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School Health Services in India: The Social School health programs include school health services, health education, a healthy environment, physical education, nutritional food service, counselling, health promotion for staff, and community support. It is extremely important to adopt methods that promote health and prevent diseases. During the post-Independence period, school health services remained a state subject until late 1970s, when the program was revitalised and accorded the status of a centrally-sponsored programme. Recognising importance of this program, the volume brings together articles on various components of school health in India that includes the Mid-day Meal (MDM) scheme, School Health Services and School Health Education.
The next three chapters examine the implementation of MDM scheme launched in 1995 with the basic objectives of improving child nutrition; promoting school attendance on a daily basis and fostering social equity. Besides these, the scheme had other possible roles such as socialisation role; employment for women; reducing the burden of household work; nutrition education; child health; community participation; making the school environment more child-friendly. Overall, the scheme aims to achieve the objective of universalisation of elementary education. Jean Dreze and Aparajita Goyal discusses the future of mid day meals based on a survey of three states—Chhattisgarh, Rajasthan and Karnataka—undertaken by Centre for Equity Studies (CES), New Delhi in 2003. The article shows there has been variations in the implementation of programme across different states. Reetika Khera reviews evidence from 10 field studies and government documents to understand how the scheme actually works on the ground. Both these articles have already been published in Economic and Political Weekly in November 2003 and November 2006 respectively. The third paper by Samson et al. examines the MDM programme in Delhi which is based on centralised kitchens model with 11 NGOs running 13 kitchens. The study records that it is commendable to provide freshly cooked meal to 950,000 children in 1,863 schools on all schooldays even though the quantity and quality of the MDM need to be improved. It points out the importance of linking MDM with School Health Services. Baru in Chapter 6 gives an overview of the school health services in India. Among other things, the paper points out while under-nutrition is a major problem among school-going children belonging to lower-middle and working classes, over-nutrition affects the upper-middle class children, who suffer from obesity and deficiency diseases occurring due to eating food high in fat content, excess of salt and a lack of adequate fibre. Several case studies based on the experiences of NGOs from different parts of the country are put together in Chapter 7. Anu Gupta shows how the school health programmes can be made interesting with the help of intervention of school health programmes such as Eklavya and Kishoravastha Shikshan Karyakram. Likewise, the other two case studies also exhibit how a more holistic approach to health education can be implemented.
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Chapter 2 highlights the link between ill-health and poverty and effects
on primary schooling. Taking a life course approach to primary
schooling, the paper lists the factors acting as constraint on children
to meaningfully participate in education which range from economic
status of the family, health status of the mother to availability and
access to quality health services. Based on the field work in six
villages and one urban settlement each from the states of Andhra Pradesh,
Karnataka and Uttar Pradesh, the study observes that when poor and weak
mothers give birth to children in the absence of family, community and
institutional support, an intergenerational process of poor health,
nutrition and education is set in motion. The paper submits that all
newly introduced programmes tend to diminish the validity of earlier
efforts though it is worthwhile to revisit earlier nutrition education
and preventive health care programmes.