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CHAPTER ONE

INTRODUCTION

1.1 BACKGROUND OF THE STUDY

With incessant outbreaks of deadly diseases such as Ebola, Lassa fever, Zika virus, HIV/AIDS, Hepatitis, Meningitis, Cholera, Typhoid, Malaria, and others, which claimed thousands of lives of people in Africa and Nigeria in particular, including school-going age individuals, one of the nation's responsibilities is to protect the lives and health of its citizens from any life-threatening diseases and other health-related issues. Revitalizing School Health Programme (SHP) will thus play a vital role in protecting, preserving, and promoting the health of individuals in schools and the nation at large since there is a relationship between students, staff, and community health.

It is a well-known saying that "health is wealth," and one of the most important aspects of all human development is health. According to the World Health Organization (WHO) (2003), health is a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity. Thus, the health of students and staff in schools is a matter of great concern if we are to ensure effective school administration for the realization of educational goals and objectives. Students' health is one of the factors that determine the learning outcomes of students; this is because a well-nourished and healthy student is expected to perform better than the malnourished and sick student. Kolbe (2002) opined that children who are unhealthy or injured, hungry or depressed, abusing drugs, or pregnant are less likely to learn than those who are not. Sarkin-kebbi (2016) stressed that if a student is sick, he/she might not be able to give maximum attention to his/her lesson or might not be able to come to school, thereby breaking the learning process.

 Furthermore, Abdou in sita (2009) opined that health and nutrition are determinants of qualitative and basic education; they are also the product of education. To get full access to educational activities and their benefits, children must be in good health and well-fed. A safe school environment helps in protecting children against health problems, absenteeism, and exclusion. In addition, according to the WHO (2014), an effective school health program can be one of the most effective investments a nation can make to simultaneously improve education and health. School health programs are a strategic means to prevent important health risks among youth and to engage the education sector in efforts to change the educational, social, economic, and political conditions.

In 2001, the Federal Ministry of Health and Federal Ministry of Education, in collaboration with WHO, took the initial step by conducting a Rapid Assessment of the School Health System in Nigeria to ascertain the status of school health. The assessment noted several health problems among learners, the lack of health and sanitation facilities in schools, and the need for urgent action in school health (Federal Ministry of Education, (FME) 2006a). A statistical study on the state of the school health system in Nigeria by the Federal Ministry of Health and Federal Ministry of Education, in collaboration with WHO in 2003, has shown that only 14% of head teachers indicated that premedical examination was mandatory in their school, only 17% of schools have school nurses, about 30% of students have low Body Mass Index (BMI), about 20% of students do not have normal visual acuity, and about 19% of students do not have normal hearing.

The study also identified that five common health problems of students that contribute to absenteeism are fever/typhoid with 55%, headache 43%, stomach ache 29%, cough/catarrh 38%, and malaria with 40%. As a result of the above, it becomes imperative for school administrators to ensure that SHP is well implemented into their schools in collaborative efforts with ministries of education, health, environment, etc., as well as stakeholders and communities (FME, 2006a).

The declarations of Dakar 2000, which stipulate Education for All (EFA) and Health for All (HFA), also paved the way for the formulation of the Nigerian National School Health Policy in the year 2006. The mission of the National School Health Policy was to put in place adequate facilities, resources, and programs that will guarantee physical and mental health, social well-being, and safety and security of the school community, which promote the learning outcomes of the child (FME, 2006a). Despite the provision of the National School Health policy with the vision of promoting the health of learners to achieve Education For All (EFA) and Health For All (HFA) in Nigeria, the School Health Programme has been neglected in Nigerian schools, right from primary, secondary, and tertiary institutions, and the program is still suffering from dwindling problems ranging from inadequate facilities, inadequate funding, lack of awareness, mismanagement, etc., and this policy becomes a mere rhetoric with poor implementation. Therefore, to assure Nigeria's philosophy of education, every Nigerian child shall have the right to equal educational opportunities irrespective of any real or imagined disabilities, each according to his/her ability to maximize their learning ability towards the actualization of educational goals and objectives. This can be only realized if adequate and appropriate facilities are provided among which are school health facilities.

1.2 STATEMENT OF THE PROBLEM

In recent years, there has been a growing emphasis on implementing comprehensive health programs in secondary schools to address various health issues among students. However, despite the recognized importance of such programs, there remains limited understanding of the factors influencing their adoption within secondary school settings. This study aims to investigate the barriers and facilitators to the adoption of school health programs in secondary schools, with the goal of informing strategies to enhance their implementation and effectiveness.

1.3 OBJECTIVES OF THE STUDY

The main objective of this study is to examine the adoption of school health programs in secondary.

Specific objectives include;

1. To assess the effectiveness of implementing comprehensive school health programs in improving physical well-being among secondary school students.

2. To examine the impact of school health programs on academic performance and attendance rates in secondary schools.

3. To investigate the relationship between the adoption of school health programs and the reduction of risky health behaviors among secondary school students.

1.4 RESEARCH QUESTIONS

1. How do comprehensive school health programs influence the physical health outcomes of secondary school students?

2. What is the association between the implementation of school health programs and academic performance as well as attendance rates in secondary schools?

3. In what ways does the adoption of school health programs correlate with the reduction of risky health behaviors among secondary school students?

1.5 RESEARCH HYPOTHESES

H1: Secondary schools with comprehensive health programs will report higher levels of physical well-being among students compared to schools without such programs.

 H2: The implementation of school health programs in secondary schools will positively correlate with increased academic performance and attendance rates.

 H3: There will be a significant negative relationship between the adoption of school health programs and engagement in risky health behaviors among secondary school students.

1.6 SIGNIFICANCE OF THE STUDY

This study has been outlined to check the adoption of school health programs in some selected public schools nationwide. The findings would be valuable for school administrators across the country to assess the level of school health programs in their schools, identify loopholes, and make necessary amendments to ensure the well-being of pupils. Additionally, the research findings could inform the government about areas where improvements are needed in the adoption of school health programs in public secondary schools nationwide.

1.7 SCOPE OF THE STUDY

This study aims to assess the adoption of school health programs in selected public schools nationwide. It focuses on evaluating the effectiveness and implementation of existing health programs within schools, identifying areas of improvement, and proposing recommendations for enhancing the overall health and well-being of students. The scope includes examining the accessibility, quality, and impact of health initiatives, with the goal of informing school administrators and government stakeholders for better program development and implementation.

1.8 LIMITATIONS OF THE STUDY

Limitations of this study include the focus on selected public schools, which may not fully represent the diversity of school environments nationwide. Additionally, the study's reliance on self-reported data from school administrators and potential recall bias among respondents may affect the accuracy of findings. External factors such as community health infrastructure and government policies could also influence the implementation of school health programs, potentially limiting the generalizability of the study's conclusions.

1.9 DEFINITION OF TERMS

1. School Health Programme (SHP): This is the concerted effort of the school that contributes to the maintenance, promotion, enhancement, restoration and improvement of the health of pupils and school personnel including health services healthful living and health education.

2. School Health Services: This is services provided through the school system to improve the health and well-being of children and in some cases whole families and the broader community.

3. School Healthful Environment: This refers to the physical environment of school buildings and school grounds and is a key factor in the overall health and safety of students, staff, and visitors. School buildings and grounds must be designed and maintained to be free of health and safety hazards, and to promote learning.

4. School Health Appraisal: A health appraisal, or health risk assessment, is a tool that allows school health providers to gather information about an individual's physical health and lifestyle. It also helps screen pupils for vision, dental etc. and to make referrals where possible.

5. Community participation: This explains the involvement of the community to the school and program and rendering of necessary assistance where needed.

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