Barriers To Effective School Health Program Among Secondary School Teachers
This study sought to find out the barriers affecting implementation of school health program in Orumba north local government area, Anambra State, Nigeria. The study focused on secondary schools within the target location. The government of Nigeria has already developed and disseminated the National school health policy and the school health implementation strategy 2009. However, little is known about the implementation of the policy hence the need to conduct this study. The study was guided by three objectives which are capacity building, support supervision and school infrastructure in relation to how they influence implementation of Comprehensive School Health Program. The researcher used descriptive survey research design where factors influencing the implementation of Comprehensive School Health Program were described as they were. A sample size of 60 respondents was selected using stratified random sampling method from all the 10 secondary schools within the location under study but only 50 respondents returned completely filled questionnaires. Qualitative and quantitative methods of data collection were used to generate the desired data through the use of a questionnaire comprising open and closed ended questions and an interview guide was used for triangulation. The findings were be analyzed using descriptive and inferential statistics and presented descriptively and through the use of tables and figures. The study established that majority of the respondents had not been trained on Comprehensive School health Program and majority of the schools represented in the sample did not have access to clean water hence predisposing students to disease outbreaks. Most schools did not have school health committees and some had inactive school health committee which indicated that the schools did not have structures in place to implement Comprehensive School Health Program. The study also established that capacity building, support supervision and school infrastructure are some of the factors that influence implementation of CSHP and also established that there was a relationship between independent variables which are capacity building, support supervision and school infrastructure; and the dependent variable which is implementation of Comprehensive School Health Program. The findings of the study are expected to contribute to effective and efficient implementation of CSHP and strengthen the capacity of school health committee in dealing with school health. The study recommends training of teachers and BOM on CSHP, gender norms and life skills, collaboration of schools and health facilities and developments of child friendly facilities in schools to assure the safety and health not only of students but also those working within the school. The researcher suggests that more studies be done on engagement of parents in school healthprograms.
1.1 Background to the Study
Integrated, comprehensive and strategic school health programs have greater potential to achieve good results.1 In 1980, World Health Organization (WHO) orientation toward developing healthy structures instead of focusing only on individual behaviors founded a comprehensive approach for the health promotion activities.2,3 The Health Promoting Schools’ (HPS) initiative was implemented in 1995 by collaboration of the health promotion, education and communication sectors, the intra-sectorial school health working group, and the regional office of WHO.4 This initiative highlights capacity development and encouragement of participation, for health which all have been accepted as powerful prerequisites to promote health and empowerment in schools.2,3 HPS addresses the relationship between health and education which is clearly reflected in the Health for All and Education for All goals of the United Nations and also in the social model of health which was corner stone of the Ottawa Charter.4,5 Attention and application of the principles of the Ottawa Charter in schools and the focus has been put on the development of health promotion structures led to the establishment of HPS.2,6
In Iran, with a population of about 75 million and a total of 13 million students, the initiative was first practiced in 2007. A joint agreement between the Ministry of Health and Medical Education (MOHME) and Ministry of Education (MOE) was signed and led to establishment of School Health Management System and also Schools’ Ranking Plan to support and monitor local HPS programs that are exploited within the network of the country’s schools.5 The HPS initiative was first exercised as a pilot program in East Azerbaijan Province at 36 schools in 2009-2010 and later it was expanded to 700 schools in 2011-2012.
HPS has been developed by WHO over the last decade and is being implemented globally.2 Studies on the experiences of participating countries in the HPS have resulted to varying results and challenges. The most important identified challenges were the mobilization of human resources and facilities to implement the initiative, inclusion of societies as whole identities, policy makers, public, private and non-governmental sectors and, also students, their parents and teachers.7 In the first meeting of the Caribbean HPS Network, the main obstacles to attain HPS aims were defined as the lack of continuous funding, insufficient and unstable governmental support, inappropriate development of HPS national networks, limited involvement, and restricted access to education and continuing education.8
The need to strengthen collaboration between the education and health sectors, technical support, and insufficient funding were among the major challenges listed by the European HPS Network.9 Leiger et al. (2001) referred to the insufficient preparedness of teachers and educational institutions in terms of health issues, shortage of time and resources, and weakness of facilities as the greatest barriers to achieve HPS goals.10 In the Eastern Mediterranean Regional Office (EMRO), HPS member countries addressed the insufficient funding and technical expertise, lack of awareness among the political leaders about the program, and also lack of infrastructures as key issues.11 HPS has now been adopted in all EMRO countries, except for Afghanistan and Libya and through using different methods many local networks have been established during the past decade.2,11 In Bahrain, HPS is organized by a committee comprising representatives from WHO and the Ministry of Health. In Jordan, the committee comprises representatives from the Ministry of Health and Education and is directed by the School Health Director-General of the Ministry of Health. Authorities in Lebanon sought help from private and governmental sectors and international organizations to implement the program.11
1.2 Problem Statement
Despite the importance of student health and school hygiene as an aspect of the infrastructure of community health, few feasibility studies have been conducted on school health programs in developing countries such as Nigeria. This study examined possible barriers to and challenges of such programs among secondary school teachers in Orumba North Local Government.
1.3 Objective of the Study
The major objective to the study is to evaluate the barriers to effective school health program among secondary school teachers in Orumba North Local Government.
1.4 Research Questions
- What is health programs?
- What are its advantages?
- (What are the factors affecting its effectiveness in Secondary school?
1.5 Significance of the study
The study will give a clear insight into the barriers to effective school health programme among secondary school teachers. There is however, insufficient evidence about the achievements of the plan and to the best of our knowledge this study will be the first systematic attempt to investigate pros and cons of the executed program to identify potential barriers and challenges school health programme have encountered in Orumba North local Government.
1.6 Scope of the Study
The research focuses on the barriers to effective school health programme among secondary school teachers in Orumba North Local Government.
1.7 Organization of the Study
This study is organized into five. Chapter covers background of the study, statement of the problem, purpose of the study, objectives of the study, delimitations of the study, definition of significant terms and organization of the study. Chapter two consists of literature review which is subdivided into subheadings concerning factors influencing implementation of comprehensive school health program in Orumba north local government area, Anambra state, Nigeria. Chapter three covers research methodology divided into; research design, target population, sample and sampling procedures, research instruments, validity of instruments, reliability of the instruments, data collection and data analysis.
Summary of the Findings, Discussions, Conclusions and Recommendations
5.1 Summary of the Findings
The study established factors of implementation of Comprehensive School Health Program in secondary schools: a case of Orumba north local government area, Anambra state, Nigeria by studying the following factors; Capacity building, support supervision and school infrastructure.
The findings show that capacity building is very important in implementation of Comprehensive School Health Program. Ranking the perceptions of the respondents on the extent to which capacity building influences implementation of CSHP based on the basis of the mean; shows that training CSHP is the most influential with a mean of 4.68 points and standard deviation of 0.68, followed by training on gender issue with a mean of 4.2 points with a standard deviation of 1.03 and life skills training had a mean score of 4.04 points with a standard deviation of 0.75. However, the fact that all the three capacity building strategies had a rating of 4 and more points at minimal standard deviation, indicate that the respondents considered capacity building to play a crucial role in the implementation of Comprehensive School Health Program. The findings also reveal that majority of the respondents had not been trained on CSHP and this could explain the poor state of implementation of the CSHP in Orumba north local government area.
The findings indicate that respondents consider support supervision to be crucial in the implementation of Comprehensive School Health Program. Majority of the respondents agreed that support supervision to schools on disease control and prevention, nutrition, special needs and rehabilitation, child rights and protection influenced implementation of CSHP. In order of priority, disease prevention and control had the highest rating with a mean rate 4.08 points with standard deviation of 1.07, nutrition 4.04 points with a standard deviation of 0.64, special needs 3.94 points with a standard deviation of 1.0 and child rights 3.82 points with a standard deviation
1.08. Therefore majority of the respondents agreed that the four support supervision areas are key in the implementation of Comprehensive School Health Program.
Majority of the respondents agreed that school infrastructure influenced implementation of Comprehensive school health Program. In order of priority water and sanitation was ranked as the most influential with a mean score of 4.76 points and standard deviation of 0.43. This is despite the majority of the respondents 70% stating that the schools they represented did not have access to clean water always and only got clean water sometimes.
Environmental safety had a mean rate of 3.82 points with a standard deviation of 0.66 while conducive classrooms had a mean rate of 3.22 points with a standard deviation of 0.93. This indicates that the respondents considered water and sanitation to be the most important infrastructure in the implementation of Comprehensive School Health Program.
Over all, the respondents rated capacity building as the most important factor influencing implementation of comprehensive school health Program with a mean rate of 4.66 with a standard deviation of 0.48. Support supervision had a mean score of 4.24 with a standard deviation of 0.96 while school infrastructure had a mean score of 4.22 with a standard deviation of 0.91. Other factors identified by the respondents were coordination and parental involvement. This indicated that the respondents considered all the three factors to be critical in the implementation of Comprehensive School Health Program. On inferential statistics, all the independent variables namely capacity building, support supervision and school infrastructure were found to have a significant relationship with the dependent variable which is implementation Comprehensive School Health Program. All the independent variables had a t statistic p value of less than 0.05 which indicated that there was a relationship with the independent variable at 5% level of significance
5.3 Discussions of the Findings
The researcher discusses the findings of this study and compares them with the findings of similar studies or literature conducted by other researchers. In doing this, the researcher is guided by the three independent variables of the study which are capacity building, support supervision and school infrastructure.
5.3.1 Capacity Building
The study sought to find out whether capacity building influences implementation of comprehensive school health program in secondary school. The findings reveal that capacity building through training in CSHP, gender issues and life skills has high influence on implementation of Comprehensive School Health Program. This finding is in line with the finding of McLean at al. (2004) who studied health capacity building in schools and found that school systems are open and adaptive to small scale innovations such as introducing programs on individual health or social issues but resistant to large scale reforms that shift basic priorities away from their academic, vocational and accreditation functions towards their socialization or custodial functions through their loosely-coupled and bureaucratic structures. He recommended that key stakeholders be properly trained on new programs before rolling them out in schools to avoid resistance or perceived interruption from the learning path.
On gender issues, the findings reveal that gender norms training is crucial in the implementation of Comprehensive School Health Program. This findings are in line with the literature of Fiona Lean (2006) who argues that gender violence in and around school has been recognized in recent years as a serious global phenomenon. We have ignored for too long what goes on in the school environment. The sad fact is that schools are not always the child-friendly places we expect them to be. Violence can be perpetrated by pupils or teachers in or around the school, or by out of school youth and/or older men who demand sex in exchange for money or gifts. Acts of gender violence are disproportionately directed at girls, but boys and teachers can also be targets hence the need to reach all stakeholders on gender norms training. In addition, United Nations (2006) study on violence against children recommended implementation life skills education to enable students to build personal skills. Governments should ensure that rights-based life skills programs for non-violence should be promoted in the curriculum through subjects such as peace education, citizenship education, anti-bullying, human rights education, and conflict resolution and mediation; with emphasis placed on child rights and positive values such as diversity and tolerance, and on skills such as problem-solving, social and effective communication, in order to enable girls and boys to overcome entrenched gender biases and to prevent and deal with violence and harassment, including sexual harassment. This is in line with the findings of the study.
5.3.2 Support Supervision
The study sought to find out ways in which support supervision influences implementation of Comprehensive School Health Program by studying support supervision on disease prevention and control, nutrition, special needs and child rights and protection. Majority of the respondents agreed that support supervision on these areas is key in the implementation of the program. This is in line with the findings of R. Govinda and Shahjahan Tapan (1999) study on support supervision in Bangladesh schools that found support of school programs by external personnel enhanced the performance of students and improved the conditions of the school.
5.3.3 School Infrastructure
The study also sought to find out the influence of school infrastructure on the implementation of Comprehensive School Health Program. The finding revealed that infrastructure is tied to the health of the pupils hence is key in implementing the program. This is in line with the finding of Sheets, M.E (2009) who studied the impact of school facilities on students and teachers and found that Poor facilities affected the health and productivity teachers and make retention of teachers difficult. On the academic side, a shift from the best facilities to the worst decreases student test performance by 3%. The study also found that the condition of school facilities has a measurable effect over and above socioeconomic conditions on student achievement and teacher experience/turnover. In addition, according to Schneider, M (2003) Schools play a critical role in promoting the health and safety of young people and helping them establish lifelong healthy behaviors. School health facilities can reduce the prevalence of health risk behaviors among young people. This argument is in line with the findings of thisstudy.
The study established that implementation of Comprehensive School Health Program is influenced by capacity building, support supervision and school infrastructure. Capacity building as a factor influences implementation of the program by equipping the stakeholders with knowledge and skills on CSHP, gender norms and life skills training. The study established that majority of the respondents were not trained on these yet they identified these areas as key in the implementation of Program.
Support supervision was also found to be key in disease prevention and control, special needs, child rights and rehabilitation and Nutrition. This mainly requires additional expertise that may not be readily available within the school or on issues that keep changing over time and require technical assessment and control. Support supervision not only enhances the health of the students but also promotes academic performance and general school welfare.
Infrastructure also was found to influence implementation of the program since health of the students could be affected by the state of the infrastructure. The researcher established that the infrastructure play a crucial role in prevention of infections and diseases and cannot be ignored while implementing Comprehensive School Health Program.
Based on the findings of this study, the researcher makes the following recommendations;
- All teachers and BOM should be trained on Comprehensive School Health Program, gender norms and life skills to equip them with the skills and knowledge required to implement the program.
- Schools should work closely with other health related institutions such as hospitals, ministry of health among others for support in technical health issues that the schools may not have the capacity to handle.
- All schools should be equipped with reliable source of clean water and child friendly facilities that cater for the need of children living with disabilities.
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