Health at Schools Programme and technical and normative resources which, as part of the National Health Service (SNS), currently regulate this activity

The National Programme for Health in Schools is a crucial tool for improving the school population health literacy, which is a basic component for promoting the health of the educational community.

In conceptual terms, the Programme proposes a holistic approach to health in schools, as part of the project aiming to create health-promoting schools. Its activities focus on improving the physical look of schools, the inclusion of students with special needs, and the early detection of risk situations, behaviour or health-related, which may affect students’ learning and success.

Health has had a partnership with the Ministry of Education since 1994, and a formal protocol since 2006, which “aims to foster the active collaboration between Schools and Health centres and the taking on of additional responsibilities with regard to the promotion of health of the extended educational community”. The Programme’s initiatives are included in school syllabi, regardless of being compulsory subjects or electives, and in project work carried out at school.

As part of the NHS, the National Programme for Health in Schools provides guidelines and standards for the work of health professionals. The partnerships with the community opened the door to the involvement of other sectors that, directly or indirectly, intervene in the promotion of health in schools, and it values the contributions of non-governmental organizations, civil society associations, scientific societies and local political authorities.
As a tool of the National Health Plan, the Programme contributes to reducing inequality, and fosters citizenship and health gains among children and adolescents in the medium and long-term.

From an historical viewpoint, there have been several occasions when Health and Education have come together in important Health in School experiences. At the end of the 19th century, the School opened up to society in order to address the serious problems affecting the country, equally opening up to health-related issues. In 1901, a royal decree on medical intervention in schools gave Portugal a pioneering role in this field at European level. With the establishment of the Republic, the School Sanitation Services were created, and “encompassed everything related to the hygiene of students and teachers, medical and pedagogical conditions of school buildings and teaching resources, as a means to guarantee the normal physical and mental development of students”. At the time, the major problems affecting the population’s health were child mortality, tuberculosis, and transmissible diseases. Health in Schools played an important role in the inoculation of students and in disseminating practices of “physical and moral hygiene”.

The Estado Novo (New Regime, 1926-1974) paid a lot of attention to Health in Schools, articulating it with Physical Education and Moral Education. In those days, School Health activities focused on the Lyceums, where the country’s elite was educated, and valued issues of the mind and morals, in the framework of the political doctrine in force. In this context, the “role of educator” granted to doctors was of primordial importance.

In the 1960s, the medical-pedagogical orthodoxy was gradually replaced by psycho-pedagogical approaches, which paid more attention to the development and social insertion of youngsters, particularly those coming from more neglected areas.
In the 1970s, the restructuring of the services of the Ministry of Health and Assistance led to the set up of a “new school health”, which aimed to be more interdisciplinary and professionalized and focused primarily on the first years of schooling.

With the reform of the Health and Assistance System, known as the “Gonçalves Ferreira Reform”, in 1971, Health School became the remit of both the Ministries of National Education and of Health and Assistance, thus closing the loop started in 1901, when the responsibility for Health at Schools was shared by the two ministries.

From a conceptual perspective, throughout the 20th century, in Portugal and worldwide, the intervention of Health in Schools was carried out in more or less comprehensive and sophisticated ways, but always in line with the development of the country’s education, health, and public health systems.
This separate double service was maintained until 2002, despite several attempts to bring them together. In that year, the Ministry of Health took on the medical staff and nurses of the former Centre for Pedagogical Medicine of the Ministry of Education, stating that “any health programme, namely health in schools, must form part of the national framework that has the purpose of ministering universal health care to the Portuguese population”.

The current National Programme for Health in Schools was approved by Dispatch no. 12.045/2006 (2nd series), published in the Government’s Official gazette no. 110 of 7 June, and disseminated through the Normative Circular Letter no. 7/DSE of 29/6/06, issued by the Directorate General for Health, which is responsible for «regulating, orienting and coordinating health promotion activities (…) and carry out specific programmes in terms of health promotion and protection ».

The Programme aims to:
· Promote health and prevent disease among the educational community, by monitoring the global health testing of students at the ages of 6 and 13, and evaluating the fulfilment of the National Vaccination Programme and legislation on school eviction;
· Support the inclusion at school of students with Special Health Needs that may affect their educational performance;
· Promote a safe and healthy school environment, namely though the assessment of safety, hygiene, and health conditions at schools;
· Strengthen the factors for protecting the educational community that relate to healthy life habits, by supporting the development of health promoting projects in priority areas, such as mental health, oral health, healthy eating, physical activity, environment and health, safety, sexual and reproductive health, consumption of legal and illegal substances, transmissible diseases and violence in schools;
· Contribute towards the implementation of the principles of health promoting schools.
The National Programme for Health in Schools is carried out by school health teams at Kindergarten and Schools of Basic and Secondary Education.

The Programme’s intervention model meets students’ real needs, and plays an active role in the management of health of determining factors in the educational community, in addition to having a consolidated information system.
A future and effective promotion of health in schools implies increased participation on the community’s part, interventions based on scientific evidence, continuance of initiatives, and sustainability of processes. The interconnection between programmes, policies, and health and education strategies, help to maximize teaching and learning opportunities and improve health empowerment.

Health Promoting Schools, or Efficient Schools, or Child-Friendly Schools, whatever name they are given, aim to improve students’ academic results, because “a healthy student learns better” and “in a school environment, health-related issues are used to complement and enhance educational priorities, such as literacy and numeracy”.

Accordingly, if we actually want to instil a new health culture in Schools and in Society anchored on responsibility, autonomy, and respect, then information, training, and involvement of the educational community in health management and decision-making processes are paramount, so that each individual student, teacher, educator, and parent may have greater control of decisions and measures that affect their health, prompting them to act collectively on the health of their families and community.
In the actual context of reform of primary health, the Public Health Unit (USP) is responsible for managing the National Programme for Health in Schools.

Despite being part of USP in functional terms, Health in Schools acts in a transversal manner and carries out its activities with multidisciplinary and inter-sector teams, and it needs to include objectives, activities and human and material resources that are necessary for carrying out the Programme in the management tools of the Health Centres Cluster (activity plan, budget and contract-programmes). The integration and the development of the Programme’s activity in the distinct Operating Units [Family Health Unit (USF), Individual Health Care Unit (UCSP), Community Care Unit (UCC) and the Shared Care Resources Unit (URAP)] are paramount for gains in efficiency and reduction of costs.

Given the economic, environmental, social, and cultural changes, Health in Schools continues to be a key instrument for maximising the health gains of the Portuguese population.

Gregória Paixão von Amann,
Senior Graduate Assistant of the Public Health Medical Career,
holder of a Master degree in Health in Schools
gregoriacpva@hotmail.com