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Primary Health Care Issues and Teaching-Learning Strategies of the School: Exploring Children’s and Social Needs

MOHAMMAD TAREQUE RAHMAN

Abstract
This paper attempts to explore the inter relationship of primary health care issues with the teaching-learning strategies of the school aiming for the children. Along with this it tries to explore the needs of the children that would make them aware about the primary health care both physically and mentally. Present practice of teaching has the lacking about making the students conscious about health and health care .Though curriculum has identified some of the objectives for achieving healthy behavior but the present teaching-learning environment and strategies is not enough suitable to change the students’ behavior for sustainable healthy body and mind. Besides the children are not preparing properly with the consciousness that they have great responsibilities towards the society to make it conscious about the healthy attitudes and behavior. Not only pointing the needs but this paper also focused some of the concepts (keeping in mind about the resource constrains) which could be effective to meet the needs of the children as well as the society.

Introduction
When something begins it gets an aim to be or for.  If it is about education, it has also got some aims. Roughly estimated by Chandra and Sharma (2004) education has two kinds of aims-the universal aims and the specific aims. Universal aims tend to remain the same, irrespective to the time and place. One of the universally accepted objectives of education is the complete development of the human being. From the earliest time to the present day and in every country of the world education has aimed to develop the abilities and tendencies of human beings in such a way that they may be able to achieve the maximum adjustment, both personal and social. To take one example, the principle that a healthy mind needs a healthy body is a universal maxim and a universal aim of education. For this reason education everywhere includes mental and physical training and education. in the other hand everywhere individuals make families after entering adult life and ensure new life. The human cycle goes such a way. But this all happens inside a structure which is called society and this cycle carries through the different social agencies. Education therefore must ensure that men and society develop in such a manner that the occasions of clash and conflict get reduced to a very minimum and cooperation increase massively so that the cycle can circle smoothly.

In the struggle for survival, man needs a healthy and strong body. Along with this, individual needs a sound thought provoking mind that can think critically and analyze the surroundings. A healthy mind in a healthy body is the key to survive successfully in the challenging society.  Over fifty years ago the World Health Organization described health as a state of complete physical, mental and social well-being, not merely the absence of disease and infirmity (WHO, 1948). Thus a child who has no tangible symptoms of ill health such as spots or pain may be regarded as healthy. This kind of reasoning prevents us from recognizing that health should entail a positive feeling of well-being. According to Hall and Elliman (2003) many factors which have the potential to seriously harm a child’s health may at best be ignored and at worst remain unrecognized, if we fail to accept that social, economic and environmental factors are as important as biological disorders as causes of poor health in children.

Contemporary thoughts and practice
Children’s of most cultures begin formal schooling during the primary years ages 6 to 8. The emphasis of schools in almost all the societies is on promoting academic learning. Even in industrialized countries classroom teachers spend the majority times providing instruction in traditional subjects especially language and reading, math and traditional science (Whiting and Edwards, 1988). What appears to be less important to parents’ teachers and even child development researchers is physical growth and psychological development during the schooling years.

Health awareness is negligible maximum in the poorer community like us where no one cares the true aspect of awareness building through education to the society and among the children. Great concern has been expressed around the world about the nutrition and health care of every young child in poverty. Poor primary year of health status found to predict serious developmental problems later in life (pollit, 1994). In a large study of families in poverty Duncan, Brooks-Gunn and Klebanov (1994) report that elementary school children who do not have an adequate diet or sufficient medical care suffer serious problems. The problems they face are very much related to their daily life issues. For an example the children mostly suffer from malnutrition and this causes a lot of diseases to the children and by the time those problems turn into difficult ones such as skin diseases, dental problems, eye problems etc. children in poverty miss many more days of schools because of physical illness (Adams & Benson, 1991). Even in the rich countries it is seen that children suffer from malnutrition. In the United States, studies of eating habits in the elementary years show that American children have diets high in saturated fats, salts and sugar. (Berenson etal, 1982; J.E Brown & Pollit, 1996). Now if this is the situation then its need to find out where is the problem lying. Apart from this as it is stated previously that World Health Organization described health as a state of complete physical, mental and social well-being, not merely the absence of disease and infirmity. So if there is no diseases in the body doesn’t mean a sound health while the mind also need to be relaxed and ready for learning as the healthy mind is the key of successful learning.

Now what does it mean being sound for a child?  Is it like feeling well same like an adult? Or it has got something different? These questions have got some easy answers. To a child it is very important to be activated. When it is seen that the child is very slow or silent the parents get worried as they feel that there must be some problem. Naturally we believe that children love to be active no matter if it playing or listening or speaking or dancing etc. the key point is their movement what shows the miter of their state of mind. While discover anything children tend to show the interest or expression through movement as each of the learning whether it is positive or negative is a new experience for them. It is seen that when children listen something exciting they tend to jump and clap. When children learn to talk then they ask so many question as each answer let them know something new and that is very essential for them. They keep asking one after another question until we get tired answering them. Children like to participate in everything whatever they see. They feel like they can do everything and they tend to try for it. They like to play the kind of game where they move things from one place to another they like to pretend like the elders, they like to draw things, they show interest in different objects specially if it has some movement or if it colorful . When the question is about secondary level children they get the movement more and more maturely they perform the different types of play. They like to watch the cartoons as the cartoon characters never be settled in one place for long. There are some of the normal tendencies that the children show and we can guess that the kid is happy. But if we think a situation where they are bound to sit passively and quietly can we think that they are feeling fine and they are happy? Can we think that they have got the perfect atmosphere for learning? Can we think that the mental health is balanced?

Children acquire new motor skills in primary years. There are important connections between motor development, brain growth, and learning. Children who exercise during school may achieve greater brain organization and may be better able to attend learning tasks. Unfortunately, motor play has declined over time in modern society. (Jeffery Trawick-Smith, 2003). School reform efforts have reduced and in some cases eliminated outdoor play time. There are trends toward deemphasizing physical growth and activity that have serious implications, including the rising rates of childhood obesity. Many schools in America have reduced the number of days children spend in physical education each week, and this includes reducing or eliminating recess periods and outdoor play altogether (Jeffery Trawick-smith, 2003). While this is the case of a modern developed country, being a representative of the developing country Bangladeshi system is unexplainable. We don’t have even a ball in many schools so that the kids can move their feet. So how come we can think of reducing absenteeism or motivating children not to play in the street rather then be an attentive student inside the class said one of the head teachers from a rural district in Bangladesh. Now what’s the solution is simple understandable. Children should provide sufficient time for playing. Its not that the recess time but they should be allowed for at least a class hour where sometime they would play  or sometime they would be involved in some creative things such as games, role play, debate, club activities or some project activities.

Academic context of Primary Health care
Children’s learning theoretically mostly depends on the learning outcomes and competencies. Based on the learning competencies teachers try to focus their teaching to the class. The learning outcomes basically focus the social needs, constitution, religious phenomena, developments issues, and personal needs, national and international needs. These needs are multidimensional and inter related and through out the teaching learning situation it is expected to achieve the competencies by the children. Now it needs to be judged whether our competencies have the option to be aware about primary health care? Is there anything so that the teachers get the chance to make the children aware about their health and health education? Teachers always tend to say traditionally that they don’t have any other alternative to go beyond the learning outcomes as it is directed in the curriculum. Educational consultants or the policy makers try to say that being the poorest they don’t have enough option to add a new subject might be called health education. “It is not totally absent in the curriculum. We have some topics in the curriculum and in the texts which are related to awareness building to the children” said a science teacher. But is this so simple adding some of the text in the textbooks and make the students aware about health?

In the past it was thought that having knowledge would be sufficient to change people’s health behavior. Now it is known that behavior is subject to multiple and complex influences of which factual information is only one. What is needed is a mechanism to make the information personally relevant to the individual and present it in a form which is accessible. The goal is sustainable improvement in health, nutrition and family welfare status of the people, particularly of the poor and vulnerable groups, including women, children and elderly with ultimate aim of their economic and social emancipation and physical and mental well being. (National Health Policy--- An Update August, 2008). Steps will also be taken to reach basic health and reproductive health information through school curricula, is one of the strategy to reach the goal. One of the challenges within schools is to carry ways for children to participate, and allow them to make a measure of control over decisions relating to health (Hart 1992). The present curriculum has some crucial competencies already identified and given for the students. So from that context it is somehow ok but as it has been told before that it is important to let the students participate and create the ways to do it. One of the problems which are almost available in all the countries is to give the excess emphasis on recall and memorization of factual information. The environment in many schools one in which the teachers possesses knowledge which they pass on to children at their discretion. There children are seen as passive recipients and empty vessels (Freire, 1972) with little to contribute from their own experience. There are lots of ways to help children to be active and understand the fact rather then being passive and memories. When it’s about the question of awareness building and primary health care dealing with the children it needs to handle with care. There are simple ways of changing passive activities in the classroom to active learning experiences which are very familiar such as surveys, practical demonstrations, role play, and games. These changes have little or no resource implications. Some examples are given below-

Passive learning activitiesActive learning activities
Lecturing: Teachers normally read the names of the healthy foods and tell the students to eat them. Traditionally the teachers read the definition of the balanced diet and tell the students to memories it.Discussion: Teacher can ask the students, what are the foods they normally ea?  Then he can give them some examples what the different food (represents the different category of food) works different essential task for the body and then can ask them if someone don’t take a particular food then what type of problem he or she can face? This way the teacher can ask, to be fit which are the food they should take everyday? And this is how he can go for the definition for balanced diet. In continuation of this teacher can say that the food they eat everyday somehow represents different category of food that make a balanced diet and can tell them about Protein, Carbohydrate Vitamin etc.
Lecturing: The teachers normally read the symptoms of different skin diseases and tell the students to memories the characteristics and their precautions.Project method :Teacher can tell the students to have a project which would identify a single skin diseases which a student have in any of his relative or in a  known person and would describe different aspects of it including the symptoms and probable precautions that he or she( the victim) could and should take to overcome from it.
Lecturing and discussion : Teachers tell the students about the importance of cleanliness and ask them to wear clean cloths and to cut their nails regularly, to use soap after coming from the toilet etc.Physical activity: the teacher can motivate the students to be clean not only by their cloths (the poorest country like us some of the students only have one shirt which they wear the whole week) only but by nature. Teacher can tell them not to through papers here and there inside the class or not to spit inside the class. The teacher can get involved the students to clean their own class once or twice in a week.
Lecturing: The teacher tells children how to make oral dehydration solution.Practical demonstration: the teacher can demonstrate how to make oral dehydration solution and help each child to make it.
Lecturing: The teachers tell the students to be positive about the nature and  tell them to plant trees,Practical activity: teachers can arrange a tree plantation week or ca fix a day in every month as a plantation day while the students would plant a tree. This task could be merged with cleanliness activities as well.

There are lots of important issues still we have left for discussion or to let the children to know such as some diseases which are very common now a days, some environmental issues which are counted as urgent need, some life skills which required to achieve to survive. But there is nothing we have for our child in our present teaching-learning environment. While if there is some information (as mentioned above in the table) in the competencies and in the textbook the teachers can change their method and can make the students aware about those issues but while no information is in the curriculum about the issues (just told before) then it makes a huge gap for building awareness. For an example recently, Dengue is a very common fever in Bangladesh and taking some measures can prevent this disease along with some other dangerous fevers. But there’s a lacking of text regarding this awareness building concept. Along with the text it is important to get some strategy so that the students get themselves involved to acquire some behaviors such as they can eliminate mosquito breeding grounds by removing unused plastic pools, old tires, or buckets; by clearing clogged gutters and repairing leaks around faucets; by regularly changing water in bird baths; and by filling or draining puddles, swampy areas, and tree stumps. Eliminating such mosquito breeding areas can be an extremely effective and permanent way to reduce mosquito populations without resorting to insecticides.. It needs to make the students aware and beside this they need to be prepared to habituate some behaviors (as discussed above) which would prevent diseases. While Defining education it’s been simple told, education is the positive change of behavior, now the question is about a child’s health then how far we are doing it?

Social issues
Prof. M.V.C Jeffreys writes, “ the school can do nothing better for the education of citizens than to make its boys and girls members of a true community in which are combined liberty and order, freedom and responsibility” The phrase member of a true community is important in terms of the responsibility of education, school and children. School needs to prepare its children in such a manner so that the children can behave positively inside the society and also can participate for building a better society.

Being a developing country we have so many aspects to think about like educating people, making the environment for better living, developing the humans as resource etc. these all are inter related and it is widely recognized that education can serve this responsibility. Recently we have maximum of our children enrolled in the primary schools but it’s important to remember that still most of the parents of those young children are not literate. So when we would think about living in a community the children need to think about their responsibility towards their society. For an example when a child can come to know about balanced food and different food with different essentials then he or she can let his or her parents know about that. When the child would be strong with the attitude of taking balanced diet then it won’t be tough for making a balanced and healthy society. As an agricultural based country our children shouldn’t be left with mal-nutrition. When a child would know the information, how to prevent mosquitoes to lay their eggs in the stored water around then he or she can look after his or her surroundings for checking if there are any stored water in the garbage or ditched broken bottles. But it’s very important to change the children’s behavior first. Our teachers teach the students how to make the dehydration solution but it is seen that with some exceptions parents tend to buy the oral saline (dehydration solution) from the shops. It is seen that, there’s a huge number of children among the dengue victim. It seems surprising when it happens in the urban communities as well. But children should know the preventive measures of dengue mosquitoes. The school and the teaching –learning strategy should have that quality of capacity building. There is a common story which can be a very relevant to this issue---

Once the authority of a country got very worried as the local games were getting lost by the over played game Cricket and Football. So they took a decision to make a rule. They fixed some marks and they also fixed some time so that the children could play those games.  After some days it was seen that children play those native endangered games only in that specific time but when they get recess they play Football and Cricket.

It is important to let the students know the information of healthy behavior while it is more important to make them aware and habituate to use the information in their behavior otherwise the result can be similar to the story. The task can be identified in two ways. If one can be achieved in a proper manner then another can be achieved by itself very easily. When children would be aware then the society would be aware as each child would aware its parents. Recently it is a very popular idea of making all, scientifically literate but isn’t it equally important, to make all literate about health? Traditionally it is seen that when there is a question of awareness building no formal education always take the lead to give some sudden impact. As for example campaigning the negative impact of early marriage resulted some positive influence preventing the early marriage. But the time has come to think that, making aware about the cause-effect relationship in the formative age of a child is much better then to aware in other time through other medium.

It is very important to evaluate the children’s opinion regarding any issues. While the children would feel that their opinion is judged by the elders for any decision making then it is natural that they would feel their importance in the family as well as inside the society and that’s very important. When  a child come to know that whatever he is telling good or bad doesn’t mean anything to the decision makers though they know something better but  remain reluctant rather then letting others to know. As it is mentioned above that knowing something is not enough while behavior towards anything is essential. So the children need to get that chance to act inside the school. They need to practice their knowledge or information through by their behavior. there are some other influential factors such as family, home environment, traditional and cultural patters of life, the media, the peer groups etc. it is seen that sometimes children start smoking by the influence oh their fellow-mates while they know that smoking is bad but they do it to avoid stigmatism.  Peer group relation act very strongly while the school should use this force towards the positive behavior.  There is a very common believe that prevention is better the cure for any country whether it is a developed country or developing. It is more relevant for the developing country as the people can’t afford sufficient money if they

Conclusion
Prevention always depends mostly on awareness and healthy behavior. Education needs to be that much capable so that it can build the children aware and healthy behaving. When they would achieve these qualities they would try to aware their parents if they (the children) feel that their voices are also important inside the family and in the society. Teachers should be aware that they have a big role here making the students prepared for this challenge. They need to reorganize their thoughts about the children and their teaching style so that the students get enough chance to be active both mentally and physically as these two aspects are closely related to a healthy human being. Sufficient timing to play, role-playing, project work, mentoring etc are very essential to generate the speed inside the children. Teachers need to find out new ways, how to involve the children more. If we succeed to make a healthy mind inside a healthy body among the children then for sure these children would make a better world for the next generation.

Reference
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