1966 REFORT EDUCATION

W f ' 3 L D I i 9 P LTI" C'FGPD'IZP. i'1C.N R e g i o n a l Office f o r t h e

E a s t e ~ n h ? e d i t e r r a n e a n

Ei:GLISH O N L Y

R E F O R T ON THE SEfi?INkR O N SCHQOL HEALTH EDUCATION KULVAIT, 1 4 2 0 M A R C H 1966

T h e v i e w s e x p r e s s e d i n t h i s R e p o r t d o not n e c e s s a r i l y r e f l e c t t h e o f f i c i a l policy of t h e World H e a l t h C r g a n i z a t i o n .

T h i s d o c u m e n t h a s b e e n p r e p a r e d by t h e Tl?rEO R e g i o n a l Office for t h e E a s t e r n P i e d i t e r r a n e a n f o r G o v e r n ~ l e n t s of W e m b e r S t a t e s i n t h e S e g i o n a n d for t h o s e who p a r t i c i p a t e d i n t h e S e m i n a r . A l i m i t e d n u m b e r of c o p i e s i s a v a i l a b l e o n r e q u e s t f o r p e r s o n s officially o r p r o f e s s i o n a l l y c o n c e r n e d with t h e f i e l d of s c h o o l h e a l t h education.

Participants and Observers who Attended the W H O Seminar on School Health Education held in Kuwait from 14 - 20 March 1966

WHO EMRO

TABLE OF CONTENTS

Page

...

1. Background and Objectives

...

2. Opening Session and Organization

...

3. Appraisal

...

4. Acknowledgement

CHAPTER I1 NAT'URE AND SCOPE OF SCHOOL HEALTH EDUCATION

.

CHA- I11 SCHOOL HEALTH SERVICES AND SCHOOL HEALTH EDUCATION I N THE COUNTRIES OF THE EASTEW MEDITERRANEAN REGION

1. General Remarks on School Health Needs and Services i n t h e Eastern Mediterranean Region

...

2. Description of School Health Services and Schnol Health Education i n t h e countries

of t h e

astern

Mediterranean Region

... ³³

CHAPTER TV SCHOOL HEALTH EDUCATION I N THE CON?TMT OF . EDUCATION AND HEALTH

. . . . . .

Panel Discussion

...

⁴⁹

CHAPTER V AN OVERVIEW OF BASIC NFBDS

1. Nutrition i n School Health Services and

...

Health Education

2. Mental Health o f t h e School Child i n the Present T r a n s i t i o n a l Stage of Rapidly Developing Nations. Dialogue followed by

...

Discussion

...

3. Some Notes on School Sanitation

E M / I B P / ~ ~ page ii

WHO EMRO

TABLE: OF CONTENTS (cont Id)

CHAPTER VII

ANNMB ANNEX C A N N M D ANNEXE

4. Health Contents i n t h e Textbooks of t h e F'rirnary and Secondary Schools i n Some of the Countries of t h e Eastern Mediterranean Region

...

5. Research i n School Health Education and

...

t h e ~ e a c h e r ' s Role

EXAMPLES OF SOME SPECIFIC PROGRAMMES I N THE

REGION

1. A Note on Teacher Training and Curriculum Development

...

2. ~ e a c h e r s

'

Preparation i n Health Education An Experiment i n t h e United Arab Republic

3 . Health Education i n Secondary Schools

-

The P a t t e r n i n Pakistan

...

4. School Health Education

-

J o i n t Cooperation Between Ministry o f Public Health and Ministry of Education i n Ethiopia

...

5. Audio-Visual Aids i n School. Health

Eduoation

...

COMMI- WORK AND RECOMMENDATIONS

1. Committee !'ark

...

...

2. Recommendations

LIST OF PARTICIPANTS, OBSERVERS AND NATIONAL PREPARATORY coI"lMIm

LIST OF COMMI- MEMBERS AGENDA

PROGRAMME O F THE SEMINAR

LIST OF DOCUMENTS

AND

BACKGROUND MATERIAL

Page

WHO EMRO

1. Background and Objectives

School h e a l t h educatior; can only become meaningful i f it is trans- formed i n t o the p a t t e r n of behaviour of t h e c h i l d during h i s school days and afterwards, 8ccepting h e a l t h a s a value and as an a s s e t . !The u l t i - mate aim of school h e a l t h education, therefore, i s not only t h e acquisi- t i o n of some knowledge of nature of disease, morphology of t h e causative . - -

agent and personal hygiene but a l s o t h e acceptance of h e a l t h behaviour as pas* of everyday l i f e . I n t h e endeavour t o reach t h i s aim, t h e following t h r e e elements a r e e s s e n t i a l p a r t s of every sound h e a l t h education pro- gramme :

a. well established school h e a l t h s e r v i c e s f o r t h e students and school personnel;

b. h e a l t h f u l school environment, physical, s o c i a l and mental;

c . organized 5 e a l t h i n s t r u c t i o n .

'L'he increasing a t t e n t i o n given t o educaLiv11 LugeLher w i t 1 1 regulations

', concerning compehsory-education has resuzted . i n - a -rapid grouFth.of school . attendance i n t h i s Region. According t o t h e UN estimates

i n

t h e academic

year 1960.1961, there were almost 17 million people i n this Region attend- ing primary or higher schools taught by over half a million teachers i n more than

95

0 0 0 , t r a i n i n g institutions: _.- - *.- . . One cannot over-emphasize t h e value of-health Bducation f o r such a large group of stuclent population, many of whom a r e i n t h e i r formative years of l i f e . I The following t a b l e explains the above point:

WHO EMRO

Number of Schools, Teaching S t a f f and School Enrolment

-

i n t h e Eastern Mediterranean

-

Region Academic year 1960- 1961

Total population: 206 972 000

Source: These f i g u r e s were compiled from d a t a contained i n t h e UN Demo-

-

graphic Yearbook, 1964.

Enrolment

1

13

163 450 2

853

065 210 647 59

837 395 356

16

386

--

Type of I n s t i t u t i o n

Primary School Secondary School Technical School Teacher Training

Number

83

223 10 588

784 286

7-.

--

Nwnber of Teaching S t a f f

344 871

108 ²⁰¹

14 044

3 583

Total Unspecified

Grand Total

10 323 1 499 482 521

21 574

504 095 95 578

20

95

598

Higher I n s t i t u t e s

1 ⁴⁸⁴

16 698 741

16 698 741

Special 203

WHO EMRO

This attention 'to eclucatlon i n tfle Reggion 1s a very enCOWaglng phenomenon. The importance f o r s t r e s s i n g h e a l t h and h e a l t h education a s p a r t of t h i s t r a i n i n g i s c l e a r .

The need f o r a c t i v e c o o p e r a t i o n between education and h e a l t h autho- r i t i e s i n m a t t e r s d e a l i n g with school h e a l t h and school h e a l t h education has long been accepted by t h e World Health Organization Regional O f f i c e f o r t h e E a s t e r n Flediterranem. The S i x t h S e s s i o n of t h e Regional

Committee (1956) i n i t s Technical Discussion on h e a l t h education emphasized t h e need f o r a c t i v e coaperation, and f o r p l a c i n g r e s p o n s i b i l i t y f o r h e a l t h education i n schools j o i n t l y w i t h b o t h education and h e a l t h a u t h o r i t i e s .

I n t h e s e d i s c u s s i o n s " s p e c i a l emphasis w a s placed on t h e value and need f o r promoting c l o s e r cooperation between t e a c h e r s , p a r e n t s , s c h o o l h e a l t h personnel and community resources1".

The Seminar on Health Education of t h e Public i n t h e E a s t e r n Mediter- ranean Region, which was h e l d i n Teheran from 28 October t o 9 November 1958,

a l s o pinpointed t h i s c o l l a b o r a t i o n .

The following s u g g e s t i o n s emerged from t h e d i s c u s s i o n s on t h e s u b j e c t of school h e a l t h education:

"1. During t h e i r b a s i c t r a i n i n g , s t u d e n t t e a c h e r s should r e c e i v e s i n p l e and > r a c t i c a l i n s t r u c t i o n on t h e b a s i c f a c t s r e g a r d i n g t h e promotion and p r o t e c t i o n of t h e i r own and t h e s c h o o l c h i l d ' s h e a l t h , cn; x i h e cause and prevention of l o c a l p u b l i c h e a l t h problems.

2. The cooperation of t h e education a u t h o r i t i e s should be sought s o t h a t h e a l t h education can be continued and expanded i n t h e secondary schools2".

Document ~1fl/RC6/~ech. ~ i s c

./lg,

page

8 -

^11.

Seminar on Health Education of t h e Pulslic i n t h e E a s t e r n Mediterranean Region, 1958. F i n a l Report: Alexandria

(m

), 1959.

Following the above Technical Discussion and t h e 1955 Seminar, t h e Regional Office i n i t s c o n t a c t s with t h e Governments has continuously s t r e s s e d the need f o r such joifit e f f o r t . This present Seminar vas con- ceived and developed t o give f u r t h e r impetus t o cooperative measures already well advanced i n many of t h e c o u n t r i e s of t h e Region.

Objectives of t h e I r e s e n t Seminar .--.

---

Basel: on these considerations, t h e following o b j e c t i v e s were s e l e c t e d f o r t h e present Seminar:

a. reviewing t h e s t a t u s of h e a l t h education a c t i v i t i e s a s p a r t of t h e school h e a l t h s e r v i u e s c a r r i e d u u t i r ~ p r i m a r y and secondary schools o? t h e c c 7 m t r i e s of t h i s Region;

b. diacuooing the health education needs of school chil&-en, taking i n t o account t h e f a c i l i t i e s and t h e provisions;

c. sharing experience on t h e means of developing b e t t e r h e a l t h education a c t i v i t i e s and t r a i n i n g i n schools;

d . studying t h e curriculum development i n schools and t h e s i g n i f i c a n t r o l e of h e a l t h education, q u a l i t a t i v e l y and q u a n t i t a t i v e l y , i n t h i s curriculum;

e. studying t h e h e a l t h education aspect i n t h e c u r r i c u l a of teacher t r a i n i n g i n s t i t u t i o n s .

On t h e i n t e r n a t i o n a l l e v e l valuable cooperation e x i s t s between WHO and other UN agencies. For example, t h e r e have been a number of j o i n t meetings with UNESCO i n various regions and a l s o a t WHO Heaclquarters i n Geneva. WHO Technical Report S e r i e s No. 193, dealing with t e a c h e r s preparation i n h e a l t h education, i s t h e outcome of one of t h e s e j o i n t e f f o r t s . The r e c e n t j o i n t p r o j e c t however was t h e preparation of a

document "planning f o r Health Education i n ~ c h o o l s " by Professor C.E. Turner, WO/UNESCO Consultant. The r e s u l t s of t h i s a c t i v e cooperation between t h e s e two agencies have been published I n form of a book, d i s t r i b u t e d t o a l l

p a r t i c i p a n t s . Coop-.ratiori with

UNICEF

i n t h e f i e l d of school h e a l t h education has a l s o been very encouraging. The document prepared on t h e

WHO EMRO

Teachers' Preparation i n Health

ducati ion'

provides an example. Further- more, UNICEF offered three fellowships f o r p a r t i c i p a t i o n i n t h i s Seminar.

Cooperation a l s o e x i s t s between WHO and FAO, e s p e c i a l l y i n t h e f i e l d of n u t r i t i o n education. The same holds t r u e f o r other UN specialized agencies and various other i n t e r n a t i o n a l agencies.

This, obviously, i s not an exhaustive account of the amount of co- operation between WHO and other UN agencies and other i n t e r n a t i o n a l bodies i n t e r e s t e d i n the f i e l d of school health education. Such an account would i t s e l f be a voluminous document.

The following r e s o l u t i o n w a s made ^during t h e Technical Discussions of t h e F i f t e e n t h ^Session of t h e Regional Committee w h i c h was held i n ^Addis Ababa i n September 1965~:

he Regional C o r n m i t t c c ,

"Having studied with i n t e r e s t the document on School Health i n the Eastern Mediterranean Region, presented by the Regional Director;

"Considering t h a t school h e a l t h services a r e among the major needs of t h i s Region;

" ~ o t i n g t h e development of various a c t i v i t i e s i n school h e a l t h services and school h e a l t h education i n a number of countries of t h i s Region f o r promotion of these services,

i. "MPRESSES i t s s a t i s f a c t i o n with t h e s t u d i e s made by t h e World Health Organization i n a few countries of t h e Region;

2. "ENDORSES the recommendations made i n the document under review;

Kamel, W.H. and Sonbaty, M.M., Teachers

'

Preparation i n Health Educa- t i o n

-

^{A n} Experiment i n the United Arab Republic, 1966,

(EM/SEM. SCH. HLTH. EDUC

.

^{/7 )}

WHO _EMRO

3.

"RECOMMENDS that t h e governments give high p r i o r i t y t o school h e a l t h s e r v i c e s including :

a . h e a l t h s e r v i c e s f o r cl?il&en, an6 other students i n various s t a g e s of t h e i r education;

b. h e a l t h s e r v i c e s f ~ r school personnel;

c. h e a l t h of t h e school environment;

d. school h e a l t h education;

e

.

^teachers

^'

preparatior, i n healt'n education;

f . mental h e a l t h of scl-loo1 children;

g. inclusion of public h e a l t h i n t o t h e c u r r i c u l a of t h e schools.

4. "RECOMMENDS medical colleges and schools t o give s p e c i a l a t t e n t i o n t o school h e a l t h and h e a l t h education;

5.

I1 REQUESTS t h e Regional Director t o make f u r t h e r surveys on school h e a l t h s e r v i c e s and h e a l t h education and t o provide a s s i s t a n c e t o t h e governments, a s required, i n school h e a l t h s e r v i c e s and school h e a l t h

education in order t o develop and promote t h e h e a l t h of the school children".

It is very pleasant t o note t h e t r e n d i n organizing or planning a c t i v e cooperation between m i n i s t r i e s of h e a l t h and of education, and with o t h e r m i n i s t r i e s such a s youth, guidance e t c . . i n t h e f i e l d of school h e a l t h educa- t i o n .

During t h e l a s t two years i n a t l e a s t t e n c o u n t r i e s of t h e Region seminars have been organized between t h e two m i n i s t r i e s of h e a l t h and education, bringing together t h e medical and educational a u t h o r i t i e s t o d i s c u s s and share experiences on promotion of school h e a l t h s e r v i c e s and school h e a l t h education. I n t h e s e seminars emphasis has been given t o school h e a l t h education, a s p a r t of school h e a l t h s e r v i c e s on t h e one hand and of t h e t o t a l community and n a t i o n a l h e a l t h on t h e other, t h u s making school h e a l t h education not a separate e n t i t y but p a r t of a wider sphere.

Attention has occasionally been given t o making t h e school a community

centre, bringing in parents and other citizens to the school for dis- cussions on improvement of the health of the community. Also attention to provision of recreation facilities and health education in physical education programmes is increasing.

Obviously,the more attention given to the school as a dynamic centre of change and improvement in the community for the present and future, the more effective will be the schcol health ed- cation activities and that has been a major aim of this Serninar.

2. Opening Session and Organization

The Seminar on School Health Education sponsored by the World Health Organization with the cooperation of the Government of Kuwait was held in the Nursing College, Ministry of Public Health, Kuwait, from 14

-

^{20 March}

1966.

Forty-one participants from sixteen countries of the Eastern Mediter- ranean Region and nine observers representing UN and some international agencies interested in school health education attended the Meetings.

The participants included, senior administrators, planners, policy makers, health educators and teachers from Ministries of Health and of Education of the countries of the Region.

Inaugural Statement by H.E. Tke Ministcr of Public Health, Kuwd;it In his inaugural speech

H.E.

El Sayed Abdul Aziz El Feleig, Minister of Publio Hcalth, Kuwait, welcomed the participants on behalf of His Highness The Amir and the Government and statel! that

s he

cultural and historical background shared by countries of the Eastern Mediterranean Region will make it easy for us to increase our cooperation in this rcspcct in order to raise the health standard of our people. The Government and people of Kuwait heartily welcome such cooperation which would yield substancial benefits to all and cause peace and friendship to prevail in our world in compliance with the charter of the United Nations and constitution of the World Health Organization which provides that the health of all people is fundamental to the attainment of peace and security and is "dependent upon the fullest co- operation of individuals and states".

WHO

mo

Excerpt of t h e Address bjr Dr. A.H. Taba, WHO Director, EMR

I n h i s address D r . A.H. Taba, Director of t h e Eastern Mediterranean Regional Office of WHO thanked H i s Highness t h e A r n i r and t h e Government of Kuwait f o r t h e i r h o s p i t a l i t y and t h e Governments of t h e Region f o r accepting the i n v i t a t i o n of libTHO f o r p a r t i c i p a t i o n i n t h e Seminar.

Dr. Taba s t a t e d t h a t "The increasing a t t e n t i o n t o education on t h e one hand and t c h e a l t h on t h e other as t h e dynarnic f o r c e s of change i n t h e communities brings t o t h e a t t e n t i o n the need f o r focussing on school h e a l t h education i n a l l countries.

"There are, according t o conservative estimates over 17 m i l l i o n students studying in primary and secondary schoolo in t h i s Region taught by over h a l f a m i l l i o n teachers. This i n i t s e l f i s a b i g e n t e r p r i s e and a growing endea.vour, considering t h e f a c t t h a t not every c h i l d of t h e school-age io attending echo01 at prcsent and t h a t plans are under w a y i n t h e majority of c o u n t r i e s f o r spreading education t o a l l school-age

children.

"The S t a t e of Kuwait is a shining example of achievement i n t h i s respect, f o r according t o t h e l a t e s t data, 97 000 students a r e a t t e n d i n g primary and secondary schools. That is, over 20 per cent of t h e e n t i r e population.

" I t becomes imperative a t t h i s s t a g e of r a p i d development, therefore, t h a t a t t e n t i o n be given t o t h e education of younger generation i n t h e

f i e l d of h e a l t h not only f o r the present h e a l t h f u l l i v i n g but f o r accepting h e a l t h a s a value and a s an a s s e t f o r f u t u r e l i f e .

"The World Health Organization, s i n c e i t s inception and by i t s con- s t i t u t i o n has placed much emphasis on t h e h e a l t h of t h e younger age-groups and, through i t s p r o j e c t s and! consultations with t h e Government and by symposia and expert committee meetings and semipars has d i r e c t e d a t t e n t i o n t o the importance of education of t h i s group i n t h e f i e l d of health.

('It i s f o r t h e f i r s t time, however, t h a t t h i s Region is bringing to- gether t h e eminent experts, planners, administrators and educators from M i n i s t r i e s of Health and of Education t o d i s c u s s and share experience on matters regarding school h e a l t h education.

WHO EMRO

"It is the general feeling "Liat sch~vl health education wlth lts important role is not limite2 to the health instructions given in the class-rooms, and the a i m of this Seminar is to discuss school health education not only as far as instruction is concerned but also in regard to the total health and educational experience that the child feels in his school days".

Audience with His Highness The Arnir

His Highness Sheikh Sabah A1 Salem A1 Sabah, The Arnir of Kuwait, received the participants and other representatives of UN and other international agencies and the WHO Secretariat, in audience. He wel- comed all and emphasized the need for increased attention to health education of school children and general public.

Or.sanization of the S e m i n a r

In the first plenary session the following were elected as Seminar Officers by the participants:

Mr. Berges Hamoud Berges, (~uwait) Chairman

Dr.

Mohamed Mahmood El-Sonbaty, (UAR) Vice- Chairman Dr. Ibrahim Alamuddin, (~ordan) Vice- Chairman

Dr. Z.G.

Panos, (cyprus) Viue- Chairman

Dr. K.

Shayer. (11-zq) Rapporteur

The Seminar was composed of plenary sessions and four committees.

Visits were also arranged to

a

number of schools, kindergmtens, school clinics, the Al-Sabah Hospital, the Kuwait Oil Company, the Water Distillation Plant and the Museum.

3.

Appraisal

In the last session of the Seminar a questionnaire was distributed to participants inviting their comments and suggestions for the improvement of similar seminars and to find out in what ways

-

in their opinion

-

^such

seminars may have tangible results. The prnticipants and observers

E M / H E P / ~ ~

page 1 0

WHO EPmO

were asked not t o s i g n t h e i r names on t h e q u e s t i o n n a i r e s h e e t s . Out of f i f t y q u e s t i o n n a i r e s d i s t r i b u t e d t h i r t y - f o u r responses were received.

The f i v e q u e s t i o n s were a l l "open-end" questioils allowing f o r a v a r i e t y of responses. Later t h e responses were c a t e g o r i z e d under d i f f e r e n t s e c t i o n s .

The o r i g i n a l q u e s t i o n s were a s follows:

1. What f e a t u r e s o f t h e Seminar were e s p e c i a l l y h e l p f u l t o you?

2. What f e a t u r e s were n o t h e l p f u l ?

3 .

What suggestions have you f o r improving s i m i l a r seminars?

4. How do you propose t o make r e s u l t s of t h e seminar known i n your country?

5.

What follow-up measures w i l l you attempt?

Following a r e t h e answers r e c e i v e d 6 i v i d e d i n t o a number of i n t e r - dependent s e c t i o n s . It i s very encouraging t o n o t e t h a t t h e m a j o r i t y of t h e p a r t i c i p a n t s found t h e seminar s t i m u l a t i n g and have made recommendations f o r t h e implementation of t h e recommendations.

1. What f e a t u r e s of t h e Seminar were e s p e c i a l l y h e l p f u l t o you?

Responses A l l f a c t o r s were found u s e f u l 8

A. Organization and approaches t h a t were found u s e f u l : Committee work

Free d i s c u s s i o n with p a r t i c i p a n t s V i s i t s

Sharing experience Panel d i s c u s s i o n s Technical papers

E f f i c i e n t o r g a n i z a t i o n of t h e Seminar

WHO E r n 0 ~ M / H E p j / 2 8 ' page 11

Responses Presence of both health and education disciplines 1

Literature distributed 1

High caliber of staff 1

Plenary sessions 1

B. Contents which were foulid helpful:

Planning for school community relationships 4

Preparation of teachers 4

Statements by participants 4

Audio-vlsual alds in school h e a l t h education 2 Strengthening curricula of primary and secondary

schools

2

2.

The

features t'mt were not helpful:

No answer 16

Nothing

13

Group discussions 2

Participarts raising their own problems 1

Too many subjects discussed 1

Time limitations 1

3 .

Suggestions for improving similar seminars:

\ - -

A. How the present seminar n o i ~ l c ! have been imaroved?

By extension of time 13

By ~ise of Arabic language 9

By better planning I"or field visits 2 By arranging sight seeing tours 1 By more emphasis on role of woman 1 By inviting finance and planning people to see

the importance of school health education 1 By inviting non-governmental agencies interested

in school health education

1

EM/HEP/~~

page 12

WHO EMRO

Responses B. Trend for future activities:

IdHO to follotu-up the recommendations up to

their implementation 2

WHO to organize future seminars

on

specific

topics in school health education 1 WHO to organize similar seminars regularly 1

WHO

to provide consultants to governments on

school health education 1

WHO to arra,nge travelling seminars on the

subject 1

C.

No suggestions 2

4. HOW the participants proposed to make results of the Seminar known in their countries?

A.

By implementation:

Assisting in the implementation of the recommendations

Organizing seminars for teachers or joint seminars for teachers and health workers

B. By

reporting and informing authorities or interested

individuals:

Reporting to authorities

Personal talks and lectures to curriculum planners and colleagues

Public information via radio, television and newspapers

Discussion in staff meetings

Sending copies of the recommendations to agerrc ies

C.

By other means

lJHO and UNESCO should send documents to Governments

Putting documents in library

WHO EMRO

D. Noanswer

5.

What fellow up measures will participants attempt?

A.

By direct action:

Personal consideration in planning Initiation of research, studies and

evaluation

Forming a coordination committee for the implementation of the recommendations

Contacting authorities to see if the recommendations were implemented Proposing a scheme for school health

education to be included in development plans

WHO/EMRO should publish a quarterly bulletin on health education as a follow-up measure

C.

No answer

nesponses

2

B.

By proposals and contacts:

4.

Acknowledgement

The particlpalis and r e p r e s e n t a t i v e s at the closing oeosion

expressed their deep gratitude to His Highness The Arnir of Kuwait, the Government and especially the Ministry of Public Health for all the courtesy and hospitality extendcd to them throughout t h e Seminar.

They also thanked the National Preparatory Committee for making a11 arrangements. Thanks were also expressed to the Eastern Mediterranean Regional Office of the World Health Organization for planning and

conducting a Seminar on such an important topic.

CHAPTER I1

This is a time of change i n public h e a l t h and i n education. Old goals and methods a r e being reevaluated and new ones explored. Many h e a l t h ~ r o b l e m s plaauing nations over t h e years a r e now within reach of prevention o r control. New h e a l t h problems a r e r i s i n g as conditions which engender them develop. Urbanization, human mobility, modern agri- c u l t u r a l practices, and i n d u s t r i a l i z a t i o n a r e among s o c i a l and t e c h n i c a l developments a f f e c t i n g health. A s peoples

'

expectations f o r a b e t t e r l i f e expand, and as an increasing number of children a t t e n d school, edu- c a t i o n a l leaders are reappraising t h e i r goals, curricula, and methods.

The g r e a t explosion of knowledge is likewise making its impact on educa- tion. I n t h e midst o f these dynamic changes, school h e a l t h education is a l s o changing.

What is school h e a l t h education?

School h e a l t h education, a s t h e term w i l l be used here, is that education f o r h e a l t h which t a k e s place within schools o r under t h e general guidance of school-related personnel. I n one sense, it is a process by which agents of education, such as teachers and h e a l t h workers, e x e r t t h e i r influence so a s t o a f f e c t t h e h e a l t h behaviour of pupils. I n another sense, it may be thought of as t h e changes which occur i n h e a l t h behaviour, individually o r c o l l e c t i v e l y

-

^{t k a t is, i n what} people under- stand, how they f e e l , and what they do i n r e s p e c t t o health. Though the

Based on t h e paper presented and the discussions of the Seminar

WHO EMFlO

primary focus i n school h e a l t h education is on pupil health, school h e a l t h education programmes must deal a c t i v e l y with h e a l t h needs of home, school and comunity. Pupils do not l i v e i n a vacuum; t h e i r h e a l t h is a f f e c t e d by conditions around them and t h e school, through i t s educational e f f o r t s , can play an important p a r t i n improving these conditions. School h e a l t h education, then, ^can be thought of a s dealing with t h e f u l l range of h e a l t h needs t h a t i n any way impinge upon t h e well-being of pupils, and of t h e homes, schools and communities i n which they l i v e and work.

School h e a l t h education includes individual h e a l t h counseling, informal h e a l t h teaching (and learning), and systematic h e a l t h i n s t r u c t i o n . Some of the most important health education takes place on a one-to-one baais between pupils and teachers o r h e a l t h workers who a r e i n d i r e c t contact with a child.

The c h i l d who is malnourished o r who has an eye i n f e c t i o n needs individual assistance as may also his parents. The young person who attends a clinic because of ill h e a l t h needs t o understand what may be wrong with him and what he himself may do t o become well. Health is frequently a personal matter requiring personal a t t e n t i o n . Individualized h e a l t h education i s an e s s e n t i a l p a r t of every school h e a l t h education programme.

Opportunities f o r informal h e a l t h teaching and learning occur through- out t h e school day. I n r u r a l areas where children may help with basic s a n i t a t i o n needs, such a s providing water, disposing of wastes, and handling of food, the pupils with guidance can o f t e n work out s a f e and s a n i t a r y pro- cedures, even with t h e simplest of equipment, and l e a r n important h e a l t h p r i n c i p l e s i n t h e process. I n many communities, modern school buildings have been constructed, providing f a c i l i t i e s which pupils must l e a r n t o use i n a s a f e and s a n i t a r y manner. I f pupils can have a p a r t i n adjusting l i g h t i n g and seating, o r i n inaugurating c l e a n l i n e s s and s a f e t y measures, a t t h e same time learning why c e r t a i n measures a r e preferable t o others, much worthwhile h e a l t h education can take place. Within community l i f e , opportunities likewise e x i s t f o r informal h e a l t h education. I n some countries, f o r example, young people serve a s volunteers i n c l i n i c s and h o s p i t a l s and i n other community h e a l t h e f f o r t s , thus, learning through f i r s t h a n d experience about h e a l t h needs a s well a s resources and programmes available t o d e a l with needs, Daily events, when adequately exploited by educators and h e a l t h workers, can become teachable moments t h a t not only add realism and i n t e r e s t t o h e a l t h education but may bring r e s u l t s i n d e s i r a b l e h e a l t h action.

A s important as individual h e a l t h counseling and informal h e a l t h teaching are, they need t o be accompanied by systematic h e a l t h i n s t r u c t i o n . Such i n s t r u c t i o n may take place through separate h e a l t h c l a s s e s o r be in- corporated i n other p a r t s of t h e curriculum such a s i n science and home economics. The manner i n which t h i s is done v a r i e s widely from school system t o school system.

0b.lectives of school health education

ObJectives of school h e a l t h education are determined i n l a r g e measures by h e a l t h needs and developments on t h e one hand and by broad purposes of education on t h e other.

As h e a l t h conditions change, goals f o r h e a l t h eciucation i n schools may likewise change. Though t h i s Region has made rapid s t r i d e s i n t h e control of such diseases as.malaria, tuberculosis, and trachoma, I am t o l d t h a t much y e t remains t o be done, nevertheless, t o eliminate these and other de- b i l i t a t i n g diseases. I n t h i s Region, a s i n other p a r t s of the world, mal- n u t r i t i o n , poor personal hygiene practices, chronic i l l n e s s , and i n s a n i t a r y environment demand constant a t t e n t i o n .

I n t h e past, education on h e a l t h d e a l t mainly with personal h e a l t h h a b i t s and t h e nature and cause of i l l n e s s and disease. I n many instances, l i t t l e p o s i t i v e a c t i o n f o r improvement was possible with e x i s t i n g knowledge.

However, modern methods of prevention and control make f e a s i b l e such atitii- t i o n a l objectives a s f o s t e r i n g use of preventive and treatment f a c i l i t i e s . Many h e a l t h problems today c m be solved only through t h e widest understand- i n g and cooperation of t h e people concernea. I n recognltlon of t h i s fact t h e World Health Organization, i n what has now become a c l a s s i c statement has said:

he aim of h e a l t h education i s t o help people t o achieve h e a l t h by t h e i r own actions and e f f o r t s . Health eaucation begins therefore with t h e i n t e r e s t of people i n improving t h e i r conditions of living, and aims a t developing a sense of

r e s p o n s i b i l i t y f o r t h e i r own h e a l t h betterment a s individuals and a s members of families, communities, or

government^."^

World H e a l t h Organization Expert Committee on Health Education of the

Public, First Report: Geneva, 1954 (world Health Organization Technical Report S e r i e s No. 89)

WHO EMRO

Universally, educators a r e r e s t a t i n g broad purpose of education i n t h e l i g h t of changing t i n e s . Schools of t h e past, t r a d i t i o n bound, e x i s t e d primarily t o transmit and perpetuate knowledge from one generation t o another. I n contrast, goals commonly expressed by educators today include increasing national unity, strengthening citizenship, r a i s i n g t h e l i t e r a c y r a t e , and educating people t o become responsible and productive members of society.

The time has arrived when leaders i n school h e a l t h education must re- define objectives t o be rnore nearly I n harmony with the changing goals of h e a l t h and education. No longer can schools be s a t i s f i e d with the mere transmission of health f a c t s . Important a s f a c t s are, f a c t s alone a r e inadequate t o evoke improvements i n h e a l t h behaviour which a r e s o necessary f o r a strong and productive citizenship. Objectives i n school h e a l t h educa- t i o n must be d i r e c t e d toward helping children t o a t t a i n h e a l t h goals on a r a t i o n a l b a s i s and through t h e i r own actfons and e f f o r t s ,

A discussion of school h e a l t h education objectives would not be complete without mention of s o c i a l , p o l i t i c a l , economic and r e l i g i o u s f a c t o r s t h a t influence the nature and scope o f h e a l t h ^education e f f o r t s .

I n most c u l t u r e s the home e x e r t s the g r e a t e s t influence on t h e child.

By t h e time t h e c h i l d reaches school, many of h i s health h a b i t s have become well established. Throughout school years, t h e values he attaches t o health a r e often determined by those values held within the family unit, values o f t e n deeply rooted i n t r a d i t i o n . A question not e a s i l y answered is t o what extent the school should d i s t u r b child-parent r e l a t i o n s h i p s through promoting health objectives t h a t run counter t o those i n t h e home, especially when home objectives a r e contrary t o sound h e a l t h practices.

School objectives must o f t e n be modified o r adapted t o be consonant w i t h values held by the hume and other s o c l a l l n s t l t u t f o n s outside t h e School, Y e t , should not t h e schools seek t o influence these values i n appropriate ways?

I n determining and f u l f i l l i n g h e a l t h education objectives, schools may f i n d common cause with other agencies and organizations, Governmental agencies, a s f o r health, s o c i a l welfare, and agriculture, influence h e a l t h objectives through the p o l i c i e s they s e t and t h e funds they provide.

Voluntary h e a l t h associations and f r a t e r n a l and c i v i c groups have h e a l t h education goals and programmes which o f t e n c a n be synchronizcd w i t h those

WHO

m o

of schools. Professional organizations i n t h e f i e l d s of health and education can prov1.de valuable leadership. The teachings of the g r e a t r e l i g i o n s a r e cogent with h e a l t h implications and r e l i g i o u s leaders a r e p o t e n t i a l colleagues f o r h e a l t h betterment. Through community development e f f o r t s and other concerted programmes, these many individuals and groups may unite f o r the comrncln purpose of improving t h e h e a l t h and well-being of both children and adults.

Content of school h e a l t h education

While objectives help point the way f o r h e a l t h education, t h e content provides t h e substance. Sound school h e a l t h education, a s already stated, deals with h e a l t h needs and i n t e r e s t s of children and of t h e homes, schools, and community of which they are a p a r t . It takes i n t o account psychologi- cal, sociological, c u l t u r a l , p o l i t i c a l and economic factors, and the avail- a b i l i t y of resources. It is based on s c i e n t i f i c a l l y sound h e a l t h f a c t s . What we teach, then, m u s t be determined by a v a r i e t y of f a c t o r s i f it is t o become t r a n s l a t e d i n t o d e s i r a b l e h e a l t h action.

I n some areas, standard h e a l t h teaching s y l l a b i developed a t national, provincial, o r l o c a l l e v e l s prescribe what s h a l l be taught i n each grade.

Too frequently, the untrained o r unimaginative teacher follows these guides with l i t t l e consideration f o r l o c a l h e a l t h conditions. The c h i l d of a c o a s t a l community and t h e c h i l d l i v i n g i n a r i d lands have the same basic n u t r i t i o n needs but foods available t o each may be q u i t e d i f f e r e n t . Sanita- t i o n problems a r e universal but assume d i f f e r e n t forms under varying

environmental conditfons. lJl-lile one community may have l i t t l e or no water, another may have enough water but s o highly polluted t h a t s p e c i a l measures must be taken t o make it s a f e f o r hum'm consumption. Certain d i s e a s e s may be more prevalent i n one a r e a than i n another. Health teaching guides can be helpful i n suggesting content of h e a l t h education. Their value is increased however, i f they a r e used f l e x i b l y and i n accord with regional o r l o c a l conditions.

I n r e a l i s t i c h e a l t h teaching, t h e needs of t h e children themselves should have primary a t t e n t i o n . These needs a r e r e l a t e d l a r g e l y t o biologic- a l processes, such a s eating, elimination, exercise and sleeping; t o

preventing o r controlling conditions which may cause o r aggravate physical defects, i l l n e s s e s , disease, and i n j u r i e s ; and t o sound emotional and s o c i a l development. Though such needs p e r s i s t throughout l i f e , they vary i n t h e i r manifestations a t d i f f e r e n t maturity levels, thus suggesting possible changes

EM/HEP/~~

page 20

WHO EMRO

i n teaching e m p h ~ s i s ns c h i l d r e n progress through school. By analyzing developmental c h a r a c t e r i s t i c s of ~ n i l c ' , ~ e n a t d i f f e r e n t age l e v e l s and under d i f f e r i n g c u l t u r a l conditions, and by considering c h i l d r e n s ' readiness t o l e a r n and breadth of i n t e r e s t , a r a t i o n a l b a s i s can be reached f o r t h e s e l e c t i o n of h e a l t h education content. Though some g e n e r a l i z a t i o n s can be

I

I made on t h i s basis, each teacher should be encouraged t o determine i n h i s own s i t u a t i o n t h ? s p e c i f i c c h i l d h e a l t h problems r e q u i r i n g a t t e n t i o n a t a given time. I must s t r e s s emphatically a t t h i s point, however, t h a t

teachers and other school yersonnel responsible f o r t r a i n i n g t h e young need t h e help of medical a u t h o r i t i e s i n l o c a t i n g and defining t h e s e problems.

Mention has been made more than once of home, school and community h e a l t h needs which a l s o mag become t h e f o c l f o r productl.ve h e a l t h education i n schools. Here again, h e a l t h a u t l l o r i t i e s can help point out those needs demanding s p e c i a l a t t e n t i o n i n a s p e c i f i c l o c a l i t y .

Methods of school h e a l t h education

Methods of h e a l t h education a r e determined not only by the nature of a problem but a l s o by ways i n which learning t a k e s place. Learning i s an a c t i v e process occurring tbxough t h e l e a r n e r ' s own e f f o r t s a s he i n t e r a c t s with h i s environment. Learning has both an emotional and a r a t i o n a l b a s i s . It is more than mere absorption of knowledge.

I n many ochool o g ~ t c m ~ , h c a l t h cducstion methods have not kept pace with other methods of education. Yet h e a l t h education, a more r e c e n t innovation i n m r ? T r ; n b ? f - l C . could take t h e l e a d through experimenting with methods appliosble t o a w i d e range of interes-Ls.

Too frequently h e a l t h has bee11 taught by r o t e learnin@; and h e a l t h f a c t s have been studied w i t h l i t t l e o r no plan f o r t h e i r t r a n s l a t i o n i n t o action.

Children need t o work a c t i v e l y on problems meaningful t o them i n order t o convert theory i n t o p r a c t i c e . The problem-solving method i s one e f f e c t i v e way.

I n c r a t i n g s i t u a t i o n s which f o s t e r learning, it i s well t o recognize t h a t s e l f - s e t goals have strong motivational value and problem-solving methods, when properly used, provide a r a t i c n a l approach t o d e c i s i o n making and a c t i o n . Learning of more l a s t i n g value i s l i k e l y t o occur when p u p i l s themselves, i n d i v i d u a l l ~ r or i n groups, s e l e c t problems from r e a l l i f e s i t u a - t i o n s and take s t e p s t o solve the problems. Such an approach is more than

WHO

m a 0

~M/'h3~/20 page 21 an i n t e l l e c t u a l exercise. Facts gathered i n t h e process a r e b e t t e r understood, retained, and applied when they a r e oriented. toward action.

Individual or group commitment may r e s u l t i n l a s t i n g behaviour change.

Though problem solving i s only one of a number of methods which can be used advantageously i n school health education, it has been s t r e s s e d here because of i t s pertinence i n contributing t o desirable h e a l t h goals.

Other methods o f t e n used i n h e a l t h eductition include various forms of discussions, drarnatizatfons, f i e l d experiences, experimentation, and t h e use of audio-visual materials. "Learning through doingn had become an axiom i n education. P a r t i c i p a t i o n of pupils i n h e a l t h a c t i o n programmes and through volunteep s e r v i c e s gravid-es a ~ r a c t i c a l way of ~ u t t i n g t h i s p r i n c i p l e i n t o practice.

Evaluating school h e a l t h education p r a c t i c e s

-

Foremost i n evaluating school health education should be an attempt t o determine whether a programme i s accomplishing w h a t . i t has s e t out t o do. Since school h e a l t h education today aims t o bring about h e a l t h improvements i n the pupils themselves, and i n conditions surrounding the pupils, then such questions a s the follov~ing need t o be pursued: Is t h e h e a l t h of an individual c h i l d or a group of children b e t t e r a s a r e s u l t of a s p e c i f i c h e a l t h education e f f o r t ? Are t h e children taking more r e s p o n s i b i l i t y f o r t h e i r own h e a l t h commensurate with t h e i r stages of development? What a r e t h e i r a t t i t u d e s toward a s p e c i f i c h e a l t h study?

Are they passively following i n s t r u c t i o n s o r a r e they e n t h u s i a s t i c a l l y and i n t e l l i g e n t l y working t o bring about a h e a l t h improvement? What changes a r e evident i n the home and community as well a s i n the school?

Unfortunately, i n working f o r a limited time with a group of children, a teacher cannot always hope t o f i n d c l e a r evidence of progress o r of achievements a t t r l b u t a b l e t o h i s own e f f o r t s . Pupil h e a l t h progress i s o f t e n slow; r e s u l t s of teaching a r e cumulative and may extend over many years. Yet through observation, interviews, study of h e a l t h records, surveys and other evaluative procedures, improvements may be discernible.

Moreover, schools can obtain information which w i l l be invaluable i n planning f u t u r e h e a l t h education programmes.

School h e a l t h education p r a c t i c e s may a l s o be evaluated by examining t h e programme i t s e l f t o determine whether i t s objectives, content, methods and materials follow generally accepted standards in health and in education

E M / H E P / ~ ~

page 22

WHO EMRO

and a r e appropriate t o a s p e c i f i c s i t u a t i o n . Many of t h e points developed i n t h i s paper suggest d i r e c t i o n s f o r such evaluation so w i l l not be repeated here.

Evaluation i s an e s s e n t i a l p a r t of every well-planned school h e a l t h education programme. To be meanirqful it must be b u i l t i n t o t h e programme from t h e s t a r t and become a continuous process. Only when pupils,

teachers, parents, h e a l t h workers and community l e a d e r s share i n evaluation, and use t h e information gained, can l a s t i n g h e a l t h progress be expected.

I n concluding t h i s statement on t h e nature and scope of school h e a l t h education, recognition is given t o t h e influence of those whose responsi- b i l i t y it is. A t t h e h e a r t of every sound programme a r e teachers who are professionally q u a l i f i e d , emotionally adjusted, and genuinely i n t e r e s t e d i n c h i l d r e n and t h e i r health. The degree t o which teachers succeed i n t h e d i f f i c u l t and ever changing t a s k of h e a l t h education i s dependent not only upon t h e i r t r a i n i n g , but a l s o upon t h e support and guidance they receive from medical leaders, h e a l t h a u t h o r i t i e s , school administrators, and t h e public.

SCHOOL HEALTH SERVICES A h 9 SCHOOL KEALTH EDUCATION I N

THE

COUNTRIES OF

THE

EASTERN MEDITECRRANEAN REGION

GENERAL FEMMNS ON SCHOOL HEALTH NEEDS AND SERVICES IN THE E A S ~ N MEDITERRANEAN

REGION^

I INTRODUCTION . .

Thn-ing the last t w e n t y years, many cor~ntries of this Region have

recognized t h e importance of t h e h e a l t h of school-age children. Increas- ing emphasis i s being given t o t h e school h e a l t h services a s more and more children a r e entering primary schools every year.

I n t h e preamble of t h e c o n s t i t u t i o n of t h e World Health Organization, it was already declared t h a t "healthy development of t h e c h i l d is of basic importance; the a b i l i t y t o l i v e harmoniously i n a changing t o t a l environ- ment is e s s e n t i a l t o such development". Accordingly, the Organization has,

i n the broadest possible sense, assigned an important place t o t h e protec- t i o n and promotion of c h i l d health within i t s global programme. This holds t r u e both f o r t h e c h i l d s t i l l l i v i n g i n t h e r a t h e r secluded environment of the family and fol- t k s zY1.,301 c h i l d being exposed t o the g r e a t e r r i s k and hazards of t h e outside environment.

I n

1950,

t h e WHO Expert Committee on School Health Services discussed the needs f o r s p e c i a l h e a l t h s e r v i c e s f o r the school-age children and f o r a health programme f o r t h i s segment of the population, Which is undergoing

1

Based o n ' t h e paper presentkd and t h e discussions of t h e Seminar

WHO EMRO

physical, mental, emotional and s o c i a l changes. The Expert Committee, i n i t s report, r e f e r r e d s p e c i f i c a l l y t c the r e s p o n s i b i l i t i e s of the country "for revising i t s h e a l t h p o l i c i e s f o r school-age children". Compulsory educa- tion, enforcing parents by law t o subject t h e i r children t o the school a u t h o r i t i e s f o r a considerable period of time, embodies the f u l l responsi- b i l i t y of t h e law-maker f o r t h e i r h e a l t h and well-being. Consequently, school health services cannot be regarded a s voluntary or "optional"

I services of t h e community, but a s obligatory services t o be provided by , the law-enforcing authority, i . e . the government.

I

I

I I1 SCHOOL HEALTH SERVICES

Organization and Administration

Wide v a r i a t i o n s e x i s t i n the organization and administratinn n f school

health services i n t h e Region. I n Aden, Iraq, Jordan, Kuwait, Pakistan, Somalia, t h e United Arab Republic and Yemen, t h e school h e a l t h s e r v i c e s are administered through t h e Ministry of Public Health. I n Ethiopia, Iran, Qatar, Saucli Arabia and t h e Syrian Arab Republic, these services are ad- ministered by t h e Ministry of Educatfon. I n some countries, a s p e c i a l school h e a l t h department i s responsible f o r t h i s service whilst i n other countries, one of t h e administrative u n i t s i n the ministry concerned d e a l s with school h e a l t h amongst other things.

The s t a f f i n g of t h e school h e a l t h department v a r i e s i n the d i f f e r e n t countries, but it is usuallyheaded by a medical d i r e c t o r . A t t h e provin- c i a l and l o c a l l e v e l the administration of t h e school h e a l t h a c t i v i t i e s i s the r e s p o n s i b i l i t y of e i t h e r t h e a s s i s t a n t d i r e c t o r o r t h e d i s t r i c t h e a l t h o f f i c e r t h e municipal h e a l t h o f f i c e r s o r medical o f f i c e r s of t h e school h e a l t h centres or u n i t s .

Private schools a r e covered i n some countries by t h e established school h e a l t h services, but they mostly have t h e i r own system of h e a l t h care which i s usually under t h e supervision of t h e school h e a l t h department.

I n f a c t , many small p r i v a t e schools have p r a c t i c a l l y no h e a l t h services a t a l l ; and some, on t h e contrary, have excellent h e a l t h services.

2. Functions

A t the c e n t r a l l e v e l , t h e functions are f u l l y o r partly c a r r i e d out i n t h e d i f f e r e n t countries and mostly include: establishment of p o l i c i e s

WHO EMRO

on protection and promotion of the h e a l t h of school children; issuance and enforcement of regulations governing t h e school h e a l t h programme;

planning organization and supervision of t h e d i f f e r e n t school h e a l t h services; r e v i s i o n of c u r r i c u l a with regard t o t h e teaching of h e a l t h subjects; t r a i n i n g of h e a l t h personnel; budgetting and assessment of school h e a l t h s e r v i c e s ancl supervision and advice t o l o c a l l e v e l s . A t the l o c a l level, the functions of t h e school h e a l t h teams ( i n school h e a l t h polyclinics, centres, units, e t c . ) usually include periodical medical examinations, screening of schocl children, detection of diseases and defects, treatment of s i c k children and school personnel, immunization and c o n t r o l of communicable diseases, supervision of school s a n i t a t i o n , counselling of students, parents and teachers i n c h i l d growth and develop- ment, p a r t i c i p a t i o n i n and extension of h e a l t h e.ducation f o r teachers, students and parents and record- keeping.

I n t h e v i l l a g e s and r u r a l areas, t h e r u r a l health c e n t r e s o r u n i t s are responsible f o r t h e h e a l t h supervision of school children.

3 .

A c t i v i t i e s

It i s most encouraging t o note t h e wide range of a c t i v i t i e s c a r r i e d out by t h e e x i s t i n g school h e a l t h services:

Periodical Examinations a r e usually c a r r i e d out on a l l school children upon f i r s t admission t o primary schools and t h e r e a f t e r upon admission t o preparatory and secondary schools. Sometimes, a f o u r t h msdical examination is made I n t h e thsr? year secondary school, before completion of s t u d i e s , Sometimes parents a r e asked t o attend t h e examination of t h e i r cllildren I n primary schools. Teachers a r e not o f t e n i n v i t e d o r obliged t o attend t h e c h i l d

'

s examination. However, t h e parents

'

and teachers

'

presence i s desirable and w i l l enable the physician ( i f i n t e r e s t e d and glven sufficient time) t o c a r r y out properly h i s function a s a h e a l t h counsellor t o t h e parents, c h i l d and teacher.

Findings a t medical examinations have c l e a r l y demonstrated t h a t a f a i r l y high percentage of children had some h e a l t h defects other than dental, which required s p e c i a l a t t e n t i o n and treatment.

Vaccination and Immunization Programmes of a l l school children have produced valuable results. In addition to mallp pox m o o i n a t i o n ,

systematic imm-w~izatfon i s reported t o be undertaken i n the majority of the countries against ^other &iseases su.ch as: diphtheria, tetanus, tuberculosis, poliomyelitis, TAB and cholera. The vaccination calendar f o r re-vaccinaticn and f o r b ~ o s t e ~ doses v a r i e s according t o the country.

Accident Prevention Accidents a r e ^ii10s-t l i k e l y t o occur during school

-- --

years and a r e ail important cause u f death and disabil-ity. Necessary care and measures f o r accident prevention a r e talien i n most countries through h e a l t h education, school h e a l t h s o c i e t i e s , precautions within the school buildings and supervision of the school environment and through t h e provision of schools with f i r s t - a i d equipment and medicaments.

Dental Health Services a r e being provided by t h e school h e a l t h s e r v i c e s or c l i n i c s i n t h e majority of the countries, but mostly i n urban areas.

School h e a l t h u n i t s a r e o f t e n equipped by mobile d e n t a l u n i t s designed fur L L - e a L m e r l t i n schools. 7% of t h e s t u a e n t s examined tiTough a p i l o t project, i n one country, were faund i n need of d e n t a l treatment.

Mental Health Services and Child Guidance are s t i l l lacking i n the maJority

-

of countries i n t h e Region. A few s p e c i a l schools f o r retarded children have been established &d a r e under the supervision of t h e Ministry of

Education. Mentally retarded children have t h e i r own t r a i n i n g centres under the supervision of the Ministry of Social Affairs. Child guidance c l i n i c s , although limited i n number, have accommodated some needs.

Care f o r Handicapped School Children has been given s p e c i a l a t t e n t i o n i n some c c w t r i e s , where s p e c i a l schools have been establishec5 f o r the blind, the deaf-mute and paralytic children, as woll as speoial C ~ ~ E E C G for the children with v i s u a l disorders or hearing impairment. Health s e r v i c e s have a l s o been provided t o s p e c i a l schools f o r the deaf and f o r t h e physically handicapped.

Early detection of v i s u a l and auditory d e f e c t s i n children i s very important. Surveys t o be c a r r i e d out i n schools might r e v e a l i n a large number of children with l a t e r a l hearing d e f e c t s which could i n t e r f e r e with learning, It i s important t o discover the c h i l d who i s mentally handicap- ped i n order t o ensure t h a t s p e c i a l a t t e n t i o n be given t o the promotion of h i s h e a l t h and t o t h e s p e c i a l problem of h i s education.

Nutrition and School Feeding Many countries in this Region are conscious of the nutrition prcblems of school children anc! are carrying out sup- plementary feeding programmes, although some of these countries are faced with budgetary difficulties, owing to their limited local resources, School Sanitation Many countries in the Region are giving considerable attention to the construction of a new and adequately equipped school buildings in their long-term development plans. However, the sanitary conditions in most of the existing schools (often occupying old rented buildings) are not adequate. Most of these schools have been renovated to secure the indispensable sanitary facilities but the sanitary conditions

a r e still h a r d l y satisfactory. Rural communities with limited resources

are particularly handicapped in their efforts to remedy the situation.

Wherever bad construction, poor ventilation and lighting, lack of washing and inadequate drinking f a c i l i t i ~ s exist as w e l l as any other unsanitary

latrines or similar deficiencies, children absorb wrong ideas and learn harmful habits, difficult to unlearn later and contradictory to what they are being taught by the teachers and the school health personnel in this respect.

Prevalent Diseases of School Children

From the information made available from countries and from other sources, findings at school medlcal examinations revealed that, in addition to dental, visual and hearing defects, there are many diseases, which

are

prevalent among the school children in this Region. Among these diseases, the following have been reported: enteric infections; parasitic diseases, such as billtarziasis, ankylostomiasis, ascariasis, other helminthic

in-

fections, amoebiasis; virus infections, particularly chicken-pox, polio- myelitis, mumps, measles; other bacterial diseases such as diphtheria, pertussis and tetanus; communicable eye diseases, mainly trachoma, con- junctivitis~ skin infections, scabies and favus; tuberculosis and malaria.

Many efforts are being made in most countries to get these diseases under control.

5.

Sports andRecreation

Physical training and sports have widely developed in schools of this Region and have been encouraged by governments. Camping, tours and

excursions receive inel-easirig a t t e r l t i o n by -the authorltles concerned.

Attendance in camp is sometimes undertaken to educate children in a health-

ful

mode of living.