The school health service is defined as "the school procedures that contribute to the maintenance and improvement of the

health of pupils and school personnel including health services healthful living and health education". But to speak the truth our school hardly ever has a well defined health programme incidentally the teaching about health is done while treating other subjects of the curriculum -such as physiology, hygiene and biology. The approach to these subjects is so academic that they are considered to be important from the 'examination point of view' and have very little effect on actual health practices and attitudes. But in general, health education should be integrated with all the activities in the curriculum. It should be a part and parcel of the chili's daily life. It must include the whole life of the child taking in to consideration his relationship with the school community as well as the community outside the school. Objectives of School Health Education: The objectives of the school health education are as follows: (i) The promotion of positive health; (ii) The prevention of diseases; (iii) Early diagnosis, treatment and follow up of defects; (iv) Awakening health consciousness in children: the objectives of school health service can be achieved through a comprehensive school health programme comprising the following activities: (i) Health appraisal of school children and school personnel; (ii) Co-operation with the home and the community; (iii) Healthful school environment; (iv) Prevention of communicable diseases; (v) Nutritional services; (vi) First aid and emergency care; (vii) Psychological services; (viii) Use of school health records; (ix) Remedial measures and follow up; (x) Health instruction; Health Appraisal: The health appraisal should cover not only the students but also the teachers and other school personnel. Health appraisal consists of periodic medical examinations and observation of children by the class teacher. The School Health Committee (1%1) in India, recommended medical examination of children at the time of entry and thereafter every four years. So one of the most important means of taking care of the physical well being of the school children is through systematic medical inspection of schools.

Generally it is seen that most of the students in the school suffer from many preventable diseases such as defective teeth, bad sight, deafness, anemia etc. but such diseases adversely affect the learning capacity of the students and cause ill health. Medical inspection is only the initial step in a great scheme of progress which involves the improvement of not only the physical but the mental and moral development of the children. Although the system of school medical inspection has been in existence for a number of years, yet the outcome of the result have not been satisfactory for the following reasons as pointed out by Secondary Education commission. (i) The medical inspection has been done in a perfunctory manner; (ii) The defects that have been brought out even by this type of examination have not been remedied because the remedial measures suggested are often not carried out; (iii) There is no follow-up, even in the case of those who have been declared as defective; (iv) Effective co-operation has not been established between the school authorities and the parents, either due to ignorance or due to lack of financial resources or reports of the school medical officers. Unless and until the present system is improved considerably, it would be a mere waste of time and money to continue this type of medical inspection in the urban areas in most schools there is provision for medical inspection of students. But in rural areas no such provision is available for students. In Western countries, the medical inspection of children is a regular feature of the school. However for making the medical inspection meaningful the following factors should be taken in to account: (i) A thorough medical examination of all pupils and necessary follow-up and treatment where necessary, should be carried out in all schools; (ii) Pupils with serious defects and those who suffer from severe illness should be examined more frequently; (iii) Medical examination should be given to teachers and other school personnel as they form a part of the environment to which the child is exposed; (iv) The teacher is in a unique position to carry out the 'daily inspection' as he is familiar with the children and can detect changes in the child appearance or behavior that suggest illness or improper growth or development; The systematic medical examination which has been described above should be supplemented by daily inspection. This inspection must be made especially on the child's entry in the school premises in the morning and any lapse from the normal should be noted and endeavour should be made to have these corrected. The inspection suggested here can be made in a few moments, while the pupils assemble in the' morning and in the same manner matters pertaining to cleanliness and neatness may also be noticed. What is a health promoting school? A health promoting school is one that constantly strengthens its capacity as a healthy setting for living, learning and working. A health promoting school: Fosters health and learning with all the measures at its disposal.

Engages health and education officials, teachers, teachers' unions, students, parents, health providers and community leaders in efforts to make the school a healthy place. Strives to provide a healthy environment, school health education, and school health services along with school/community projects and outreach, health promotion programmes for staff, nutrition and food safety programmes, opportunities for physical education and recreation, and programmes for counselling, social support and mental health promotion. Implements policies and practices that respect an individual's well being and dignity, provide multiple opportunities for success, and acknowledge good efforts and intentions as well as personal achievements. Strives to improve the health of school personnel, families and community members as well as pupils; and works with community leaders to help them understand how the community contributes to, or undermines, health and education. Health promoting schools focus on: Caring for oneself and others Making healthy decisions and taking control over life's circumstances Creating conditions that are conducive to health (through policies, services, physical / social conditions) Building capacities for peace, shelter, education, food, income, a stable ecosystem, equity, social justice, sustainable development. Preventing leading causes of death, disease and disability: helminths, tobacco use, HIV/AIDS/STDs, sedentary lifestyle, drugs and alcohol, violence and injuries, unhealthy nutrition. Influencing health-related behaviours: knowledge, beliefs, skills, attitudes, values, support. Health ofmothers, newborns, infants and children isimportantfor any society. A healthymother gives birth to healthy infants who grow into adults with sound body andmind, live a productive life, and contribute to the family and society. Being the prime caregivers of children,mothers have themostsignificant impressionable effect on their children in the early development years(Tamis 2001; Landry 2000). The healthy future of a society depends on the health ofthe children oftoday and theirmothers, who are guardians ofthatfuture. If physically andmentally healthy, women can steertheir children and the family towards prosperity and long lasting happiness.UnitedNationsOrganization has acknowledged womens role by declaring thatsustainable development could not be achieved withoutthe full empowerment,

participation, and contribution of women andmen, in conditions of equality (BeijingDeclaration 1995). Poormaternal health can have significant negative impact on the family and society asitis amajor determinant ofthe health of children and indirectly affectsthe formation of human capital. According to research,themotherless children diemore frequently; aremore atrisk of becomingmalnourished and less likely to enroll atschool(Ainsworth 1998). The babies ofill or undernourished pregnant women aremore likely to have a low birth weight(Reed 1998: 6; Kramer 1987) and impaired development. Low birthweight (LBW) children in turn are at greaterrisk of dying and ofsuffering frominfections and growth retardation, have lowerintelligence and higherrisk of developing chronic diseasesin adulthood (Grivetti 1998). Societies that have developed, have always given emphasisto the health care ofmothers, newborns and children. Situation in Pakistan Government of Pakistan being a signatory to theU.NDeclaration ofHuman Rightsisresponsible of ensuring rightto health for allthemembers of its population including women and children. Thisrightis enshrined in the 1973 constitution of Pakistan as part ofthe economic,social and culturalrightssection and includes: basic necessitiesfor an adequate standard of living including employment, nutrition,shelter, healthcare, and education.Ourreligiousteachings highlightthe need oftaking care of health ofmothers and children. Our greatleadership always emphasized the importance of women and children in developing a sustainable society and a vibrant Pakistan. Yetthe situation of health ofmothers, newborns and children is not satisfactory. Thematernalmortality ratio (MMR) in Pakistan according to themostrecent PakistanDemographic and Health Survey (PDHS)is 276/100,000 live births. The irony isthatmost ofthese deaths are preventable and only highly underdeveloped countrieslike Ethiopia, Somalia and Rwanda havematernal death rates worse

than ours. The figures of infant and child deaths are evenmore alarming. The infantmortality rate (IMR) in Pakistan is 78/1000 live births out of which about 2/3rd are contributed by newbornmortality. Thismeans that out of every 1000 live born babies, 78 infants die before seeing theirfirst birthday while 58 ofthemdo notsee the completion of even the firstmonth oftheirlife. Worse,the IMR has actually deteriorated asit was 76/1000 according to surveys conducted in 2003. Mortality among children under 5 years of age is 94/1000 live births and hasimproved frompreviousfigures of 98/1000 in 2003. The highmaternalmortality in our country isrelated to high number of pregnancies which are considered asthe biggestrisk factorformaternal deaths.Out ofthe 30million women ofreproductive age, about 5 million become pregnant each year. Most ofthemdo not get proper nutrition and antenatal care. The limited number of hospitals cannotsustain 5million births, hencemajority (60%80%) ofthemoccur atImproving the Coverage of Maternal,Newborn and ChildHealth in Pakistani Media. 13 home, conducted by untrained and unskilled birth attendants. Like all biological processes, not every delivery issmooth and 1015% of deliveries become complicated for which themothershould be taken to a hospital in an emergency condition. Many ofthese pregnancies are unplanned and unwanted, and the dangerousmethod of abortion is adopted to end this unwanted pregnancy. Majority ofthe abortions are unsafe, are conducted by untrained dais, and lead to complicationsincluding deaths but are notreported. According to estimates, for 1000 pregnancies ending up in live birthsin Pakistan, 29 pregnancies are terminated through abortions. Combined, allthese factors contribute to about 15,000maternal deaths every yearin our country.

Hospitals in Pakistan whether private or public do not follow and oblige HCWM guidelines of WHO and do not practice Pakistan bio-safety rules 2005. The trainings which we conducted in 10 major hospitals are

financially feasible to be replicated in other hospitals of the country. We recommend that: 1. Continuous supervision and monitoring mechanisms should be developed for effective implementation of HCWM in hospitals. 2. A dedicated committee on HCWM should be formulated and regularly meetings should be organised at facility level. 3. A separate head should be created in hospital for financial needs in HCWM equipments. 4. Continuous training of Health Care workers need to be organised for better results in HCWM. 5. A continuous supply of PPE and HCWM consumables should be provided to the public sector hospitals on the basis of needs. 6. Evidence based research should be conducted in the field of HCWM in Pakistan. 7. Dedicated and motivated staff should be deployed for this activity in each hospital. 8. Remuneration for hospital workers should be given priority. 9. Catchment area should be declared and proper transportation mechanism of waste for treatment and disposal be ensured. 10.Proper segregation should be performed at each hospital before incineration or treatment of waste.

Health Services Health Department is the key department entrusted by the people of Punjab with the fundamental responsibility for the health of communities and the entire

population. Health Department delivers primitive, preventive as well as curative health care services of Primary Health Care level to Tertiary Health Care level. The services for Punjab are provided through a well designed infrastructure. Health Department across the province is divided into: 2,461 Basic Health Units (BHUs) 293 Rural Health Centers (RHCs) 88 Tehsil Headquarters Hospitals (THQs) 34 District Headquarter Hospitals (DHQs) 23 Teaching/ tertiary Care Hospitals Free of cost consultation, diagnostic facilities and medicines are provided to the patients particularly focusing on the poor and marginalized segments of the society. Health Department also provides free of cost preventive measures including immunization 8 vaccine for preventable diseases like Polio Tuberculosis Diphtheria Whooping Cough Tetanus Hepatitis-B H-Influenza Measles Besides measures to prevent, treat and control other communicable diseases and Epidemics / Disasters, these vaccines are provided through Expanded Program on Immunization (EPI) for children under 2 years and pregnant ladies. Health Department is producing its own trained and qualified Human Resource keeping the HR development needs and requirements of Health Care Infrastructure in mind. Health Care Services Health care services are the diagnosis, treatment, and prevention of disease, illness, injury, and other physical and mental impairments in citizens. Health care services are delivered by specialists in medicine, chiropractic, dentistry, nursing, pharmacy, associated health, and other care providers. The health care

services represent the efforts put in delivering primary care, secondary care and tertiary care, as well as in public health. Preventive Care Services Preventive care refers to measures taken to prevent diseases, (or injuries) rather than curing them or treating their symptoms.Read more Promotive Services These services are defined as "The process of enabling people to increase control over their health and its determinants, and thereby improve their health". Read more Curative Care Services Curative care is the kind of health care traditionally oriented towards seeking a cure for an existent disease or a medical condition. Read more Rehabilitation Services Rehabilitative services can help people, with disabilities, to get gainfully employed and do away with reliance on others. This includes meeting the physical, psychosocial, emotional and spiritual needs of patients and their families while incorporating the nursing and rehabilitative processes. Such Services should be provided to all patients in both inpatient and outpatient settings at all levels of care. Read more Health Care Delivery System Health sector of Punjab has an extensive network of public and privately managed health infrastructure throughout the province. The Government is by far the major provider of hospital services in rural areas, and it is also the main provider of preventive care throughout the province. The public sector health delivery system is composed of four tiers: Outreach and community based services Outreach and community-based services, which focus on immunization, sanitation, malaria control, maternal and child health and family planning. Read more Primary Health Care The primary care facilities include Basic Health Units (BHUs) and Rural Health enters(RHCs) mainly preventive, outpatient and basic inpatient care. Read more

Secondary Health Care Tehsil Headquarters Hospital(THQ) and District Headquarters Hospital(DHQ) for out patient, inpatient and also specialist care.Read more Tertiary Care Tertiary care hospitals located in the major cities for more specialized inpatient care. Read more General Terms