WHO guideline on school health services

Recommendation
Comprehensive school health services should be implemented.

Strength of recommendation: strong. Certainty of evidence: moderate.

Rationale: this recommendation is strong because:
• all evidence consistently points in a beneficial direction, including evidence related to acceptability and equity;
• the evidence suggests that – if school health services are implemented well – they will have lasting benefits for students;
• the overall certainty of the evidence in the systematic reviews is moderate;
• although there were no studies in low- and middle-income countries that provided highcertainty evidence, the observational studies that took place in low- and middle-income countries also identified benefits and did not identify significant harms; and
• schools offer a compelling, broad and relatively convenient opportunity to reach children and adolescents with needed comprehensive health services.

Implementation considerations
• This recommendation is for comprehensive school health services that have adequate resources and are implemented well.
• School health services need to be implemented with quality, fidelity and over the long term. The resource implications must be carefully identified, examined and met.
• In practice, implementation will be variable.
In some settings it may be difficult and/or not yet feasible to implement comprehensive school health services similar to those that the systematic reviews found were evaluated in controlled studies in high-income countries. Substantial resources, time and leadership may be needed to achieve this. In many low- and middle-income countries it may nonetheless be feasible to implement some aspects of comprehensive school health services now, even if not yet all aspects.
• Protecting student confidentiality is paramount, and school health workers are also obliged to prevent possible discrimination or stigma towards students.