A study was conducted to identify the barriers that led to poor implementation and a decline of school health services in Mpumalanga and Gauteng.


The four problem areas were identified:

  • Governance
  • Program-related factors
  • Managerial factors
  • Community involvement


School health services are not treated as a priority and more political support is required.

Program-related factors

The following program-related barriers were identified:

  • Schools are not consistent when implementing the health services.
  • Nurses are inexperienced and used for other functions in health care facilities, taking them away from schools health. This resulted in schools being visited every 2-3 years only.
  • Only screening was done and no health promoting activities were given. Follow up visits were not done.
  • Poor roads and limited resources affected service delivery.
  • No community involvement.
  • No inter-sector collaboration took place.

Managerial barriers

Management in the health and educational fraternity often did not support the programs which resulted in:

  • Negative attitudes and low nursing staff morale
  • Reports of school health findings were ignored
  • Nurses were not supervised and no “spot checks” were done which resulted in poor control over the quality of services rendered
  • School principals refused entry of nurses in to certain schools
  • Lack of awareness and understanding of the school’s health services potential impact on health


No communication with parents resulted in low trust,  awareness and returning consent forms.


Parliament to rededicate commitment to safeguard schools health services as an economic and political asset.

National departments to guide provinces.

Provinces to be responsible for operational procedures.

Role clarification required between district health and local government

Study’s publication date February 2010

Related Tags: Preventative Healthcare, Quality Health Services