A students’ health center design for Qatar

By Najat Abdrabbo Alyafei, Head of Oral Public Health Operations, Primary Health Care  Corporation, Qatar

The proposed School Health Centers (SHCs) are primary care facilities that mainly focus on providing comprehensive health care targeted to school children aged between 4 and 17 years old in Qatar. The existing body of knowledge demonstrates a relationship between health status, quality of life, and academic performance among school children. School children with good health are more likely to fare better in their academic performance than school children with poor health.

The link that health status has with academic performance and quality of life among children provided unique insight towards the establishment of SHCs by the Primary Health Care Corporation (PHCC). This project aims to deliver the effective and efficient delivery of health services exclusively to school children. The new SHC design can be named as the Tolabi School Health Center (TSHC), where Tolabi refers to school children in Arabic language.

School health services have significant contributions towards achieving the common goal of education system and the healthcare system. In terms of the education system’s goals, these school health services have a crucial role in managing school children’s needs, especially those with chronic health problems . The services are also designed to help with easier access and referrals by linking students, health care providers, school staff, and the community to promote school children’s health care in a safe and healthy learning environment. The school health services aim to ensure all school children are healthy and ready to learn.

The SHCs evolved and developed following the public health nursing movement in the early 1900s. School-based health services have been implemented in various countries, including the United States and Singapore. Based on the current 2017 survey conducted by the National Assembly on School-Based Health Care census, approximately 2,000 SHCs are available in the United States. They operate nationwide, serving over 2 million preschool students through 12th grade. In schools, SHCs improve access to care, enhance outcomes in terms of health and education, and increase levels of service satisfaction.

In 1954, School Health Services (SHS) were available to children through 15 units distributed throughout the State of Qatar under the Ministry of Education.

Law article of Cabinet Resolution No. 8 of 1971 provided the guidelines for reorganizing administrative apparatus in the education sector. The decision to move SHSs from the MOE to MOPH was made based on the proposal brought forth by the MOPH and SHS was renamed as School Health Department (SHD).

The authorisation of the movement of the SHS was obtained through the final decision on 17/1/1990 by His Highness, the Amir of Qatar. Based on the above decision and authorisation, a new Article 2 was developed. Article 2 stated that as of 01/7/1990, the Primary Health Care Department (PHCD)’s affiliation with the SHS at the MOPH would perform all the tasks and responsibilities previously undertaken at the MOE through the SHD. Development of the Emiri Resolutions No. 15 law which catalyzed the establishment of the Primary Health Care Corporation (PHCC) prompted the transfer of the PHCD to the PHCC.

The SHD had 61 staff members that included a family physician, pediatrician, ophthalmologist, optometrist, ENT, psychiatrist, clinical psychologist, psychologists, and Social workers. The department also consisted of dentists, dental assistants, nurses, a head nurse, nurse in-charge, a patient care attendant, pharmacist, pharmacist technician, lab technician, dermatologist, non-medical staff, and dietician.

The staff members in the SHD were working in one building and provided services to the all schools in Qatar until it was rescinded.

In 2012, after SHD polyclinics were revoked, all students were referred to their respective health centers (HCs). The present article proposes the need to establish new health centers in Qatar under the Operation Directorate of the PHCC, targeting schoolchildren aged 4-17 years old.

A Students’ Health Center Design

The article discusses the health services delivered by a multidisciplinary team of service providers, including physicians, nurses, dentists, dental hygienists, dental assistants, pharmacists, laboratory technicians, social counselors, dietary counselors, researchers, and other professionals the field of health care.

The health services that SHCs will provide include emergency, physical and dental screening for new and transferred school students, medical and dental treatment, immunizations, management of chronic diseases, primary medical care for injuries and illness, laboratory tests, referrals, and care coordination.

Besides, school health services will include emergency, age-specific chronic illness management, immunizations, and primary medical care activities regarding handling illnesses and injuries. Moreover, to further enhance the comprehensive treatment, the students’ health services will include laboratory tests and referrals in coordination with other health care facilities. Also unique to the designed SHC, are its research and wellness sections.

The SHCs seeks to improve the achievement of holistic health and wellbeing among school-aged children in Qatar. SHCs provides the opportunity to transform school children into healthy and well-informed adults with the ability to take care of themselves and their future children. The SHC seeks to improve the health and wellbeing of school children based on the following premises:

1. Providing child-centered care in a supportive environment.

2. Preventing the transmission of infection from adults to children.

3. Prioritized care with reduced waiting time for children.

4. Receiving all illness students and uncomplicated cases of emergencies directly from schools.

5. Significantly reducing the burden of existing PHCCs.

6. Enrichment center for Health Promotion and Disease Prevention Programs.

a. Mandatory Screening and Vaccination Services

b. Health Museum and Enrichment Center

c. Student Counseling Services

d. Skills Training Center

e. Wellness Center

f. Activity Oriented Health Laboratory

g. Conducting Health Fairs

h. Auditorium

7. Research Center for children.

8. Improvement in the academic performance of children due to reduced days of illness.

Provide Child-Centered Care in A Supportive Environment.

Children have distinct needs from adults in terms of medical and non-medical needs. Such needs are tailored to health services for children and adolescents. However, children’s health care visits can be a challenging and stressful experience because they are unfamiliar with the health care environment and clinical procedures.

Such an experience can lead to anxiety and feelings of helplessness among children. The most common negative response reported among children in health care visits is high anxiety levels that can affect their psychological health status. Besides, increased anxiety levels hinder children’s efficacy to cope with treatment and lead to uncooperative behaviour and negative attitudes towards their service providers. The sense of helplessness, together with fear and pain, can also make children feel powerless in healthcare settings. Children’s emotional responses during health care visits can contribute to aggressive behaviours, withdrawal, poor cooperation, and relapse.

Children also demonstrate a delay in clinical treatment and spend more time to complete medication. Feelings of helplessness also lead to reduced patient satisfaction. Hence children require more time and specially trained care providers who are compassionate.

Children are mainly disoriented in an undisclosed healthcare environment where they receive the necessary care with adults. The SHCs are exclusively developed for children because the healthcare facilities have significant impacts on a child’s mind and body during their visit.

The attractive medical environment, colour scheme, child-friendly medical techniques, and reduced waiting time mitigate anxiety and stress levels among children during health care visits. Like adults, children are also affected by different types of diseases, and since SHCs emphasize children, the approach to address children’s needs should differ from that used for adults.

The health practioner will apply their professional skills and competencies to ensure school children are comfortable with this. Using children-friendly equipment, administering drugs, and using effective and straightforward communication that complements children’s understanding level will make school children feel comfortable and enjoy the experience of SHCs.

Infection Transmission from Adults to Children

Children are the most affected population by health-related infections. They are highly vulnerable to infections because of developing immune systems and frequent visits to healthcare settings. Social and human factors are among the risk factors for infection transmission among children. Factors, including children’s closeness to adult patients in the healthcare facility, touching their mouths with infected hands, and their low immune responses, facilitates the transmission of infections.

Waiting rooms are the most affected areas in the healthcare facility that present opportunities and facilitate infectious agents’ transmission to patients. The increasing outbreaks of infectious diseases like measles, tuberculosis, respiratory tract infections, Rotavirus, Varicella zoster, Pertussis, and other infectious-related diseases among children have been traced to physicians’ workstations, including their offices or clinics. The most common infection transmission route among children includes direct contact or physical contact with infected persons and vulnerable patients.

Children are also infected through indirect contact, such as through contaminated surfaces, including hands, bedrails, equipment, and materials. Such infections are mainly viral since most viruses such as respiratory and gastrointestinal viruses are viable on physical objects and surfaces for a couple of hours.

Children also get airborne infections through their exposure to infectious environments or substances. Airborne transmission often occurs due to infectious particles and aerosols of small droplet nuclei or skin squama’s suspended in the air and spread by air currents. Organisms that because airborne infections are mainly found in corners, corridors, and in and out of windows where children can easily touch. This airborne transmission poses a threat to children’s health status and reflects the need to establish a health care approach to combat further infections. The concern of infection transmission from adults to children can be addressed by having exclusive SHCs for children.

Children visiting similar healthcare settings with adult patients also encounter crowded waiting rooms, reception, share similar space with unfamiliar people, and are limited to move in the facility freely. These experiences increase stress, which in turn, initiates reciprocal immune response through the release of hormones by the autonomic nervous systems.

Besides, high levels of stress that children develop due to encounters in the healthcare facility lead to increased cytokines, including interleukin-6 and serum cortisol, which impairs the immune response, inhibits wound healing and affects the wellbeing of children. Reducing the challenges that children face in the healthcare facility may help improve their health status and wellbeing.

Prioritized Care with Reduced Waiting Time for Children

Long waiting hours are detrimental as it can lead to delayed diagnosis and treatment, increased mortality and patient greater dissatisfaction rates. It is an essential indicator of healthcare quality and reducing the amount of waiting time reduces anxiety and stress in parents and children.

The best interests of children are mainly served when they receive care at a possible time. Therefore, reducing the waiting time for children can be achieved by establishing or opening pediatric clinics around the school. Existing evidence illustrates that the establishment of school clinics is crucial for coordinating health care assessments, plan and execute individualized healthcare plans for each student in a more efficient and timelier manner4.

Significantly Reducing the Burden of Existing PHCCS

In Qatar, Primary Health Care Corporation (PHCC) serves more than 90% of the entire population by providing primary care services. The PHCC works in partnership with Hamad Medical Corporation (HMC), with expanded inpatient beds by approximately 25%. In terms of a national workforce that serves the country’s population, it is evident that PHCCs have the highest percentage of 21.1% of the workforce while HMC has 12.1%. Based on the report by HMC, it is evident that every year, up to 5,000 children visit HMCs and PHCCs for treatment and follow-up practices.

The increasing patient load compared to the number of nurses attending patients within the PHCCs can make patients dissatisfied due to their perceptions that healthcare professionals may not provide proper care due to paucity of time, lack of patient-physical communication, and the nature of the disease. The high number of patients may hinder the development of an interpersonal doctor-patient relationship and impede patients’ ability to seek preventive care advice in the facility.

Consequently, directing school children for health care services at SHCs will undoubtedly help ease the burden of seeking care at the existing PHCCs. In terms of the number of children visiting pediatric emergency, a survey conducted in 2017 showed that the visits are high, with HMC and PHCCs recording 598,885 visits compared to 258,608 ambulatory visits or calls with 2,339 life flight activations.

Therefore, introducing SHCs will help reduce the number of pediatric visits by widening the scope of SHCs for minor illnesses, routine care and follow up, and utilization of wellness facilities. Reduced pediatric visits will prevent overutilization of existing limited PHCCs facilities in the pediatric emergency units for non-emergency illnesses.

Enrichment Center for Health Promotion and Disease Prevention Programs

Based on the need to achieve health promotion, prevention, early intervention, and reduction of health risks, SHCs would be essential to educate school children on healthy behaviors they should practice into their adulthood. The SHCs also seeks to foster treatment by seeking improving children’s attitudes towards appropriate health services.

Research Center for School Children

Establishing this will be crucial in ensuring a suitable environment for research and development on school children’s health issues. Researcher involving disease epidemiology, knowledge, attitudes, behaviours, and practices of children, utilization of services, patient satisfaction, and quality improvement projects. Besides, the SHCs will provide a suitable environment to study the impacts of interventional programs, including training of schoolteachers and peer education programs.

Academic Performance Improvement Among Children Due to Reduced Days of Illness

The concept of SHCs originates from the assumption that health status, education and health are linked, and unmet clinical, emotional, and social needs impede student’s learning. Students with good health status are more likely to show improved academic performance while poor physical and mental health poses adverse effects on academic performance among children.

(The second part of this article will appear in the January issue of Public Health)