After a two-year study on healthcare/health rights for school-aged children (5 to 17 years) and school health services in urban settlements in Nigeria, researchers have raised significant concerns regarding the health and safety of school children.
The study was conducted by researchers from the Health Policy Research Group (HPRG) at the University of Nigeria and the Education & Society Division at the University of Dundee in the United Kingdom, in partnership with the London School of Hygiene and Tropical Medicine, the Rivers State Ministry of
Health, and the Community-led Responsive and Effective Urban Health Systems (CHORUS).
Findings from the study led to two policy dialogues on the health of school-aged children and school health services.
In a communiqué issued at the end of a national policy dialogue it held in Abuja to brainstorm on issues around Nigeria’s child health laws/legislation, the research group suggested five strategies for reimagining and rejuvenating school health in the country.
The communiqué read: “We have reached a consensus on the five strategies for reimagining and rejuvenating school health, which include: leadership, frontline action, reviewing the NSHP, funding, and consequences for infringements of children’s health rights.
“On leadership, we believe the Child’s Rights Act clearly emphasises the duty of the relevant authorities responsible for child protection to ensure that every child achieves optimal health.
“After examining the content of the NSHP and considering the evidence from this research, we advocate for a shared leadership approach in the NSHP, partnering with the Ministry of Education and the Ministry of Health and Social Welfare. Both ministries must critically assess their roles based on their comparative advantages and legal responsibilities.
“Also, the Ministry of Women Affairs, whose legal roles include formulating and implementing child rights and protection policies in Nigeria, must participate in the leadership setup.
“This should be followed by effectively incorporating the National Primary Health Care Development Agency (NPHCDA) and its state-level counterparts. School health services are part of the minimum service package to be delivered by primary healthcare in Nigeria, and the NSHP and NCHP equally affirm this.
“Additionally, to invigorate school health and prioritise it as a national development goal, it is essential for the Ministry of Budget and Economic Planning to prominently feature “School Health” in the upcoming National Development Plan.
“Regarding frontline action, we have established that the disconnect between schools and the primary health system constitutes a clear violation of our child rights laws and child health legislation, namely the CRA, NSHP, NPHDAYP, and NCHP.
“These laws and policies explicitly mandate the comprehensive integration of all child health services into the primary healthcare system. With this understanding, we have collected empirical evidence, including geographical assessments through the GIS, which endorses connecting school clusters with PHCs.
“We agree that the School Health Desk Office (SHDO), typically based at the State Primary Healthcare Agency level, can only function effectively with intentional decentralisation efforts.
“Thus, we strongly recommend establishing a School Health Unit (SHU) within the relevant PHCs to oversee designated school clusters, paying attention to the population of pupils per cluster to avoid over-clustering. Additionally, schools should designate trained health focal persons to act as liaisons between themselves and the SHUs.
“This step is crucial to stimulate frontline actions aimed at fulfilling the objectives of the School Health Policy and promoting child protection more broadly. We are finalising a protocol to regulate SHU operations and practices, addressing governance, financing, human resources, information systems, and service delivery.
“This protocol will also outline guidelines for referrals from PHCs to higher-level facilities when necessary, and emphasise the importance of governing informal health providers, such as Patent Medicine Vendors, operating within these clusters. We will hand in the protocol to the NSHP leadership structure.
“The National School Health Policy (NSHP) is outdated and requires a thorough review. Our analysis highlights critical areas needing attention in this review process.
“Firstly, the NSHP’s overall vision should align with contemporary global and national health and child protection priorities, particularly the health-promoting school initiative supported by the health and child sectors of the United Nations.
“Secondly, the policy’s strategic elements must clearly define the range and types of services provided under school health, work with evidence-based models to sustainably deliver these services, outline the active involvement of children in implementing the policy, clarify the distinct responsibilities of relevant ministries and agencies, designate technical workgroups, and establish financing mechanisms that depend on government funding, innovative sourcing, and private sector involvement.
“Thirdly, realistic key indicators for measuring the policy’s progress should be established, with evidence-based and locally led frameworks for monitoring.
“Fourthly, the revised NSHP should include legal frameworks establishing and regulating school health units (SHUs), reiterating children’s health rights, and defining the penalties associated with violations.
“Fifthly, priority should be given to equity and inclusion issues, such as special provisions for children with disabilities, orphans, and those living in urban slums. Lastly, efforts must be made to ensure that the NSHP is well-publicised and included in school curricula as part of civic education.
“Research indicates that more than 60% of secondary school teachers are unfamiliar with the NSHP, which obviously reflects worse awareness scenarios among children and caregivers.
“On the part of funding, the ongoing Basic Health Care Provision Fund (BHCPF) provides an opportunity to fund school health initiatives. We strongly advocate for granting school children vulnerability status, enabling them to access Vulnerable Group Fund (VGF) support.
“This initiative could be phased in, starting with public school children or children living in poverty. Furthermore, we suggest conducting an actuarial cost analysis to determine the most feasible premiums for school children.
“School Health Units (SHUs) require funding, and in addition to appropriations from the government, we believe they could also receive funds from donors and the private sector if well-positioned.
“Consequences for child health rights’ infringement: In Nigeria, the child protection landscape is quite inadequate, mainly due to the ongoing violations of children’s rights, including their health rights, without any significant penalties enforced. We are concerned that these violations and associated penalties are largely unfamiliar to the public.
“Therefore, we appreciate the initiative proposed by President Bola Tinubu to establish a specific Child Protection and Development Agency. However, this effort still requires proactive agents on the frontline, which the proposed SHUs embody perfectly.
“We are confident that through this grassroots framework (the SHUs), the specifics of violations against children’s health and well-being can become ingrained within local communities, which is the most significant step to take in enforcing child protection nationwide.
“Our conclusive position is that approximately 70% of Nigeria’s children face risks to their wellbeing and health due to inadequate enforcement of existing child health legislation and the outdated NSHP.
“Nigeria’s health system has centred mainly on children under five (0-4 years), leading to this age group being viewed as the standard for children.
“This oversight of school-aged children (ages 5-17) is troubling, as it exacerbates the poor child protection and health outcomes Nigeria experiences on a global scale.
“To address this issue, schools must become the focus, given their crucial roles in education and daily child management for approximately nine months each year.
“Thus, it’s vital to rethink and revitalise school health services in Nigeria. An urgent review of the NSHP is necessary to ensure it effectively promotes actions that enhance the health and well-being of children. We have pinpointed key areas for this review while strongly urging connecting schools with the primary health system.
“This linkage should involve transferring the management of school health services to School Health Units (SHUs) housed in primary health facilities to supervise school clusters.
“As we work to finalise the protocol for the SHUs, we have suggested initial steps to kickstart this process. We will keep collaborating with relevant authorities until we are confident that every Nigerian child receives the support they need for optimal health and wellbeing.”