1.1 Background to the Study
Integrated, comprehensive and strategic school health programs have greater potential to achieve good results.1 In 1980, World Health Organization (WHO) orientation toward developing healthy structures instead of focusing only on individual behaviors founded a comprehensive approach for the health promotion activities.2,3 The Health Promoting Schools’ (HPS) initiative was implemented in 1995 by collaboration of the health promotion, education and communication sectors, the intra-sectorial school health working group, and the regional office of WHO.4 This initiative highlights capacity development and encouragement of participation, for health which all have been accepted as powerful prerequisites to promote health and empowerment in schools.2,3 HPS addresses the relationship between health and education which is clearly reflected in the Health for All and Education for All goals of the United Nations and also in the social model of health which was corner stone of the Ottawa Charter.4,5 Attention and application of the principles of the Ottawa Charter in schools and the focus has been put on the development of health promotion structures led to the establishment of HPS.2,6
In Iran, with a population of about 75 million and a total of 13 million students, the initiative was first practiced in 2007. A joint agreement between the Ministry of Health and Medical Education (MOHME) and Ministry of Education (MOE) was signed and led to establishment of School Health Management System and also Schools’ Ranking Plan to support and monitor local HPS programs that are exploited within the network of the country’s schools.5 The HPS initiative was first exercised as a pilot program in East Azerbaijan Province at 36 schools in 2009-2010 and later it was expanded to 700 schools in 2011-2012.
HPS has been developed by WHO over the last decade and is being implemented globally.2 Studies on the experiences of participating countries in the HPS have resulted to varying results and challenges. The most important identified challenges were the mobilization of human resources and facilities to implement the initiative, inclusion of societies as whole identities, policy makers, public, private and non-governmental sectors and, also students, their parents and teachers.7 In the first meeting of the Caribbean HPS Network, the main obstacles to attain HPS aims were defined as the lack of continuous funding, insufficient and unstable governmental support, inappropriate development of HPS national networks, limited involvement, and restricted access to education and continuing education.8 The need to strengthen collaboration between the education and health sectors, technical support, and insufficient funding were among the major challenges listed by the European HPS Network.9 Leiger et al. (2001) referred to the insufficient preparedness of teachers and educational institutions in terms of health issues, shortage of time and resources, and weakness of facilities as the greatest barriers to achieve HPS goals.10 In the Eastern Mediterranean Regional Office (EMRO), HPS member countries addressed the insufficient funding and technical expertise, lack of awareness among the political leaders about the program, and also lack of infrastructures as key issues.11 HPS has now been adopted in all EMRO countries, except for Afghanistan and Libya and through using different methods many local networks have been established during the past decade.2,11 In Bahrain, HPS is organized by a committee comprising representatives from WHO and the Ministry of Health. In Jordan, the committee comprises representatives from the Ministry of Health and Education and is directed by the School Health Director-General of the Ministry of Health. Authorities in Lebanon sought help from private and governmental sectors and international organizations to implement the program.