Health education
THE persistent neglect of human resource development is severely affecting social and economic outcomes in Pakistan. The country shamefully remains at the lowest ranking at 147 out of 148 countries, and compares poorly with its neighbours in South Asia.
For example, according to the Human Development Report 2015, the average years of schooling in Pakistan are 7.78, compared to 9.97 for Bangladesh, 11.69 for India and 13.71 for Sri Lanka. Similarly, health outcomes in Pakistan with life expectancy at 66.2 years are also the lowest in the region reflecting the inescapable linkage between education and health in human resource development.
Low budgetary allocations not only account for systemic failures and poor quality of education, they also result in unhygienic school environments such as lack of toilets and clean drinking water. While school dropout rates are high mainly due to poverty and lack of employment opportunities, these also occur due to health problems especially in the rural areas, where diagnosis and treatment options are limited. Moreover, learning disabilities remain neglected and undiagnosed, with the result that these children are forced to opt out of school.
In most countries, after the Alma-Ata agreement, school health and nutrition programmes have been introduced for early detection not only of medical problems but also to identify disabilities among children. In Pakistan, the National Commission for Human Development (NCHD), in collaboration with the Bill and Melinda Gates Foundation, launched a school health programme (SHP) in 2005, to improve school performance through health awareness and prevention and cure of common diseases at the school and community level.
School health initiatives have had little success.
Till 2008, the programme was implemented by NCHD in 16 districts of Pakistan; three from the then NWFP, five from Punjab, four from Sindh and four from Balochistan. The NCHD initiated training and capacity building of teachers to identify health problems among students through screening and referring them to district hospitals, and also providing glasses to those with weak eyesight.
This programme was discontinued in Sindh in 2006 due to the chronic problem of ghost workers. However, in Punjab, the programme was duplicated and later placed with the Punjab health sector reforms programme, under which school health and nutrition supervisors were hired and partially trained to visit government schools regularly. There is little progress to date as these workers are without job security and traverse the intricate abyss of providing services to schools and communities in a bureaucratically hostile environment.
The need for school health education with focus on improving the school environment, screening, health services and nutritional support for needy children was articulated in the National Education Policy 2009. But there were no specific interventions and mechanisms laid down to further these objectives under the policy.
Malnutrition remains a major problem even in Punjab, the richest province in Pakistan. In a paper published in the Journal of Medical and Health Sciences, it was found that in Sargodha district’s Bhalwal tehsil, 46.41pc of schoolchildren were suffering from various degrees of malnutrition, with about 12pc suffering from severe third- and fourth-degree malnutrition. In addition, 19pc had skin problems, indicating poor personal hygiene, along with physical deformities.
According to a research study conducted by the Nur Centre for Research and Policy in Lahore, there were many institutional weaknesses in SHP which needed to be rectified through legislation, holistic school reforms, structured monitoring mechanisms and greater ownership of the SHP by the health and education departments. It was pointed out that many components of the SHP were being carried out by school teachers themselves, who were already overburdened with election and census duties, as well as polio vaccination programmes.
These are serious structural issues. There is a dire need on the part of the federal government to direct the provinces to introduce basic healthcare in schools by taking stakeholders on board, distributing health advocacy materials, organising orientation seminars for key officials, and preparing curricula for training of teachers and school health and nutrition supervisors. Secondly, inclusive education must be made part of the effort, as without including children with disabilities, the country cannot meet the target of Education For All as mandated by the UN.
Thirdly, provinces should constitute task forces to formulate and launch pilot projects, such as school nutrition, promotion of iodised salt, provision of clean water, toilets and sanitation, hygiene education, health screening, identifying disabilities etc. At the same time, there must be networking and identification of relevant provincial level institutes and organisations which can extend technical support at the district level. The will and determination of the political leadership to invest in this important area will benefit health and education of future generations in Pakistan.
The writer is a former federal secretary.
Published in Dawn, February 25th, 2016