How keeping health records of school children can pave the way to universal health coverage

How convenient would it be to have health information and vaccination records of school-going children stored in a web portal from which individual health data can be extracted anytime and from anywhere using the unique student ID? Not only would it benefit individuals greatly, but the health data of children coming from different regions and from different economic backgrounds will provide insights on specific development needs in the health sector.

Universal health coverage means providing access to healthcare for all at an affordable cost and Bangladesh targets to achieve that by the year 2032. The country needs a strategy that covers everyone, and school can be a great place to start as it will build a healthy population from early on.

A government decision published in November 2021 stated that over 30 million students will be assigned student IDs to discourage the unhealthy competition triggered from the roll number system. These IDs will eventually be converted to NIDs. Based on this news, I designed a School Health Record program and implemented it in two schools in Jashore.

Approximately 1,800 school-going children’s health records were documented by six doctors for three months through health campaigns. This was made possible thanks to the patronage of a benevolent donor, cooperation of the administration, and support of the local member of the Parliament. Data is still being compiled but I will share some initial findings here.

Why is it important to monitor the well-being of school children? 

Around 45% of Bangladeshis are aged between zero to 24, another 40% is between 25-54. According to the UNFPA, with a median age of 27.6, Bangladesh’s youthful population has the potential to lead to a demographic dividend if investments are made in health, education, skills development, and employment generation, especially for the adolescents and youth.

Monitoring the health of school children will help in early detection of diseases and learning problems, optimize school attendance to prevent dropouts, reduce health inequalities, improve education outcomes, and provide additional incentive to send children to school. This may also be considered primary care where a referral system can be introduced as the gate-keeper to reduce burnout in specialist doctors. Investing in school children’s health is a nation-building effort that will impact the future of a country’s social and economic development.

How would digitization of student health work? How will it help?

Doctors would be assigned to take full medical, immunization, and family history along with physical examination of all students from age five to 18. All data will be systematically compiled in electronic medical records adhering to the laws of protected health information. Masked data can then be used to generate trends that will benefit in the development of multiple sectors.

Incidence of specific diseases or nutritional deficiencies, school to school health condition variation, gender specific problems, and geographical needs identification can link the schools and communities to take interventions to improve health status.

The Jashore school program revealed important facts among school children. For instance, 85% of children examined cannot swim. Since drowning is one of the leading causes of death among children in Bangladesh, communities can start a program on teaching this skill to children; 65% of all child delivery happens through cesarean section, local hospitals can increase their capacity to ensure safe delivery; sore throat and cough are more common than diarrhoea in children, this might be an indication that there is more awareness on maintaining food and personal hygiene — this can also be taken as a sign to design programs for children to take more vitamin C and flu shots.

All parents claimed that vaccination was completed but very few could produce the vaccine cards, a digital platform for immunization schedule and completion can also be arranged. The program also highlighted high incidence of diabetes and hypertension among the parents, reinforcing the need to build awareness against non-communicable diseases.

The other advantages are: Quick access to one’s health record, avoiding contracting severe diseases that will save expenses, trend analysis linking departments of health and education, and increasing health seeking behaviour.

Is the school health record system a common practice in other countries? 

It is mandatory in the US. In Singapore, school health was established in 1921 with the vision to build a healthy, productive population that would eventually benefit the nation. Malaysia has provided school health services to all government and government-aided schools since 1975. India’s School Health Program appoints two teachers in every school as “Health and Wellness Ambassadors.” WHO supports the 53 Member States of the WHO European Region to develop and sustain School Health Services as part of their national health systems.

Can Bangladesh implement a school health program?

Unbeknownst to many, Bangladesh already has a school health program since 1951 — 21 out of the 23 school health clinics are in district level and two in Upazilla level. The district civil surgeon is the authority under whom two medical officers, one pharmacist and one medical assistant are working for each clinic. An initiative can be taken to revamp the whole program.

If six dedicated doctors in Jashore along with a data entry team could compile data of 1,800 students in a web portal, then the government can surely undertake a national level intervention to develop school health record systems to expand the channel of access to healthcare. The Shurokkha app, with 150 million people’s vaccine information, is a shining example already. If implemented, the data generated from such a task must be used to improve health outcomes, take remedial actions, and monitor changes. Universal enrollment of the health, education, and ICT ministry can make this happen.

As we move towards being a smart Bangladesh, we need to seize the moment to make revolutionary changes in health service delivery. Data-driven decision-making should be at the core of all health development. The life of an average Bangladeshi youth is yet to happen, the onus is on us to facilitate a smooth transition towards a more digitized health sector for the youth and their children.

Dr Maliha Mannan Ahmed is the Founder and Executive Director of Organikare. She has an MBBS, MBA, and a Master’s in Health Care Leadership.

Source of Dhaka Tribune