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Health Promotion in South African Schools: Protecting Our Future Generation

Importance of Health Promotion in Schools

The population group of children and adolescents should be targeted and prioritized when it comes to behavioral interventions. Due to possessing higher adaptability rate and increased likelihood that they can motivated for healthier choices towards forming healthier lifestyles. There is a need for conducive policies and programs to create behavioral changes and children should be provided with a supportive environment where they are to live, play and study. 

Schools are ideal settings to model, promote and reinforce healthy behaviors among children and adolescents.  We need to develop and implement interventions that are culturally appropriate, specific for the various health situations, and relevant target groups. If we are to be successful in a sustainable health promotion approach, then a multidisciplinary collaboration is required (Macnab et al., 2010)

Overview of Current Perspectives & Practices

There is a heightened cause for concern of emerging non-communicable diseases which is affecting the current health status of the people in Africa. The practice of proper diet, physical activity, and prevention of alcohol and tobacco use, are of top priority to achieving improved health outcomes. In the earlier stages of a person’s life, they have the potential to be able to prevent future diseases from occurring. The Ottawa Charter for Health Promotion and the Jakarta Declaration guided the formation of the WHO Global School Health Initiative, launched in 1995. This initiated the creation of Health Promoting Schools (HPS) that focus on ‘constantly strengthening its capacity as a healthy setting for living, learning and working’. The HPS initiative works to link family and community to the school, and the whole spirit and atmosphere of the school is considered. This includes focus on the attitudes of the staff members, type of management and policies in place that determine health outcomes of the students (Dukhi &Srinivas, 2014).

Some Notable Initiatives Thus Far

In the Eastern Cape Province of South Africa, there are currently 180 schools following the World Health Organization’s Health-Promoting School Initiative emphasizing the Alma Ata’s holistic ‘health for all’ ideals. The WHO’s ‘Right to health’ along with South Africa’s Bill of Rights have remained important in making paper-based progress. In keeping mind to promote healthy living to the population and training them to prevent non-communicable diseases is achievable in a feasible manner if there is a strategic focus in Health promoting schools in South Africa. The participation from the community and organizations of the women the youth population are vital in implementing Health promoting schools in South Africa. The stakeholders in the Department of Health, Department of Education and community engagement services of Universities, have cooperated and supported with the resources at their disposal  (Dukhi &Srinivas, 2014).

The Umthathi Training Project (UTP)

A non-governmental organization (NGO) is operating in Grahams town, of the Eastern Cape region of South Africa, and they are providing education and developmental training focusing in organic cultivation methods. Their three main objectives are: agriculture, community development and school gardens. The members of the community are given training on acquiring knowledge and skills for cultivation, nutrition and livelihood. This will enable them to grow their own food and feed their families, and if they produce enough, they can then sell these to generate income for themselves. The school gardens program and the school feeding scheme is managed and supported by the vegetables grown in the school gardens. The students are taught to transfer these skills to their respective family members and community. The school follows a three-year program in part for their school garden project where lessons are taught which include Perm culture gardening. In addition to this, business, and leadership skills in accordance with health and nutrition, are taught to the students. During the 2008–2009 period, 45 schools, of which 20 were in the local area and 25 in the outlying areas, participated in the program, with various other schools enrolled in the first phase of the program during 2010 (Umthathi Africulture Project, 2007).

School health nurses in the Tshwane district, South Africa

The Integrated School Health Program (ISHP) is a full package initiative which consists of integrated learning involving learners, educators, parents, and other stakeholders. They were always ensured to enable learners to benefit from the initiative. The ISHP serves as a guide for the school health nurses in the provisioning of school-based health promotions. School-based health promotions are a legal requirement as a guide for the school health nurses in the provision of school health services. General testing included conducting visual and basic hearing tests and regular measurements of height, weight and body mass index (BMI), looking for fine and gross motor skills problems. Oral health checks and screening for chronic illnesses or long-term health conditions. The Department of Health and Basic Education emphasizes that school health nurses are also required to perform various tests including basic mental health or psychological risk assessment including mouth, dental and ear screening (Dibakwane & Peu, 2018).

Two School-Based Smoking Prevention Programs among South African High School Students

Life Skills Training (LST) Intervention

Grades 8 and 9 school children are preferred for the LST curriculum, comprising of 8 units, where students are provided with individual workbooks, and an educator’s manual is provided to the teachers. There are a range of topics and contents that are covered in this and includes: building general, and substance use specific life skills including decision making, stress management, affect management, assertive communication, and resisting peer pressure(Resnicow et al., 2008).

HARM Minimization Intervention, aka KEEP LEFT

Like the LST program, the KEEP LEFT has identical curriculum and unit numbers for each of grades 8 and 9 and students were also provided with a workbook and teachers were provided with an educator's manual.                                                                                                       Through a decision-making framework, it addresses physical, social, and psychologic harms associated with tobacco and other drug use and provides direction on how to reduce and prevent further use of such substances. Moving to the LEFT, which means reducing risk is beneficial, and should be implemented at all levels of use, using continuum of risk. For the persons who have initiated use, prevention methods focused on intervening addiction risks, reducing consumption, and ultimately quitting. Pertaining to different contexts where regarding the cues for smoking by the youth, some may smoke in the company of friends at parties, or others may just be solitary smokers, to take as examples. Thus the KEEP LEFT program provides divisive strategies to reduce frequency, intensity, addiction to smoking, with the long-term goal in mind for complete cessation (Resnicow et al., 2008).

A Way Forward

The cases and programs being developed in South Africa, show us the way forward in how to successfully promote, implement and sustain health-promoting school environments. There are already existing institutions that support and integrate their schools with healthy lifestyle approaches and practices. 

Some important lessons and takeaways we can learn from existing programs to offer space and flexibility for the local communities to facilitate the initiative and there is need for support from the technical teams in the provinces and management teams in schools. Cross-sectoral integration and the achievement of process objectives are also a key part of evaluating such initiatives. 

The Health-Promoting Schools initiative in South Africa calls for continuous support from the government resources, consistent training to school staff and basic tools to monitor health outcomes of the students. The role of parents and learners is not well reported in available documents and was noted by practitioners to consider further attention and information collection.

 It is always a good idea to find a common language between students, teachers and school nurses, using a holistic concept of health including social, psychological, spiritual and environmental dimensions, to be able to sustain the important knowledge about health and wellbeing.

Bio of Author:                                                                                                                                      

Rafayat Ahamed is a Health Sciences student at SFU and wants to pursue a career in epidemiology and health promotion education. His hobbies are listening to music and hiking mountain trails. 


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