Evaluation of the implementation of the national policy for school health in Namibia

Abstract

Background: A school health policy is intended to improve learners’ quality of life; however, three challenges are faced in the policy implementation: i) low coverage of health assessments; (ii) poor and inequitable nurse-to-school ratios; and (iii) the lack of data collection. Purpose: The purpose of this study was to evaluate the implementation of the national policy for school health in Namibia with the view of proposing a framework to strengthen the national school health policy (NSHP). Setting and population: The study was conducted in three regions of Namibia. The population from which the study’s sample was derived comprised school principals, primary healthcare supervisors and NSHP national and regional managers in the Khomas, Oshana and Kavango regions of Namibia. Methods: A sequential, exploratory mixed-methods design was used for this study to evaluate the NSHP’s implementation across management levels, schools and health facilities in the country. A purposive sampling method was used to select participants for interviews and focus group discussions in the qualitative strand. Non-probability convenience sampling was used to select respondents for the quantitative strand’s structured questionnaires. Quantitative data from completed structured questionnaires (n=300) were analysed using SPSS. Thematic analysis was used to derive themes and subthemes from the qualitative data. Results: Qualitative findings indicated a lack of skilled staff, training, equipment and recordkeeping as factors contributing to non-compliances with the NSHP’s implementation. These findings were further described statistically by the quantitative results. The quantitative results indicated a correlation between job position and work experience in the policy’s implementation. This was revealed by the study findings that managers at the national level (n=66; 100%), had sufficient knowledge and better attitudes towards the NSHP. Also, employees with more than 10 years of experience (n=114; 60.3%) had good knowledge of the policy (variation). The findings indicated poor implementation of NSHP interventions, thus assuming low compliance with Namibia’s NSHP. The results show that eighty-one (n=81; 71.1%) and (n=63; 52.5%) schoolteachers from urban and rural schools indicated negative attitudes toward school health policy implementation, respectively. The results indicate that nurses who conducted health programmes at the time were completely uninformed of the NSHP (n=102; 68%), had not implemented NSHP or had never even seen the policy document. Development of conceptual framework: The qualitative and quantitative results and literature review contributed to the formulation of an NSHP implementation conceptual framework in Namibia. The framework consists of monitoring and evaluation strategies to enhance the school health policy’s implementation. Conclusion: The study reflected a gap between policy knowledge, attitudes and implementation of the NSHP. Insufficient documentation of interventions led to poor reporting in the database system. Based on the findings, a framework was formulated to improve implementation and compliance with the NSHP.