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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

[email protected]

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



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



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



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



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.



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



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



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.



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



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


Symbol





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.



Table 3


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


Symbol





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



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



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.



Table 4


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


Symbol





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



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.



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



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



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).



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



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.



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



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



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.



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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