UNDER-FIVES' CLINICS

Under-fives' clinic is a low-cost strategy to provide promotive, preventive, curative and referral health services for preschool children, within the available resources. Structurally, these clinics may be considered as a modification of ‘well-baby clinics', which mainly provided preventive services.

Obj ectives: Preschool children account for ~7-8% of total population and ~10% total deaths. Under-fives' clinics target this population with following objectives, which are also enshrined in its emblem (Fig. 28.1):

• Care in illness, e.g. early diagnosis and treatment or referral, of illnesses including growth/developmental abnormalities.

• Preventive care, e.g. immunization, nutritional sur­veillance and supplementation, periodic health checkups and health education

• Growth monitoring and recording on a growth chart for ready reference, every month during 1^st year, alternate month during 2^nd year and then quarterly till 5 years of age.

• Family planning services, denoted as the red central triangle in the emblem, are integrated component of under-fives clinic services.

Organization: These services are mainly provided by ANMs and MPWs, with assistance from non­professionals, e.g. local volunteers and Balwadi workers, after basic training to economize as well as popularize the services. Currently, many of these services have been incorporated with other health care projects, e.g. ICDS. 28.3.12 SCHOOL HEALTH SERVICE

School health service (SHS) is an important component of community health service, aimed to provide comprehensive and integrated health services for school­going children within the available resources. Although existing even before independence, SHS have been strengthened and streamlined after recommendations by a special school health committee 1961, Govt. of India. Objectives: School-children contribute to ~1/4^th of total Indian population, which is highly susceptible to environmental influences as well as easily approachable and amenable to inculcate good health practices. SHS targets this specific population with following objectives:

• Promotion of positive health,

• Prevention of diseases and ill-health,

• Early diagnosis, treatment, referral and follow-up,

• Generation of health consciousness,

• Provision of healthy school environment.

Organization: SHS are provided by special ‘school health clinics', conducted by local PHCs or municipal health agencies on fixed days and time, in coordination with schools' staff within its jurisdiction. A whole­time medical officer is appointed to cover ~5000-6000 children, with additional help from specialists and paramedical workers. Local school health committees are expected to supervise functioning of these services, while National School Health Council acts as an advisory and coordinating body.

Components: Following services are provided under school health services:

• Health appraisal:

± Periodic medical checkups on admission and then, at least every four years.

± Periodic health check of school personnel, who also form the school environment

• Selective evaluation of any child, suspected as sick by teachers.

• Remedial measures including specialist referrals and follow-up.

• Prevention of communicable diseases, e.g. immunization.

• Healthful school environment, to fulfil minimum standards of spacing, cleanliness, sanitation and water supply.

• Nutritional services including mid-day meals and specific supplements, e.g. iron and Vit. A.

• First aid and emergency care, via training of teachers to ensure minimum first-aid supply.

• Mental health promotion by providing stress-free environment and assistance of school counselors.

• Dental health - periodic evaluation and care

• Eye/ENT health - periodic evaluation and care.

• Health education, with special emphasis on personal and environmental hygiene and family adjustments.

• Education of handicapped children to maximize their potential.

• Proper maintenance and use of health records.

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