#Back2SchoolHealth
Strategies to Reopen Schools
…learning in a safe environment.
Abbreviations.
CASEL: Collaborative for Social and Emotional Learning.
COVID-19: Coronavirus Disease 2019.
EiEWG: Education in Emergencies Working Group.
NCDC: Nigerian Centre for Disease Control.
PHEIC: Public Health Emergency of International Concern
SEL: Social and Emotional Learning.
UNICEF: United Nations Children’s Educational Fund
WHO: World Health Organization.
Dedication
This Paper is dedicated to the Memory of Mrs. Theresa Kofoworola Osibamowo. A Woman of Multiple Substances who through consistent focus, determination, quest for excellence and an undying spirit built impact-driven families across three-generations, three-continents and multiple industries. Sun Re O Mama Efunbo. You will never be forgotten!
Acknowledgements.
My gratitude goes to my indefatigable boss Dr. Efunbo Dosekun who initiated me to the concept of School Health and who has continuously nurtured my spirit even up till this day, my Strategic Partner Seyi Adebanjo with whom I banter most of the concepts in this paper (and we are even yet to agree on many), the Management Team of Outreach Group with whom a lot of the experiments that birthed this concepts were conducted, my family who supported my late nights doing the research, and finally and most importantly the Almighty God for giving me the Grace.
Dr. Segun Ebitanmi,
+234 806 764 4530.
September 2019.
Introduction.
The Director General of the World Health Organization (WHO) declared the outbreak of the coronavirus disease 2019 (COVID-19) on 30th January 2020 a Public Health Emergency of International Concern (PHEIC). On 27th February 2020 the Federal Ministry of Health announced the confirmation of the first case of Corona virus disease in Lagos State, Nigeria. In the same communication the Honourable Minister of Health announced that the Multi-sectoral Coronavirus Preparedness Group led by the Nigeria Center for Disease Control (NCDC) and immediately activated its National Emergency operations Center. On March 19th, 2020 a circular from the Federal Ministry of Education granted approval for the closure of all schools for a period of one (1) month commencing from Monday 23rd March 2020 to prevent the spread of the Coronavirus (COVID-19). Each State in Nigeria has contextualised this circular. The closure of schools affects close to 46 million students throughout the country. https://reliefweb.int/sites/reliefweb.int/files/resources/nigeria_education_sector_covid-19_response_strategy_north_east_.pdf
Why reopen schools?
Disruptions to instructional time in the classroom can have a severe impact on a child’s ability to learn. The longer marginalized children are out of school, the less likely they are to return. Children from the poorest households are already almost five times more likely to be out of primary school than those from the richest. Being out of school also increases the risk of teenage pregnancy, sexual exploitation, child marriage, violence and other threats. Further, prolonged closures disrupt essential school-based services such as immunization, school feeding, and mental health and psychosocial support, and can cause stress and anxiety due to the loss of peer interaction and disrupted routines. These negative impacts will be significantly higher for marginalized children, such as those living in countries affected by conflict and other protracted crises, migrants, refugees and the forcibly displaced, minorities, children living with disabilities, and children in institutions. School reopenings must be safe and consistent with each country’s overall COVID-19 health response, with all reasonable measures taken to protect students, staff, teachers and their families.
https://unesdoc.unesco.org/ark:/48223/pf0000373348
We also know that, for many students, long breaks from in-person education are harmful to student learning. For example, the effects of summer breaks from in-person schooling on academic progress, known as “summer slide,” are also well-documented in the literature. According to the Northwest Evaluation Association, in the summer following third grade, students lose nearly 20 percent of their school-year gains in reading and 27 percent of their school-year gains in math.[14] By the summer after seventh grade, students lose on average 39 percent of their school-year gains in reading and 50 percent of their school-year gains in math. This indicates that learning losses are large and become even more severe as a student progresses through school. The prospect of losing several months of schooling, compared to the few weeks of summer vacation, due to school closure likely only makes the learning loss even more severe.
https://www.cdc.gov/coronavirus/2019-ncov/community/schools-childcare/reopening-schools.html
This means that in the minimum of Six Months that these children will have been at home by the time of resumption, they will have lost over 60% of their knowledge.
Schools play a critical role in supporting the whole child, not just their academic achievement. In addition to a structure for learning, schools provide a stable and secure environment for developing social skills and peer relationships. Social interaction at school among children in Primary School is particularly important for the development of language, communication, social, emotional, and interpersonal skills. https://www.cdc.gov/coronavirus/2019-ncov/community/schools-childcare/reopening-schools.html
The dilemma of parents who must pay more to employ nannies to chaperone out-of-school children when their incomes have stagnated (or even depreciated) due to the pandemic is very evident.
The case for a quick, safe and secured return of children to schools cannot be over-emphasized.
On the other hand, there are reported cases of severe manifestations of the COVID19 in children and as such the common notion that COVID19 does not affect children has been effectively dispelled.
“Recent evidence suggests that children likely have the same or higher viral loads in their nasopharynx compared with adults and that children can spread the virus effectively in households and camp settings,” the guidance states.
Transmission of the virus to and among children may have been reduced in spring and early summer due to mitigation measures like stay-at-home orders and school closures, the CDC says. https://edition.cnn.com/2020/08/15/health/us-coronavirus-saturday/index.html
Juxtapose this with the fact that even if children generally do not come down with the severe form of COVID19 as commonly as adults, the school community is made up of ADULTS (and even elderly) teachers and administrators who may bear the brunt of getting infected from an asymptomatic child that carries the virus to school. This is not to forget that children have ADULT parents who interact closely with these children and can become the final victim of an asymptomatic COVID-19 carrier.
Therefore, despite the need for a swift return to school of the children, an improperly planned (and prepared) return to school can lead to a disaster of unimaginable proportions.
Re-opening schools and learning centres therefore requires a very careful, painstaking, meticulous and comprehensive process that involves among others;
A. An immersive and synergistic engagement of ALL stakeholders in the school community (including pupils/students, teachers, administrators, parents, service providers, and regulators) to build capacity for a School Health “Community Centred Care”;
B. Building of a National School Health Network (mediNet).
C. The Development of a Comprehensive, Responsive and Safe School Health Service.
#Back2SchoolHealth will try to provide a framework that takes cognizance of these detailed guidelines and endeavors to recommend practices that implements all elements of an effective Back to School Strategy with the intention of guiding all members of the school health community on a safe and effective return to school of the children.
Community – Centred Care.
The most important distinction to make on a back to school strategy for this season is that the risks, complexities and comprehensiveness of an effective back to school strategy makes it imperative that all members of the School Health community (Students/Pupils, Parents, Teachers, Administrators, Regulators, International Agencies) must be actively involved in the research and development, design, implementation, risk management, monitoring and evaluation of a safe, effective, all-inclusive, back-to-school strategy.
To best serve all students through a time of stress and uncertainty, schools will need inclusive decision-making processes that leverage the critical insights of those from the full community. They will need to form a coalition that includes representation from educators, mental health professionals, community partners, families, and students to develop a plan for rebuilding safe, supportive, and equitable environments that provide robust opportunities for social, emotional, and academic learning in the multiple spaces students grow and develop (e.g., after-school, Head Start, and summer programs). It is important to ensure that coalitions include members from historically marginalized groups, including those impacted deeply by events during school building closures.
A broad coalition of diverse stakeholders will help set a vision for reuniting and renewing the school community, communicating the importance of SEL and supporting learning environments, identifying core goals that resonate across the community, and guiding implementation of a plan that will meet all students’ needs.
Strategies of engaging the School Health Community includes;
i. Building a virtual school health community using platforms like email, Instagram, WhatsApp or Facebook.
ii. Conducting periodic conferences where current local/international evidence are used to educate the school health community on current practices locally and internationally.
iii. Having a School Health Committee made up of representatives of all the stakeholder groups (Students/Pupils, Parents, Teachers, Administrators, Regulators, International Agencies) that considers these evidences and uses them to chart an effective back-to-school strategy.
iv. Continuously carrying along ALL members of the school health community through WhatsApp posts, Facebook posts, podcasts, email newsletters.
v. Actively stimulating feedback from the community, graciously accepting these feedback, acting on tem, demonstrating action and reverting to the community what has been done with the feedback.
School mediNet – Building the National School Health Monitoring Infrastructure.
There now must be massive investments in building NATIONAL (even INTERNATIONAL) Capacity for managing school health. The COVID-19 pandemic has demonstrated that “the virus anywhere, threat to health everywhere”. The National School Health Infrastructure must include:
I. A School Health Committee made up of representatives of all stakeholders in the School Community. This Committee will serve as a local monitoring organization to evaluate the implementation of all policies dictated by the school, local, national or international agencies.
ii. An Electronic Medical Record of all pupils/students of these schools with a summary medical record on a School Health Portal that is accessible to key authorized stakeholders. This can ensure that a case of COVId-19 in any School can quickly be detected and appropriate measures taken to isolate the pupil/school to protect the larger community.
Iii. State School Health Monitoring Task Force that is composed of public (and private agencies contracted by the State Healthcare Monitoring Agency) and carries out periodic inspections of all schools in the state to ensure compliance with all components of the State Policies and Guidelines. This taskforce will report findings to the State Ministry of Health which will take all disciplinary actions (up to and including the close down of a school when necessary) to whip erring schools into line.
IV. A National School Health Technical Committee that continually studies the National “State of Affairs” and evaluates this vis-à-vis current evidence locally and internationally, and implements intervention measures as it deems fit based on evidence.
V. A National Database of ALL Schools and Learning Centres with a summary of the Key Performance Indicators for each School maintained and updated daily. This should be displayed by a National Dashboard Visible to all Stakeholders (Nationally and Internationally).
The Safe School Service.
- Learning from home.
Federal, state and local governments should take responsibility for ensuring learners are “safe to learn at home.” It is important that all learners participate in an inclusive arrangement, irrespective of their locations, access to the internet, and socio-economic background. Further, that they are also safe to learn regardless of the type of distance learning they engage in. This involves, for example, sharing public health messages about COVID-19, including its symptoms, how it is transmitted, and how to prevent transmission. Furthermore, the impact of COVID-19 means that more learners are online, which leaves them vulnerable to risky online behavior, cyber-bullying, sexual exploitation, and other cyber threats. It is recommended that, for children, continuous child-friendly messaging using infographics, cartoons, animations, and so on that show how to protect themselves should also be available in their learning packages.
- Social Distancing.
In schools and other learning facilities, learners should be supported to stay two meters apart. However, there are exceptions where the two-meter rule cannot be reasonably applied and other risk mitigation strategies may be adopted. Examples include early years, younger primary school children, and those with additional needs. In these circumstances, risk assessments must be undertaken with the best interests of the learners, teachers, and other education personnel in mind. The scenarios require organizing learners and children into small groups with consistent membership and compliance to the risk mitigation strategies. The membership of these groups should not change unless the NCDC public health guideline suggests otherwise. The safety and hygiene measures outlined in this document should, as in all cases, be followed carefully. It is imperative that safe distancing between adult staff working with such groups be maintained.
Alternative Models of Learning Should be incorporated Such As:
- Outdoor Learning.
- Staggered Attendance.
- Alternate Attendance.
- Platooning.
- Decreased Interaction.
- Flexible Schedules.
- Creative Delivery.
C. Mask Mandate
Current Guidelines from the WHO on Children wearing mask is as follows:
Children aged 5 years and under should not be required to wear masks. This is based on the safety and overall interest of the child and the capacity to appropriately use a mask with minimal assistance.
WHO and UNICEF advise that the decision to use masks for children aged 6-11 should be based on the following factors:
- Whether there is widespread transmission in the area where the child resides.
- The ability of the child to safely and appropriately use a mask.
- Access to masks, as well as laundering and replacement of masks in certain settings (such as schools and childcare services).
- Adequate adult supervision and instructions to the child on how to put on, take off and safely wear masks.
- Potential impact of wearing a mask on learning and psychosocial development, in consultation with teachers, parents/caregivers and/or medical providers.
- Specific settings and interactions the child has with other people who are at high risk of developing serious illness, such as the elderly and those with other underlying health conditions
WHO and UNICEF advise that children aged 12 and over should wear a mask under the same conditions as adults, in particular when they cannot guarantee at least a 1-metre distance from others and there is widespread transmission in the area.
D. Safety and Hygiene.
- Disinfect and fumigate facilities, including hostel accommodation; particular attention given to those used as temporary isolation and treatment centers and for other purposes during the pandemic .
- Ensure a School COVID-19 Referral System, including protocols and procedures to take if learners, teachers, administrators, and other education personnel become unwell while in schools Develop detailed protocols and provide facilities and measures for the maintenance of two-meter safe distancing to comply with NCDC guideline.
- Develop detailed protocols and provide facilities to establish and maintain prescribed hygiene standards and practices, including WASH, hand washing, access to adequate gender-segregated toilet facilities, cross-ventilation of class rooms and hostel accommodation, use of face masks, proper food preparation and handling as well as disposal of wastes.
- Sensitize, train, and build capacity of teachers, administrators, and other education personnel to effectively use and comply with the School COVID-19 Referral System and protocols for safe distancing and hygiene in schools.
- Set up school hygiene committees with designated hygiene champions to monitor and promote compliance.
E. The School-Based Health Centre (SBHC) and Referral System.
The complexities, depth, and breadth of the engagements, service development and delivery, risk management, research and development, monitoring and evaluation, and continuity of care that is needed to conceptualize, deploy and manage effectively and efficiently, a Safe School System, post COVID-19 is not one that any School can mange on its own. The need to have a School Based Health Centre with a properly trained and monitored School Nurse is critical to the assurance of the much needed quality. A School Based Health Centre with a School Nurse will;
- Educate and Engage the School Community on the School Back to School Strategy.
- Ensuring the availability of an Effective School Health Facility with the appropriate equipment and consumables.
- Organize a questionnaire-based screening of all members of the School Community (Students/Teachers/Administrators) before each member is allowed into the School environment.
- Continuously monitor the state of health of all members of the community and carry out necessary interventions up to and including referrals when necessary.
- Monitor closely the health of vulnerable members of the community (e.g. children with chronic diseases like asthma/diabetes/sickle cell disease, of children with special needs) and ensure appropriate precautions are taken to prevent them from being exposed to the virus. This is because current evidence shows that individuals with underlying medical conditions are very prone to the severe form for the COVID-19 infection.
- Liase with a Medical Centre with a licensed medical professional for continuity of care as need be.
- Liaise with all public health agencies for notification as stipulated.
Summary and Conclusions
As much as it is imperative, due to the multiple risks that children are facing out of school, to reopen the schools as much as possible, a hasty, rushed and improperly rushed resumption can only lead to disaster. A word as they say is enough for the wise.
Finally “On an occasion like this, it becomes more of a moral duty to speak one’s mind. It becomes a pleasure”.
Dr. Segun Ebitanmi read Medicine in the Ahmadu Bello University Zaria and finished in the late 90s. He started one of Nigeria’s first Medical Software Companies, Synapses as founder and pioneer Managing Director. He has supervised implementation of Medical Software projects from Private Hospitals up to and including Teaching Hospitals. In running Outreach Hospitals as Chief Operating Officer he has managed the rapid growth and expansion of the hospitals to become one of the top ten (10) hospitals, winning multiple awards in the process. As an astute aficionado of Modern Information Management Systems Thinking his passion is to deliver a sustainable, impact driven health system that transforms lives of 100m Nigerians.