Quality of implementation of the school health program in a rural district of Oyo State, Nigeria: a public-private comparison

Abstract

There is abundant evidence that the first and only School Health Policy (SHPo) in Nigeria was adopted in 2006, but no study has since evaluated the quality of implementation (QoI) in government and privately funded schools. This study was conducted to evaluate the QoI of the School Health Program (SHP) in public and private primary schools of a rural Local Government Area in Oyo State using the SHPo framework as a guide. A comparative-descriptive cross-sectional design was chosen. A two-stage sampling technique was used to select 46 primary schools in a rural area: 30 public and 16 private. An observational checklist was used to assess the five domains of the SHP, namely: School Health Services (SHS), Skills Based Health Education (SBHE), School Feeding Services (SFS), Healthful School Environment (HSE) and School, Home and Community Relationship (SHCR), as listed in the Nigerian SHPo framework. QoI was assessed by exploring the availability, suitability and functionality of basic provisions for SHP implementation. The majority of schools (90% public; 87.5% private) had first-aid boxes, but they had no contents in 23.3% of public and 68.8% of private schools. In only one private school was evidence of periodic medical inspection. A school meal service was present in 93.3% of public and 18.8% of private schools. Only one private school practiced medical screening. Some had gender-sensitive toilets (81.3% private; 33.3% public). None of the schools had evidence of pre-employment medical and routine screening for non-communicable diseases for staff. Overall, around 50% of schools had poor QoI of the SHP (63.3% public; 25.0% private). QoI of the SHP in selected rural public and private primary schools was generally poor, but with better quality in private than public schools.