By Zubeida Mustafa
AT a time when the very future of our schools is so bleak, it appears almost crass to write about the need for introducing a school health programme in Pakistan. But, as pointed out by an observer, diseases take a heavier toll than bomb blasts. Hence they should not be ignored.
Besides we have been warned that the war we are engaged in will be of long duration. Life must then go on — as will the cycle of health and disease. And both — school safety and students` health — must be provided for.
Last week, a seminar in Karachi on the `Impact of water and sanitation on health` would normally not have caught my attention, given that this issue has been talked about endlessly with no worthwhile result.
Nevertheless, hidden in the outpouring of words that such gatherings produce, was a one-line statement that came like a bolt from the blue.
One didn`t expect it as learned experts were pontificating on the advantages of clean water and sanitation. Prof Rasheed Jooma, director general of health, who was the chief guest on the occasion, casually mentioned that the federal health ministry “might revitalise the school health programme”.
One fervently hopes that it does. Dr Jooma would earn the gratitude of millions of parents if he translates his words into reality.
Few would recall that at one stage the government had introduced a health programme for school students. Needless to say it never got off to a good start and is now virtually dead. If the government thinks it worthwhile to revive this project, it certainly deserves to be commended and no delay should be brooked.
One hardly needs to emphasise the close link between health and education, something that is universally recognised. One reinforces the other. A child in good health can apply himself to his studies better. His school attendance record is good, and being alert and energetic the student can be expected to perform better academically. Besides, health education must start early in life to have an impact.
The ideal approach therefore is to link the two sectors where linkages are available. This could be done by introducing a strong school health programme, especially in public-sector institutions, which account for 87 per cent of primary-level enrolment in the country. Students in these schools have modest means and are often denied adequate healthcare.
The government would do well to look into some programmes that NGOs have adopted to give some health cover to their students. Some of them are doing very well.
Take the case of the Garage School in Neelum Colony, a low-income locality in Clifton, Karachi. Set up by Shabina in 1999 with a handful of children on its rolls, this school has expanded over the years. Today it has over 300 students. Shabina adopts an incremental approach. Initially she was providing rudimentary healthcare on an ad hoc basis. This has now been formalised and expanded to include students and their families as well.
Since February, Dr Aniqa Khan has been holding a clinic on the school premises thrice a week in the afternoon. The students of the school as well as their families receive coverage free of cost. This might even involve expensive surgery and hospitalisation which is provided through the network of health facilities and consultants which Dr Khan has created through personal contacts
The most recent beneficiary of this arrangement was Kainat, a five-year-old who suffered from a serious congenital heart problem. Three weeks ago, Kainat underwent delicate cardiac surgery at a leading hospital in Karachi. Funds were raised for the child as an appeal went round on the Internet with the hospital also providing concessionary rates.
When the school admits new children all of them undergo a medical check-up so that any serious condition can be detected — that is how Kainat`s case came to light. Any child who feels unwell is encouraged to visit Dr Khan with his parents not just to obtain medicines but also to receive counselling on health awareness. The doctor has periodically arranged group discussions with the community on health, hygiene, lifestyle, diet and family planning.
The health clinic has begun to make an impact. Absenteeism in class has decreased and the health of the children has improved. Adopting the preventive approach, Shabina gets donors to pay for the vitamins, iron and calcium pills she hands to the children every morning, costing over Rs21,000 a month. When a donor is available, they also get fruit, eggs and milk to supplement their diet. Dr Aniqa Khan treats other families in Neelum Colony whose offspring are not attending the Garage School for a nominal fee.
It all appears to be so simple and doable. One hopes the health ministry will study this model and adopt it. Why should it be left only to the NGOs and other individuals committed to education and health to think outside the box? The government with its greater resources should be the one taking the initiative to introduce a programme of this kind. The Global Competitive Index places Pakistan at the lower rungs of health-related indicators. The recently announced National Education Policy speaks vaguely of providing health services and food in schools but one will have to see if the authorities are serious about it.
What is needed is a holistic approach to the child`s education. He is a part of his family which lives in a community. Until an effort is made to reach out to them and integrate the classroom with the social environment, no education project can succeed.
If primary healthcare were to be integrated with education — schools can form the nucleus — it will be possible to reach out to the community. This will considerably reduce the load on tertiary healthcare institutions.