Meeting the Needs of Children's Health in India

School children at the Kendriva Vidvalava School in Delhi.

As the Chilean poet Gabriela Mistral once said, "We are guilty of many errors and many faults, but our worst crime is abandoning the children, neglecting the fountain of life." Good health and education are cornerstones for the development of any civilization, and the responsibility of delivering these services lies largely with the state. It is necessary that children be seen as an investment for the future, and government spending in these areas must be adequate, especially in a fast-growing economy like India.

It is estimated that the burden of disease for school-age children of 5-15 years is 11 percent of the total global burden of disease. There are an estimated 1.2 trillion school-age children, with 88 percent of those living in poorer countries. As much as the burden is derived from poverty-related issues, it is this 88 percent that is most at risk. Ninety-nine percent of child deaths occur in poor countries.

Child health requires action on a global scale. Pneumonia causes 2 million childhood deaths annually, while measles results in more than 700,000 child deaths annually. More than 1,500 children are infected with HIV every day. Also, HIV leaves millions of school-age children without parents. These children carry greater work loads, which affects their growth and education.

UNICEF reports that more than 2 million children die every year from preventable infections. Infant mortality in India is as high as 63 deaths per 1,000 live births. Children in India continue to lose their lives to vaccine-preventable diseases such as measles, which remains the biggest killer. For children surviving these hurdles, by the time they reach school, they may be underweight, malnourished and susceptible to multiple illnesses. Children form a large proportion of India's population, and improving quality and coverage of health and nutrition services, reducing mortality rates, and improving access to education and skill development should be priorities of government.

The School Health Programme is the only public sector program specifically focused on school-age children. Its main focus is to address the health needs of children, both physical and mental, including nutrition interventions, yoga facilities and counseling. It increases the efficacy of other investments in child development, ensures better educational outcomes and improves social equity. In addition, the services are provided in a cost-effective manner.

Recognising the importance of this program, many states in India are revitalizing their School Health Programme. In 2010, the government of Andhra Pradesh (a state on India's southeast coast) launched Jawahar Bala Arogya Raksha, also called the Child Holistic Improvement Programme (CHIP). The aim of CHIP is to promote positive health among school children. It also focuses on prevention of diseases, early diagnosis, treatment and follow-up. It highlights the importance of awakening health consciousness in children and promoting a healthful environment.

The CHIP policy framework has been developed along the following lines:

  • Focus on health as well as education outcomes: A comprehensive School Health and Education Record have been developed. Each child's health details and educational outcomes are recorded in this book, and it is sent to the parents twice a year.
  • Formation of a formal, multi-sectoral policy: An effective coordination has been established between the departments of health, school education, tribal welfare, SC welfare, ST welfare, BC welfare, disabled welfare and women and children.
  • Usage of existing infrastructure as much as possible: The focus is on the school as an institution for provision of school health services. Existing staff from health and education are being utilized.
  • Building the progam around simple, safe and familiar health and nutrition interventions by being inclusive and innovative.

Drawing from the NRHM Guidelines for School Health, CHIP also has the following components built into it:

  • Basic health screening for all school-age children and referral for children requiring specialized care;
  • Immunization for children at age 5, 10 and 15;
  • Micronutrient (vitamin A and iron folic acid) management;
  • Bi-annual de-worming for all school-age children;
  • Health education;
  • Capacity building of teachers and involved health personnel; and
  • Strengthening of the Mid-Day Meal services.

CHIP was launched on November 14, 2010 on the occasion of Children's Day. Following the launch, in-depth trainings on school health were conducted for 158,000 medical staff and school teachers in 22 districts of Andhra Pradesh. Comprehensive Student Health and Education Records have been issued to close to 8.2 million child students studying in 78,702 government and government-aided schools across the state. As of March, health screening has been conducted for close to 2 million students in 16,232 schools. Additionally, 22,667 students have been referred to higher medical centers for specialized treatment. A special deworming drive was undertaken and close to 7.5 million students, three lakh teachers and medical staff were dewormed in Andhra Pradesh.

Despite the obvious benefits of school health programs, the implementation is generally riddled with problems. The Departments of Health and Education need to work together to pool human resources and budgets. The strength of the program will hinge on two challenges.

One is increased teacher responsibility. As the teachers are more in contact with the children than the medical personnel, teachers are more likely to recognize physical and mental problems faced by the students. Hence, building a comprehensive school health program requires teachers to take an active role in delivering it. The second important factor is a strong referral system, which is a huge challenge. However, with proper referral channels the children will benefit immensely. There will of course be many other challenges, but with each one met, again, it is the children who benefit.

Anusha Bharadwaj is a member of the AP State School Health Committee and she has played a key role in developing the school health policy and processes for the newly launched Jawahar Bala Arogya Raksha Programme in the State of Andhra Pradesh, India.