preparation.

One means of improving health education is by the information between countri8s Iii th similar ch2racteristics. exchange between individuals responsible for the production materials or information should be encouraged and aided.

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exchange of The direct

of such

Close co-operation should be continued between United Nations Agencies and such organization as the ~lJorld Confederation of Organizations of the Teaching Profession (HCOTP) and other international non-governmental organizations concerned with the health and education of children.

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REVIEl'l OF COUNTRY REPORTS

The Reports received provide valuable information relative to the Seminar theme on child health and the school. The responding countries illustrate the wide range and diversity of conditions found in the countries and territories of the Western Pacific Region. However, it should be kept in mind that the Background Reports are not official statement s. Participants were not nominated as representatives of Governments; rether, they were selected for their qualifications and ability to contribute to the exchange of information at the Seminar.

The excerpts included under each sub-heading have been taken directly from country reports. Since countrie~ are not identical, no attempts were made to link them together.

1. BRIEF DESCRIPl'ICN OF SCHOOL HEALTH PROGRAMNES

(a) Administrative responsibility for school health services, healthful environment, hLalth education

Country philosophy and government structure vary greatly within the Region, consequently there is no single pattern for administering school health services. In some of the responding countries major responsibility for such services lies wi 1jh the hinistry of Education, in others with the Ministry of Health, and irJ a few responsibility is divided. The extent of co-operation varies.

The following excerpts from the Reports submitted by participants for Seminar use indicate where responsibility for certain aspects of school health programmes is placed in the different countries:

The Ministry of Education is responsible for the administration of school health and the l':!inistry of Health and Social Affairs co-operates.

The ~linistries of Education and of Health have jOintly promulgated a Standard of School Health Programme in which the aims, organiza-tion, personnel, budget, activities (including health services, health teaching and school environmental sanitation), etc. of the Programme have been stipulated.

* * * The administrative authority for the school health service is the Ministry of Education with guidance and advice from the Ministry of Health.

* * * Education at school is the responsibility of the Department of Cultural Affairs, i.o. Department of Education as far as health

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ANNEX -

education is concerned; the Department of Public Health, as far as medical control of pupils and teachers and the condition of the school buildings are ccncerned.

The Dducation Act provides for the appointment of school medical officers to examine children attending school; notify the parents or guardians of any such child of any disease or bodily defect; and report on the condition of school buildings and grounds, 'lnd upon any other matter affecting tl18 health of children. The school medic~l service is under the control of the Department of Health and is administered by it.

Officials of Education and of Health Departments work m nd-in-hand.

School medical and dental services are administered by the State Department of Health.

(b) Organization and scope of health services for children in or through the school

There is great diversity in the scope of services and the availability of personnel, resources, and facilities. In a few countries schools have the services of physicians, dentists, nurses, and other personnel, especially employed either by Ministries of Health or of EducatioD. Children who live in urban areas have more access to such services. However, efforts are being made in some places to provide children in rural areas with the kind of assistance they need, such as floating cliniCS, helicopter service, dental clinics, and mobile clinics which move about from placG to place.

The following selections fran Country Reports give an interesting over-view of the variations in health services provided for children:

The functions of the Sohool Health Service are as follows:

1.' Kedical examination of school children and medical check-up of school personnel.

2. Supervision of sanitation in schools.

3. Home visits.

4. Operates school clinics for treatment of minor cases; also travelling dispensaries visiting rural schools.

s. Prevention of infoctious diseases, including BeG vaccination. 6. Gives school dental service, operates school dental huts

and mobile dental clinics.

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All school staff participate in varying degrees in the health service;

The principal of the school has responsihi.lity for the total school health services •

The health co-ordinator, frequently a head teacher has responsibility for co-ordinating school health services and accelerating the in-service education in health for teachers in his school.

The school nurse arranged the documents, drugs, records, and equipment in a health room; makes preparation far the health examination; provides health guidance; gives first-aid treatment.

The classroom teacher makes every attempt to maintain environmental sanitation of his classroom, to be skillful in health observation of children, and to provide appropriate health guidance to his pupils.

The school physicians, dentists, and pharmacists serve tr~ school on a part-time basis. !hey give advice on professional matters.

The health centres co-operate with the schools, particularly in the prevention of corr~unicable diseases, X-ray examinations, health education and environ;nental sanitation to the best of their human and material resources.

The health service is under the control of the Public Health Departlllent and the Ninistry of Health, ani the role of the teachers is that of a sympathetic co-operator with the personnel responsible for performing the services according to the official standard of the school.

It is suggested that every school should set up a health council or committee to plan, promote, and conduct the school health programmes. School administrators, teachers, physicians, and nurses usually are mEmbers of the health councilor committee. In addition the committee might include a dentist, a sanitary enf,ineer, a health educator, and others.

The committee's functions are as follows:

1. Training of teachers and health personnel in school health and health education, in-service in nature, and conducted periOdically.

2. Project planning on school health programme such as school health services activities, sanitation; school nutrition programme.

3. School health supervision ~ health supervisors (inspectors) at least twice a year •

4. Production of health education materials, audio-visual aids such as pamphlets, charts, posters, slides, and motion pictures.

5.

6.

7.

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Survey and study of school health problems and sanitary conditions for evaluation and for future planning.

Recommendation of regulations governing school health practices and standards.

Budget makinG in reg~rd to financial aid to schools in relation with special health projects or activities.

j\ljedical, dental, and nursinc; services are organized by the Department of Health. The medical and nursinG personnel and part of the staff of the local district health office of the Department of Health provide service for schools under the control of the Director of the Division of Child Hygiene. The school dental service is under the control of the Director of the Division of Dental HYbiene. It is organized by District Dental Officers and School Dental Nurses. The service is based on dental clinics that serve a group of schools and are built by the education authorities on school grounds that are in most central position. Because the school dental service has insufficient staff, older children (including post-primary children) are cared for by dentists in private practice, under arrangements made by the School Dental Service.

School nurses, officially known as public health nurses, not only supervise the health of children at school under the direction of school medical officers, but also co-operate with school staffs on health education proGrammes and act as social workers by visiting homes and advising parents on health matters affecting their children.

Child health clinics have been organized by the Department of Health. Zach of these has its own social worker. The psychologist in each clinic is the Department of Education's local psychologist. Psychological clinics are organized b:r the Department of Education. viider aspects of social work are covered by Departmont of bducation Child ~Jelfare Officers and visiting teachers.

Health services are available to pre-school and school children. In practice, owing to shortaGe of staff, very li tt le is dore for post-primary school children other than BCG vaccinations. Treatment is not provided. Immunization is carried out in infancy, usually by private practitioners, aGainst diphtheria and \-1hoopin[ cough. BoostGr immunization is eiven on entering school. Recently, polio immunization has been offered to all children. Social Security Services look after emergencies whether illness or accident; private or hospital medical treatment is available to all without charge.

Collaboration with the teachers is close through: discussion with the school staff on health matters, including aspects of the health education programme, lessons to children by public health nurses and school dental nurses, and school visits to health exhibitions. Teachers co-operate in preparing children for health examinations, and hold the children's individual health records along with their sch~ol records.

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Co-operation with the home is ensured by inviting parents to be present at medical examinations of their children at school and by visits to the home by public health nurses.

Medical Officers give talks in the evenings to parents and parent-teacher groups.

1.

2.

3.

4.

5.

6.

The role of the nurse in the school health programme is:

Examination of all children: as new entrants, in Standard II, in Form II.

Selection of defective children for medical examination.

Discussions with teachers on health matters.

Talks to children on health matters.

Follow-up into homes when desirable.

Contact with visiting teachers, child welfare officers and other outside agencies.

Health cards are kept.

The school health services in services in rural areas are under the supervision of health stations or centres. Nemcal and nursing personnel of the health stations and centres usually help in school physical examinations, preventive inoculations, or in treatment of illness or emergencies.

School teachers get the co-operation from parents through personal interviews with parents, home visiting, parent-teacher associations, mothers and sisters clubs or by correspondence.

* * * In the villages the pupils receive treatment from patrolling native

medical orderlies. Every principal of a village school is provided with a bottle of quinine. Every teacher is X-rayed at least once a year. Patrolling missionaries usually carry a first-aid kit with them.

Periodic Health Examination

There are evidences that in most countries the shortage of qualified personnel makes it impossible to accomplish as much as might be desired. Several references are made to the need for finding ways of utilizing the services of present staff and facilities to better advantage • In many instances, there seems to be a lack of follow-up. The following comments describe the frequencies of health examinations and give clues to follow-up procedures;

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Periodic health examinations for pupils, teachers and other school personnel are carried out in April every year under the school health law. X-ray and parasite examinations may be carried out when they are needed. The examination includes such items as measurement of height, weight, chest aircumference and sitting height; condition of nutrition; presence of disease or abnormality of spinal column and thorax; vision, colour blindness and audition; presence of eye disease, ear, nose and throat disease and skin disease; presence of disease or abnormality of teeth; presence of tuberculosis; presence of parasite eggs; presence of other diseases or abnormalities. Sometimes, functional examinations such as vital capacity, grip strength, etc., may be added.

Within three weeks after the health examination is made, the school must:

1. Give results to children and their parents, and

2. Carry out such appropriate follow-up measures as can be secured;

encourage preventive measures of disease

give advice on medical treatment

point out what examinations are necessary or what immunizations should be given

encourage parents to tam their children to their family physicians

select children for special classes (the delicate, the mentally retarded, the blind, the deaf, etc.)

~ suggest adaption in the school days, e.g. more rest, more exercise

limit partiCipation in school excursions.

Before admission to the school all children are required to submit medical certificates; these certificates can be obtained from the school medical officer free of charge. Certain immunizations are required either before entrance to school or during thE: first year of school life.

Accumulated record is kept of the child's health status. The information is kept confidential and the record kept in the school health centre. Upon occasions the school medical officer and the health service co-operate in the solution of child health problems. The school medical officer makes periodic reports to his superiors, A school health cmtre Will be established in thE: near future in co-operation with tre social

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service. The centre will contribute to the efficiency of the school health programme.

Medical examinations are given to children soon after school admission, as well as periodically at tIE ages of 9, 12, 15, and 18. Follow-up inspections are conducted at 6-monthintervals. Cases with defects found during medical inspection are referred to appropriate clinics for correction and treatrent. No charges of any sort are made unless a participant is hospitalized for causes other than infectious diseases, then a S1llall hospital maintenance fee is required.

Periodic health examinations are given at school, either by part-time or specially anployed physicians, and at health centres and health stations. Treatment and correction of physical defects are done in school clinics. Illness and emergencies are referred to health stations or hospitals. Follow-up of trachoma, tuberculosis and other communicable diseases are done by home visits or by correspondence. A health record is required for every student. Co-ordination with health services for children of pre-school age and after leaving school is seldom done.

Health examination of elementary schoolchildren during 2-3 months before entering school is required by law, and extensive health records are kept.

* * * Annual examinations of Bohoolchildrtm are given early in the school

year. Certain immunizations are required. Adequate provisions are made for maternity leave and illness among teachers.

COOlprehensive health records of individual children are kept in the clinics