Assessment of the Quality of School Health Education and Health Services in Governmental Schools at Khan Younis and Rafah Governorates, Palestine
Prepared by the researcher –
Naji M. Abu Luli – Clinical Instructor, Palestine College of Nursing, Ministry of Health, Gaza, Palestine
Zeyad Abu Heen – Dept. of Environment and Earth Sciences, Islamic University – Gaza, Palestine
Yousef Aljeesh – Faculty of Nursing, Islamic University – Gaza, Palestine
Democratic Arab Center
Journal of Afro-Asian Studies : Sixth issue – July 2020
A Periodical International Journal published by the “Democratic Arab Center” Germany – Berlin. The journal deals with the field of Afro-Asian strategic, political and economic studies
Abstract
Background: This study is considered one of the most important studies that should be highlighted in order to raise the developmental level of the state in all fields, especially the educational institutions, since the child today is the man of the future and for this the government should pay great attention to his health.
Objectives: this study aimed at assessing the quality of school health education and school health services in governmental schools at Khan Younis and Rafah Governorates.
Methods: The researcher used the descriptive analytical design in the study. Since population size is relatively small, the researcher considered the population as the sample of study (census), which consists of the school health coordinators in governmental schools at Khan Younis and Rafah Governorates whose number (97 ). The researcher used a questionnaire for the school health coordinators whose number (97). The researcher verified the validity and reliability of study tool.
Results: The findings of the study indicated that the level of implementing school health education was very good level with weight mean 82.1%, moreover the level of implementing health services in governmental schools at Khan Younis and Rafah Governorates was very good with weight mean 85.6%.
Conclusions:
The field of school health education and school health services in the governmental schools at Khan Younis and Rafah Governorates needs some recommendations as Increaseing number of health seminars to educate students about physiological changes, appointing a resident nurse for each group of near schools to deal with emergencies occurring at these schools, support the school health team with modern equipment.
Background
A school is an educational institution designed to provide learning spaces and learning environments for the teaching of students under the direction of teachers. Most countries have systems of formal education, which is commonly compulsory. In these systems, students progress through a series of schools. ( Roser, Max; Ortiz-Ospina, Esteban (2019).
The school health program is considered one of the most important components of the school and it’s group of concepts, principles and systems provided to reinforce students health in the school age and reinforce society’s health through schools (Abu Zaida, 2006). The school health has a group of interests including medical services fields, school environment fields, health education and canteen, nutritional fields.
School health education is defined as a comprehensive health curricula. It is a blend of community, schools, and patient care practice; Health education covers the continuum from disease prevention and promotion of optimal health to the detection of illness to treatment, rehabilitation and long-term care, this concept is recently prescribed in current scientific literature as ‘health promotion’, a phrase that is used interchangeably with health education ( Glanz, et. al, 2008).
Health services is defined as the services to students to appraise, protect, promote health. These are designed to ensure access or referral to primary care, prevent and control disease and health problem, provide emergency care, provide a safe environment, and provide educational and counselling opportunities for prompting health (Maurer & Smith, 2013).
The school health services are offered to students in the first, seventh and tenth grades in the governmental schools in the Gaza Strip which totalling 400 schools. The coverage rate for a medical examination was 96% in 2015-2016, the number of students who were examined was 63295 students out of 65996 students )MOH, 2016).
The attention of the school health began after the Ministry of Education had taken charge in 1994, from the Palestinian National Authority, where there was a special department for school health in the directorates of education. A teacher has been assigned at each school to conduct medical supervision inside the school in addition to his work as a teacher and called school health coordinator.
The researcher carried out this study to assess quality school health education and health services provided to students and he hopes the responsible of school health programs in Ministry of Education and Ministry of Health could benefit from its results.
Materials and subjects
Study design
The design of this study was a descriptive, analytical cross-sectional one. This method is appropriate for description of the status of phenomenon and its relationship and comparison between variables.
Setting and period of the study
The study was carried out in governmental schools at Khan Younis and Rafah Governorates, the study was conducted during the period from April 2017 and end in November 2017.
The study population and sampling is consist of the school health coordinators in governmental schools at Khan Younis and Rafah Governorates whose number (97 ) present in table(1).
Table (1): The number the school health coordinators and their response .
| Rafah schools | East Khan Younis schools | West Khan Younis schools | Total | |
| The number of school health coordinators | 35 | 37 | 32 | 104 |
| Response
|
34 | 33 | 30 | 97 |
| Percent of response | (97)% | (89)% | (93)% | (93)% |
Study instruments
The researcher used a structured questionnaire for collecting data, the researcher used Likert scale of 5-points to prepare structured questionnaires according to literature review and researcher experience in school field.
Data analysis was conducted using Statistical Package for Social Sciences (SPSS 24) for statistical analysis. Data was collected in the period 23/8/2017 to 10/10/2017.
Ethical considerations.
The researcher was committed to all ethical consideration required to conduct a research. Ethical approval was obtained from General Administrator of School Health in Ministry of Education and Higher Education. Also, an official approval was obtained from General Directorate of planning in Ministry of Education and Higher Education. Moreover, an official approval was obtained from Directorate of Education Rafah, also an official approval was obtained from Directorate of Education east Khan Younis, and an official approval was obtained from Directorate of Education Khan Younis.
Results
Table (2) shows the distribution of participant’s characteristics according to their sociodemographic characteristics. There are 40.2% of study participants have age between 36 – 45 years and 33.0% have age above 45 years. Regarding the distribution of study participants according to their gender, (61.9%) of the study participants were females while 38.1% were males. There are 88.7% of the study participants married and 11.3% were not married. Regarding to educational level, 88.7% of the participants had a BSc certificate while 3.1% higher degree, about 55% of the participants had experience more than 10 years while 4.1% less than 5 years. There are 48.5% of study participants work in girls school and there are 36.0% work in boys school. Regarding the distribution of study participants according to their directorate, (35.1%) of the study participants were work in Rafah while 34.0% in Eastern KhanYounis and 30.9% in Western KhanYounis.
Table (2): Distribution of the study participants according to their demographic data
| Items | No. | 100 % |
| Age | ||
| Less than 35 years | 26 | 26.8 |
| From 36 to 45 Years | 39 | 40.2 |
| More than 45 Years | 32 | 33.0 |
| Total | 97 | 100.0 |
| Gender | ||
| Male | 37 | 38.1 |
| Female | 60 | 61.9 |
| Total | 97 | 100.0 |
| Marital Status | ||
| Not Married | 11 | 11.3 |
| Married | 86 | 88.7 |
| Total | 97 | 100.0 |
| Education Level | ||
| Diploma | 8 | 8.2 |
| Bachelor | 86 | 88.7 |
| High Degree | 3 | 3.1 |
| Total | 97 | 100.0 |
| Experience Years | ||
| Less than 5 Years | 4 | 4.1 |
| From 5 to 10 | 40 | 41.2 |
| More than 10 Years | 53 | 54.6 |
| Total | 97 | 100.0 |
| Type of School | ||
| Boys | 35 | 36.0 |
| Girls | 47 | 48.5 |
| Mix | 15 | 15.5 |
| Total | 97 | 100.0 |
| Directorate | ||
| Eastern KhanYounis | 33 | 34.0 |
| Western KhanYounis | 30 | 30.9 |
| Rafah | 34 | 35.1 |
| Total | 97 | 100.0 |
Table (3): Distribution of the study participants according to their responses about Topics by mean, median and standard deviation.
| Topics | weighted Mean
%)) |
Median | Std |
| Topic 3: Field of Health Education | 82.1 | 82.7 | 10.1 |
| Topic 1: Field of School Health Services | 85.6 | 87.4 | 8.9 |
| Total | 83.85 | 85.05 | 9.5 |
Table (4): Distribution of the study participants according to their responses about Topic 2: Field of Health Education
| Phrase | Mean | Weight Mean | Std | T | Sig. | Rank |
| There are lectures that are given to students about the most important diseases and health problems. | 4.4 | 87.0 | 0.6 | 22.323 | 0.000 | 3 |
| Awareness leaflets and health guidance manuals are distributed to students. | 4.3 | 85.0 | 0.7 | 17.736 | 0.000 | 5 |
| The school health team is provided school with written instructions to deal with emergency cases and accidents. | 4.1 | 81.8 | 0.9 | 11.778 | 0.000 | 8 |
| There is awareness effort to schools about common diseases. | 4.4 | 88.2 | 0.7 | 18.991 | 0.000 | 2 |
| There are awareness seminars held for teachers and students. | 4.1 | 82.8 | 0.8 | 15.030 | 0.000 | 7 |
| Meetings are held with parents of students and there are health seminars held for them. | 4.0 | 79.0 | 0.9 | 10.062 | 0.000 | 11 |
| Health events and days such as (World Health Day) are revived. | 4.5 | 89.2 | 0.7 | 21.267 | 0.000 | 1 |
| There are special programs presented about physical changes experienced by male and female students. | 3.7 | 73.0 | 1.0 | 6.394 | 0.000 | 15 |
| Phrase | Mean | Weight Mean | Std | T | Sig. | Rank |
| Psychological support is provided for students. | 4.1 | 81.8 | 0.8 | 13.827 | 0.000 | 9 |
| There is coordination with health institutions to provide the necessary health education for students. | 4.2 | 83.2 | 0.6 | 18.392 | 0.000 | 6 |
| There is cooperation between health coordinator and the art teacher to make wall paintings (murals) that convey health messages to students. | 4.0 | 79.0 | 0.9 | 10.587 | 0.000 | 12 |
| Health competitions are held among students. | 4.0 | 79.0 | 0.8 | 11.615 | 0.000 | 13 |
| The school library is provided with useful health books and publications for students. | 3.8 | 76.8 | 0.9 | 9.282 | 0.000 | 14 |
| Health courses are held for teachers about school health. | 4.3 | 86.8 | 0.6 | 20.507 | 0.000 | 4 |
| First aid courses are held for students. | 4.0 | 79.6 | 0.9 | 10.844 | 0.000 | 10 |
| Total | 4.1 | 82.1 | 10.1 | 77.367 | 0.000 |
Table (5): Distribution of the study participants according to their responses about Topic Field of School Health Services
| Phrase | Mean | Weight Mean
(%) |
Std |
| There is a prior coordination with school when conducting examinations and giving vaccinations for students. | 4.6 | 92.0 | 0.7 |
| School Health Team in corporation with school health committee conducts comprehensive periodic medical examinations for all students concerned. | 4.6 | 91.4 | 0.7 |
| Oral and dental examinations are performed for students. | 4.6 | 91.4 | 0.7 |
| The list of checked and transferred students is prepared according to attached forms in the guide for health services. | 4.6 | 91.2 | 0.6 |
| The school health team prepares a monthly report about school visits and detected cases. | 4.5 | 90.8 | 0.6 |
| Vaccinations are given according to schedule of the ministry of health. | 4.5 | 89.8 | 0.7 |
| Information and examinations are recorded in a medical file for the student. | 4.5 | 89.4 | 0.7 |
| Vaccinations are recorded in the health file of the student. | 4.5 | 89.4 | 0.7 |
| Suitable place for the health check is prepared to ensure privacy of students during the check. | 4.5 | 89.2 | 0.8 |
| Student with infectious disease is excused from school attendance. | 4.4 | 88.6 | 0.8 |
| Examinations and vaccinations are sufficient for students. | 4.4 | 88.6 | 0.8 |
| Students are physically prepared for the health check. | 4.4 | 88.2 | 0.7 |
| Disease cases that detected from students are transferred to competent health centers and follow up therapy and discuss it with parents. | 4.4 | 87.6 | 0.8 |
| Absent students who have failed to obtain medical services are followed up. | 4.4 | 87.4 | 0.7 |
| Emergency diseases cases are followed up and suitable first aid is provided. | 4.4 | 87.2 | 0.6 |
| All appropriate precaution are taken to control infectious diseases when the first case at school occurs. | 4.3 | 86.4 | 0.8 |
| The school health team is committed to the time and place set for it. | 4.3 | 86.2 | 0.7 |
| Vaccinations are saved in the appropriate refrigerator. | 4.3 | 85.0 | 0.8 |
| Infection control measures are taken when vaccinations are given. | 4.2 | 84.4 | 0.6 |
| Students are psychologically prepared for the health check. | 4.2 | 83.2 | 0.9 |
| Ensure ask and investigate about the possibility of any infectious diseases during routine visit to schools. | 4.2 | 83.2 | 0.9 |
| The number of school health team is sufficient to conduct the process of examination for students without affecting their school achievement. | 4.1 | 82.2 | 0.9 |
| There is special care plan for students with special needs. | 4.0 | 79.4 | 0.9 |
| Family and local community participate in any activities related to the prevention of infectious diseases. | 3.8 | 76.2 | 0.9 |
| The medical history of the student and his/her family is recognized. | 3.8 | 75.4 | 1.0 |
| School health team uses modern equipment and suitable methods for detection and examination. | 3.7 | 74.0 | 0.9 |
| The acute disease (Diarrhea, cold, flu, etc ..) of students are followed up and treated. | 3.7 | 73.2 | 1.0 |
| Total | 4.3 | 85.6 | 8.9 |
Discussion
The weighted mean of all topics was 83.8%, while the Topic 1: Field of school health education with weighted mean 82.1%, and Topic 2: Field of school health services with weighted mean 85.6%.
The researcher found that the weighted mean for topic of the field of health education was 82.1% and significant less than 0.05 which mean the participants agree about this topic. According to the results the highest paragraph was number (7) ” Health events and days such as (World Health Day) are revived” with weighted mean 89.2% and significance less than 0.05, followed by paragraph number (4) ” There is awareness effort to schools about common disease” with weighted mean 88.2%. While the lowest paragraph was number (8)” There are special programs presented about physical changes experienced by male and female students” with weighted mean 73.0% and significance less than 0.05, followed by paragraph (13) ” The school library is provided with useful health books and publications for students” with weighted mean 76.8%. According to the result of this topic, the participant agrees and had a positive attitude about this topic.
In the present study, researcher found that the level of implementing health education in governmental schools at Khan Younis and Rafah Governorates very good level with weight mean 82.1%. This is due to the interest of schools in the process of health education. Also the new curriculum includes many observations that concerning the health education. In addition to the students participation of in the design of appropriate means of health education.
These results are consistent with the results of (Jerjawi, 2011) who revealed that health education applied with very good level with weighted mean (83.45) and also consistent with the results of(Al-Ghazali, 2015) who revealed that health education applied with very good level.
On the other hand, these results are inconsistent with the results of (Badh, 2006) who showed that school health education applied with medium degree, with mean( 3.38) and percent 68%, due to some reasons. The lack of interest of some schools to apply the process of health education through its internal media is the first reason. The second reason the difficulty of coordination of some schools with the Ministry of Health and Education in the field of health education and the ineffectiveness of the Health Committee. Also these results are inconsistent with the results of (Serdaty,2014) who showed that school health education applied with weak degree with mean(2.03) %, because of absence of the role of parents in the schools and their lack of contact with the medical team. Moreover, these results are inconsistent with the results of(Atta, 2003) who showed little interest in health education.
And also the researcher found that the level of implementing school health services in governmental schools at Khan Younis and Rafah Governorates with level with weight mean 85.6%, this is due to several reasons. The first reason is the interest of the Ministry of Health and Ministry of Education. Secondly, the full coordination between the two ministries, their concern to conduct the tests fully to detect diseases early and the existence of a plan of work for the school health team.
According to the results the highest paragraph was ” There is a prior coordination with school when conducting examinations and giving vaccinations for students.” with weighted mean 92.0% and significance less than 0.05, followed by paragraph ” School health team in corporation with school health committee conducts comprehensive periodic medical examinations for all students concerned” with weighted mean 91.4%. While the lowest paragraph was” The acute disease (Diarrhea, cold, flu, etc ..) of students are followed up and treated. ” with weighted mean 73.2% and significance less than 0.05, followed by paragraph ” School health team uses modern equipment and suitable methods for detection and examination” with weighted mean 74.0%. According to the result of this topic, the participant agree and had a positive attitude about this topic.
These results are consistent with the results of (Jerjawi, 2011) who showed that school health services applied with high degree with weighted mean( 87.51) and also consistent with the results of (Serdaty, 2014) who showed that school health services applied with high degree with mean(3.72).
On the other hand, these results are inconsistent with the results of (Badh, 2006) who showed that school health services applied with medium degree, with mean( 3) percent 60% and also inconsistent with the results of (Atta, 2003) and (Al-Ghazali, 2015) who show that school health services applied with medium degree, because of lack of adherence to the periodic examination by some doctors and the great shortage of human and physical supplies.
Conclusions:
The field of school health education and school health services in the governmental schools at Khan Younis and Rafah Governorates needs some recommendations as Increaseing number of health seminars to educate students about physiological changes, appointing a resident nurse for each group of near schools to deal with emergencies occurring at these schools, support the school health team with modern equipment.
Acknowledgment
First and foremost, I thank Allah for helping me every moment and during my study.
I would like to express my profound and sincere gratitude to my supervisors, Dr. Zeyad Abu Heen and Prof. Dr. Yousef Aljeesh, for their ongoing encouragement, valuable comments, support, advice and endless patience in improving my writing. I have learned a lot of experiences from them. I really appreciate that. Thanks so much Dr. Zeyad Abu Heen and Prof. Dr. Yousef Aljeesh.
My great thanks and gratitudes to the department of Earth Science and Environmental at Islamic University. My great thanks and gratitudes to my classmates of the Master Programme of environmental health for spending nice time during our study in Islamic University.
I will not be thankful if I do not mention my family for being there when I needed them most, also for their constant encouragement during my study period.
My gratitude also to my colleagues who always offer help and suggestions of practical value and encouragement during my study period.
Last but not least, I would like to thank the Ministry of Health and the Ministry of Education in Gaza Strip for its acceptance and supporting for this research.
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