assessment of the quality of school health services in...
TRANSCRIPT
Assessment of the Quality of School Health
Services in Governmental Schools at Khan
Younis and Rafah Governorates, Palestine.
تقييم جودة الخدمات الصحية المدرسية بالمدارس الحكومية .فلسطين رفح,خانيونس و تيفي محافظ
By
Naji M. Abu Luli
Supervised by
A Thesis Submitted in Partial Fulfillment of the Requirements for the Degree of
Master of Environmental Health
November / 2017
Prof. Dr. Yousef Aljeesh
Faculty of Public Health
Medicine - IUG
Dr. Zeyad Abu Heen
Assistant Professor in
Environmental and Earth
Science Department- IUG
ضحــغث خــال١ــــــخ اإلعـــــــــبؼـاغ
اجحش اؼ اذساعبد اؼ١ب ػبدح
طحخ اج١ئ١خ –بعغز١ش اؼ اج١ئ١خ
The Islamic University of Gaza
Deanship of Research and Graduate Studies
Master of Environmental Sciences -
Environmental Health
i
إلــــــــــــــشاس
أنا الموقع أدناه مقدم الرسالة التي تحمل العنوان:
Assessment of the Quality of School Health Services in
Governmental Schools at Khan Younis and Rafah
Governorates, Palestine.
تقييم جودة الخدمات الصحية المدرسية بالمدارس الحكومية
.فلسطين رفح,خانيونس و تيفي محافظ
أقر بأن ما اشتممت عميو ىذه الرسالة إنما ىو نتاج جيدي الخاص، باستثناء ما تمت اإلشارة إليو حيثما ورد،
لنيل درجة أو لقب عممي أو بحثي لدى أي االخرين وأن ىذه الرسالة ككل أو أي جزء منيا لم يقدم من قبل
مؤسسة تعميمية أو بحثية أخرى.
Declaration
I understand the nature of plagiarism, and I am aware of the University‟s policy on
this.
The work provided in this thesis, unless otherwise referenced, is the researcher's own
work, and has not been submitted by others elsewhere for any other degree or
qualification.
:Student's Name بولوليأناجي هحسن اسم الطالب:
:Signature التوقيع:
28/01/2018 التاريخ:Date:
iii
Abstract
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. Therefore, this study aimed at
assessing the quality of school health services in governmental schools at Khan
Younis and Rafah Governorates. 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 two
groups, the first group is consist of the school health coordinators in governmental
schools at Khan Younis and Rafah Governorates whose number (97 ), the second
group is consist of school health team whose number (14). The researcher used three
tools for collecting data, the first tool a questionnaire for the school health
coordinators whose number (97), the second tool observational checklist for school
health fields whose number (97), the third tool focus group interview of the school
health team . The researcher verified the validity and reliability of study tool. The
findings of the study indicated that the level of implementing health services in
governmental schools at Khan Younis and Rafah Governorates was very good with
weight mean 85.6%, as well as the level of implementing school health education
was very good level with weight mean 82.1%, moreover, the level of the school
health environment was very good with weighted mean 84.4% and the level of food
services and school canteens was very good with weighted mean 80.6%. The study
recommended a series of recommendations including appointing a resident nurse for
each group of near schools to deal with emergencies occurring in the school, support
the school health team with modern equipment, increase number of health seminars
and improve the environmental health services of the schools.
Keywords: Quality, School Health services, Khan Younis , Rafah.
iv
اخض
الدراسات التي يجب تسميط الضوء عمييا من أجل رفع المستوى التنموي لمدولة في وتعتبر ىذه الدراسة من أىم
جميع المجاالت وخاصة المؤسسات التعميمية حيث أن الطفل اليوم ىو رجل المستقبل وليذا يجب عمى الحكومة
المدرسية في . لذلك، ىدفت ىذه الدراسة إلى تقييم جودة الخدمات الصحية بصحتو اىتماما كبيرا تولي أن
ولما ،في الدراسة المدارس الحكومية في محافظتي خان يونس ورفح. استخدم الباحث المنيج الوصفي التحميمي
كان حجم مجتمع الدارسة صغيرا نسبيا، فقد اعتبر الباحث مجتمع الدارسة ىو نفسو عينة الدراسة و التي تتكون
صحة المدرسية في المدارس الحكومية في محافظتي من مجموعتين، وتتكون المجموعة األولى من منسقي ال
(. 14(، أما المجموعة الثانية فتتألف من فريق صحة المدرسة وعددىم ) 97)خان يونس ورفح وعددىم
(، 97ولى استبانة لمنسقي الصحة المدرسية وعددىم )داة األواستخدم الباحث ثالث أدوات لجمع البيانات، األ
اجراء مقابالت مع الثالثةداة و األ (97) اوعددى ة المدرسيةحالحظة لممجاالت الصداة الثانية استمارة مواأل
كما تحقق الباحث من صحة وموثوقية أداة الدراسة. أشارت نتائج الدراسة إلى أن ،فريق الصحة المدرسية
نسبي بوزن جيد جدا و رفح في محافظتي خان يونس مستوى تطبيق الخدمات الصحية في المدارس الحكومية
٪، ومستوى البيئة 82.1بوزن نسبي بمستوى جيد جدا المدرسي التثقيف الصحي مستوى تطبيق بينما ،85.6٪
بوزن جيد جدا المدرسية والمقاصف خدمات الطعام٪( ومستوى 84.4) بوزن نسبيالصحية المدرسية جيد جدا
مقيم لكل مجموعة من المدارس ة /من التوصيات منيا تعيين ممرض بعدد٪. أوصت الدراسة 80.6نسبي
القريبة لمتعامل مع حاالت الطوارئ التي تحدث في المدرسة ودعم فريق الصحة المدرسية بالمعدات الحديثة
رس.االبيئية لممد وزيادة عدد الندوات الصحية وتحسين الخدمات
رفح ، خانيونس. ، المدرسية الكممات المفتاحية : الجودة ، ، الخدمات الصحية
v
Dedication
This is dedicated
To my father, God has extended his life.
To my beloved mother,
who I owe my life and success.
To my brothers, my sisters and my family.
To my dear wife.
To my children (Hmza, Marim, Mohamed, Belal ).
To my friends, students and colleagues.
To all who helped me in completing this study.
With love and respect.
Naji M. Abu Luli
vi
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.
Naji M. Abu Luli
vii
Table of Contents
Declaration .................................................................................................................. i
Abstract ...................................................................................................................... iii
iv .......................................................................................................................... اخض
Dedication ................................................................................................................... v
Acknowledgment ....................................................................................................... vi
Table of Contents ..................................................................................................... vii
List of Tables ............................................................................................................ xii
List of Figures .......................................................................................................... xiv
List of Abbreviations ............................................................................................... xv
Chapter (1): Introduction .......................................................................................... 2
1.1 Background ............................................................................................................ 2
1.2 Research problem .................................................................................................. 3
1.3 Significance of the study ........................................................................................ 4
1.4 Study objectives .................................................................................................... 4
1.4.1 General objective ................................................................................................ 4
1.4.2 Specific objectives .............................................................................................. 5
1.5 Context of the study ............................................................................................... 5
1.5.1 Demographic Context ......................................................................................... 5
1.5.1.1 Palestine ........................................................................................................... 5
1.5.1.2 Gaza Strip ........................................................................................................ 5
1.5.1.3 Rafah Governorate ........................................................................................... 6
1.5.1.4 Khan Younis Governorate ............................................................................... 7
1.5.2 Palestinian health care system ............................................................................ 7
1.6 Definitions of terms ............................................................................................... 8
1.6.1 Theoretical definition of terms ........................................................................... 8
1.6.1.1 Assessment ....................................................................................................... 8
1.6.1.2 Quality ............................................................................................................. 8
1.6.1.3 The School ....................................................................................................... 8
1.6.1.4 Health ............................................................................................................... 8
1.6.1.5 Healthy School ................................................................................................. 8
1.6.1.6 Health Services ................................................................................................ 9
viii
1.6.1.7 School Health Services .................................................................................... 9
1.6.1.8 The school Health service Guidance Manual ................................................. 9
1.6.2 Operational definition of terms: .......................................................................... 9
1.6.2.1 School Health Services ................................................................................... 9
1.6.2.2 School Environment ........................................................................................ 9
1.6.2.3 Health Services Providers .............................................................................. 10
1.6.2.4 School Health Education ............................................................................... 10
Chapter ( 2): Conceptual framework and Literature review .............................. 12
2.1 Conceptual Framework ........................................................................................ 12
2.1.1 History of school health .................................................................................... 13
2.1.2 School health in Palestine ................................................................................. 13
2.1.2.1 Mission of school health in Palestine ............................................................ 14
2.1.2.2 Vision of school health .................................................................................. 14
2.1.2.3 The general goal of school health .................................................................. 14
2.1.2.4 The specific goals of school health ................................................................ 14
2.1.2.5 Reasons for attention with school health in Palestine .................................... 14
2.1.2.6 The reality of school health in Palestine ........................................................ 15
2.1.2.6.1 School Furniture ......................................................................................... 15
2.1.2.6.2 The Toilets .................................................................................................. 16
2.1.3.6.3 School canteen ........................................................................................... 16
2.1.2.7 The school health team of MOH .................................................................... 17
2.2 School Health ....................................................................................................... 17
2.2.1 Health Services ................................................................................................. 18
2.2.2 School health services ....................................................................................... 18
2. 2.2.1 Important functions of school services ......................................................... 19
2.2.2.2 The fields of school health services ............................................................... 19
2.2.3 The health services which are presented to the students of Gaza Strip in
2016/2017: ................................................................................................................. 19
2.2.3.1 Medical Examination in 2016/2017: .............................................................. 20
2.2.3.2 Vaccination .................................................................................................... 22
2.2.3.3 Dental Services: ............................................................................................. 22
2.3 School health environment .................................................................................. 23
ix
2.3.1 Environment ...................................................................................................... 23
2.3.2 Environmental health ........................................................................................ 23
2.3.3 School environment .......................................................................................... 24
2.3.4 School health environment ............................................................................... 24
2.3.5 Why is the School Environment Important? ..................................................... 24
2.3.6 The overall goal of attending to the school environment ................................. 25
2.3.7 Components of school health environment ...................................................... 25
2.3.8 Measures of school health environment team : ................................................ 25
2.3.9 Report of school health environment team in 2015-2016 ................................. 27
2.4 Health Education .................................................................................................. 27
2.4.1 Health Education ............................................................................................... 27
2.4.2 school health education ..................................................................................... 28
2.4.3 Key elements of comprehensive school health education include : ................. 28
2.4.4 Report of school health education team in GS of 2015-2016: ......................... 28
2.5 Nutritional Services ............................................................................................. 31
2.5.1 Nutrition ............................................................................................................ 31
2.5.2 Food .................................................................................................................. 31
2.5.3 Proper nutrition ................................................................................................. 32
2.5.4 Balanced healthy food ...................................................................................... 32
2.5.5 The importance of school nutrition ................................................................... 32
2.5.6 School nutrition elements: ................................................................................ 32
2.5.7 Malnutrition ...................................................................................................... 32
2.5.8 School canteen .................................................................................................. 33
Previous studies ......................................................................................................... 33
Chapter (3) :Materials and Methods ...................................................................... 39
3.1 Study design ......................................................................................................... 39
3.2 Setting of the study .............................................................................................. 39
3.3 Period of the study ............................................................................................... 39
3.4 Inclusion criteria .................................................................................................. 39
3.5 Study population and sampling........................................................................... 39
3.6 Study instruments ................................................................................................ 40
3.7 Pilot Study ............................................................................................................ 41
x
3.8 Validity of the instrument .................................................................................... 42
3.8.1 Face and content validity .................................................................................. 42
3.8.2 Reliability estimated for study tools ................................................................. 42
3.9 Data collection ..................................................................................................... 42
3.10 Ethical considerations. ....................................................................................... 43
3.11 Data entry and statistical analyses ..................................................................... 43
Chapter ( 4) : Results and Discussion .................................................................... 45
4.1 Introduction .......................................................................................................... 45
4.2 Socio-demographic characteristics of the study .................................................. 45
4.2.1 Distribution of the study participants according to their demographic data ..... 45
4.2.2 Distribution of the study participants according to their work in schools and
directorate .................................................................................................................. 47
4.2.3 Distribution of the study participants according to their responses about Topic
Field of School Health Services ................................................................................. 48
4.2.4 Distribution of the study participants according to their responses about Topic
2: Field of Health Education ...................................................................................... 52
4.2.5 Distribution of the study participants according to their responses about Topic
3: Field of school health environment ....................................................................... 56
4.2.6 Distribution of the study participants according to their responses bout Topic 4:
Food services and school canteens ........................................................................... 58
4.2.7 Distribution of the study participants according to their responses about Topics
by mean, Median and standard deviation .................................................................. 61
4.2.8 Assessment school health services field (observational checklist ) ................ 61
4.2.9. Differences between Topics and Gender ......................................................... 63
4.2.10. Differences between Topics and Education Level ....................................... 64
4.2.11. Differences between Topics and age ............................................................. 65
4.2.12. Differences between Topics and Experience years ....................................... 66
Chapter (5 ):Conclusion and Recommendations ................................................... 68
5.1 Conclusion ........................................................................................................... 68
5.2 Recommendations ................................................................................................ 70
References ................................................................................................................. 71
The References ......................................................................................................... 72
Appendix (1): General Administration of School Health in Ministry of
Education and Higher Education ........................................................................... 76
xi
Appendix (2): General Directorate of planning in Ministry of Education and
Higher Education ..................................................................................................... 77
Appendix (3): Approval from Directorate of Education in Rafah ..................... 78
Appendix (4): Approval from Directorate of Education in East Khan Younis 79
Appendix (5): Focus groups meeting for school health team of MOH ............... 80
Appendix (6): List of arbitrates .............................................................................. 81
Appendix (7): Study Time Schedule ....................................................................... 82
Appendix (8): Questionnaire (English version) ..................................................... 83
Appendix (9) : Questionnaire (Arabic version) ..................................................... 91
Appendix (10): Observational Checklist............................................................... 98
xii
List of Tables
Table (1.1): Area of Governorates in Gaza Strip (Source: PCBS, 2016) ............ 6
Table (2.1): The number of students registered and examined by the target
group (1st, 7th, 10th grades) in governmental schools at Khan Younis and Rafah
Governorates. ...................................................................................................... 21
Table (2.2): Health problems among students ................................................... 21
Table (2.3): The total vaccinations in the academic year 2016-2017 in Rafah
and Khan Younis school. .................................................................................... 22
Table (2.4): The number of students who have dental examination and dental
problem in the academic year 2016-2017 in Rafah and Khan Younis school. .. 23
Tabel (2.5): Components of a healthy school environment ............................... 26
Table (2.6):The percentage of environmental detection on buildings was 77 %.
............................................................................................................................ 27
Table(2.7): Health education seminars In the first semester of 2016-2017. ...... 29
Table (2.8): Annual report of health education activities for the academic year
2015-2016. .......................................................................................................... 30
Table(2.9): Health education seminars in the first semester of 2016-2017 ....... 30
Table (2.10): Annual report of dental education activities for the academic year
2015-2016. .......................................................................................................... 31
Table (3.1): The number the school health coordinators and their response . ... 40
Table(3.2): Domains and items of structure questionnaire. ............................... 41
Table(3.3): Cronbach alpha for study domain ................................................... 42
Table )3.4): Likert scale used in the instruments of the study ........................... 43
Table (4.1): Distribution of the study participants according to their
demographic data ................................................................................................ 46
Table (4.2): Distribution of the study participants according to their work in
schools and Directorate ...................................................................................... 47
Table (4.3): Distribution of the study participants according to their responses
about Topic Field of School Health Services ..................................................... 49
Table (4.4): Distribution of the study participants according to their responses
about Topic 2: Field of Health Education .......................................................... 54
Table (4.5): Distribution of the study participants according to their responses
about Topic 3: Field of school health environment ............................................ 57
xiii
Table (4.6): Distribution of the study participants according to their responses
bout Topic 4: food services and school canteens .............................................. 59
Table (4.7): Distribution of the study participants according to their responses
about Topics by mean, median and standard deviation ...................................... 62
Table (4.8): Assessment school health services by mean, median and standard
deviation (observational checklist ) ................................................................... 62
Table (4.9): Differences between Topics and Gender ....................................... 63
Table (4.10): Differences between Topics and Education level ....................... 64
Table (4.11): Differences between Topics and age ........................................... 65
Table (4.12): Differences between Topics and Experience ............................... 66
xiv
List of Figures
Figure (2.1): Diagram of conceptual framework. ..................................................... 12
Figure (2.2): Diagram of The school health team. .................................................... 17
Figure (2.3): The coverage ratio for Medical Examination. ..................................... 20
xv
List of Abbreviations
BSc Bachelor of Science
BMI Body Mass Index
DT Diphtheria Tetanus
GS Gaza Strip
IUG Islamic University of Gaza
MOH Ministry of Health
NGOs Non-Governmental Organizations
PCBS Palestinian Central Bureau of Statistics
PCN Palestine College of Nursing
PHC Primary Health Care
SHS School Health Services
SHP School Health Program
TOPV Trivalent Oral Polio Vaccine
UNRWA United Nations Relief and Works Agency
UNEP United Nations Environment Programme
WHO World Health Organization
1
Chapter 1
Introduction
2
Chapter 1
Introduction
This chapter gives a general overview of the research concept and problem. In
addition, it presents the main objectives to be achieved.
1.1 Background
The school is considered the second mother to students which affects in the
construction and the preparation of the students. It‟s the place where students spends
most of his time. It has an important role in the upbringing of students, responding to
their basic needs and providing of health services to students and maintain them
(Serdaty, 2014).
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.
The supervisors on education cooperation with the Ministry of Health focus on the
necessity of attention on the school health and its fields.
School Health Services (SHS) constitute one of the components of the School Health
Program (SHP) and deal with the maintenance of the health of school children.
Effective SHS facilitate early detection and diagnosis of diseases, whereby prompt
intervention ultimately reduces school-age morbidity and mortality ( Oyinlade, et. al,
2014).
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
3
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 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.
1.2 Research problem
Health care and disease prevention are the most important goals of the decision-
makers, but thinking of achieving comprehensive health care still exists. The family
plays a prominent role in receiving health values students, but the school has both a
practical and applying role in this side.
Many conferences and studies were held and recommended on concentrating,
developing of school health program and focusing on the delivery of health services
and health education. The first Palestinian National Conference which was held in
Gaza city in 1996, recommended on the necessity of school health promotion both
theoretically and practically through creating a health approach with the various
education curricula and prepare training course for teachers to carry out health
reinforcement tasks each according to his specialization (Al-Jerjawi, 2011).
The importance of care in school health, its large impact and its effective results
appear especially on the students level in primary school because they carry all the
fast learning qualifications, the student in this period is needed for the right
information in health and means of applying it, besides, students in this period are
endangered to disease, injuries and accidents (Serdaty, 2014).
It is noted that there is a significant increasing in the percentage of the cases were
detected among school students during the medical examination, where the
percentage of the cases were detected in 2016-2015 in all governmental schools in
the Gaza Strip 18% )MOH, 2016).
The ministry of health faces many problems that encounter the work of school health
team, these problems are the siege, bad economic situations, the decreasing numbers
of workers in school health as result of quitting the employees from their jobs due to
the political situation, not providing modern devices and increasing numbers of
schools and students. All this affects on the quality of health services provided for
4
students and that‟s what urges the researcher to study this problem by assessing
school health services (MOH, 2017).
1.3 Significance of the study
The significance of study appears in assessment school health services in
governmental schools at Khan Younis and Rafah Governorates, to know what school
health services are presented, to develop medical programs provided for them and to
determine strength and weakness points.
This study is considered very important for the following reasons :
1- The school health with its all components is considered one of the most strategies
that can prevent health and social problems.
2- The study uses students who are a wide range of the society.
3- The progress of students depends on the level of their health status.
4- Giving benefit for the workers of school health fields through focusing on the
quality of prevention programs, the developing of habits and the right health
lifestyles.
5- Early detection of diseases through periodic checking for students.
6- The level of health awareness in our society needs more attention. In addition, that
a lot of health problems are preventive.
7- Students are considered to be awareness messengers for their families in the
present and the future.
1.4 Study objectives
1.4.1 General objective
The general objective of the study is to assess the quality of school health services in
governmental schools at Khan Younis and Rafah Governorates, in the light of
guidelines of school health services.
5
1.4.2 Specific objectives
The specific objectives of the study are summarized in the following points:
1- To identify school health services provided to students.
2- To assess school's health education activity and environmental health.
3- To assess food services and school canteens.
4- To identify the commitment of school health service providers to the guideline of
school health services.
1.5 Context of the study
1.5.1 Demographic Context
1.5.1.1 Palestine
Palestine, the land of Arabism and the cradle of religions, located in the South West
Asia and situated on the Eastern coast of the Mediterranean Sea which consider in a
strategically important location (Ministry of Tourism and Antiquities, 2013). It
extended from the Mediterranean Sea in the West to the borders of Jordan in the East
and from Ras-Naqoura in the North to Rafah in the South. It is 26,323 square
kilometres (PCBS, 2013).
The total population of Gaza Strip and West Bank at mid-2016 was about 4.81
million; 2.36 million females and 2.45 million males, the estimated population of
Gaza Strip totalled 1.88 million of which 956 thousand males and 925 thousand
females while the estimated population of West Bank was 2.93 million of which 1.49
million males and 1.44 million females. The percentages of population in rural and
camps areas were 16.6% and 9.5% respectively while the percentage of the urban
population at mid-2016 was 73.9% (PCBS, 2017).
1.5.1.2 Gaza Strip
Gaza Strip is situated on the southeastern coast of Palestine with Latitudes of
31:29:45 N and Longitudes of 34:21:38 E. The area is bounded by the 1948 cease-
fire line in the north and east, the Mediterranean in the west and Egypt in the south,
6
see Figure (1.1). The total area of the GS is 365 km2 see table (1.1) with
approximately 45 km long and 6-12 km wide (UNDP, 2014).
Table (1.1): Area of Governorates in Gaza Strip (Source: PCBS, 2016)
Governorate Area (km2)
Rafah 64
Khan Younis 108
Deir al-Balah 58
Gaza 74
North Gaza 61
Total 365
1.5.1.3 Rafah Governorate
Rafah Governorate is located on the south edge of the Palestinian coastal plain on the
Egyptian-Palestinian border, it is located at longitudes 31.29 east, latitudes 34.26
north. Climate Rafah is semi-desert despite its proximity to the Mediterranean Sea.
The average temperature is 30 degrees in summer, ten degrees of winter and the
average rainfall is 250 mm, moreover, the most of the rainfall occurs during the
period from October to March and also the height of the governorate ranges is 40 to
60 meters above sea level. The total area of Rafah Governorate is 64 km2 according
to the structure of the Gaza Strip. It also has a population of 225.5 thousand, which
accounts for 12% of the total population of the Gaza Strip (PCBS, 2016).
The number of governmental schools in Rafah Governorate is 37 schools, while the
number of UNRWA schools in Rafah Governorate is 42. Rafah is the southern
entrance to Palestine and contains five border crossings: the Rafah crossing the
Kerem Shalom crossing and the Sufa crossing are fuctional, the Gaza International
7
Airport and the Salah al-Din gate not functional and also has a beautiful beach on the
far west on the shores of the Mediterranean Sea and it is only about 3.5 km long
(Municipality of Rafah, 2017).
1.5.1.4 Khan Younis Governorate
Khan Younis is located in the extreme south-west of Palestine, 10 km on the
Egyptian-Palestinian border, it is located at longitudes 34,18 east, latitudes 31.21
north, The climate of Khan Younis is followed by the Mediterranean climate. The
average annual temperature is 21 degree, the average rainfall is 250 mm and the
height of the governorate ranges is 50 meters above sea level. The total area of Khan
Younis Governorate is 108 km2 according to the structure of the Gaza Strip. It also
has a population of 232 thousand, according to (PCBS) which accounts for 17% of
the total population of the Gaza Strip. Barqouq Castle is one of the most important
historical landmarks in the governorate, also has a beautiful beach on the far west on
the shores of the Mediterranean Sea and it is only about 9 km long. It has also
features large areas of agricultural land. The number of governmental schools in
Khan Younis Governorate is 76 school, while the number of UNRWA schools in
Khan Younis Governorate is 52 (Municipality of Khan Younis, 2017).
1.5.2 Palestinian health care system
It is worthy mentioning that some information about health care system and health
status of Palestinians. Palestine is a developing country, suffering from many
problems and troubles which vary from economic to political ones. However, it is
extraordinarily fragmented, Palestinian Ministry of Health financed by a patchwork
of patient payment, taxes, donor contributions, and social insurance revenues.
The Palestinian health care system is a mixture of Governmental, Non-Governmental
Organizations (NGOs) ), private sector, United Nations Relief and Works Agency for
Palestinian Refugees in the Near East (UNRWA), MOH is responsible for a
significant portion of both Primary Health Care (PHC) and secondary care. In our
situation, the MOH faces a big challenge in order to satisfy health need and to
8
facilitate coordination among all sectors to face any unexpected situation especially
in the GS (MOH, 2011).
1.6 Definitions of terms
The definition of terms includes theoretical and operational definitions for the
research study.
1.6.1 Theoretical definition of terms
1.6.1.1 Assessment
Assessment involves judging or evaluating measurement data for the purpose of
reaching a conclusion. The presentation of the measurement data influences its
interpretation for performance assessment purposes. To display data in an
understandable form, three factors must be considered the type of data to be reported,
the audience and the information‟s intended use.( Spath, 2009).
1.6.1.2 Quality
A quality product or service is one that meets or exceeds expectations. Expectations
can change, so quality must be continuously improved and also quality is defined as
Perceived degree of excellence ( Spath, 2009).
1.6.1.3 The School
The school is considered the appropriate place to spread and educate the health
concepts (Omar, 2013).
1.6.1.4 Health
Health is defined as "a state of complete physical, mental, and social well-being and
not merely the absence of disease or infirmity” (WHO, 2006).
1.6.1.5 Healthy School
School Health is defined as the schools which constantly try to develop their capacity
on how to live and work in a good health (Denman, et. al, 2001).
9
1.6.1.6 Health Services
Health services is defined as the services provided by the school to find a suitable
school environment and provide health education, health supplies and all things
leading to better health for students (Omar, 2013).
1.6.1.7 School Health Services
School Health Services (SHS) constitute one of the components of the School
Health Program (SHP) and deal with the maintenance of the health of school
children. Effective SHS facilitate early detection and diagnosis of diseases, whereby
prompt intervention ultimately reduces school-age morbidity and mortality.
Physicians are pivotal in achieving this; teachers, parents, and the government also
have vital roles ( Oyinlade, et. al, 2014).
1.6.1.8 The school Health service Guidance Manual
The school health service guidance manual has been prepared to clarify the policies
established by the school health departments to be a beacon to guide doctors, nurses
and school health teams all over the country. It also aims to standardize the adopted
concepts and procedures in the school health program. In addition, it facilitates the
training of a new or an alternative school health staff and an practical reference to the
work of all the school teams from all governorates around the country.
(School health services guidance manual, 2010).
1.6.2 Operational definition of terms:
1.6.2.1 School Health Services
School Health Services are a prevention services designed to promote the health of
students, identify and prevent health problems and injuries through periodic
examinations and ensure care for students.
1.6.2.2 School Environment
The school environment is one of the components of the school health program and
reflects all the activities that are being done to provide and provide the healthy
environment in the school and the safety of the students. These activities include
11
supervising the building and school furniture, supervising the toilets, storage and
drinking water safety.
1.6.2.3 Health Services Providers
Health services providers is an individual who provides preventive, curative,
promotional, inspection, monitor and educate to students, families or communities.
Which include physicians, dentists, nurse and teacher in school ( school health
coordinators).
1.6.2.4 School Health Education
School health education is one of the components of the school health program and it
is providing the students with health information and teaching healthy behaviors,
spreading health awareness among students and solving the health problems facing
students.
11
Chapter 2
Conceptual framework
and Literature review
12
Chapter 2
Conceptual framework and Literature review
2.1 Conceptual Framework
The researcher reviewed the available literature to design the conceptual framework
(figure 2.1). The conceptual framework is the map that guides the design and the
implementation of the study and its effect mechanism for illustration and
summarizing the study variables.
Figure (2.1): Diagram of conceptual framework.
(Self-developed model)
School Health
Services
Food
Services
Medical Examination
Dental Services
Health Education
First Aid
Immunizations
Enviromental Health
13
2.1.1 History of school health
Interest in school health and its programs began in various part of the world at the
beginning of the 19th
century. In 1812, Jesse Weiss observed that schools students in
England had been nearsighted (myopia). Supervision of students health began in
1842 in both America and Europe, the supervision then extended to most of the
world countries and supervision of the students has been initiated through the
establishment of health offices in schools for the treatment of sick cases among
students and the work of these offices continued for a long time( Salama, 2001).
In 1880 Fien was the first German doctor to work in school health in Frankfurt city,
after that, another doctor joined the school health school in Lausanne city,
Switzerland in 1888. The Swedish government also conducted an examination of
about 11,000 Swedish students, in the same year, the French government began a
comprehensive examination of its students (Al Ghamdi, 2006 ). In1895, about six
doctors examined primary school students in Moscow in the Soviet Union. The
English doctor Priestley Smith published a report that there is a relationship between
students nearsighted and their ability to attain academic achievement, from that date,
the attention of health authorities throughout the civilized world has begun to focus
on school health programs (Metwally, 2002).
In Arab world, Egypt was the first Arab country to care for school health, this was in
1882 followed by Iraq in 1936. In Jordan, interest in school health began in it is first
primitive forms since the establishment of the kingdom in 1921, but its actual
practices began in the early sixties, there was a team from the ministry of health who
toured the schools in order to examine the students and provide primary health care
services to them. Then, the Ministry of Education and in cooperation with the
Ministry of health began to organize programs for school ( Abu Lila, 2002).
2.1.2 School health in Palestine
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 (Al-Jerjawi, 2011) .
14
2.1.2.1 Mission of school health in Palestine
School health seeks to improve students health and school community mentally,
physically, psychologically and socially through the provision of preventive and
curative health services, as well as, empowering them with the knowledge and skills
necessary to effectively deal with life conditions in a safe and healthy environment in
which parents, the community, educators and students participate .
2.1.2.2 Vision of school health
Towards a student community that enjoys health, physical, psychological, mental and
social welfare in Palestine.
2.1.2.3 The general goal of school health
The general goal of school health is to enhance the students physical, psychological,
social and mental health and configure a healthy environment for the student's
natural growth and development in order to obtain the maximum possible
educational achievements.
2.1.2.4 The specific goals of school health
1- Improving students health status, thus ensuring their development needs through
the early detection and follow-up of disease and disabilities, also through the
prevention of it and its potential complication.
2- Improving students environment conditions.
3- Helping students adopt proper behavioural patterns and healthy habits that
promote their health, the health of their families and the community in which they
live.
4- Establishing health information system to provide a nationally useful information
base.
2.1.2.5 Reasons for attention with school health in Palestine
1- The students of the school and kindergarten are more than 30% of the total
population.
15
2- The school is considered a gathering of students for the transfer of health
messages and because of their impact on parents and the community.
3- Disparity of the health and growth needs of students with different age groups.
4- School represents a stage in which personality and behaviours are formed. Also
during school students requirement of the necessary life skills to cope with different
circumstances of life, including sound psychological and mental development. As
well as, the knowledge that is generally reflected either positively or negatively on
students life and future.
5- The comprehensiveness of school health services and its holistic view of the
student.
6- Disease prevention and early detection to ensure effective treatment, protect it
from potential complication and reduce the material and moral onus.
(School health services guidance manual, 2010).
2.1.2.6 The reality of school health in Palestine
Our Palestinian schools seem to have a general ignorance of school health culture,
where the lack of interest in providing health care and treatment services for
students. As well as the school environment is not appropriate, the school buildings
mostly in places emitting noise and its ground area is not suitable as they are far
away from international standards that recommend 10 – 15 square meters per
student. In addition, the lack of playground and gardens, as well as the classrooms
away from international standards, which recommends 8 meters length , 6 meters
wide and 4 meters height for school classrooms that facilitates hearing and vision
process, this is in addition the lack of good lighting for the classrooms (Al-Jerjawi,
2011).
2.1.2.6.1 School Furniture
In our schools, much of the worn out furniture, the blackboards need to be changed
continuously, as well as the broken seats need to be maintained periodically to be
comfortable for students to sit and suitable for concrescence ( physical growth ).
16
2.1.2.6.2 The Toilets
We should take care of their cleanliness periodically, most wash basins are
unsuitable for students age and length, scarcity of using detergents and toilets
cleaners continuously. Therefore, it‟s a must to make sure that it suitable for
students, as well as caring of its lighting and ventilation.
2.1.2.6.3 School canteen
It‟s important to pay attention to the cleanliness of food and drinks offered to
students as well as the tools used to prepare food and not to be indifferent to workers
health at the school canteen, therefore, it is necessary to ensure that they receive a
certificate of free infection diseases annually, also pay attention to the cleanliness of
their appearance, clothes and hands .
In this area, it‟s the responsibility of the school to educate its students about the
important of food to the human body and its functions by introducing them to the
food needed for them such as carbohydrate, fats, protein, vitamins, minerals and
water.
The school also has a duty to educate its students about malnutrition, such as
thinness, obesity, vitamin deficiency. The school should instruct its student on the
causes of non-communicable disease and infectious disease methods of transmission,
prevention and treatment as well as acquired natural disease. They also have to teach
them first aid and it's important to students such as stopping bleeding from the nose,
wounds, burns, fractures, poisoning, chocking and first aid of drowning (Al-Jerjawi,
2011).
17
2.1.2.7 The school health team of MOH
Figure (2.2): Diagram of the school health team.
(School health services guidance manual, 2010).
2.2 School Health
School health is defined as the schools which apply a structural and systematic plan
to improve the health and welfare of all students, teachers and administrators
(Buijs, 2009). It is defined also as the schools that focus on developing their
programs starting with providing health information and ending with modifying
behaviour in an effort to develop an appropriate environment physically,
psychologically and socially in the framework of joint cooperation with the
community (Abdullah, 2010). It is defined also an economical and feasible way to
School Health Team
Health Worker
Register Nurse
General Physician
Dentist Health Educator
Environmental Health Inspector
Psychologist
18
raise the level of society by its final results which focus on the health of young
students making a perfection in their physical, mental, and emotional capabilities to
live peacefully away from health problems during their lives (Abu Laila, 2002).
2.2.1 Health Services
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).
2.2.2 School health services
School health services is defined as the health care delivery system that is
operational within a school or college. These services aim at promoting and
maintaining the health of school children so as to give them a good start in life. In
addition, these services seek to enable children benefit optimally from their school
learning experience. School health services deal with health appraisals, control of
communicable diseases, record keeping and supervision of the health of school
children and personnel. It is the aspect that concerns itself with the evaluating the
health of an individual objectively. Health appraisals afford the school authorities the
opportunity to detect signs and symptoms of common diseases as well as signs of
emotional disturbances that could impede the learning activities of children. School
health services are both preventive and curative services and it helps in providing
information to parents and school personnel on the health status of school children
(Maurer & Smith, 2013).
It also provides advisory and counseling services for the school community
and parents. It includes pre-entry medical screening, routine health
screening/examination, school health records, sick bay, first aid and referral
services. Other services rendered include health observation (which involves
physical inspection of the physiology and behaviours of children), health
examinations (screening tests and medical diagnosis) and health records
19
(keeping of records of the health histories of children)( Kuponiyi, et. al,
2016).
2. 2.2.1 Important functions of school services
1- Direct client care, such as screening, diagnosis, and treatment, including the
administration of medication; provisions for emergency care; and counselling and
mental health services.
2- Coordination of care, including referrals and linkages with other health providers
and communication with school staff and families.
3- Health promotion and disease prevention education (Maurer & Smith, 2013).
2.2.2.2 The fields of school health services
The fields of school health services that include providing medical care and
treatment services to students, detecting infected cases between students to be
isolated and transferred to the hospital, providing medicines and tools to aid
emergencies. As for the field of the service of school environment, it includes paying
attention to the maintenance and cleanliness of the school building and classrooms as
well as the maintenance of school furniture to be renewed when needed and fixing
water sources and reservoirs periodically, moreover, cleaning the toilet facilities
daily, providing adequate and healthy food in the cafeteria, protecting the school
environment from pollution. As for the field of health education, it includes health
education in school, instill the right concepts and foundations among the students,
encouraging them to leave the incorrect habits and practices, increasing the
awareness about healthy food and the correct ways to eat, and avoiding diseases
caused by improper nutrition ( Asaad, 2008).
2.2.3 The health services which are presented to the students of Gaza
Strip in 2016/2017:
Medical examination and screening test.
vaccination
Dental services
21
Health education and counselling.
Environmental health
2.2.3.1 Medical Examination in 2016/2017:
The target group (1st, 7th, 10th grades) was examined by school health team, this
group includes 104 governmental schools at Rafah and Khan Younis Governorates.
The coverage ratio for this examination is 97% as presented in figure (2.2). The number
of students who were examined was 19837 students out of 20511 students, as
presented in table (2.1).
The number of cases which was detected by the medical examination in
governmental Rafah schools is 1496 with 21%, while the number of cases, which
was detected by the medical examination in Khan Younis is 1776 with 13% (MOH,
2017).
Figure (2.2): The coverage ratio for Medical Examination (MOH, 2017).
Not examined students
3%
examined students
97%
Not examined students
examined students
21
Table (2.1): The number of students registered and examined by the target group
(1st, 7th, 10th grades) in governmental schools at Khan Younis and Rafah
Governorates.
Governorates No. of
registered
students
at 1st
grade
No. of
examined
students
at 1st
grade
No. of
registered
students
at 7th
grade
No. of
examined
students
at 7th
grade
No. of
registered
students
at 10th
grade
No. of
examined
students
at 10th
grade
khan Younis
3989 3929 3018 2946 6141 5840
Rafah
1586 1538 1224 1212
4553 4372
Total
5575 5467 4242 4158 10694
10212
(MOH, 2017).
Health problems which suffering from students in governmental schools at Khan
Younis and Rafah Governorate as presented in table (2.2).
Table (2.2): Health problems among students
Health problems Level and gender of grade
Nearsighted (myopia), malnutrition, non-
descending testicle
First grade for males
Pediculosis, nearsighted, malnutrition First grade for females
Nearsighted, malnutrition, varicocele Seventh grad for e male
Nearsighted, malnutrition Seventh grade for female
Nearsighted, malnutrition Tenth grade for male
Nearsighted, malnutrition, thyroid
hyperplasia
Tenth grade for female
(MOH, 2017).
22
There are 427 students who are transferred to the primary care center and to the
governmental hospitals in governmental Rafah schools for visual examination.
However, the number of students who is transferred for visual examination in
governmental Khan Younis schools is 680. The hearing test was only in
governmental Khan Younis schools; there are 547 cases that are transferred to the
primary care center and governmental hospitals. (MOH, 2017).
2.2.3.2 Vaccination
There was just one vaccination team who worked in governmental schools at Khan
Younis and Rafah Governorates which include the target group.The field work
started concurrently with the beginning of school year, the team gave the first-grade
students (TOPV+DT) vaccine, moreover, they gave ninth grade students (DT adult)
vaccine, this year, the coverage ratio 99,7%, as presented in table (2.3).
Table (2.3): The total vaccinations in the academic year 2016-2017 in Rafah and
Khan Younis school.
T.O.P.V
D.T d.T
Governorates No. of
student
registered
at 1st
grade
No. of
student
had
vaccine
at 1st
grade
No. of
student
registered
at 1st
grade
No. of
student
had
vaccine
at 1st
grade
No. of
student
registered
at 9th
grade
No. of
student
had
vaccine
at 9th
grade
KhanYounis 3989
3976 3989
3976 3318 3307
Rafah 1586
1578 1586 1578 1228 1220
(MOH, 2017).
2.2.3.3 Dental Services:
The dental services are presented with medical screening which include a dental
examination and giving preventing methods about dental care by presenting some
educational and awareness activities. The pathological cases are transfered to the
dental clinics which are affiliated with the Ministry of Education and spread all over
Gaza strip's directorates.
23
The number of the students who have tooth decay in the first grade is high because
the student does not realize the importance of dental care and s/he does not know the
kinds of food which hurt his/her teeth like sugar and sweet. However, the number of
the students who have gingivitis in the 7th and 10th grade is high because of the
careless of these teenagers that they do not brush their teeth permanently presented in
table (2.4). (MOH, 2017).
Table (2.4): The number of students who have dental examination and dental
problem in the academic year 2016-2017 in Rafah and Khan Younis school.
Khan Younis Rafah
First grade Seventh
grade
Tenth
grade
First
grade
Seventh
grade
Tenth grade
The
registered
students
3989 3018 6141 1586 1224 4553
The
examined
students
3929 2946 5840 1538 1212 4372
Students
have tooth
decay
818 500 1199 521 312 890
Students
have
gingivitis
1 1093 476 - 1012 117
2.3 School health environment
2.3.1 Environment
Environment is defined as all the physical, chemical, and biological factors external
to a person, and all the related behaviours (WHO, 2006).
2.3.2 Environmental health
Environmental health is defined as all the physical, chemical, and biological
factors external to a person and all the related factors impacting behaviours. It
24
encompasses the assessment and control of those environmental factors that
can potentially affect health. It is targeted towards preventing disease and
creating health-supportive environments, this definition excludes behavior not
related to the environment, as well as behavior related to the social and
cultural environment, as well as genetics (WHO, 2015).
2.3.3 School environment
School environment is defined as a combination of basic factors to be intertwined
including physical, biological and social factors where the homogeneity of such
factors leads to a better health situation (School health services guidance manual,
2010).
2.3.4 School health environment
School health environment is defined as the process of inspecting the school
environment and developing the necessary mechanisms to reach the school to the
best health condition. The school's health team who including the environmental
health inspector, is responsible for monitoring the school environment (School health
services guidance manual, 2010). School health environment is defined also as
physical and aesthetic surrounding and psychological climate and culture of the
school (Maurer & Smith, 2013), it is defined also as healthful school environment”
as “one that protects students and staff against immediate injury or disease and
promotes prevention activities and attitudes against known risk factors that might
lead to future disease or disability (WHO, 2004).
2.3.5 Why is the School Environment Important?
The physical environment of school buildings and school grounds 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. Studies have shown that student achievement can be affected
either positively or negatively by the school environment. Policies and protocols
must be in place to ensure food protection, sanitation, safe water supply, healthy air
25
quality, good lighting, safe playgrounds, violence prevention, and emergency
response, among other issues that relate to the physical environment of schools.
(New Hampshire Department of Education. 2017)
2.3.6 The overall goal of attending to the school environment
To provide a healthy, appropriate, safe and appropriate school environment and
reducing the spread of environmental diseases and injuries related to the
environment.
2.3.7 Components of school health environment
Provision of safe and sufficient water, sanitation, and shelter from the elements are
basic necessities for a healthy physical learning environment. Equally important is
the protection from biological, physical and chemical risks that can threaten
children‟s health presented in table )2.5).
Infectious diseases carried by water and physical hazards associated with poor
construction and maintenance practices are examples of risks children and school
personnel face at schools throughout the world (WHO, 2004).
2.3.8 Measures of school health environment team :
The school health team, in cooperation with the health committee, checks the health
situation in the school during the school year.
The inspection process is focused on the following areas (priorities):
1- Reservoirs and drinking water
2- The necessity of making sure that drinking water samples are taken for laboratory
examination in the laboratory of the Ministry of Health.
3- Water centers.
4- Canteens.
5 - The need to make sure to take samples of the sales of Canteens.
6. Waste disposal.
7- Safe and safety (School health services guidance manual, 2010).
26
Tabel (2.5): Components of a healthy school environment
(WHO, 2004)
Provision of basic necessities •Shelter
• Warmth
• Water
• Food
• Light
• Ventilation
• Sanitary facilities
• Emergency medical care
Protection from biological threats • Molds
• Unsafe or insufficient water
• Unsafe food
• Vector-borne diseases
• Venomous animals
• Rodents and hazardous insects
• Other animals (e.g. dogs)
Protection from physical threats • Traffic and transport
• Violence and crime
• Injuries
• Extreme heat and cold
• Radiation
Protection from chemical threats • Air pollution
• Water pollution
• Pesticides
• Hazardous waste
• Hazardous materials and finishes
• Asbestos, paint, • Cleaning agents
27
2.3.9 Report of school health environment team in 2015-2016
The number of governmental school buildings in the Gaza Strip was 266 schools.
The environmental survey was conducted on 204 schools with 77 %. table (2.6).
A number of 28 water samples was taken, 14 water samples for microbiological, 14
water samples for chemical composition have been examined and the results were
negative (MOH, 2016).
Table (2.6):The percentage of environmental detection on buildings was 77 %.
(MOH, 2016)
2.4 Health Education
2.4.1 Health Education
Health education is defined as a distinct academic discipline that influences and
seeks the improvement of individual, family and community health (Maurer &
Smith, 2013), health education is defined also as a planned, sequential, K-12
curriculum that addresses the physical, mental, emotional and social dimensions of
health. The curriculum is designed to motivate and assist students to maintain and
improve their health, prevent disease, and reduce health-related risk behaviours. It
allows students to develop and demonstrate increasingly sophisticated health-related
knowledge, attitudes, skills, and practices. The comprehensive health education
curriculum includes a variety of topics such as personal health, family health,
community health, consumer health, environmental health, sexuality education,
mental and emotional health, injury prevention and safety, nutrition, prevention and
control of disease, and substance use and abuse. Qualified, trained teachers provide
health education (School Health Bakersfield City School District, 2017).
Percentage
%
Environment check Number of schools Region
81 39 48 North
60 32 50 East Gaza
59 34 57 West Gaza
86 25 29 Middle Area
91 55 56 Khan Younis
96 25 26 Rafah
77 204 266 Total
28
Health education is defined also any combination of planned learning experiences
based on sound theories that provide individuals, groups and communities the
opportunity to acquire information and the skills needed to make quality health
decisions ( Gold & Miner. 2002).
2.4.2 school health education
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).
2.4.3 Key elements of comprehensive school health education include :
1- A documented, planned and sequential program of health instruction for students
in grades kindergarten through 12 class.
2- A curriculum that address and integrates eduction about a range of categorical
health problems.
3- Activities that help young people develop skills to avoid health problems.
4- Instruction for a prescribed amount of time at each grade level.
5- Management and cooridination by an eduction professional.
6- Instruction from teachers who are trained to teach the subject.
7-Involvement of parents, health professionls and community members.
8-Periodic evaluation (Maurer & Smith, 2013).
2.4.4 Report of school health education team in GS of 2015-2016:
The school health teams make a lot of activities and educational seminars for the
students and their parents. They present some various issues which connected to our
society. They give the parents information concerned with them and their families'
health care, Here we have some of the presented subjects:
29
⦁ Household Safe
⦁ The Addiction
⦁ The Chips' Risks
⦁ Soft drinks
⦁ School violence
⦁ Smoking and its damage
⦁ Obesity
⦁ Toothbrush
⦁ Early marriage
⦁ Personal hygiene
⦁ Anemia
⦁ Proper nutrition
⦁ Marriage of relatives (MOH, 2016).
In the first semester of 2016-2017, 160 health education seminars were conducted in
all governmental schools in the Gaza Strip, presented in table(2.6). In 2015-2016,
246 health seminars were held for students in all governmental schools in the Gaza
Strip, 46 seminars for parents, 19 first aid training and 53 health meetings with health
committees to discuss some of the issues that concern them. presented in table (2.7).
Table(2.7): Health education seminars In the first semester of 2016-2017.
Total Rafah Khan
Younis
Middle
Area
West
Gaza
East
Gaza
North
Gaza
160 107 4 31 4 4 10 Number of health
education seminars
(MOH, 2016).
Moreover, the school health team (dentists and nurses) provided many dental
education lectures in how to care for the teeth and the correct way to clean the teeth
using the brush and specifications of the healthy brush. In the first semester of 2016-
2017, 89 dental education seminars were conducted in all governmental schools in
31
the Gaza Strip presented in table(2.8) while 384 lectures were held in all
governmental schools in the Gaza Strip in 2015-2016 presented in table(2.9).
Table (2.8): Annual report of health education activities for the academic year 2015-
2016.
Seminars for
students
Seminars for
parents
First aid
training
Meetings of
health
committees
Region
1 8 3 5 North
52 7 2 7 East Gaza
7 9 3 9 West Gaza
565 52 6 52 Middle Area
58 7 3 8 Khan younis
45 5 2 52 Rafah
246 46 59 53 Total
(MOH, 2016).
Table(2.9): Health education seminars in the first semester of 2016-2017
Total Rafah Khan
Younis
Middle
Area
West
Gaza
East
Gaza
North
Gaza
89 5 2 59 53 - 44 Number of dental
education seminars
(MOH, 2017).
31
Table (2.10): Annual report of dental education activities for the academic year
2015-2016.
Dental Education Seminars
Region
11 North
108 East gaza
- West gaza
34 Middle Area
200 Kha younis
31 Rafah
384 Total
(MOH, 2016).
2.5 Nutritional Services
2.5.1 Nutrition
Nutrition is the science that interprets the interaction of nutrients and other
substances in food in relation to maintenance, growth, reproduction, health and
disease of an organism. It includes food intake, absorption, assimilation,
biosynthesis, catabolism, and excretion ( Sarwar, et. al, 2015).
2.5.2 Food
Food is defined as any material manufactured and not manufactured, raw or prepared
for human consumption, including water and beverages, and any material used in
32
industry or food processing except cosmetics, smoking and materials used as
medicine (Hamid, 2005).
2.5.3 Proper nutrition
Proper nutrition is defined as one of the main reasons for strengthening the body's
immunity against diseases, acute or chronic illness, as malnutrition leads to
weakening of the immune system in the body (Skik, 2013).
2.5.4 Balanced healthy food
Balanced healthy food is defined as the food that contains all the nutrients (fats,
carbohydrates, vitamins, mineral salts, fiber and water) necessary for the body in
quantities appropriate to the daily needs and it is necessary for human growth and
development of muscles and bones and strengthen. It helps to heal wounds and
disease resistance and provide the body with the energy of doing its work in the
activity and vitality (Skik, 2013).
2.5.5 The importance of school nutrition
1 –For healthy physical and mental growth.
2 - for a distinct mental and physical activity.
3.For Improve body immunity and disease resistance (School nutrition policy,
2008).
2.5.6 School nutrition elements:
1 - Nutrition awareness and encourage eating breakfast.
2 - Provision of food.
3 - Assess the nutritional status and attention to diversity of food.
4 - Interest in the sanctifiers and supervision
5. Malnutrition diseases
2.5.7 Malnutrition
Malnutrition is defined as the condition in which one feeds improperly and is not
only due to very low intake of food but is caused by a combination of factors such as
33
the practice of wrong eating habits and behaviors, poor health care and insufficient
intake of proteins and energy-producing substances. Malnutrition results in a range
of diseases, including anemia, short stature, wasting and weight loss )Surhi, 2014).
Malnutrition is defined as also a condition that results from eating a diet in which
nutrients are either not enough or are too much such that the diet causes health
problems (Facts for life, 2010).
2.5.8 School canteen
School canteen is defined as the place prepared and equipped in terms of
construction and health and is one of the most important elements of the school
environment, where the preparation of food and drink and sell it to students in the
permitted standards.
The contract was also terminated with the guarantor of a canteen in one of Rafah
schools for sale, corrupt and unhealthy food (School Health and Education
Department 2017).
So the officials should supervise and pay great attention to the canteens in all aspects
from the construction aspect or the employees in terms of their personal cleanliness
and ensure that they have a certificate of disease free. The commitment to uniforms
also includes the quality of the meals provided to the students and also the awareness
of healthy nutrition, It is reflected not only on the student or the school but also on
whole society.
Previous studies
The researcher reviewed of previous researches and studies which connected with the
subject of the current study which concerning in assessing of school health services
in governmental schools at Khan Younis and Rafah Governorates to gain the most
important results recommended by these studies and get benefits of the methods,
procedures and recommendations.
34
Here are some of these studies :
(Al-Ghazali, 2015)
This study aimed to assess the level of implementing of the school health program in
primary schools in Lattakia city (Seria) . The study sample was consisted of (140)
principals distributors on (20) School who were chosen by using stratified random
sample method, for the academic year (2014-2015). The data collected by a
constructed questionnaire; a pilot study was carried out to determine the validity and
reliability questionnaire. The data analyzed through the application of descriptive
statistical analysis that included (frequency, percent). The finding of the study
indicated that the level of implementing school health program was good in
(28.37%), moderate in (56.74%) and in (14.89%). In addition, most schools lack
attention to environmental services and the supervisor of health does not have a
certificate of nursing. The study recommended to take care of periodic medical
examination for students, improve the school environment and assign a nurse in each
school.
(Al-Sarairah, et. al, 2012)
This study aimed to recognize the level of school health in the State of Kuwait from
female principals and teachers‟ point of view. The study sample was consisted of
(104) female principals and (670) female teachers, who were chosen by using
stratified random sample method with a percentage of (50%) female principals and
(5%) female teachers from the study population. The questionnaire was used to
collected the study data. The findings of the study indicated that the level of the
school health in the primary schools in the state of Kuwait was medium from the
female principles‟ point of view. The level of the school health in the primary
schools in the State of Kuwait was medium from the female teachers‟ point of view.
The study recommended conducting continuous training courses for female primary
school principals and teachers to provide them with the necessary skills for school
health, awareness female principals and teachers about the importance of raising the
level of the school health by preparing suitable training programs and evaluating the
school health programs to determine the strength and weakness points and applying
the suitable procedures.
35
(Badh, 2006)
This study aimed to identify the reality of the health services programs presented to
the students of Zarqa (Jordan) Governorate Schools. The study population consisted
of all schools principals in Zarqa Governorate (316) for the academic year
(2003/2004). The questionnaire was used to collected the study data which consisted
of 40 items, covered fields of schools health programs; health services, health
education, schools health environment. The researcher also verified the validity and
reliability of study tool. The findings of the study indicated that the level of
implementation of health services programs in the schools of Zarqa Governerate was
medium. The researcher recommended an increasing in the training of the medical
and associated medical staff by the supervisors of the school health services and
advised the directors of the educational directorates to be more interested in
accomplishing the environmental reforms required by the staff of school health
programs.
(Atta, 2003)
This study aimed to assess the medical service for physical education in high
secondary schools for boys in Khartoum state. The study sample was consisted of
(26) physical education teachers, which chosen by using purposive method. The
questionnaire was used to collected the study data. The findings of the study
indicated that the role of school in the health services was unclear, there was a
shortage in human and material facilities, there was a deficiency in the health
services presented to students and health knowledge and guidance is neglected.
The researchers recommended a set of recommendations, including Health services
should be made available for students, training physical educator in the principle of
health care, more over facilitating the relation between schools and community in
the execution of health programs and improving physical education programs so that
it can effect positively the health of student.
(Jerjawi, 2011)
This study aimed to identify the reality of health education in governmental schools
of Gaza City. The researcher used analytical descriptive method in the study. The
questionnaire used to gather the data of the study, the researcher applied
36
questionnaire on a random sample of health education supervisors composed of (129)
selected from (50) government schools in Gaza City. The findings of the study
indicated the school supervises school health environment carefully, it showed
standard deviation (12.266) with a rate 91.46%, the school has a role in teachers and
students health care, it showed (10.87) standard deviation with a rate 87.51%, more
over the school has a role in student health educational, It showed (14,66) standard
diversion with a rate 83,45%. The researchers recommended a set of
recommendations, the most important the need to activate the role of the teacher in
the field of school health by attending specialized seminars and training programmes,
moreover, attention to be considered for team work perception between students,
teachers and schools administrative employees.
(Omar, 2013)
This study aimed to determine the role of male and female principals of public
schools in providing health services to schools of Jerash (Jordan). The study sample
consisted of (63) male and female principals of Jerash schools– Jordan, the
questionnaire used to gather the data of the study. The findings of the study indicated
the degree of male and female principals of public schools in providing health
services to schools of Jerash was medium as a whole. The results also showed that
arithmetic mean of paragraphs related to the role of male and female directors of
public schools in providing health services ranged from (2.12 to 4.85). The study
recommended a series of recommendations including providing adequate financial
allocations for schools to provide health needs as well as paying much attention to
water taps, toilets and washrooms in schools that need to be with a high quality and
with sufficient numbers.
(Oyinlade, et. al, 2014)
This study aimed to evaluate school health services in public and private schools in
Sagamu (Nigeria). The researcher used a cross-sectional study carried out on private
and public nursery, primary and secondary schools in Sagamu, Ogun State. The
study sample consisted of 91 schools, randomly selected from 182 available,
comprising 53 private nursery/ primary schools, 22 public nursery/primary schools,
11 private secondary schools and 5 public secondary schools were inspected for
37
availability of the components of the SHS and evaluated using the SHS Evaluation
Scale. Data were analyzed by using SPSS. The findings of the study indicated only
one (1.1%) school benefited from the services of a school doctor. Essential drugs and
materials for first aid services were available in 85 (93.4%) of the schools while only
26 (28.6%) had a sick bay. Screening tests for disabilities were performed in only 10
(11%) of the schools visited. Although school midday meals were available in all the
schools, they were not free. Private secondary schools had the highest percentage of
good school health evaluation scores (63.6%), while 96.2% of the private primary
schools had poor health service evaluation scores.
(Khandakja, 2000)
This study aimed to assess the reality of the school health services practiced by the
school health doctors in the basic government schools in the province of Irbid from
the perspective of managers and supervisors. The study population consisted of all
school health managers and school health supervisors (702). The study sample was
consisted of (550) all school health managers and school health supervisors who
were chosen by using simple random sample method. The questionnaire was used to
collected the study data, which consisted of 63 items, covered fields of schools health
programs; health services, health education, schools health environment. The
researcher also verified the validity and reliability of study tool. The findings of the
study indicated that the level of implementation of health services programs in the
schools of Irbid Governorate was medium and also the result show that statistical
differences between reality of the school health services and level of gender,
experience, age and occupation.
(Serdaty, 2014)
This study aimed to determine the reality of school health in Algeria from the point
of view of the actors in the sector. The researcher used analytical descriptive method
in the study, the questionnaire was used to collected the study data. The researcher
also verified the validity and reliability of study tool. The findings of the study
indicated that Students was received health care with high level with mean 3.72, the
level of health education was weak with mean 2.03 and level of school health
environment was high with mean 3.80.
38
Chapter 3
Materials and Methods
39
Chapter 3
Materials and Methods
This chapter presents study methodology which include the study design, study
population, sample of the study, setting of the study, inclusion criteria, study
instrument and data collection, validity and reliability, pilot study, ethical
consideration and data entry and statistical analyses.
3.1 Study design
A descriptive analytical cross sectional study is used to assess the quality of school
health services in governmental schools at Khan Younis and Rafah Governorates.
This method is appropriate for description of the status of phenomenon and its
relationship and comparison between variables.
3.2 Setting of the study
The study was carried out in governmental schools at Khan Younis and Rafah
Governorates.
3.3 Period of the study
The study was conducted during the period from April 2017 according to the time
table that has been prepared for the study and end in November 2017 (Appendix 7).
3.4 Inclusion criteria
- School health coordinators in the governorates of Rafah and Khan Younis.
- School health coordinators attending school.
- Agree to participate in this study during period of data collection.
3.5 Study population and sampling
The study population and sampling consists of two groups, the first group is consist
of the school health coordinators in governmental schools at Khan Younis and Rafah
Governorates whose number (97 ) present in table(3.1).
The second group is consist of school health services team whose number (14).
41
Table (3.1): 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)%
3.6 Study instruments
The researcher used three instruments for assessment of the quality of school health
services in governmental schools at Khan Younis and Rafah Governorates which
included:
The first instrument was a structured questionnaire which was designed by the
researcher based on the review of the literature and researcher observations and
under the guidance of the supervisors (Appendix 8). The researcher used Likert
scale of 5-points to prepare structured questionnaires according to literature review
and researcher experience in school field. The designed face to face questionnaire
consists of two parts:
Part One: includes questions related to personal and school characteristic data like
age, gender, social status, years of experience, education, type of school and
directorate.
Part two: four domains prepared for assessment of the quality of school health
services (table 3.2) based on Likert scale of 5-points were used to assess the
41
quality of school health services in governmental schools at khan younis and Rafah
Governorates, actually, the researcher asked the school health coordinators to
express about their degree of acceptance rating 5-points Likert scale (5=
strongly agree, 4= agree, 3=uncertain, 2= disagree, 1= strongly disagree).
Table(3.2): Domains and items of structure questionnaire.
No Domain Item
1 Field of school health services
1 - 27
2 Field of health education 28 - 42
3 Field of school health environment 43 - 55
4 Field food services and school canteens 56 - 72
The second instrument was direct observational checklist. The tool used for assessing
the quality of school health services. It includes four fields: school health services,
health education, school health environment, food services and school canteens and
the number of observational checklist is( 97 ) (Appendix10).
The third instrument was focus group interview, this tool used for assess the quality
of school health services through appoint view work school heath team which
number six medical screening team; ( team for female school (3), team for male
school (3), six immunization team, one health educator and one environmental health
inspector ( Appendix 5).
3.7 Pilot Study
A pilot study was conducted before starting the actual data collection as a pretest to
determine the real time needed to fill the questionnaire and identify areas of
vagueness, to point out weaknesses in wording, translation to Arabic, predict
response rate, and to test the validity and suitability of the questionnaire. A total of
17 participants were chosen from the study target population to conduct the pilot
42
study. There were no changes made within the questionnaire and it is clear, no
ambiguity. The sample of pilot study was included within the study sample.
3.8 Validity of the instrument
3.8.1 Face and content validity
The questionnaire was sent to a panel of expert persons (Appendix 6) to assess the
clarity and relevance of the questionnaire to the objectives of the study. All
comments on the questionnaire were taken in consideration, as a result; some
modification was done for some of the items. In addition, a pilot study was
conducted before starting the data collection of the questionnaire.
3.8.2 Reliability estimated for study tools
The researcher used Cronbach alpha coefficient to estimate the reliability coefficients
for each dimension and the total score of the scale. The results are shown in table
(3.3). They were all acceptable.
Table(3.3): Cronbach alpha for study domain
Domain
No of items Alpha coefficient
Field of school health services
27 2.955
Field of health education 15 2.899
Field of school health environment 13 2.789
Field food services and school canteens 17 2.889
Total score 72 2.957
3.9 Data collection
Firstly, the researcher himself collected data by using a face-to-face questionnaire
and a direct observational checklist. Consent form was obtained from the participants
43
for participating in the study after clarifying the purpose of the study and confirmed
the anonymity and confidentiality of information. Data was collected in the period
23/8/2017 to 10/10/2017.
Responses used 5 point Likert scale the extent to indicate which they agree or
disagree with each item (Table 3.4). Time allocated for a face-to-face questionnaire
was about 30 minutes.
Secondly, for an observation checklist, the researcher assess the school health field in
97 school and time allocated for filling was one hour.
Thirdly, for focus groups, the researcher conducted 5 focus groups with school heath
team which number six medical screening team ( 2 groups), six immunization team,
one health educator and one environmental health inspector.
Table 3.4: Likert scale used in the instruments of the study
Level of agreement Strongly agree Agree Neutral Disagree Strongly disagree
Scale 5 4 3 2 1
3.10 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 (Appendix1). Also, an official
approval was obtained from General Directorate of planning in Ministry of
Education and Higher Education (Appendix 2). Moreover, an official approval was
obtained from Directorate of Education Rafah (Appendix3), also an official approval
was obtained from Directorate of Education east Khan Younis (Appendix4) and an
official approval was obtained from Directorate of Education Khan Younis
(Appendix5).
3.11 Data entry and statistical analyses
Data analysis was conducted using Statistical Package for Social Sciences (SPSS 24)
for statistical analysis, The data was gathered and then the instruments reviewed,
appropriate entry method, data cleaning then doing frequency tables for study
variables, percentages and using one sample t test and ANOVA test .
44
Chapter 4
Results and Discussion
45
Chapter 4
Results and Discussion
4.1 Introduction
This chapter illustrates the results of statistical analysis of the data, including
descriptive analysis that presents the socio -demographic characteristics of the study
sample and the answers to the questions of the study. The researcher used statistical
tests including frequencies, percentages and using one sample t test to analyze the
paragraphs of questionnaire. The paragraph is positive, meaning that the respondents
agree with their content if the calculated t value is greater than the tabular t value of
1.97 (or the probability value is less than 0.05 and the relative weight is greater than
60%. The negative is considered to be negative in the sense that the sample does not
agree with its content if the calculated t value is smaller than the tabular t value of
1.97 (or the probability value is more than 0.05 and the relative weight is less than
60%). The probability value was greater than (0.05).
4.2 Socio-demographic characteristics of the study
4.2.1 Distribution of the study participants according to their
demographic data
Table (4.1) shows the distribution of participant's characteristics according to their
age, gender, marital status, educational level and years of experience. 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.
46
Table (4.1): 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
47
4.2.2 Distribution of the study participants according to their work in
schools and directorate
Table (4.2) shows the distribution of participant's characteristics according to their
work in schools and directorates. 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 (4.2): Distribution of the study participants according to their work in schools
and Directorate
Items No. %
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
48
4.2.3 Distribution of the study participants according to their responses
about Topic Field of School Health Services
By using one sample t test table (4.3) shows that the weighted mean for topic of the
field of school health services was 85.6% and significant less than 0.05 which mean
the participants agree about this topic. According to the results the highest paragraph
was number (26) " 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 number (1) " 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 number (17)" 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 (7) " 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.
In the present study, researcher found that the level of implementing school health
services in governmental schools at Khan Younis and Rafah Governorates with high
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.
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).
In additional, the result of focus group was consistent with the present study result
concern school health services. ( School health services and screen test and dental
test implemented with high level)
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)
49
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.
Table (4.3): Distribution of the study participants according to their responses about
Topic Field of School Health Services
Phrase Mean Weight
Mean
Std T Sig. Rank
School Health Team in
corporation with school health
committee conducts
comprehensive periodic medical
examinations for all students
concerned.
4.6 91.4 0.7 21.868 0.000 2
Students are physically prepared
for the health check. 4.4 88.2 0.7 19.371 0.000 12
Students are psychologically
prepared for the health check. 4.2 83.2 0.9 12.781 0.000 20
Suitable place for the health
check is prepared to ensure
privacy of students during the
check.
4.5 89.2 0.8 17.923 0.000 9
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 27.455 0.000 4
The medical history of the
student and his/her family is
recognized.
3.8 75.4 1.0 7.821 0.000 25
51
Phrase Mean Weight
Mean
Std T Sig. Rank
School health team uses modern
equipment and suitable methods
for detection and examination.
3.7 74.0 0.9 7.456 0.000 26
Ensure ask and investigate about
the possibility of any infectious
diseases during routine visit to
schools.
4.2 83.2 0.9 13.498 0.000 21
All appropriate precaution are
taken to control infectious
diseases when the first case at
school occurs.
4.3 86.4 0.8 16.031 0.000 16
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 17.994 0.000 13
Student with infectious disease
is excused from school
attendance.
4.4 88.6 0.8 17.588 0.000 10
Family and local community
participate in any activities
related to the prevention of
infectious diseases.
3.8 76.2 0.9 9.350 0.000 24
There is special care plan for
students with special needs. 4.0 79.4 0.9 10.396 0.000 23
Oral and dental examinations
are performed for students. 4.6 91.4 0.7 21.425 0.000 3
51
Phrase Mean Weight
Mean
Std T Sig. Rank
The school health team prepares
a monthly report about school
visits and detected cases.
4.5 90.8 0.6 24.007 0.000 5
Information and examinations
are recorded in a medical file for
the student.
4.5 89.4 0.7 20.933 0.000 7
The acute disease (Diarrhea,
cold, flu, etc ..) of students are
followed up and treated.
3.7 73.2 1.0 6.796 0.000 27
Absent students who have failed
to obtain medical services are
followed up.
4.4 87.4 0.7 19.804 0.000 14
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 12.684 0.000 22
The school health team is
committed to the time and place
set for it.
4.3 86.2 0.7 17.740 0.000 17
Examinations and vaccinations
are sufficient for students. 4.4 88.6 0.8 17.310 0.000 11
Vaccinations are given
according to schedule of the
ministry of health.
4.5 89.8 0.7 21.212 0.000 6
52
Phrase Mean Weight
Mean
Std T Sig. Rank
Vaccinations are saved in the
appropriate refrigerator. 4.3 85.0 0.8 15.040 0.000 18
Infection control measures are
taken when vaccinations are
given.
4.2 84.4 0.6 18.457 0.000 19
Vaccinations are recorded in the
health file of the student. 4.5 89.4 0.7 21.903 0.000 8
There is a prior coordination
with school when conducting
examinations and giving
vaccinations for students.
4.6 92.0 0.7 21.525 0.000 1
Emergency diseases cases are
followed up and suitable first
aid is provided.
4.4 87.2 0.6 21.774 0.000 15
Total 4.3 85.6 8.9 91.312 0.000
4.2.4 Distribution of the study participants according to their responses
about Topic 2: Field of Health Education
By using one sample t test table (4.4) shows 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
53
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.
In additional, the result of focus group was consistent with the present study result
concern health education. ( School health education implemented with high 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.
54
Table (4.4): 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
55
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
56
4.2.5 Distribution of the study participants according to their responses
about Topic 3: Field of school health environment
By using one sample t test table (4.5) shows that the weighted mean for topic of the
field of school health environment was 84.4% and significant less than 0.05 which
mean the participants agree about this topic. According to the results the highest
paragraph was number (12) " There is a first aid kit in the school " with weighted
mean 92.2% and significance less than 0.05, followed by paragraph number (2) "
Water tanks are monitored and sealed." with weighted mean 89.6%. While the lowest
paragraph was number (10)" The number of students in the classroom corresponds to
the classroom area" with weighted mean 75.2% and significance less than 0.05,
followed by paragraph (9) " Water and soap are provided in student‟s toilets. " with
weighted mean 77.0%. 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 level of the school health environment in
governmental schools at Khan Younis and Rafah Governorates is very good with
weighted mean (84.4%), due to the importance of this field, moreover, school
administration and school health team is aware of the need to protect and care for the
school environment to accommodate the students studying and get them the highest
grades.
These results are consistent with the results of (Jerjawi, 2011) who showed that the
school monitors the school's healthy environment carefully with weighted mean(
91.46) and also consistent with the results of (Serdaty,2014) who showed that he
school environment in primary schools represents a healthy environment for students
with high degree with mean(3.80).
In additional, the result of focus group was consistent with the present study result
concern school health environment. ( School health environment monitor regularly).
On the other hand, These results are inconsistent with the results of (Al-Ghazali,
2015) and (Omar, 2013) who showed that the level of the school health environment
was weak because of the weakness of periodic supervision of health units.
57
Table (4.5): Distribution of the study participants according to their responses about
Topic 3: Field of school health environment
Phrase Mea
n
Weight
Mean
Std T Sig. Rank
School environment is
supervised to ensure that it is
suitable for students‟ health
needs such as (student's seats,
lighting, ventilation and
heating).
4.4 87.2 0.7 18.881 0.000 7
Water tanks are monitored and
sealed.
4.5 89.6 0.6 23.801 0.000 2
Safety and security factors for
students are evaluated.
4.4 87.6 0.6 22.570 0.000 5
Proper ways and methods of
waste disposal are ensued in
schools.
4.1 82.6 0.7 15.592 0.000 9
Schools are provided with
cleaning materials.
4.4 88.4 0.7 20.315 0.000 4
Tanks and drinking water safety
is inspected.
4.5 89.4 0.6 23.649 0.000 3
Drinking water samples are
taken for laboratory test
periodically.
3.9 77.2 1.1 7.734 0.000 11
Toilets at schools are inspected
for cleanliness.
4.4 87.4 0.7 20.755 0.000 6
58
Phrase Mea
n
Weight
Mean
Std T Sig. Rank
Water and soap are provided in
student‟s toilets.
3.9 77.0 1.0 8.296 0.000 12
The number of students in the
classroom corresponds to the
classroom area.
3.8 75.2 1.1 6.677 0.000 13
The school health team in
corporation with the health
committee supervises the
processing of the first aid a
cupboard.
4.1 82.8 0.8 13.595 0.000 8
There is a first aid kit in the
school.
4.6 92.2 0.6 27.823 0.000 1
The first aid kit contains all
supplies.
4.0 80.2 0.9 11.111 0.000 10
Total 4.2 84.4 9.2 86.693 0.000
4.2.6 Distribution of the study participants according to their responses
bout Topic 4: Food services and school canteens
By using one sample t test table (4.6) shows that the weighted mean for topic of the
food services and school canteens was 80.6% and significant less than 0.05 which
mean the participants agree about this topic. According to the results the highest
paragraph was number (8) " The staff of the canteen has a disease-free certificate"
with weighted mean 93.2% and significance less than 0.05, followed by paragraph
number (5) " The contents of the canteen are supervised " with weighted mean
91.2%. While the lowest paragraph was number (12)" There is a plan to supervise
students who suffer malnutrition and anemia" with weighted mean 65.0% and
significance less than 0.05, followed by two paragraphs (11) "The canteen area is
59
decorated with purposeful drawings related to nutrition" with weighted mean 65.1%.
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 the food services and school
canteens in governmental schools at Khan Younis and Rafah Governorates is very
good with weighted mean 80.6%, This result is close to reality because of the
concentration of schools on the canteens, cleanliness, workers, food diversity and
water cleanliness are the main issues of regular monitoring in school health
departments. The school administration takes concern the criticism of the students,
the public and the ministry.
These results are consistent with the results of (Jerjawi, 2011) and (Badh, 2006) who
showed their interest in the school canteens and food diversity. In additional, the
result of focus group was consistent with the present study result concern food
services and school canteens (food services and school canteens monitor regularly
and good supervion).
Table (4.6): Distribution of the study participants according to their responses bout
Topic 4: food services and school canteens
Phrase Mean Weight
Mean
Std T Sig. Rank
Canteen building is designed
in an appropriate manner. 4.0 79.8 0.8 11.498 0.000 10
Canteen is periodically
renovated. 3.5 69.8 1.1 4.284 0.000 14
There is a fire extinguisher
available inside the canteen. 3.9 77.4 1.1 7.527 0.000 11
The electrical wiring for the
canteen is safe and does not
cause any risk on students.
4.2 84.6 0.8 14.251 0.000 9
61
Phrase Mean Weight
Mean
Std T Sig. Rank
The contents of the canteen
are supervised. 4.6 91.2 0.5 29.496 0.000 2
There is a sewage network
in the canteen. 4.4 87.0 0.7 18.415 0.000 6
The cleanliness of staff of
the canteen is monitored. 4.5 90.6 0.5 28.773 0.000 3
The staff of the canteen has
a disease-free certificate. 4.7 93.2 0.5 31.549 0.000 1
The staff of the canteen is
committed to their uniform
(Long sleeves bib).
4.2 84.8 0.8 15.737 0.000 8
The alignments of students
is in front of the canteen to
buy are arranged.
3.4 67.2 1.1 3.345 0.001 15
The canteen area is
decorated with purposeful
drawings related to nutrition
3.3 65.1 1.2 2.078 0.040 16
There is a plan to supervise
students who suffer
malnutrition and anemia.
3.3 65.0 1.0 2.363 0.020 17
The cleanliness and quality
of food and drinks offered to
students is monitored.
4.4 88.8 0.8 17.990 0.000 4
61
Phrase Mean Weight
Mean
Std T Sig. Rank
Filtered water is used to
prepare food. 3.8 75.8 1.0 7.906 0.000 13
Students are encouraged to
have breakfast. 4.3 85.6 0.7 17.902 0.000 7
There is a refrigerator inside
the canteen. 4.4 87.6 0.8 16.300 0.000 5
Frying oil is changed daily
when processing falafel
sandwiches.
3.8 76.8 0.9 8.826 0.000 12
Total 4.0 80.6 10.3 74.266 0.000
4.2.7 Distribution of the study participants according to their responses
about Topics by mean, Median and standard deviation
Table (4.7) shows the weighted mean of all topics was 83.5%, while the highest
topics was Topic 1: Field of school health services with weighted mean 85.6%,
followed by Topic 2: Field school health environment with weighted mean 84.4 %,
followed by Topic 3: Field of school health education with weighted mean82.1 %,
while the lowest topics was Topic 4: Field food services and school canteens with
weighted mean 80.6%.
4.2.8 Assessment school health services field (observational checklist )
Table (4.8) shows the weighted mean of all topics in observational checklist was
78.2%, while the highest topics was topic field of school health services with
weighted mean 92.3% followed by field school health education with weighted mean
82.2%, followed by field health school environment with weighted mean 71.2, while
the lowest topics was food services and school canteens with weighted mean 68.2%.
62
Table (4.7): Distribution of the study participants according to their responses about
Topics by mean, median and standard deviation
Topics weighted
Mean
)%)
Median Std
Topic 1: Field of School Health Services 85.6 87.4 8.9
Topic 2: Field of School Health Environment 84.4 84.6 9.2
Topic 3: Field of Health Education 82.1 82.7 10.1
Topic 4: Food Services and School Canteens 80.6 80.0 10.3
Total 83.5 83.6 8.2
Table (4.8): Assessment school health services by mean, median and standard
deviation (observational checklist )
Topics weighted
Mean
)%)
Median Std
field school health services 92.3 92.2 1.8
Field school health education 82.2 81.0 8.1
Field health school environment 71.2 71.2 3.8
Field Food Services and School Canteens 68.7 67.9 3.2
Total 78.2 78.2 2.6
According to the researcher observer ( checklist) there are the commitment of school
health service providers to the guideline of school health services.
63
Also according to the researcher observer (observational checklist ) there are no
measure blood pressure for the students, examine the blood group of students, speech
assessment for students, conduct sensitivity tests for students, blood test for students
(hemoglobin), students are trained in emergency evacuation, medication are
distribute to students at school, examination of blood sugar for the students and
provide support to students with special needs.
4.2.9. Differences between Topics and Gender
Table (4.9) shows that there are no statistical differences between topics as a total
(School health services, School health education, Health school environment) and
gender (sig. > 0.05), while there is a statistical significance between topic (4) Food
Services and School Canteens (sig. < 0.05), there are no relationship between (fields
of school health services, health education school health environment) and gender.
These results are disagree with the results of (Khandakja, 2222) who showed that
statistical differences between topics as a total and gender; the difference between
the this study result and author because of different sample size.
Table (4.9): Differences between Topics and Gender
Topics Gender N Mean Std T Sig.
Field of School Health
Services
Male 37 86.0 9.9 0.357 0.722
Female 60 85.4 8.3
Field of Health
Education
Male 37 81.5 11.5 -0.451 0.653
Female 60 82.5 9.2
Field of school health
environment
Male 37 85.3 10.6 0.740 0.461
Female 60 83.8 8.4
Food Services and
School Canteens
Male 37 83.4 12.1 2.160 0.033
Female 60 78.8 8.6
Total Male 37 84.3 9.7 0.804 0.424
Female 60 82.9 7.2
64
4.2.10. Differences between Topics and Education Level
Table (4.10) shows that there are no statistical differences between topics as a total
and education level (sig. > 0.05), there are no association between (fields of school
health services, health education school health environment and Food Services and
School Canteens) and education level.
These results are disagree with the results of (Khandakja, 2222) who illustrated that
statistical differences between topics as a total and education level, the different
between my result and author because of different sample size and area.
On other hand, these results are agree with the results of (Al-Sarairah, 2012) who
illustrated that no statistical differences between topics as a total and education.
Table (4.10): Differences between Topics and Education level
Topics Education N Mean Std T Sig.
Field of School Health
Services
BSc 86 85.3 9.2 -0.715 0.476
Master 3 89.1 7.5
Field of Health
Education
BSc 86 81.8 10.4 -1.018 0.311
Master 3 88.0 8.3
Field of school health
environment
BSc 86 84.4 9.5 -0.414 0.680
Master 3 86.7 10.0
Field Food Services
and School Canteens
BSc 86 80.3 10.7 -0.765 0.446
Master 3 85.1 3.8
Total
BSc 86 83.2 8.5 -0.86 0.392
Master 3 87.5 6.3
65
4.2.11. Differences between Topics and age
Table (4.11) shows that there are no statistical differences between topics as a total
and age (sig. > 0.05), there are no association between (fields of school health
services, health education school health environment and Food Services and School
Canteens) and age level.
These results are agree with the results of (Al-Sarairah, 2012) who displayed that no
statistical differences between topics as a total and age level.
Table (4.11): Differences between Topics and age
Topics Age N Mean Std F Sig.
Field of School Health
Services
35 y and less 26 85.5 9.1 0.38 0.685
36 - 45 39 84.8 8.6
46 and more 32 86.7 9.3
Total 97 85.6 8.9
Field of Health
Education
35 y and less 26 82.3 8.9 0.013 0.988
36 - 45 39 81.9 10.5
46 and more 32 82.2 10.8
Total 97 82.1 10.1
Field of school health
environment
35 y and less 26 82.9 8.7 0.526 0.593
36 - 45 39 84.6 10.0
46 and more 32 85.4 8.9
Total 97 84.4 9.2
Field Food Services
and School Canteens
35 y and less 26 79.5 10.3 0.193 0.825
36 - 45 39 81.0 10.3
46 and more 32 81.0 10.5
Total 97 80.6 10.3
Total
35 y and less 26 83.0 7.4 0.168 0.846
36 - 45 39 83.3 8.3
46 and more 32 84.1 9.0
Total 97 83.5 8.2
66
4.2.12. Differences between Topics and Experience years
Table (4.12) shows that there are no statistical differences between topics as a total
and experience years e (sig. > 0.05), there are no association between (fields of
school health services, health education school health environment and Food
Services and School Canteens) and experience years level.
These results are agree with the results of (Al-Sarairah, 2012) who illustrated that no
statistical differences between topics as a total and experience years level.
On other hand, these results are disagree with the results of (Khandakja, 2222) who
showed that statistical differences between topics as a total and education Level.
Table (4.12): Differences between Topics and Experience
Topics Age N Mean Std F Sig.
Field of School Health
Services
Less 5 years 4 82.6 15.8 0.251
0.778
5 – 10 years 40 85.6 7.6
More than 10 53 85.9 9.4
Total 97 85.6 8.9
Field of Health Education
Less 5 years 4 73.3 13.0 1.632
0.201
5 – 10 years 40 82.8 8.8
More than 10 53 82.3 10.6
Total 97 82.1 10.1
Field of school health
environment
Less 5 years 4 82.3 12.2 2.023
0.138
5 – 10 years 40 82.3 9.7
More than 10 53 86.1 8.5
Total 97 84.4 9.2
Field Food Services and
School Canteens
Less 5 years 4 79.1 17.5 0.938
0.395
5 – 10 years 40 79.0 9.1
More than 10 53 81.9 10.5
Total 97 80.6 10.3
Total
Less 5 years 4 79.8 11.8 0.73
0.484
5 – 10 years 40 82.8 7.2
More than 10 53 84.2 8.8
Total 97 83.5 8.2
67
Chapter 5
Conclusion and
Recommendations
68
Chapter 5
Conclusion and Recommendations
5.1 Conclusion
This study used the descriptive approach to assess the quality of school health
services in governmental schools at Khan Younis and Rafah Governorates, . Since
population size is relatively small, the researcher considered the population as the
sample of study (census), which consists of two groups, the first group is consist of
the school health coordinators in governmental schools at Khan Younis and Rafah
Governorates whose number (97 ), the second group is consist of school health team
whose number (14). The researcher used three tools for collecting data, the first tool
a questionnaire for the school health coordinators (97), the second tool observational
checklist for school health field(97), the third tool focus group of the school health
team whose number (5) groups. As well as follow the statistical analysis. So we will
discuss the important results in the light of the academic and field observations.
Which are the following:
1- The study population and sampling of school health coordinators demographics
showed that 38.1% of the total samples were males and 61.9% of the samples were
females.
2- The prominent age group in the sample were employees whose age between 36-45
years old, which constituted 40.2%. 86% percent of study populations are married.
3- Employees who have a bachelor degree are most prominent in the sample which
constituted 88.7%, there are 48.5% of study participants work in girls school and
there are 36.0% work in boys school.
4- 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% Western KhanYounis.
5- This study showed that the weighted mean for topic of the field of school health
services was 85.6% and significant less than 0.05 which mean the participants agree
about this topic.
69
6- Regarding health education, this study showed 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.
7- The results showed that the weighted mean for topic of the field of school health
environment was 84.4% and significant less than 0.05 which mean the participants
agree about this topic.
8- The results showed that the weighted mean for topic of the field food services and
school canteens was 80.6% and significant less than 0.05 which mean the
participants agree about this topic.
9- The researcher found that there were not statistically significant differences
observed in socio-economic demographic variables (age, gender, experience years
and educational level) in relation to school health coordinators total score in the
different domains of the study.
10- According to the researcher observer (observational checklist) the weighted
mean of all topics was 87.1%; the highest topics field of school health services with
weighted mean 92.3% followed by field School health education with weighted
mean 82.2%, followed by field health school environment with weighted mean 71.2,
while the lowest topics was field food services and school canteens with weighted
mean 68.2%.
11- When making focus group interview with school health team followed MOH,
they showed that all of school health fields implementing with very good level.
71
5.2 Recommendations
1- Activating of the school health committees to organize the purchase during the
break.
2- Supporting the school health team with modern equipment to carry out the
examination and follow up process with high efficiency.
3- Increaseing number of health seminars to educate students about physiological
changes.
4- Appointing a resident nurse for each group of near schools to deal with
emergencies occurring in the school.
5- Supporting school feeding programs and treating malnutrition problems by
providing school restaurants that meet health conditions and ensure safe storage and
consumption of food and ensure that it contains appropriate foods of high nutritional
value appropriate to the different ages of students.
6- Permanent inspection and monitoring of restaurants in terms of hygiene and water
and sanitary equipment used, the use of basic disinfectants, and periodic monitoring
of restaurant workers.
7- Providing more written instructions and graphics that encourage proper nutrition.
8- Improving the physical environment in the school by paying attention to the
availability of appropriate health conditions in the classroom and the number of
students is appropriate.
9- Improving the environment services of the school, especially with regard to water
center and daily supervision and provision of supplies.
10-Conducting measure blood pressure, examine blood group, speech examination,
examination of blood sugar for students and blood test for students (hemoglobin). .
71
References
72
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.الجامعة اإلسالمية، غزة
بيق التربية الصحية في مدارس التعميم الحكومي بمدينة غزة، (. واقع تط2011الجرجاوي، زياد، أغا، ىاشم. )
.(1)13مجمة جامعة األزىر، غزة، سمسمة العموم اإلنسانية،
فمسطين في ضوء الدليل االرشادي –(. تقييم المقاصف المدرسية لممدراس محافظة غزة 2015السرحي، فايز. )
الجامعة االسالمية. –كمية العموم –نشورة لممعايير صحة البيئة المدرسية. رسالة ماجستير غير م
(. مستوى الصحة المدرسية في المدارس االبتدائية في دولة الكويت 2012الرشيدي، تركي. ) الصرايرة، خالد،
، العدد 26من وجية نظر المديرات و المعممات. مجمة جامعة النجاح لألبحاث، العموم اإلنسانية، المجمد
10 .
(. تقويم الخدمات الصحية لمتربية البدنية في المدارس الثانوية لمبنين 2003عوض احمد. )العطا، & عز الدين بوالية الخرطوم. جامعة السودان لمعموم والتكنولوجيا.
75
،دار األندلس لمنشر والتوزيع، حائل ،2(. الصحة المدرسية، ط2006) الغامدي، أحمد، عمى، أبو عمرو. .المممكة العربية السعودية
واقع برامج الخدمات الصحية المقدمة لمطمبة في مدارس محافظة الزرقاء في األردن من .(2007احمد. )بدح، .2،العدد 21مجمة جامعة النجاح لألبحاث، العموم اإلنسانية، المجمد .وجية نظر مديري المدارس
(. سالمة الغذاء . وزارة الصحة، فمسطين.2005حميد، محمود. )
(. واقع خدمات الصحة المدرسية التي يمارسيا أطباء الصحة المدرسية في المدارس 2000خندقجي، دمحم. )
األساسية الحكومية في محافظة اربد من وجية نظر مديري المدراس والمشرفين، رسالة ماجستير غير منشورة
جامعة اليرموك.
سطين.(. تغذية اطفال المدارس. دائرة التغذية، وزارة الصحة، فم2013سكيك، عمي. )
.(. الجوانب الصحية في التربية الرياضية، دار الفكر العربي، القاىرة2001) سالمة، بياء الدين، إبراىيم.
دراسة -واقع الصحة المدرسية في الجزائر من وجية نظر الفاعمين في القطاع (.2014) .صدراتي، فضيمة ميدانية بوحدات الكشف و المتابعة و المدارس االبتدائية و المؤسسات العمومية لمصحة الجوارية بوالية بسكرة
.
ل، حائ، يعوزلتر والمنشس لدألن، دار الصحيةالثقافية م امفاىيس وسأ) .2002( .ليومت ،ميظلععبد ا ،وليمت .يةودلسعابية رلعالمممكة ا
(. تقيين هدى تطبيق برناهج الصحة الودرسية في 2257صالح, ليندا, هرعي, سوير, & الغزالي , يوسف. )
309X-ISSN: 2079, 38(2.)سلسلة العلوم الصحية هدارس التعلين األساسي في هدينة الالذقــيــة.
فمسطين. -الدليل االرشادي لمصحة المدرسية . رام هللا (. 2010وزارة الصحة الفمسطينية. )
.
76
Appendix 1: General Administration of School Health in Ministry of
Education and Higher Education
.
77
Appendix 2: General Directorate of planning in Ministry of
Education and Higher Education
78
Appendix 3: Approval from Directorate of Education in Rafah
79
Appendix 4: Approval from Directorate of Education in East Khan
Younis
81
Appendix (5): Focus groups meeting for school health team of MOH
In The Name of Allah Most Gracious Most Merciful
Meating for school health team of MOH
First: Personal Data: Please put the mark ( √ ) in the appropriate blank:
4.Educational Level
□ Diploma
□ Bachelor
□ Master
□ PHD
3. Social
Status
□ Single
□ Married
□ Widow
□ Divorced
2. Gender
□ Male
Female □
1. Age
……… Years
6. Ministry Name
□ Health
□ Education
5. Experience Years
□ Less than 5
□ 5-10 Years
□ More than 10
Second part: Questions for school health team of MOH
1- What tests are offered to students at school?
2- What level of application of health services are offered to students?
3- What activities are offered to students in the health education process?
4- What is the role of the school health team in health education process and what
the level of applied?
5- What are the things that are supervised by the school environment and what the
level applied?
6- What is the reality of food services and school canteens?
81
Appendix (6): List of arbitrates
NO Name Affiliation
1 Dr. Ahmed AL Shaer Islamic University
2 Dr. Khalil Shaib PNC
3 Dr. Yaser AL Nehal IUG
Dr. Akram Abu-Salah PCN
4 Dr. Mutasim Salah
University college of
Applied Sciences
5 Dr. Ayman Abou Mostafa
MOH
6 Dr. Ali AL Khateeb University college of
Applied Sciences
7 Dr. Tisser AL Sherfa Ministry of Education and
Higher Education
8 MR. Mahmoud Abu Samaan
Ministry of Education and
Higher Education
9 Dr. Abed AL Rahman Al Hamas PCN
10 Dr. Mohamed AL Jerjay PCN
82
Appendix (7): Study Time Schedule
Month
Activities 2017
April
May
June
July
Aug
Sep
Oct
Nov
1 Literature Survey,
permission
2 School visits &
Data collection
3 Data analysis
4 Interpretation the
results
5 Written the thesis
83
Appendix 8: Questionnaire (English version)
First of all, I‟d like to express my best regards, and here you are the questionnaire
which is prepared for “Assessment of the quality of school health services in
governmental schools at khan younis and Rafah Governorates” to fulfill
requirements of acquiring Master degree in Environment and Earth Sciences
Department at Islamic University of Gaza, particularly Environmental Health
Division.
I hope you will kindly full the questionnaire by answering all paragraphs with
objectivity. Known that your opinions will give considered important and will be
used just for purposes of the study and scientific research. Also, these data will be
treated confidentially for having results leading to improve the quality of school
health services in governmental schools at khan younis and Rafah Governorates.
Researcher
Naji Abu Loli
ثغــضح اغـبؼــــــــــخ اإلعـــــال١ــخ
ػبدح اجحش اؼ اذساعبد اؼ١ب
وـ١ــــــــــــــــــــخ اؼـــــــــــــــــــــ
طحخ ث١ئخ –بعغز١ش اؼ اج١ئ١خ
The Islamic University of Gaza
Deanship of Research and Graduate Studies
Faculty of Science
Master of Environmental Sciences -
Environmental Health
84
In The Name of Allah Most Gracious Most Merciful
A questionnaire for school health teachers
First: Personal Data: Please put the mark ( √ ) in the appropriate blank:
4.Educational Level
□ Diploma
□ Bachelor
□ Master
□ PHD
4. Social
Status
□ Single
□ Married
□ Widow
□ Divorced
3. Gender
□ Male
Female □
2. Age
……… Years
8. Directorate
□ East Khan
Younis
□ West Khan
Younis
□ Rafah
7. School Type
□ Male
□ Female
□ Mixed
6. School Name 5. Experience
Years
□ Less than 5
□ 5-10 Years
□ More than 10
Second: Topics of the study: Please put the mark (√ ) in front of the phrase that you
consider it appropriate and represent your personal opinion from each one below:
No. Phrase Strongly
Agree
Agree uncertain Not
Agree
Strongly
Not
Agree
Topic 1: Field of School Health Services:
1 School Health Team in
corporation with school health
committee conducts
comprehensive periodic medical
examinations for all students
concerned.
2 Students are physically prepared
for the health check.
3 Students are psychologically
prepared for the health check.
85
NO. Phrase Strongly
Agree
Agree uncertain Not
Agree
Strongly
Not
Agree
4 Suitable place for the health
check is prepared to ensure
privacy of students during the
check.
5 The list of checked and
transferred students is prepared
according to attached forms in
the guide for health services.
6 The medical history of the
student and his/her family is
recognized.
7 School health team uses modern
equipment and suitable methods
for detection and examination.
8 Ensure ask and investigate
about the possibility of any
infectious diseases during
routine visit to schools.
9 All appropriate precaution are
taken to control infectious
diseases when the first case at
school occurs.
10
Disease cases that detected from
students are transferred to
competent health centers and
follow up therapy and discuss it
with parents.
11 Student with infectious disease
is excused from school
attendance.
12 Family and local community
participate in any activities
related to the prevention of
infectious diseases.
13 There is special care plan for
students with special needs.
14 Oral and dental examinations
are performed for students.
15 The school health team prepares
a monthly report about school
visits and detected cases.
86
NO. Phrase Strongly
Agree
Agree uncertain Not
Agree
Strongly
Not
Agree
16 Information and examinations
are recorded in a medical file
for the student.
17 The acute disease (Diarrhea,
cold, flu, etc ..) of students are
followed up and treated.
18 Absent students who have failed
to obtain medical services are
followed up.
19 The number of school health
team is sufficient to conduct the
process of examination for
students without affecting their
school achievement.
20 The school health team is
committed to the time and place
set for it.
21 Examinations and vaccinations
are sufficient for students.
22 Vaccinations are given
according to schedule of the
ministry of health.
23 Vaccinations are saved in the
appropriate refrigerator.
24 Infection control measures are
taken when vaccinations are
given.
25 Vaccinations are recorded in the
health file of the student.
26 There is a prior coordination
with school when conducting
examinations and giving
vaccinations for students.
27 Emergency diseases cases are
followed up and suitable first
aid is provided.
87
NO. Phrase Strongly
Agree
Agree uncertain Not
Agree
Strongly
Not
Agree
Field health education
28 There are lectures that are given
to students about the most
important diseases and health
problems.
29 Awareness leaflets and health
guidance manuals are
distributed to students.
30 The school health team
provides school with written
instructions to deal with
emergency cases and accidents.
31 There is awareness effort to
schools about common diseases.
32 There are awareness seminars
held for teachers and students.
33 Meetings are held with parents
of students and there are health
seminars held for them.
34 Health events and days such as
(World Health Day) are revived.
35 There are special programs
presented about physical
changes experienced by male
and female students.
36 Psychological support is
provided for students.
37 There is coordination with
health institutions to provide the
necessary health education for
students.
38 There is cooperation between
health coordinator and the art
teacher to make wall paintings
(murals) that convey health
messages to students.
39 Health competitions are held
among students.
40 The school library is provided
with useful health books.
88
NO. Phrase Strongly
Agree
Agree uncertain Not
Agree
Strongly
Not
Agree
41 Health courses are held for
school health teachers.
42 First aid courses are held for
students.
Topic 3: Field of school health environment:
43 School environment is
supervised to ensure that it is
suitable for students‟ health
needs such as (student's seats,
lighting, ventilation and
heating).
44 Water tanks are monitored and
sealed.
45 Safety and security factors for
students are evaluated.
46 Proper ways and methods of
waste disposal are ensued in
schools.
47 Schools are provided with
cleaning materials.
48 Tanks and drinking water safety
is inspected.
49 Drinking water samples are
taken for laboratory test
periodically.
50 Toilets at schools are inspected
for cleanliness.
51 Water and soap are provided in
student‟s toilets.
52 The number of students in the
classroom corresponds to the
classroom area.
53 The school health team in
corporation with the health
committee supervises the
processing of the first aid a
cupboard.
54 There is a first aid kit in the
school.
89
NO. Phrase Strongly
Agree
Agree uncertain Not
Agree
Strongly
Not
Agree
55 The first aid kit contains all
supplies.
Topic 4: Field Food Services and School Canteens
56 Canteen building is designed in
an appropriate manner.
57 Canteen is periodically
renovated.
58 There is a fire extinguisher
available inside the canteen.
59 The electrical wiring for the
canteen is safe and does not
cause any risk on students.
60 The contents of the canteen are
supervised.
61 There is a sewage network in
the canteen.
62 The cleanliness of staff of the
canteen is monitored.
63 The staff of the canteen has a
disease-free certificate.
64 The staff of the canteen is
committed to their uniform
(Long sleeves bib).
65 The alignments of students is in
front of the canteen to buy are
arranged.
66 The canteen area is decorated
with purposeful drawings
related to nutrition.
67 There is a plan to supervise
students who suffer malnutrition
and anemia.
68 The cleanliness and quality of
food and drinks offered to
students is monitored.
69 Filtered water is used to prepare
food.
91
NO. Phrase Strongly
Agree
Agree uncertain Not
Agree
Strongly
Not
Agree
70 Students are encouraged to have
breakfast.
71 There is a refrigerator inside the
canteen.
72 Frying oil is changed daily
when processing falafel
sandwiches.
91
Appendix 9 : Questionnaire (Arabic version)
بداية أىديك أطيب التحيات، ويطيب لي أن أضع بين أيديكم االستبانة المرفقة التي تم تصميميا
الحكومية بمحافظتي رفح و " تقييم جودة الخدمات الصحية المدرسية في المدارس بيدف
و ذلك استكماال لممتطمبات الحصول عمى درجة الماجستير في قسم البيئة وعموم خانيونس"
تخصص صحة بيئة. -االرض بالجامعة اإلسالمية
لذا نأمل منكم التكرم بتعبئة االستبانة باإلجابة عمى فقرات االستبانة بكل صراحة و موضوعية، عمومات التي ستدلون بيا ستكون محل اىتمام وعناية وستستخدم ألغراض عمما أن أراءكم والم
الدراسة والبحث العممي فقط، وسيتم التعامل معيا بكل سرية وعناية لمتوصل لنتائج تفضي إلى تحسين جودة الخدمات الصحية المدرسية المقدمة في المدارس الحكومية بمحافظتي رفح و
خانيونس"
اجبحش / بع أث
0599 908737عاي/
ثغــضح اغـبؼــــــــــخ اإلعـــــال١ــخ
ػبدح اجحش اؼ اذساعبد اؼ١ب
وـ١ــــــــــــــــــــخ اؼــــــــــــــــــــــ
طحخ ث١ئخ –بعغز١ش اؼ اج١ئ١خ
The Islamic University of Gaza
Deanship of Research and Graduate Studies
Faculty of Science
Master of Environmental Sciences -
Environmental Health
92
اشل ......... .
بسم ميحرلا نمحرلا هللا
اعزجبخ ذسع اظحخ اذسع١خ
ه ( ف اشثغ ابعت √ فضه ضغ ػالخ ) اشخظ١خ :اج١ببد أال:
. اؼش1
)عخ( .............
:اغظ. 2
روش □
أض □
احبخ االعزبػ١خ :.3
أػضة/ أغخ □
زضط/ح □
اس/ح □
طك/ح □
4 .
اغز
:ازؼ١
دث □
□ ثىبس٠ط
بعغز١ش □
دوزسا □
:عاد اخجشح . 5
عاد 5أل □
عاد 10- 5 □ عاد 10أوضش □
. اع اذسعخ: 6
...........................
اذسعخ: . ع7
س رو □ بسإ □ شزشوخ □
اذ٠ش٠خ:. 8
ششق □ خب١ظ
غشة □ خب١ظ
□ سفح
بعجخ رض سأ٠ى ( أب اؼجبسح از رشب٠شع ازفض ثضغ إشبسح )صب١ب: حبس اذساعخ:
لبػزى اشخظ١خ ى عؤاي ب ٠أر:
غ١ش
افك
ثشذح
غ١ش
افك
حب٠ذ
افك افك
ثشذح
اشل افمشح
اذسع١خ اظح١خ اخذبد احس األي: غبي
٠م فش٠ك اظحخ اذسع١خ ثبزؼب غ اغخ
ثئعشاء افحطبد اطج١خ اذسع١خ اظح١خ
اذس٠خ اشبخ ى اطالة اؼ١
5
2 اظح ٠ز ر١ئخ اطجخ عغذ٠ب فحض
3 اظح ٠ز ر١ئخ اطجخ فغ١ب فحض
93
غ١ش
افك
ثشذح
غ١ش
افك
افك افك حب٠ذ
ثشذح
اشل افمشح
٠ز رحض١ش ىب بعت فحض ثح١ش ٠ض
ض اظحصبء افحأاخظط١خ طجخ
4
اح١ ٠ز سطذ لائ اطجخ افحط١
ف اذ١ اإلسشبد فك ابرط اشفمخ
خذبد اظح١خ
5
6 أعشر بتط طجػ ازبس٠خ ا ٠ز ازؼشف
حذ٠ضخ أعضح اذسع١خ اظحخ فش٠ك ٠غزؼ
افحض ىشف بعجخ طشق
7
٠ز ازمظ اغؤاي ػ احزب١خ عد
أشاع ؼذ٠خ )اغذس, اىبف ,...( خالي
اض٠بسح اشر١١خ ذسعخ
8
٠ز ارخبر وبفخ اإلعشاءاد ابعجخ ىبفحخ
األشاع اؼذ٠خ ػذ ظس أي حبخ
ثبذسعخ
9
اشاوض إ اىزشفخ اشض١خ احبالد رحي
ػالعب رطسب زبثؼخ اخزظخ اظح١خ
األس أ١بء غ بلشزب
10
٠ؼف اطبت اظبة ثأشاع ؼذ٠خ اذا
اذسع
11
٠شزشن األ اغزغ اح ف ا٠ شبطبد
اؼذ٠خرزؼك ثبلب٠خ األشاع
12
٠عذ خطخ سػب٠خ خبطخ ثبطالة ر
االحز١بعبد اخبطخ
13
14 رغش فحطبد ف األعب
ئػذاء رمش٠ش ٠م فش٠ك اظحخ اذسع١خ ث
شش ػ اض٠بساد اذسع١خ احبالد
اىزشفخ
15
اؼبد افحطبد ثف طج رذ
خبص ثبطبت
16
شاع احبدحزبثؼخ ؼبغخ األ٠ز
از ٠زؼشع ب اطجخ ) اإلعبي/ اششح /..(
17
94
غ١ش
افك
ثشذح
غ١ش
افك
افك افك حب٠ذ
ثشذح اشل افمشح
از٠ رخفا ػ اغبئج١زبثؼخ اطجخ ٠ز
احظي ػ اخذبد اظح١خ
18
اذسع١خ وبف إلعشاء ػ١خ ػذد فش٠ك اظحخ
افحض طالة د رأص١ش ػ رحظ١ اطبت
اؼ
19
٠زض فش٠ك اظحخ اذسع١خ ثبلذ اىب
احذد
20
افحطبد ازطؼ١بد وبف١خ طالة
21
٠ز إػطبء ازطؼ١بد حغت عذي صاسح
اظحخ
22
ثبضالعخ اخظظخ٠ز حفع ازطؼ١بد
23
٠ز ارخبر إعشاءاد ىبفحخ اؼذ ف إػطبء
ازطؼ١
24
٠ز رذ٠ ازطؼ١بد ف ف اطبت اظح
25
عشاء إ٠عذ رغ١ك غجك غ اذسعخ ػذ
ػ١خ افحض ازطؼ١ طالة
26
زبثؼخ االشاع اطبسئخ رمذ٠ اإلعؼبف رز
اال ب
27
احس اضب: غبي ازضم١ف اظح
شاع األأػ حبضشاد طالة ػ ٠ز
اشبو اظح١خ
28
رص٠غ ششاد رػ١خ وز١جبد طح١خ اسشبد٠خ
طجخ
29
٠ضد فش٠ك اظحخ اذسع١خ اذسعخ ثزؼ١بد
احادسىزثخ زؼب غ حبالد اطاسا
30
رػ١خ اذسعخ ثبألشاع اشبئؼخ ٠ز
31
ػ ذاد رػ١خ ذسع١ اطالة
32
س ػ ١بء األأغ بداالعزبػرغش
ذاد طح١خ
33
95
غ١ش
افك
ثشذح
غ١ش
افك
افك افك حب٠ذ
ثشذح افمشح
اشل
٠ب اظح١خ رفؼ١ ابعجبد األ ٠ز إح١بء
ض ) ٠ اظحخ اؼب .... اخ (
34
٠ز ػشع ثشاظ خبطخ ػ ازغ١شاد اغغ١خ
از ٠ش ثب اطالة اطبجبد
35
رمذ اذػ افغ طجخ
36
ازغ١ك غ اؤعغبد اظح١خ زمذ٠ ٠ز
االص طجخ زضم١ف اظحا
37
ؼ اف ث١ غك اظحخ ازغ١ك ٠ز
ؼ سع عذاس٠خ م سعبئ طح١خ
38
اطالة ػ غبثمبد طح١خ ث٠١ز
39
ىزجخ اذسعخ ثبىزت اظح١خ ٠ز رض٠ذ
اف١ذح
40
اظحخ اذسع١خذسع ػ دساد ٠ز
41
دساد اعؼبف أ طجخ٠ز ػ
42
اذسع١خ اظح١خ اج١ئخ احس اضبش: غبي
ػ ث١ئخ اذسعخ زأوذ ذ ٠ز اإلششاف
ض ) الءزب الحز١بعبد اطالة اظح١خ
مبػذ ازال١ز اإلضبءح از٠خ ازذفئخ (
43
غاللبإحىب إخضابد ا١ب ٠ز شالجخ
44
اغالخ اؼبخ طالةرم١١ ػا األ 45
زخض اظح١حخ اطشق ارجبع اعبئ ٠ز
افب٠بد
46
ثباد االصخ زظ١ف اذسعخ رضد
47
رفمذ اخضابد عالخ ١ب اششة ٠ز
48
فحض ١ب اششة خز ػ١بد أ ٠ز
ثشى دس اخجش
49
رفمذ دساد ا١ب ظبفزب ٠ز
50
ثذساد ١ب اطجخ ش ابء اظبث١رف٠ز
51
96
غ١ش
افك
ثشذح
غ١ش
افك
افك افك حب٠ذ
ثشذح افمشح
اشل
٠زبعت اػذاد اطالة ثبفظ غ غبحخ افظ
52
ثبزؼب غ ٠ششف فش٠ك اظحخ اذسع١خ
عؼبفبد اغخ اظح١خ ػ رغ١ض خضاخ اإل
١خاأل
53
أ إعؼبف حم١جخ ثبذسعخ ٠عذ
54
و ػ اال االعؼبف حم١جخ رحز
اغزضبد
55
خذبد اطؼب امبطف احس اشاثغ :
ج امظف ظ ثطش٠مخ بعجخ
56
رش١ امظف ثشى دس٠ز
57
٠زفش طفب٠خ حش٠ك داخ امظف
58
ازذ٠ذاد اىشث١خ مظف حىخ ال رشى
خطش
59
ػ ب ٠حز٠ امظف اذسع٠ز االششاف
60
٠حذ شجىخ طشف طح ثبمظف
61
٠ز زبثؼخ ظبفخ اؼب١ ثبمظف اذسع
62
٠عذ ذ اؼب١ شبدح خ االشاع
63
اؼب ثبمظف ٠زض ثبض اخبص ث
)ش٠ي ثأوب ط٠خ (
64
97
غ١ش
افك
ثشذح
غ١ش
افك
افك حب٠ذ
ثشذح
افمشح افك
اشل
٠ز رظ١ االططفبف اب امظف اذسع
ششاء
65
رض٠ طمخ امظف ثشعبد بدفخ رزؼك
ثبزغز٠خ
66
األ١١ب ازغز٠خ عء طالة زبثؼخ خطخ ٠عذ
67
ظبفخ ػ١خ اأوالد شالجخ ٠ز
اششثبد امذخ طالة
68
اطؼب اػذاد ف افزش ابء اعزخذا ٠ز
69
االفطبس عج ربي ػ اطالة رشغ١غ ٠ز
70
اذسع ثبمظف االطؼخ حفع صالعخ ٠عذ
71
٠ز رغ١ش ص٠ذ ام ١٠ب ػذ رغ١ض
عذ٠زشبد افالف
72
98
Appendix 10: Observational Checklist
No. Paragraph Always
Often
Sometimes Rarely never
School health services field
1 Measure the length of
students.
2 Measure the weight of
students.
3 Calculate body mass
index.
4 Test the strength of sight
for the students.
5 Conducting tests on eye-
related diseases
6 Test the strength of
Hearing for students.
7 Test of Thyroid gland
8 Conducting tests for skin
diseases for students
9 Conducting dental and oral
examination
10 Conducting tests for
Reproductive and urinary
systems.
11 Conducting tests for heart.
12 Monitoring and treat acute
diseases.
13 Conducting abdominal
examinations.
14 Conducting Spinal cord
examinations.
15 Give Prophylactic
vaccinations for students
16 The vaccinations kept in
special refrigerators
17 Infection control measure
will be taken during
vaccinations
18 Check in the validity of
vaccinations
99
NO. Always
Always Often
Sometimes Rarely never
19 The vaccinations and the
investigations registered in
the student medical file
20 Follow up emergency
diseases and give first aid
21 Identifying the medical
history for students
22 Using advanced equipment
and suitable method for
investigations and
detections
23 The place of examination
insure the privacy of the
students
School health education Field
24 Provide health education
through school podcast
25 Revive and activate health
events ( International
Health Day)
26 The school carry out
activity including health
activities
27 Give lectures for the
students about health
nutrition
28 Make lectures for the
students about impotent
topics according to age
category
29 Doing health seminars for
the parents
30 Giving a health
competition for the
students
31 Involve parents in health
awareness programs
32 Hold healthy plays
33 Put panels and disrepute
brochures
Health school environment
34 School has first aid kit
35 The bag contains sterile
gauze and gauze bandage
111
No. Paragraph Always Often
Sometimes Rarely never
36 The bag contains
sphygmomanometer
37 The bag contains
glucometer
38 The bag contains some
medications like pain killer
39 The waste eliminate by
burning
40 The waste eliminate by
municipality
41 The waste are collected in
nylon bags and loaded
outside the school
42 Waste baskets are
available in each class
43 Closed containers are
available to collect waste
inside the school
44 The location of the bath
rooms are suitable
45 The number of the
bathrooms enough and
supply with water
46 There is basket inside the
health facilities
47 Provides an effective
ventilation and lighting
system for classrooms
48 There are facilities
designed for the handicap
49 Provide controlled sewage
system
50 The disposal of wastewater
through the sewage
51 The source of drinking
water is municipal
52 Drinking Water Source
/Water Dispensers (Water
Tanks - Filters)
53 Chlorine pills are added to
drinking water tanks
54 Drinking water is
constantly available inside
the school
111
No. Paragraph Always Often
Sometimes Rarely never
55 Drinking water tanks
sealed
56 Tanks are constantly
cleaned
57 Samples are taken from
drinking water
58 The number of drinking
water taps is adequate and
its height is suitable for
students
59 The number of students
corresponds to classroom's
areas
Food services and school canteen
60 The canteen building is
designed in an appropriate
manner
61 A fire extinguisher is
available inside the
canteen
62 The electrical wiring of the
canteen is tight and does
not constitute a hazard
63 sewage network available
in canteen
64 A sink is available inside
the canteen
65 Good lighting is available
inside the canteen
66 There is good ventilation
inside the canteen
67 stove is available in the
canteen
68 The workers in the canteen
are committed to their
uniforms (long-sleeved
bibs)
69 Employees have a disease-
free certificate
70 There is good cleanliness
in the canteen
112
No. Paragraph Always Often
Sometimes Rarely never
71 The canteen has nearby
food Expiration period
(less than one month)
72 The food is exposed and
exposed to flies and dust
73 The canteen guarantor sells
food items that are not
allowed ( chips)
74 the guarantor canteen
Sells soft drinks
75 Filtered water is used to
prepare food
76 The queues are organized
in front of the school
canteen for purchase
77 The canteen area is
adorned with targeted
nutrition labels
78 There is a food storage
refrigerator at the school
canteen
Other matters
79 Measure blood pressure
for the students
80 Examine the blood group
of students
81 Speech examination for
students
82 Conduct sensitivity tests
for students
83 A blood test for students
(hemoglobin)
84 Students are trained in
emergency evacuation
85 Medication are distribute
to students at school
86 Examination of blood
sugar for the students
87 Provide support to
students with special needs