Evaluation of the implementation of the School Health Policy in two schools in Cape Town

[摘要] School-going children have unique health challenges that deserve a focused attentionfrom policy makers, commonly done through the provision of school healthprogrammes. The education system provides the most comprehensive existinginfrastructure for reaching school-going children and school health programmesenable health problems to be addressed at relatively low cost. The 2003 SouthAfrican National School Health Policy (NSHP) aims to deliver equitable and focusedhealth services to school-going children in order to safeguard their right to optimalhealth and development. There is currently limited information on the process ofimplementation of the NSHP, implementation context at different schools, as well asfacilitating and constraining factors that impact on the implementation of this policy.Aim: The main aim of this study was to evaluate the implementation of the 2003National School Health Policy in two primary schools in Cape Town.Methods: This was a process evaluation that used qualitative methods primarily.Two schools located in different education districts were selected via convenientsampling for an in-depth study. Within each school, participants were purposivelyselected based on their potential to provide relevant information. The final sampleconsisted of seven individuals; five educators and two school health nurses. Datacollection tools included an in-depth semi structured interview schedule, selfadministeredquestionnaire and document review. Interviews were recorded,transcribed and later analysed to obtain key themes.vResults: The evaluation found that the NSHP has been implemented in a phasedmanner, disadvantaged areas were prioritized, different staff-mix with regards to thecomposition of the school health team was used and the minimum requirements interms of health assessment for Grades R and 1 learners (Phase 1 services) were met.Educators and school health nurses did not have the same level of knowledge andunderstanding of the NSHP, and educators were less informed about this policy thannurses. The policy context influenced working relationships between different actorsor stakeholders. Challenges or constraints to policy implementation included broadsystemic problems such as poverty and staff shortages, lack of dedicated budget forschool health services and insufficient prioritisation of school health services bysenior departmental managers, all which constrained effective policy implementation.Although findings of this study cannot be generalized to other schools, they giveimportant insights into the current implementation process of the NSHP. It is one ofthe few studies focusing on the process of policy implementation in recent years andthe in-depth qualitative methods allowed the researcher to explore the complexitiesand contradictions of policy implementation in post-apartheid South Africa.Conclusion: This policy has for the most part been implemented according tospecified policy implementation guidelines and minimum requirements forimplementing phase 1 services were met. It is recommended that a dedicated budgetshould be allocated to school health services and existing structures within the schoolsystem such as School Governing Bodies be utilized effectively to encourage parentalinvolvement in school health. Nurses should advocate for increased support for these services among all stakeholders, including managers in the Department of Health.

[发布机构] University of the Witwatersrand