School Health Clinics
Delhi Government’s Department of Health & Family Welfare and Department of Education came together to synergise and expand their horizons to provide physical and mental health services to children in schools through Aam Aadmi Mohalla Clinics (AAMCs) in schools.
80 structures have already been constructed and readied by the Public Works Department (PWD) out of the 265 plots identified inside school premises for the construction of the School Health Clinics (SHCs). In 233 schools, already existing rooms have been earmarked for the functioning of SHCs.
A pilot of the visionary School Health Clinics project is currently being implemented in 20 Delhi Government schools for a period of 3 months which started in March 2022. The learnings from the pilot project would be incorporated in developing a scheme to cover all Directorate of Education (DoE) schools in Delhi.
Through its Delhi@2047 platform, DDC Delhi has invited keen private sector/CSR initiatives and philanthropic organizations to partner for developing the module, tools for performance indication, digital infrastructure and other aspects of the SHC project. The following organisations have partnered with Delhi Government for an ongoing collaboration on the SHC project through the Delhi@2047 platform hosted by DDC Delhi:
- Indraprastha Apollo Hospitals
- BSES Rajdhani Power Ltd
- BSES Yamuna Power Ltd
- The Hans Foundation
Need for the Initiative
Children have been repeatedly recognised as a vulnerable group by social scientists- making intervention at a primary level crucial. The health concerns of school children are mainly in the categories of malnutrition, infectious diseases, intestinal parasites, diseases of the skin, eye, ear, dental caries etc. Out of 12,586 Indian school children aged 6-14 years, 38.8% of children have one or more identifiable skin conditions (Study in Epidemiology of Skin Diseases in School children, a study from Northern India). Several micronutrient deficiencies affect functional- particularly cognition and physical performance of children (A study in Micronutrient Deficiency and Cognitive and Physical Performance in Indian Children), thus making it important to identify and prevent subclinical deficiencies, particularly of iron and B-vitamins. Most of these health situations can be handled at the level of a primary care OPD.
Moreover, rising mental health concerns among school-going adolescents have been widely spoken about, but they largely go undiagnosed in the present health infrastructure present in schools. According to the WHO report, India tops the list of countries with the greatest burden of mental and behavioural disorders and nearly half of all mental health problems originate before the age of 15. Further, according to the National Mental Health Survey (2015-16), the prevalence of mental disorders among adolescents is reported around 7.3 percent. A study conducted by Delhi State Legal Services Authority (DSLSA) on 225 government schools found that 36% of the students who dropped out consumed a substance. 12-13% of school students suffer from emotional, behavioural and learning problems. Suicide rates among children are perilously rising. A 2015 Delhi Commission for Protection of Child Rights (DCPCR) study found that the mean age of street children in Delhi taking drugs was about 13 years with the mean initiation age being as low as 9 years!
Features of the Initiative
Health is not merely the absence of any disease or infirmity but a state of complete physical, mental and social well-being. Holistic healthcare of children needs equal focus on physical as well as mental health. Regular health check-ups and tests can help find health issues before they start and help find problems early where the chances for treatment and cure are better. Therefore, providing the right health services, screenings and treatments for children in schools will help them have a healthier life. With this vision, Delhi Government designed the School Health Clinics project which seeks to pair the interventions of diagnosis, treatment and prevention related to physical and mental health concerns of the children.
Under the project, each Delhi Government school would have one School Health Clinic in the form of either a 600 sq ft. porta cabin on the school premise or a room in the school building. This structure would house compartments for physical health screening, OPD consultation, medicine dispensing and a separate room for individual counselling sessions. The SHCs would operate for the entire duration of the school shift. In double-shift schools, two separate sets of staff will work for the entire duration of each shift from the same SHC.
A School Health Clinic (SHC) would function through a team of one doctor, one psychologist, one Nursing Officer (NO), and one multi-task worker (MTW). While the psychologist, nursing officer and MTW would be appointed at every SHC, the doctor would be appointed for a cluster of 5 schools/SHCs. The staff would collectively be responsible for the diagnosis, treatment and prevention of recognized diseases, disabilities and deficiencies in the physical and mental health of the students.
The physical healthcare would involve regular screening, primary treatment through OPD, first aid, dispensing of essential medicines and recognized nutritional supplements, referrals to the Delhi Government’s secondary and tertiary hospitals and regular follow-up. Additionally, each child would be provided with a digital health card to maintain their health portfolio.
30 students would be screened for 30+ diseases, disabilities and deficiencies each day in the SHC by the nursing officer. On the identification of students with diseases, disabilities and deficiencies curable through primary OPD in SHC, the nursing officer would present these students to the doctor for OPD treatment during the doctor’s weekly visit to the school. For those students requiring secondary or tertiary care, the doctor would refer them to higher centres. The nursing officer would regularly follow up with such students till the reception of treatment. The nursing officer, with the help of MTW, would maintain the digital health records of the students through school health cards.
Mental healthcare will be targeted through a trained psychologist. Primary modes of intervention would be individual counselling sessions, need-based group counselling sessions and group life skills sessions
A psychologist would conduct 4-5 individual counselling sessions and 4 life skill sessions each day. During these sessions, on identification of students requiring secondary and tertiary care, the psychologist would refer them to higher centres and follow up regularly till completion of treatment
The focus would be on life skill education, negating peer pressure, self-esteem issues, interpersonal relationships, adolescent and reproductive health, substance misuse management and abilities to cope with stress and anxiety.
How would an SHC Team work?
The doctor would visit each school in the cluster of 5 schools on a rotational basis such that s/he is present in each school once a week (Monday to Friday), conduct OPD for children identified by ANM through the screening process, and prescribe treatment through OPD or refer to higher health centres. The doctor/ANM would be dispensing medicines as prescribed to the school children.
For specialized intervention for the mental health concerns of school children, a professional psychologist having relevant experience in child and adolescent issues would conduct individual counselling sessions and group life skill sessions, refer students to higher health centres, if needed, and regularly follow up till the treatment is completed.
The Nursing Officer (ANM/PHNO/GNM) would conduct screening of 30 students per day, thereby identifying students to be attended to by the doctor in OPD, assist the doctor and provide first-aid services whenever required, and assist the psychologist to conduct group life skill sessions, dispense medicines as prescribed by the doctor, distribute the tablets under the Weekly Iron and Folic Acid Supplementation (WIFS) Programme, distribute sanitary napkins, and maintain digital health records of the students. The MTW would be responsible for clinic maintenance and queue management.
Expected Impact of the SHC Project
- 100% of children in each Delhi Government school will be screened for primary health concerns every 3 months.
- Deviant cases recognized during screening will be provided with treatment for the identified ailment by a qualified doctor.
- The children will develop treatment-seeking behaviour.
- Their entire journey from diagnosis to treatment at higher centres will be followed up.
- They will receive the required professional counselling at school to deal with different mental health concerns.
- The adolescents will be aware of the physical and emotional changes and equipped to be comfortable with them.
- They will be equipped to negate peer pressure.
- They will be able to identify personal strengths and weaknesses.
- They will be able to demonstrate healthy expressions of needs.
- They will be able to effectively deal with unhealthy relationships.
- They will be able to identify the relationship between personal hygiene and good health.
- They will be able to demonstrate healthy eating habits.
- They will be able to learn to prefer long-term satisfaction as opposed to instant gratification.
- They will be able to learn and promote the safe use of the internet.