Experts in policy development, health, education, and other relevant sectors have stressed the need to re-envision the linkage between schools and the primary healthcare system (Schools-PHC Linkage) to respond to the health concerns of school-aged children.

This suggestion comes after new research showed worrying gaps in how school-aged children in Nigeria can get health care.

The findings were discussed at a two-day meeting in Abuja. The meeting, which took place 9-10 April, was organised by the Health Policy Research Group (HPRG) from the University of Nigeria, working with the CHORUS project.

The research looked at both slums and non-slum communities in Rivers State. It used different methods to gather information, to highlight both quantitative and qualitative evidence of the healthcare challenges facing children aged 5–17.

The event brought together policymakers, researchers, and representatives from development agencies to review the findings of the new study.

The study, called the PUSH Project (Protect Urban School Children’s Health), involved interviews, group discussions, classroom observation, and surveys with 408 schoolchildren and 156 school staff.

Introducing the project, the lead researcher, Prince Agwu, stressed that the Nigerian government needs to pay more attention to children older than four.

He revealed that many illnesses, both those that spread (like infections) and those that don’t (like some chronic diseases), affect children in this age group, including malaria, fever, and respiratory infections.

Acknowledging that Nigeria has made some progress with children’s health, with most focus on children under five, Agwu regretted that less attention has been paid to the health of school-aged children (5-17 years), who make up a large part of all children.

He also highlighted that the laws and plans that exist for children’s health, such as the Child Rights Act, the National School Health Policy, and the National Policy on the Health and Development of Adolescents and Young People in Nigeria (2019), aren’t having enough of a positive impact on children’s health.

Referring to data from the ‘Kids Rights Index’ and ‘Child Flourishing Index on children’s rights, he said that Nigeria is among the worst countries in the world and is ranked alongside ‘war-torn countries’.

According to researcher, Chinelo Obi, who presented what people said in the research (qualitative findings), the health of children in urban slums is made worse by several factors.

She pointed to the prevalence of substance abuse, risky sexual behaviours, and harmful health practices such as the use of herbal concoctions.

She added that some caregivers and even health workers exhibit negative attitudes, driving children and guardians toward informal and unregulated care providers like patent medicine vendors (PMVs).

Another researcher, Ifunanya Agu, presenting the numbers from the research (quantitative findings), said that schools in Rivers, especially in slum communities, often don’t have proper sickbays or trained health staff. She added that most children who felt unwell were often sent home, taken to a chemist, or left unattended.

According to her, about 66.2 per cent of students and 60.9 per cent of school personnel confirmed the unavailability of sickbays, while 70 per cent said there were no qualified health personnel in their schools.

The data also showed that when children fall ill, 14.5 per cent are sent home, 24 per cent have their parents called, and only 13.5 per cent are taken to PHCs. Only 43.9 per cent gave their pupils first aid.one of the students surveyed had any formal link with a local health centre near their school.

The study also showed that 88.2 per cent of children expressed willingness to report bad healthcare practices, but lacked clear avenues to do so​.

In the same development, only 38 per cent of students confirmed their schools checked the nutritional value of their meals, while 56 per cent of school personnel admitted to also checking meals brought by the students.

More alarmingly, 39 per cent of children had never been taught about the levels of healthcare (primary, secondary, tertiary), suggesting widespread gaps in healthcare literacy.

The findings further revealed the alarming patronage of Patent Medicine Vendors (Chemists) by those looking after the children, showing that 41 per cent of the school personnel use chemists to provide first aid treatment to the children. Accessing PHC came third with just about 13 per cent of them using it for children’s health needs.

Speaking to reporters, the former Rivers State Commissioner for Health, Adaeze Oreh, said that the state government supported the HPRG’s PUSH project because they needed policies to be based on evidence and facts.

While Nigeria has made progress in children’s healthcare, especially for babies and young children under five, Oreh said that most school-aged children are still being overlooked.

She described a gap in policy that has meant children aged 5–17, who make up over 70 per cent of Nigeria’s child population, are not getting the care they need.

She mentioned findings from a meeting in Rivers in 2024, where it was found that although plans exist, poor teamwork between different government departments and a lack of clear responsibility for funding has stopped these plans from being properly put into action.

“We are not trying to undermine the very valid emphasis and attention that’s being given to a newborn, infant, and under-five health, but also drawing attention to this middle – the 70 per cent who are aged between five years and 17, that are mainly domiciled, about 60 to 65 million children in schools in this country, and we do not have effective means of addressing their health and well-being, but we have existing primary health care structures, and we can use that as a leverage to providing their health needs,” she said.

According to Oreh on the new research and the workshop, the goal was to shift from policy discussions to implementable strategies tailored for states across Nigeria.

She called for urgent attention to the use of existing PHC structures as a viable way to bridge the healthcare gap for school children.

“If this evidence that is gathered from sound, robustly conducted research is applied to policy making and decision making, we should see a turnaround in the population, child health population statistics. The reason is, if we are witnessing improvements in newborn health, in infant health, in under-five child health, and there is, like I said before, 70 per cent of the population, who don’t have or who have minimal access,” she said.

Without this shift, she warned, the nation’s progress in reducing child mortality could be reversed by the poor health outcomes of its older children.