Quality of Implementation of the School Health Program in Oyo State, South-West Nigeria: A Rural-Urban Comparative Survey

Abstract

Background: The implementation of the School Health Program (SHP) is core to the realization of the goal of National Policy on Education. Despite the formulation and adoption of the National School Health Policy (NSHPo) in Nigeria in 2006, no study has been conducted to evaluate the quality of its implementation. This study was carried out to appraise the quality of implementation of the program in public primary schools in rural and urban Local Government Areas (LGAs) of Oyo State, Nigeria. Methodology: The study utilized a comparative cross-sectional design. A two-stage sampling technique was used to select 49 public primary schools; 26 rural and 23 urban, from two selected LGAs. Observational checklist (OC) was used to assess the SHP in the selected rural and urban schools from the LGAs. The checklist comprised of 4 sections; the school administrative information and implementation items for each of the three main components of the SHP as listed below i.e. School Health Services (SHS), School Health Education (SHE) and Healthful School Environment (HSE). The overall quality of implementation was measured by assessing the availability, appropriateness and functionality of basic health, sanitation and education facilities on a 79-point scale (SHS-21, SHE-10, HSE-48). Scores of <40%, 40-49% and ≥50% were categorized as poor, fair and good quality of implementation of the SHP respectively. Data were analyzed using SPSS version 22. Results: All the schools in both the urban and rural public primary schools had functional Parent Teacher Association. Neither the rural nor the urban public primary schools had trained first aiders, school health assistants or school health nurses. Even though most (87.8%) of the schools had first aid boxes (rural-100% versus urban-73.9%), 56.5% and 23.1% of the first aid boxes in the urban and rural public schools contained nothing. Only 8.7% of the urban schools had a sick bay. None of the public primary schools in both the rural and urban locations had major communicable health problems, HIV/AIDS education and use and abuse of drugs in their health instruction curriculum. Majority of the schools in the rural locations (88.5%) had sources of water supply compared with 10 (43.5%) of the schools in urban LGAs. Some (38.8%) of the schools had refuse bins located either on the corridors or at the corners of the classrooms. Higher proportions of schools in the urban areas (27.8%) had dustbins compared with (20.7%) of the rural schools. Overall, (59.2%) schools had poor quality of implementation of the SHP (rural-65.4% versus urban- 52.2%). Conclusion: The study revealed poor quality of implementation of the school health program in the selected rural and urban public primary schools in Oyo State as various essential equipment/items for effective school service delivery were either inadequate or lacking. There is a need for concerted efforts to improve/upgrade the standard of the program in both rural and urban public primary schools in the State.