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GSE JOURNAL OF EDUCATION 2013 (ISSN 2289-3970)
WorldConferences.net 135
STRATEGIES FOR OPTIMIZING IMPLEMENTATION OF THE
SCHOOL HEALTH AND NUTRITION PROGRAM IN PUBLIC
ELEMENTARY SCHOOLS IN THE PHILIPPINES
Adela Jamorabo-Ruiz
Director, University Quality Assurance Center
Polytechnic University of the Philippines
Sta. Mesa. Manila, Philippines
Ma. Amparo B. Guiking
Department of Education - Cadiz City
Negros Occidental, Philippines
ABSTRACT
The study examined the level of implementation of the School Health
and Nutrition Program (SHNP) along its four components in public
elementary schools. The implementation of the SHNP in public
elementary schools has not been achieved to highest level for its four
components in instruction, services, healthful school living and
school-community coordination. Assessment on the implementation of
the SHNP did not differ among school principals, health personnel and
selected pupils. A proposed scheme was presented by the researchers
to help the school principals and health personnel in optimizing the
implementation of SHNP. Strategies to address the problems
encountered were formulated. Foremost were the employment of
needed personnel and strategies to increase awareness about health and
nutrition issues among the stakeholders.
Keywords: School Health and Nutrition Program (SHNP), school
health and nutrition (SHN), strategies, optimizing implementation
Introduction
A significant amount of research has addressed the effectiveness of school
health interventions and the relationships between health, cognition, school
participation and academic achievement. Health and education are intrinsically
linked; good health is vital for effective learning and effective learning benefit
children life-long. Well-nourished children perform better in school, grow into
healthier adults and are able to give their own children a better start in life (UNICEF,
2006). Poor health and malnourishment had been recognized as one of leading causes
of absences and of children dropping out of school. Malnourished children are not in a
position to learn the skills needed for later learning and employment (UNESCO
Report, 2012). Muhi (2009) and Palacol (2007) emphasized the effects of health and
nutrition on the academic performance of students. The problems facing Filipino
children are considerable and are pressing - these are directly related to health,
nutrition, education, and protection. These four core threats to the optimum well-
being of young children have implications in guaranteeing children’s rights to
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survival, protection, development and participation. The problems are closely linked
and indicate an urgent need for an intensive and integrated effort to ensure the
optimum development of young children.
In the public schools set up, the Philippines has a peculiar structure in the
delivery of health and nutrition. Unlike in other countries where school health and
nutrition services fall under the jurisdiction of its equivalent to the Department of
Health (DOH), in the Philippines, the Department of Education (DepEd) has the sole
responsibility for these services. The rationale is simple: the academic performance
of a student directly correlates with his/her health and nutrition status. The healthier
and nutritionally well-off a child is, the more receptive he/she is in the classroom.
Another justification for DepEd to assume responsibility of health and nutrition in
school is because it would enable better coordination among various players
involved like school health personnel, principals, teachers, and parents. And more
importantly, DepEd receives the biggest budget allocation from the national
government, thus giving it more accountability to provide the basic services for all
the students. Because of this experience, the government saw it best that the delivery
of school health and nutrition services be a function of the DepEd and not of DOH.
Thus, the responsibility is lodged on DepEd (Ilagan, 2007).
In the Department of Education, improving the health and nutrition status of
schoolchildren is equally important and relevant as raising their academic
performance School age children face health and nutrition problems that may affect
their physical development, their capacity to attend school and ability to learn. The
Health and Nutrition Center of DepEd is mandated to safeguard the health and
nutritional well-being of the total school population, giving priority to the elementary
grade school children. The School Health and Nutrition Program (SHNP) is an
integral part of the total school program. It embraces four major components which
include Health and Nutrition Instruction, Health and Nutrition Services, Healthful
School Living and School-Community Coordination for Health and Nutrition (School
Health and Nutrition Service Manual, 1997). These components are implemented
through the various programs and projects that are interrelated to and supportive of
one another. Support instructional materials have been developed and are integrated in
appropriate subject areas in the elementary and secondary level of education for the
following programs and projects: School-Based AIDS Education Project; School-
Based Prevention and Control of Cardio-Vascular Diseases; Feminine Hygiene
Educational Program; Oral Health Education (BSBF) Program; National Drug
Education Program; Teacher-In-Child-Parent (TCP) Approach, and Preventive
Nephrology Project.
At the national level, the Health and Nutrition Center (HNC) coordinates
among the Regional Health and Nutrition Units (HNUs). The HNC also creates
policies to guide the SHNP and monitors the performance of HNUs and division
Health and Nutrition Sections (HNSs). The HNUs act as a mediating body between
the HNC and the HNSs. HNUs monitor and guide the performance of the HNSs and
report their observations to HNC. HNSs are the frontline agencies of the SHNP. The
members of the HNSs are tasked to conduct the medical and dental examinations,
engage in health education, conduct health treatments when possible, and all the
other services embodied in the SHNP.
School health and nutrition programs are among the most cost effective
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interventions that exist to improve both children’s education and health. They can
add four to six points to IQ levels, 10% to participation in schooling, and one to two
years of education (UNESCO Report, 2005). It is also an established fact that the
performance of the individual is directly related with his/her health and nutritional
status. Citing the World Health Organization, Jamorabo-Ruiz and Serraon-Claudio
(2010) acknowledged that nutrition is an input to and foundation for health and
development. Better nutrition means stronger immune systems, less illness and
better health. Healthy children learn better. Healthy people are stronger, are more
productive and more able to create opportunities to gradually break the cycles of
both poverty and hunger in a sustainable way. Better nutrition is a prime entry point
to ending poverty and a milestone to achieving better quality of life.
Many of the diseases and malnutrition that impact school-age children are
preventable and/or treatable. Schools offer a readily available infrastructure to reach
children and since some treatments are inexpensive, SHN interventions are among
the most cost-effective health interventions. SHN interventions also improve equity.
Diseases and some forms of malnutrition affect the poor more than the non-poor.
Children from poorer households are also less able to have access to or afford
treatment. SHN interventions redress this inequity and unlike many educational
interventions such as text-books, teacher training or others that may tend to benefit
the highest achieving students the most (possibly increasing inequality in the
education system), SHN benefits the poorest children more and helps those who are
most disadvantaged the chance to take better advantage of their educational
opportunities (Del Rosso, 2009).
Statistics, however shows that DepEd face current realities in its delivery of
School Health and Nutrition Program. According to Basic Education Statistics
(DepEd 2011) there was a 22 million enrollment during school year 2010-2011,
which is about 1/5 of the country’s total population. The DepEd physician-to-
student-ratio is 1:120,936 public school pupils. This situation occurs because most
Health and Nutrition Sections (HNSs) have only one medical doctor while some
even have none. The dentist-to-student-ratio is 1:25,487 while the nurse to student-
ratio is 1:5,537. A nutritionist-dietitian is employed only in the Regional level.
Putting this into perspective that a school year in the Philippines is only about nine-
and-a-half months long, there is really a dearth of health personnel in DepEd.
Besides the lack of manpower, many public schools lack basic medicines and
first aid emergency supplies while the country’s public school clinics are staffed by
teachers (in the absence of DepEd physicians, dentist and nurses who are unable to
hold permanent office in these school clinics except in the case of well financed
school divisions) with limited training in and knowledge of effective school health
and nutrition service delivery. A functional health and nutrition program must have
personnel, school administrators, supervisors and teachers with a good working
knowledge of health and nutrition education consistent with the socio-economic,
cultural, and political philosophy of the people.
The information gleaned from the cited data prompted the researchers to
assess the implementation of the School Health and Nutrition Program of both the
implementers and the service providers as well as the recipients of the program. The
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study can be a benchmark in enhancing the program implementation relating to health
and nutrition in all schools in particular the public elementary schools. The school
community may benefit from this research based on the observations and experiences
in the implementation of the SHNP. Parents of school age children will benefit from
relevant information on the health and nutrition status of their children and become
active participants in the health and nutrition programs conducted by schools.
The school administrators, teachers, health personnel, school community-
based health staff such as clinic nurses and doctors, and program coordinators in
policy and program development may also benefit with more appropriate
understanding that is essential for attaining and maintaining proper health and
nutrition status of children. Thus, broadening the base of evidence and identifying
program leanings to hopefully increase their level of commitment to ensure the need
for support and promotion of all health services.
Objectives
The study examined the level of implementation of the SHNP along its four
components in public elementary schools. It attempted to answer the following
questions: 1) How do the respondents composed of school principals, health
personnel, and selected pupils rate the school health and nutrition program in the
areas of health education, health and nutrition services, healthful school living, and
school-community coordination?, 2) Is there a significant difference in the level of
implementation of the school health and nutrition program along the four
components?, 3) What are the problems encountered by the health personnel and
school principals in the implementation of the school health and nutrition program?,
and 4) What strategies are proposed to optimize the implementation of the school
health and nutrition program?
Methodology
The researchers used the descriptive method of research and gathered data
with the use of researcher-prepared questionnaire and survey forms. Three (3) groups
of respondents: the school principals, health personnel, and selected grade VI pupils
totaling three hundred sixty eight (368) were involved in this study.
The study focused on the level of implementation of the School Health and
Nutrition Program of Public Elementary Schools in Cadiz City, Philippines. The
Division is composed of 4 districts, fifty one (51) elementary schools and eighteen
(18) secondary schools. The study covered the 51 public elementary schools and their
51 elementary principals for the first group of respondents. The second group
included health personnel who were directly involved in carrying out the basic
services to the schools, in particular the implementation of health and nutrition
programs: five (5) health personnel composed of three (3) public health nurses; one
(1) dental aide and one (1) health and nutrition coordinator. The third group of
respondents was composed of the 312 selected pupils out of the 1,424 grade six pupils
who were the direct beneficiaries of the school health and nutrition program.
The instrument consisted of three (3) parts. Part I was on the profile of the
respondents. Part II was the tool that assessed the effectiveness of the implementation
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of school and nutrition program. Part III identified the problems encountered by the
respondents, in particular, the principals and health personnel who are the
implementers of the program. The prepared questionnaires were pre-tested to 20
selected grade six students in an elementary school in Sagay City, which was located
next to Cadiz City.
The interpretation of data was confined only from the respondents. Statistical
treatments of data included percentages, and weighted mean in presenting the level of
implementation of the four components of SHNP and the seriousness of problems
encountered by the implementers of the program. A 4-point scale (1 = not manifested;
2 = seldom manifested; 3 = manifested; 4 = highly manifested) was used to indicate
level of illness or the indicators used and a rating scale was used to interpret the
weighted means i.e., 3.50–4.00 = highly manifested; 2.50–3.49 = manifested; 1.50–
2.49 = seldom manifested; 1.00–1.49 = not manifested. The F-test or analysis of
variance (ANOVA) was used in establishing the relationship between the assessments
of the three groups of respondents on the four components of the program.
Furthermore, the study looked on the problems encountered by the implementers of
the program. The proposed optimization on the implementation of School Health and
Nutrition Program was drafted to suit the needs of the beneficiaries of the program.
Results and Discussion
Level of Implementation of School Health and Nutrition Program along its Four
Components
On the level of implementation of school health and nutrition program along
its four components, the findings revealed that only health and nutrition education
were rated as highly implemented while for health and nutrition services, healthful
school living and school-community coordination were all rated as implemented. Our
results agree with Babasa (2006) that the School Nutrition Program has brought
moderate effects on the achievement of the pupils and it should be continuously
implemented considering the pre-implementation and post-implementation so that
actual effects may be quantified.
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Table 1
Level of Implementation of School Health and Nutrition Program along
Health and Nutrition Education
Indicators of Health and Nutrition
Education
MEAN RESPONSE AND
INTERPRETATION
Overall
School
Princip
als
INT
Health
Person
nel
INT
Selecte
d
Grade
VI
Pupils
INT WM INT
1. Teachers integrate basic health and
nutrition concepts in the
curriculum
3.37
HI
3.80
HI
3.51
HI
3.5
6
HI
2. Teachers conduct health and
nutrition lectures/ talks to classes or
pupils before and after any health
activity.
3.29
HI
3.60
HI
3.36
HI
3.4
2
HI
3. Health personnel conduct in-
service trainings and seminars for
teachers on current health and
nutrition problems.
2.82
I
3.40
HI
2.76
I
2.9
9
I
4. Health personnel conduct health
and nutrition guidance and
counseling to students.
2.90
I
3.40
HI
2.85
I
3.0
5
I
5. Health personnel confer with the
teachers about the kind of follow-
up needed by the students.
3.08
I
3.80
HI
2.94
I
3.2
7
HI
6. Health personnel act as resource
persons to strengthen health and
nutrition program implementation.
3.08
I
3.80
HI
2.85
I
3.2
4
I
Average Weighted Mean 3.09 I 3.63 HI 3.04 I 3.2
5
HI
Legend: Rating Scale Verbal Interpretation
Symbol
3.25 – 4.00 Highly Implemented HI
2.50 – 3.24 Implemented I
1.75 – 2.49 Seldom Implemented SI
1.00 – 1.74 Not Implemented NI
Table 1 shows the level of implementation of school health and nutrition
program on education component. In the six items presented, three items are highly
implemented and three items are implemented. On top of the list and consistent
among the three groups of respondents is that “teachers integrate and conduct basic
health and nutrition concepts in the curriculum” and “teachers conduct health and
nutrition talks before and after any health activities” with an overall weighted mean
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of 3.56 (highly implemented) and 3.42 (highly implemented) respectively. These
indicate that public elementary teachers were quite knowledgeable in imparting to
pupils the need for health and nutritional education.
This also showed an agreement with Executive Order No. 595 known as the
Health Education Reform Order (HERO) of 2006 which seeks to empower school
heads to develop the schools as health promoter by integrating health and nutrition
program in the School Improvement Plan (SIP) under the School-Based
Management (SBM). This also supports Del Rosso’s (2009) views that children need
to be healthy to learn and learn to be healthy.
As for the role of health personnel in health and nutrition education,
“conferring with teacher on the kind of follow-up that student need” revealed an
overall mean of 3.27 (highly implemented) although for the principals, it was only
implemented. In “conducting in-service trainings and seminars on the update of
health and nutrition problems”, it showed the lowest weighted mean of 2.99
(implemented). These reveal the need for health personnel to continually inform the
teachers on the vital and latest health and nutritional issues and concerns. Moreover,
in “conducting guidance and counseling to pupils about health and nutrition”, a
weighted mean of 3.05 (implemented) was obtained. This may be due to the fact that
four existing health personnel will not be able to cater to the fifty one (51) public
elementary schools not to mention secondary schools. For the health personnel
surveyed, they perceived that these three indicators were “highly implemented” in
contrast to the views of both principals and students.
As a whole, three out of six indicators along health and nutrition education or
50% were “highly implemented”; and the remaining three or the other 50% were
“implemented”. The average weighted mean for the three respondents’ assessment is
3.25 (highly implemented). In particular and noteworthy is the indication of the
competence of the school teachers in implementing health and nutrition program in
terms of knowledge, attitudes and practices that are of vital importance for program
improvement, re-direction and re-alignment of resources.
Table 2 indicates the health and nutrition services that include procedures
designed to determine the health and nutritional status of the school population with
appropriate intervention. Of the 16 indicators, five obtained a weighted mean of
“highly implemented” (HI), eight were “implemented” (I), two were “seldom
implemented” (SI) and one was “not implemented” as assessed by the three groups
of respondents.
Of these services, “teachers render first-aid treatment in case of emergency”
obtained the highest overall weighted mean of 3.51 (highly implemented) and the
only indicator where the three groups of respondents had agreement. This showed
the readiness and alertness of public elementary teachers in addressing emergency
situations inside the school premises. In “determining the physical and mental fitness
of the pupils who will participate in physical education programs, athletic meets and
other related activities” obtained a weighted mean of 3.39 (highly implemented) but
only the health personnel responded as “highly implemented” while both the
principals and pupils rated it as “implemented” only. This pattern of assessment
results were also seen in “health personnel conducting height and weight
measurement, a procedure of evaluating the nutritional status of the students”, which
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obtained the third highest weighted mean of 3.38 (highly implemented); in “health
personnel providing feeding program” with a weighted mean of 3.29 (highly
implemented) and in “health personnel performing physical assessment”
(examination of the eyes, ears, nose, throat, neck, mouth, skin, extremities, posture).
In “identifying exceptional and physically handicapped children”, it attained
a weighted mean of 3.03 (implemented) which can be attributed to the fact than the
division has maintained a school for specially handicapped children as well for the
mentally gifted (SPED Elementary School). This also support the advocacy of EFA
that children need to be in an accepting, safe environment that enables them to take
risks and ask for help, in order to acquire the skills, procedures, and strategic
knowledge that will allow them to become independent learners.
Meanwhile for school clinic that “caters to the emergency needs of the school
population” including the “supply of appropriate medicines and medical supplies”,
obtained a weighted mean of 3.22 (implemented) and 3.13 (implemented)
respectively. This is because public elementary schools do not have enough funds
unlike the secondary schools that have their own maintenance and other operating
expenses (MOOE) allotment. Noteworthy is the “availability of school health
personnel” with a weighted average of 1.57 (not implemented) for school physician;
2.16 (seldom implemented) for school dentist; and 2.23 (seldom implemented) for
school nurse. In reality though public elementary schools in Cadiz City do not
maintain a school health personnel like a doctor, a nurse or a dentist. The health
personnel assigned in the School Health and Nutrition Section of the Division Office
serve the health and nutrition needs of 51 public elementary schools and 18 public
secondary schools. This finding shows that the two perennial problems that haunt
and hurt the health-care system in the Philippines are the shortages of doctors, and
the concentration of health personnel in the urban areas.
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Table 2
Level of Implementation of School Health and Nutrition Program Along
Health and Nutrition Services
Indicators of Health and
Nutrition Services
MEAN RESPONSE AND
INTERPRETATION
Overal
l
School
Princip
als
INT
Health
Person
nel
INT
Selecte
d
Grade
VI
Pupils
INT WM INT
1. Health personnel perform
physical assessment
(examination of the eyes, ears,
nose, throat, neck, mouth, skin,
extremities, posture, heart and
lungs.)
3.18
I
3.60
HI
3.03
I
3.27
HI
2. Health personnel conduct
height and weight measurement
(procedure of evaluating the
nutritional status of the
students.)
3.20
I
3.60
HI
3.34
I
3.38
HI
3. Health personnel determine the
physical and mental fitness of
the pupils who will participate
in physical education programs,
athletic meets and other related
activities.
3.10
I
4.00
HI
3.08
I
3.39
HI
4. Health personnel provide
feeding program to qualified
beneficiaries.
3.12
I
3.60
HI
3.14
I
3.29
HI
5. Health personnel perform oral
examination, oral prophylaxis
2.75
I
3.60
HI
2.84
I
3.06
I
6. Teacher conducts classroom
inspection (fast inspection of
pupils in the classroom noting
their general cleanliness, signs
& symptoms of illness and
treatment or correction made.)
3.24
I
3.40
HI
3.01
I
3.22
I
7. Teachers familiarize pupils
with simple first-aid procedures
3.02
I
3.60
HI
2.96
I
3.19
I
8. Teachers render first-aid
treatment in case of emergency.
3.41
HI
3.80
HI
3.32
HI
3.51
HI
9. Pupils with health problems are
promptly referred to and
followed up by the appropriate
health professionals in the
school and community.
2.94
I
3.80
HI
2.84
I
3.19
I
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10. Communicable diseases are
referred to health agencies for
proper diagnosis and treatment.
2.75
I
3.80
HI
2.72
I
3.09
I
11. Exceptional and physically
handicapped children are
properly identified.
2.84
I
3.40
HI
2.86
I
3.03
I
12. School clinic caters to the
emergency needs of the school
population.
3.18
I
3.40
HI
3.09
I
3.22
I
13. School clinic supplied with
appropriate medicines and
medical supplies.
2.73
I
3.60
HI
3.06
I
3.13
I
14. Availability of school health
personnel
a. school physician
1.24
NI
2.00
SI
1.48
NI
1.57
NI
b. school dentist 1.41 NI 3.60 HI 1.47 NI 2.16 SI
c. school nurse 1.49 NI 3.60 HI 1.59 NI 2.23 SI
Average Weighted Mean 2.73 I 3.53 H
I
2.74 I 3.00 I
Legend: Rating Scale Verbal Interpretation
Symbol
3.25 – 4.00 Highly Implemented HI
2.50 – 3.24 Implemented I
1.75 – 2.49 Seldom Implemented SI
1.00 – 1.74 Not Implemented NI
In general, along the component of health and nutrition services, the listed
indicators for school health and nutrition services had an overall weighted mean of
3.00 (implemented). Teachers who render first-aid treatment in case of emergency
for which the principals, health personnel and pupils agreed earned the highest
weighted mean of 3.51 (highly implemented). In addition, functions such as the
conduct of classroom inspection, familiarization of first-aid treatment to pupils and
giving referrals to pupils with health problems obtained only an implemented
response. Meanwhile, health personnel participation such as physical assessment,
conduct of height and weight measurement and providing feeding program reveals as
highly implemented. While performing referrals, oral examinations and identification
of handicapped children showed as being implemented only. For school clinic having
medical supplies available and being able to cater the emergency needs of the school
population, it obtained a response of being implemented.
Our results support the study of Asuncion (2007) that it is not enough that
students learn the health concepts and score highly in cognitive achievement test, but
they must also embody these concepts and apply them in their daily living. Hence,
measuring the frequency of practiced healthy behavior among Grade VI pupils will
effectively determine the capacity of health instruction to meet its very purpose of
providing positive changes in health behavior.
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Table 3
Level of Implementation of School Health and Nutrition Program Along
Healthful School Living
Indicators of Healthful School
Living
MEAN RESPONSE AND
INTERPRETATION
Overal
l
School
Princi
pals
INT
Health
Person
nel
IN
T
Select
ed
Grad
e VI
Pupil
s
I
N
T
WM IN
T
1. Classrooms adequately ventilated
and lighted
3.12 I 3.00 I 3.21 I 3.11 I
2. Functional clinic is set up 2.73 I 3.80 H
I
2.91 I 3.15 I
3. Maintenance of a school canteen 2.49 SI 3.40 H
I
3.01 I 2.97 I
4. Adequate potable water supply
for drinking and hand
washing/food washing.
2.43
SI
3.00
I
2.73
I
2.72
I
5. Availability of tooth brushing
facilities
2.65 I 3.60 H
I
2.69 I 2.98 I
6. Proper waste disposal 2.98 I 3.80 H
I
3.13 I 3.30 H
I
7. Toilet bowls and urinals sufficient
for the students.
2.35
SI
2.80
I
2.88
I
2.68
I
8. Playground safe and free from
hazards
2.92 I 3.20 I 3.04 I 3.05 I
9. Fire prevention equipment 1.61 N
I
2.40 SI 2.05 SI 2.02 S
I
10. Adequate provisions and
maintenance of school health
facilities.
1.94
SI
3.20
I
2.72
I
2.62
I
Average Weighted Mean 2.52 I 3.22 I 2.84 I 2.86 I
Legend: Rating Scale Verbal Interpretation
Symbol
3.25 – 4.00 Highly Implemented HI
2.50 – 3.24 Implemented I
1.75 – 2.49 Seldom Implemented SI
1.00 – 1.74 Not Implemented NI
Table 3 reveals the school health and nutrition program along its component
healthful school living which pertains to the provision of wholesome and safe
environment and organization of a healthful school day. The maintenance of “proper
waste disposal” has the highest weighted mean of 3.30 (highly implemented)
although the principals and the pupils rated this indicator as “implemented”. With
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regard to the “setting of functional clinic”, and “availability of tooth-brushing
facility” with a weighted mean of 3.15 (implemented) and 2.98 (implemented),
respectively, the health personnel rated these indicators as highly implemented since
the facilities were accessible to the school children, but the principals and the pupils
rated these indicators as “implemented”. The presence of “adequately ventilated and
lighted classrooms” found a weighted mean of 3.11 (implemented) consistent with
the three groups of respondents. These point out that the classrooms which are
adequately ventilated and lighted are quite noticeable in public elementary schools.
For “playground being safe and free from hazards”, the weighted mean was 3.05
with each group of respondents rating this indicator as “implemented” highlighting
the existence of a safe playground environment in every school.
While “adequate potable water for drinking and hand/food washing” reveal a
weighted mean of 2.72 (implemented) school principals said this was “seldom
implemented.” With regards to the availability of “toilet bowls and urinals for the
pupils”, its weighted mean of 2.68 (implemented) and was not coherent among the
three groups of respondents since the principals said this was “seldom implemented”.
The putting up of sufficient toilet bowls and urinals are encouraged in the schools.
The only item that has a contradicting response from the three groups of respondents
is the “maintenance of school canteen”: seldom implemented for principals, highly
implemented for health personnel and implemented for pupils.
For “adequate provisions and maintenance of school health facilities”, the
overall weighted mean is 2.62 (implemented) with health personnel giving it a
weighted mean of 3.20 (implemented) while principals gave a weighted mean of
1.94 (seldom implemented). These emphasized the need to improve the delivery of
health services in public elementary schools. And noticeably, “fire prevention
equipment” reveals the lowest overall weighted mean of 2.02 (seldom implemented).
This only identifies the need of public schools to maintain fire prevention equipment.
The healthful school living component of SHN program implementation shows an
overall weighted mean of 2.86 (implemented). This indicates that the provision of
school environment is suitable and conducive to learning for the pupils.
Table 4 displays the school-community coordination for health and nutrition
component of school health and nutrition program. It shows the coordinated
endeavor to link the school with the home and community so that there is an
effective carry-over of health and nutrition practices. One indicator that obtained the
highest overall weighted mean of 3.38 (highly implemented) was when parents are
invited to attend P.T. A. meetings to discuss health and nutrition issues and needs.
Both health personnel and selected grade VI pupil give a weighted mean of 3.60
(highly implemented) and 3.39 (highly implemented) respectively. These reveal that
parents are involved figures in the implementation of school-community
coordination for health and nutrition.
The indicator “health personnel confer with parents and teachers on the
health status and needs of the children” got an overall weighted mean of 3.42 (highly
implemented). While the principals rated it at 3.08 (implemented), both the health
personnel and selected grave VI pupil agreed that this indicator was “highly
implemented” with a weighted mean of 3.80 and 3.34 respectively. However, the
“follow up of cases of sick children, teachers and other school personnel through
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house/hospital visits” obtained only an overall weighted mean of 2.82
(implemented). These point out that while health personnel discuss the health and
nutrition concerns of pupil with teachers and parents, follow-up and monitoring,
however, needs improvement. As far as when “health personnel coordinate with
community health agencies the proper management and referrals as well as for other
health and nutrition projects”, an overall weighted mean of 3.07 (implemented) was
obtained with health personnel’s rate at 3.60 (highly implemented) while both school
principals and pupils rated it at 2.73 (implemented) and 2.88 (implemented)
respectively. These indicate an understandable coordination between the health
personnel and community agencies.
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Table 4
Level of Implementation of School Health and Nutrition Program Along
School-Community Coordination for Health and Nutrition
Indicators of School-Community
Coordination for Health and
Nutrition
MEAN RESPONSE AND
INTERPRETATION
Overal
l
School
Principa
l
INT
Health
Person
nel
INT
Selecte
d
Grade
VI
Pupils
INT WM INT
1. Parents are invited to attend P.T.A
meeting to discuss health and
nutrition issues & needs.
3.14
I
3.60
HI
3.39
HI
3.38
HI
2. Health personnel confers with
parents/teachers concerning health
status and needs of children
3.08
I
3.80
HI
3.34
HI
3.41
HI
3. Health personnel follow-up cases
of sick children, teachers and other
school personnel through
house/hospital visits
2.57
I
3.40
HI
2.49
SI
2.82
I
4. Health personnel coordinate with
community health agencies
regarding proper management and
referrals and other health and
nutrition projects.
2.73
I
3.60
HI
2.88
HI
3.07
I
5. Parents and other people in the
community participate in health
surveys to discover health and
nutrition needs and problems.
2.65
I
3.40
HI
2.83
HI
2.96
I
6. Joins civic action activities in
cooperation with professionals,
civic and religious organizations,
local government units and DOH.
2.47
SI
3.60
HI
2.63
HI
2.90
I
Average Weighted Mean 2.77 I 3.57 HI 2.93 I 3.09 I
Legend: Rating Scale Verbal Interpretation
Symbol
3.25 – 4.00 Highly Implemented HI
2.50 – 3.24 Implemented I
1.75 – 2.49 Seldom Implemented SI
1.00 – 1.74 Not Implemented NI
For “parents and other people in the community participating in health
surveys”, both principals and pupils agreed that it was implemented with a weighted
mean of 2.65 and 2.83 respectively, while health personnel gave a 3.40 (highly
implemented) rating. The same with “civic action activities and coordination with
other professionals, civic and religious organizations, local government units and
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DOH”, which obtained an overall weighted mean of 2.90 (implemented), in which
both principals and selected grade VI pupils rated it as ‘implemented’ with a
weighted mean of 2.47 and 2.63 respectively. These emphasize that different level of
coordination and participation has been practiced within the school and community
for health and nutrition activities. This collaboration has never been more important,
realizing that there are a variety of individuals within the school setting and the
community who can impact the health status of the student, the need for developing a
coordinated school health and nutrition program become obvious.
As a whole, two indicators or 33% were “highly implemented” while the
remaining four or 67% were “implemented”. For health personnel all indicators were
highly implemented; for school principals five indicators were implemented while
one was seldom implemented; and for the pupils three indicators were implemented,
two were highly implemented and one was seldom implemented. The
implementation of school-community coordination for health and nutrition showed
an overall weighted mean of 3.09 (implemented). The importance of this component
has reached public awareness and collaboration has been implemented.
Assessment of the Three Groups of Respondents on the Implementation of School
Health and Nutrition Program along the Four Components
There was no significant difference in the level of implementation of school
health and nutrition program along its four components as perceived by the three
groups of respondents.
Table 5 presents the analysis of variance on the assessment of the three
groups of respondents on the level of implementation of the school health and
nutrition program along the four components. The computed F value of 2.84 at .05
level of significance in 2/367 degrees of freedom and the F tab of 19.50 for health
and nutrition education indicate that there is sufficient evidence that all the means are
equal, indicating no significant difference exist on the assessments of the three
groups of respondents. For health and nutrition services, the computed F value is
.0008 which is lesser than the F tab of 19.50 indicates as well that all means are
equal if not all, pointing out that no significant difference exists on the assessment of
the principal, health personnel and grade VI pupils. In terms of healthful school
living, the computed F- test is equal to 6.20, F tab ≤ 19.50. For school-community
coordination for health and nutrition, the computed F observe value of 2.225, F tab ≤
19.50, the result shows that the null hypothesis is accepted.
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Table 5
Summary Table of ANOVA (F-test) Showing the Significance Difference on the
Assessment of the Three Groups of Respondents on the Implementation of
SHNP along the Four Components
SHNP
Componen
t
Source of
Variance
Sum of
Squares df
Mean
Square
F obs
F tab
Result
Health and
Nutrition
Education
Between groups
Within group
Total
1.75
113.46
115.21
2
365
367
0.88
0.31
2.84
19.50
NS
Health and
Nutrition
Services
Between groups
Within group
Total
3.37
730295.39
730298.76
2
365
367
1.685
2000.81
0.0008
19.50
NS
Healthful
School
Living
Between groups
Within group
Total
5.33
158.51
163.84
2
365
367
2.67
0.43
6.20
19.50
NS
School-
Communit
y
Coordinati
on for
Health
Between groups
Within group
Total
1.78
146.25
163.84
2
365
367
0.80
0.40
2.225
19.50
NS
Where: df = degrees of freedom NS = Not significant F obs = F observe F-
tab= F tabulated value
The above mentioned pattern clearly implies that respondents shared the
same belief in the continuous implementation of SHN program particularly on its
components. Although the overall assessment of the principals, health personnel and
pupils indicate an inherent realization of the program, there is really a need to
improve and optimize its implementation through a much coordinated effort from all
its stakeholders.
A comprehensive school health and nutrition program empowers students
with not only the knowledge, attitudes, and skills required to make positive health
decisions but also the environment, motivation, services, and support necessary to
develop and maintain healthy behaviors. It also includes health education; a healthy
environment; health services; counseling, psychological, and social services;
integrated school and community efforts; physical education; nutrition services; and
a school-based health program for faculty and staff.
Problems Encountered in the Implementation of School Health and Nutrition
Program Components
The problems encountered in the implementation of school health programs
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by school principals and health personnel vary from “not a problem” to “very serious
problem”. Serious problem hound the lack of health personnel. On the other hand lack
of resources, lack of support from the parents and community, lack of training
knowledge on the different components of the program and lack of updated
educational materials were considered as less serious problems.
Table 6
Degree of Seriousness of the Problems Encountered in the Implementation of
School Health and Nutrition Program by the Two Groups of Respondents
Problems
School
Principal
Health
Personne
l
Overall
WM INT WM INT WM INT Ran
k
Lack of knowledge and skills on how to
integrate health concepts.
3.
29
N
P
3.
60
N
P
3.
45
N
P 14
Lack of support from school administrator. 3.
39
N
P
3.
40
N
P
3.
40
N
P 13
Lack of time of teachers in supervising the
health activities of students.
2.
96 LS
3.
60
N
P
3.
28
N
P 12
Lack of coordination between parents and
teachers.
3.
10 LS
3.
40
N
P
3.
25
N
P 11
Limited number of school children is benefited
by health and nutrition activities.
2.
61 LS
3.
60
N
P
3.
11 LS 10
Lack of improvement observed in the home,
school and community.
2.
59 LS
3.
60
N
P
3.
10 LS 9
Lack of parents support to the health and
nutrition activities.
2.
69 LS
3.
40
N
P
3.
05 LS 7
Lack of training knowledge on the different
components of the program.
2.
69 LS
3.
40
N
P
3.
05 LS 7
Lack of support from the community. 2.
75 LS
3.
00 LS
2.
88 LS 5
Tolerance of some teachers of poor health
habits and practices.
3.
10 LS
2.
60 LS
2.
85 LS 4
Lack of updated health and nutrition education
materials.
2.
49 S
3.
60
N
P
3.
05 LS 7
Lack of income generating project that will
support health and nutrition activities.
2.
27 S
3.
00 LS
2.
64 LS 3
Lack of resources and funds for health and
nutrition activities.
2.
24 S
3.
00 LS
2.
62 LS 2
Lack of health personnel. 1.
90
V
S
2.
80 LS
2.
35 S 1
Average Weighted Mean 2.
72
L
S
3.
29
N
P
3.
00
L
S
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Legend: Rating Scale Verbal Interpretation Symbol
3.25 – 4.00 Not a Problem NP
2.50 – 3.24 Less Serious LS
1.75 – 2.49 Serious S
1.00 – 1.74 Very Serious VS
Table 6 shows the problems encountered by the respondents in the
implementation of school health and nutrition program in public elementary schools.
Problems ranged from “not a problem” to “very serious”. Among the fourteen (14)
problems presented, four were considered as “not a problem”; nine (9) were thought
to be “less serious” problem; and only one was believed to be a “serious” problem.
As the implementers and service providers, school principals and health
personnel have the firsthand knowledge in confronting the difficulties in the
realization of the program. For “knowledge and skills on how to integrate health
concepts”, both the principal and health personnel agreed that it is not a problem,
which shows the highest overall weighted mean of 3.45. These indicate that health
and nutrition concepts are integrated and taught in the different subject areas and
related activities. The “support from school administrators” which pertains to the
school principals, obtained an overall weighted mean of 3.40 (not a problem). This
was understandable since the implementation of the school health and nutrition needs
the full support from school heads and that, principals are accountable for the safety
within the school.
As for the need of “teachers to supervise the health activities of students”,
school principals thought of it as a less serious problem with a weighted mean of
2.96 while for health personnel it was not a problem (weighted mean of 3.60). Five
(5) other problems were considered less serious by the school principals but not a
problem according to the health personnel. These were “coordination between
parents and teachers” (weighted mean of 3.10 vs 3.40), “school children benefited by
health and nutrition activities” (weighted mean of 2.61 vs 3.60), “lack of
improvement observed in the home, school and community” (weighted mean of 3.10
vs 3.60), “parents support to the health and nutrition activities” (weighted mean of
2.69 vs 3.40), and “lack of training knowledge on the different components of the
program”.
Both the school principals and health personnel considered these problems as
less serious: “support from the community” (weighted mean of 2.75 vs 3.00), and
“tolerance of some teachers of poor health habits and practices (weighted mean of
3.10 vs 2.60).
The problem with “lack of updated health and nutrition education materials”
showed a contrasting response from the principals (weighted mean of 2.49; serious
problem) and from the health personnel (weighted mean of 3.60; not a problem). For
the problem on “lack of resources and funds” as well as “income generating project
that will support health and nutrition activities”, the school principals considered
them as serious problems (weighted mean of 2.24 and 2.27 respectively) while the
health personnel thought of them as less serious problems (each with a weighted
mean of 3.00).
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Significantly is the lack of health personnel, considered to be a very serious
problem for the principals (weighted mean of 1.90) but less serious for the health
personnel (weighted mean of 2.80). As observed by the researchers this was really a
very serious problem since there is no dentist and medical doctor available in the
school and health section in the Division of Cadiz City.
Based on the findings of the study what schemes are proposed in optimizing the
implementation of the school health and nutrition program?
As illustrated in Figure 2, the Department of Education through its Health
and Nutrition Center is mandated to safeguard the health and nutritional well-being
of the total school population giving priority to the elementary grade school children.
To ensure a functional School Health and Nutrition Program, the school health and
nutrition personnel, school administrators, supervisors and teachers should have a
working knowledge of the philosophy of its four components which are health and
nutrition education, health and nutrition services, healthful school living and school-
community coordination for health and nutrition. These programs can help children
and adolescents attain full educational potential and good health by providing them
with the skills, social support, and environmental reinforcement they need to adopt
long-term, healthy behaviors.
Figure 2
Optimizing the Implementation of School Health and Nutrition Program in
Elementary Schools
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As the first educators of their children, parents can provide important
information that will assist in the development and implementation of the child’s
educational program. Parents reinforce and extend the educational efforts of teachers
and are a very important part of the school team. They need to feel that their child is
part of the group and has been accepted on an equal footing with the others; that the
teacher is cooperating with them; and that they have a role to play in their child’s
education. In addition, parent associations provide valuable information and
resources related to students’ needs and strengths. In addition, teachers benefit from
contact information about various community-based agencies and other professionals
who focus on children with special learning needs, and should be encouraged to
contact them as needed, and use the resources they provide. These organizations may
need to provide local, regional, and provincial opportunities for specific development
and help identify local mentoring supports.
The rationale for school-based health and nutrition programs and the
approach to their implementation have undergone a paradigm shift over the past two
decades. The traditional perception of these programs as seeking to improve the
health of school children cannot be justified on the basis of mortality or public health
statistics alone. Instead, it is increasingly recognized that a major—perhaps the
major— impact of ill health and malnutrition on this age group is that on cognitive
development, learning, and educational achievement. Improving students' health and
nutritional status can redress common sources of absenteeism, poor classroom
performance and early school dropout, and thus boost the possibility of Education for
All. Healthier children stay in school longer, attend more regularly, learn more and
become healthier and more productive adults. In consequence, the clearest benefit of
school health and nutrition programs is measurable in terms of education outcomes
and their economic returns.
To optimize the implementation of the school health and nutrition program in
elementary schools, the herein proposal (Table 7) is endorsed for implementation by
the Department of Education for implementation effective school year 2013-2014.
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Table 7
Proposed Scheme in Optimizing the Implementation of School Health and
Nutrition Program in Public Elementary Schools
Objectives Activities
Persons/
Agencies
Involved
Fund
Sources Success Indicators
PROBLEM
IDENTIFICATIO
N
1. To hire medical
officer and dentist
as frontrunner in
the full
implementation of
SHN program
Recruitment and
Selection Process
Schools
Division
Superintendent
, Human
Resource
Division
DBM &
DepEd
Full
implementation of
the program with
involvement of key
personnel
2. To acquire
funds and
resources and
medical facilities.
Provide a
framework for
implementing the
SHNP.
- Adopt a
coordinated SHN
policy that
promotes health
through
classroom lessons
and a supportive
school
environment
- Training for
school staff/ SHN
coordinators
- Family and
community
involvement
School
principals,
health
personnel,
teachers,
parents,
LGUs,
School
Funds,
Local
School
Board,
Division
Funds,
Solicitation
s from
governmen
t and
private
organizatio
ns, medical
association
s
Increased
involvement for all
the stakeholders
and programs are
implemented
3. To conduct
seminars/training
s for school
health and
nutrition
implementers
particularly for
teachers and
divisions’ health
personnel.
Prepare training
design, upgrade
on the objectives
of the program
Career
development
program
School Health
and Nutrition
Section health
personnel
Speaker from
DepEd
Central Office
in particular
from the
Division
Fund,
Local
School
Board,
School
Fund,
Upgrade
knowledge on the
health and nutrition
concepts as well on
the suitable
implementation of
SHN program
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Health and
Nutrition
Center and
schools with
records of
successful
implementatio
n
of the SHNP
PLANNING/
ORGANIZING
1. Prepare a
school health and
nutrition plan
that is attainable
and directed to
the improvement
of the health and
nutrition status of
the school
children.
Conduct
meetings,
symposium,
related activities
for health and
nutrition
School
principals,
parents,
teachers,
pupils,
barangay
officials and
health
workers
School
Fund,
Local
School
Board,
Solicitation
s, Parents
Contributio
ns,
Awareness will be
increased on the
different
components of the
SHN program.
Action plan will be
understood and
implemented
Full support from
all the
stakeholders.
Objectives Activities
Persons/
Agencies
Involved
Fund
Sources Success Indicators
2. Organize
school health
committee to
manage wider
participation in
SHNP.
Improve school-
community
relationship
through:
1. Proper
representation
from parents,
local officials,
medical and
nutrition
associations
2. Creation of
recurring health
and nutrition
activities to
support the
program and its
components
School
principals,
teachers,
parents, local
government
officials,
barangay
officials,
medical and
nutrition
associations
Division
Fund,
School
Fund,
Local
School
Board,
Solicitation
, Donations
Improved
relationship from
the community and
other organizations
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IMPLEMENTA
TION/
MONITORING
/
EVALUATION
1. To evaluate
SHNP
implementation as
to efficiency &
effectiveness.
Hold regular
meetings to
provide feedback
on the level of
implementation.
Regularly
evaluate the
effectiveness of
the SHNP and
change the
program as
appropriate to
increase its
effectiveness.
Management
Committee of
school
principals,
health
personnel,
teachers, local
health board,
parents,
students
Division
Fund,
School
Fund
Presentation of
problems
encountered and
possible action will
be taken up
Conclusions
1. The implementation of School Health and Nutrition Program in public
elementary schools has not been achieved to highest level of implementation for its
four components. On health and nutrition education, both the health personnel and
teachers portray a big role in the realization of the program. The provisions for health
and nutrition services are prevalent but still perceived as falling short. Healthful
school living have a favorable learning environment despite their deficient facilities
and supplies. For school-community coordination, awareness on the importance of
the program has been imparted but needs further improvement.
2. There is no significant difference in the assessment of the school
principals, health personnel and selected grade VI pupils in public elementary
schools on the implementation of School Health and Nutrition Program along its four
components of education, services, healthful school living and school-community
coordination.
3. The presented problems encountered in the implementation of school
health programs by school principals and health personnel vary from not a problem
to very serious problem. Serious problem revolved on the lack of health personnel.
On the other hand, lack of resources, lack of support from the parents and
community, lack of training knowledge on the different components of the program
and lack of updated educational materials were considered as less serious problems.
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Recommendations
Strategies classified under problem identification, planning and organizing,
and, implementation, monitoring and evaluation were recommended to address the
problems encountered in the implementation of the SHNP.
1. The Division of City Schools must employ the needed personnel. More
importantly that of medical officer and dentist positions which are deemed crucial in
a truly effective and efficient implementation of the program. For the health
personnel to function, medical equipments should be provided as well. Update also
the trainings of health personnel. A periodic evaluation of the objectives and
implementation of the school health and nutrition program components be made by
the School Health and Nutrition Unit Regional level. Recognition should be given to
schools with hardworking and committed school health program implementers
through financial assistance or medical facilities to further improve the
implementation and the realization of giving priority to the elementary grade school
children.
2. Increase the awareness of all SHNP players about health and nutrition
issues. A resource center should be set up at the Health and Nutrition Section of the
Division as a forefront in disseminating health and nutrition information particularly
to the stakeholders in the education sector such as school administrators, teachers,
pupils, and parents. Consider availing the services of a registered nutritionist-
dietitian as consultant or a part-time basis. Teachers should be trained on matters
relating to health and nutrition. Mobilize the community to undertake active
participation. The sustainability of the program is of great concern because they
largely depend on the donor funding of government and non-government
organizations.
3. The problems encountered by the respondents in the implementation of
the school health and nutrition program components should be given preferential
attention and action in the school or district level. School leaders, community
leaders, and parents must commit to implementing and sustaining health and
nutrition education programs within the schools. Such support is crucial to
promoting healthy behaviors for the pupils in the elementary schools.
4. The proposed scheme in optimizing the implementation of School
Health and Nutrition Program in public elementary schools prepared by the
researchers is endorsed to the Department of Education.
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