To describe the implementation of ISHP in rural Free State in 2015.


There were  shared understanding of the ISHP under the study participants and several obstacles were identified in the interviews.

Some stakeholders were not committed to the program and a lack of liaison with educators caused a break in communication.

Paper and electronic systems were still in place which resulted in doubling of tasks. Certain roles were overloaded, there were lack of transport and human resources.

The referral process was not standardized and the existing infrastructure could not attend to the additional patient load generated by school health services.

Data gathering was haphazard and no statistical monitoring took place, schools had no access to ISHP information.

Schools and the community often mistrusted the school health services due to the lack of the program details being shared.


School health services are a vital part of primary health care especially in rural areas. Despite an initial national drive to promote the program wide spread success are blocked by communication breakdown, role conflicts and the perceived lack of priority in provinces to deliver schools health.

Study publication date July 2017

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