Barriers to the successful implementation of school health services in the Mpumalanga and Gauteng provinces
Background: The level of development of a country is measured by the health status of its children. The higher the mortality and morbidity rates in children, the more the country is challenged to improve its health care system. Although South Africa accepted the Convention on the Rights of the Child (CRC) in 1996 thereby committing itself to prioritisation of children, the implementation of school health services in South Africa has deteriorated to levels that contravene these rights. The promotion of health in schools requires a strong political commitment that will influence all levels of policy making, in other words national, provincial and local, towards an integrated and coordinated school health programme. Methods: A qualitative, explorative and descriptive study was conducted to identify barriers that led to poor implementation and a decline of school health services in the Mpumalanga and Gauteng provinces. The data-collection method of choice for this study was focus group discussions, which were conducted with all intersectoral role-players involved in school health programmes. To ensure broad representation of the various stakeholders, 10 participants were selected from five districts in each of the two provinces. This resulted in 50 participants per province. Results: The study findings reveal the following as barriers that hamper successful implementation of comprehensive school health programmes:
• Barriers related to governance, for example lack of national policy guidelines for school health services and failure of government to prioritise school health services • Programme-related issues, such as lack of intersectoral collaboration and unrealistic nurse–learner ratios
• Management-related issues, such as lack of support by management and managers’ limited knowledge of the Healthpromoting Schools Initiative
• Community-related issues, such as health professionals not including the communities in school health programmes
Conclusions: The need for political commitment in consistently placing the health and education of learners as a priority on the national agenda cannot be over-emphasised. Having adopted the CRC, South Africa took a giant step towards the prioritisation of child protection and care issues. This commitment can only be achieved through conscious intersectoral efforts that will promote a spirit of working together and sharing scarce resources towards one common goal.
Keywords: school health services; health-promoting schools; health care policy; Prim ary Health Care Model; barriers