| Summary: | MPH, Faculty of Health Sciences, University of the Witwatersrand === School-going children have unique health challenges that deserve a focused attention
from policy makers, commonly done through the provision of school health
programmes. The education system provides the most comprehensive existing
infrastructure for reaching school-going children and school health programmes
enable health problems to be addressed at relatively low cost. The 2003 South
African National School Health Policy (NSHP) aims to deliver equitable and focused
health services to school-going children in order to safeguard their right to optimal
health and development. There is currently limited information on the process of
implementation of the NSHP, implementation context at different schools, as well as
facilitating and constraining factors that impact on the implementation of this policy.
Aim: The main aim of this study was to evaluate the implementation of the 2003
National School Health Policy in two primary schools in Cape Town.
Methods: This was a process evaluation that used qualitative methods primarily.
Two schools located in different education districts were selected via convenient
sampling for an in-depth study. Within each school, participants were purposively
selected based on their potential to provide relevant information. The final sample
consisted of seven individuals; five educators and two school health nurses. Data
collection tools included an in-depth semi structured interview schedule, selfadministered
questionnaire and document review. Interviews were recorded,
transcribed and later analysed to obtain key themes.
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Results: The evaluation found that the NSHP has been implemented in a phased
manner, disadvantaged areas were prioritized, different staff-mix with regards to the
composition of the school health team was used and the minimum requirements in
terms of health assessment for Grades R and 1 learners (Phase 1 services) were met.
Educators and school health nurses did not have the same level of knowledge and
understanding of the NSHP, and educators were less informed about this policy than
nurses. The policy context influenced working relationships between different actors
or stakeholders. Challenges or constraints to policy implementation included broad
systemic problems such as poverty and staff shortages, lack of dedicated budget for
school health services and insufficient prioritisation of school health services by
senior departmental managers, all which constrained effective policy implementation.
Although findings of this study cannot be generalized to other schools, they give
important insights into the current implementation process of the NSHP. It is one of
the few studies focusing on the process of policy implementation in recent years and
the in-depth qualitative methods allowed the researcher to explore the complexities
and contradictions of policy implementation in post-apartheid South Africa.
Conclusion: This policy has for the most part been implemented according to
specified policy implementation guidelines and minimum requirements for
implementing phase 1 services were met. It is recommended that a dedicated budget
should be allocated to school health services and existing structures within the school
system such as School Governing Bodies be utilized effectively to encourage parental
involvement in school health. Nurses should advocate for increased support for these services among all stakeholders, including managers in the Department of Health.
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