Ayushman Bharat School Health and Wellness Programme has less than 50% uptake

Almost three years after its implementation, with a robust syllabus from NCERT, less than half of India’s States have started weekly classroom sessions with students

Only a few schools have been efficient in setting aside time for programmes on health and nutrition for children. | Photo Credit: The Hindu

It has been nearly three years since the School Health and Wellness Programme was launched under the Ayushman Bharat scheme, and so far only 15 of India’s States – less than half – have started weekly 40-minute classroom sessions with students, official sources from the Union Health Ministry told The Hindu.

A crucial cog in implementing the programme for middle, secondary, and senior secondary grades across government and government-aided schools are Health and Wellness Ambassadors (HWAs). Two teachers, preferably one male and one female, in every school, are to be designated as HWAs, says the National Health Mission website. They are meant to be trained at the State-level, to impart health promotion and disease prevention information in a joyful and interesting manner, according to the operational guidelines of the Ministry.

Until December 2022, only 71 of 766 districts have achieved 100% HWA training targets, according to Ministry data. Only four States and UTs – Andhra Pradesh, Sikkim, Chandigarh, Dadra and Nagar Haveli – have achieved 100% coverage. Some States are on the road to achieving targets, like Rajasthan (99%), Uttarakhand (97%), and Haryana (92%).

“In 2022-23, over 300 districts have been targeted to be covered across 36 States and UTs,” a senior health ministry official said.

In States like Chhattisgarh and West Bengal, the number of HWAs trained is at 8% and 9% respectively. States like Uttar Pradesh (29%), Karnataka (31%), Andaman and Nicobar Islands (32%) and Madhya Pradesh (34%) have also not met training targets.

The Health Ministry is facing various challenges in implementing the programme. One major hindrance is that teachers at government schools are overworked. In Delhi for instance, the Health and Wellness Programme syllabus is in addition to the Happiness Curriculum, Desh Bhakti Curriculum, and Entrepreneurship Mindset Curriculum that schools are already implementing.

“Moreover, not all States have set aside the weekly time slot in the classroom schedule to conduct these programmes. There is currently no formal reporting structure or accountability to ensure that the syllabus is implemented,” said a State Programme Officer working with the Department of Health in Delhi.

The challenge is conducting adequate teacher training programmes while maintaining quality. “In most schools it is viewed as an additional activity and teachers who are on the verge of retiring are allocated the HWA responsibility. They may not be interested in taking classes,” the officer added.

The syllabus, designed by the National Council of Educational Research and Training (NCERT) in conjunction with the Ministry of Health and the Ministry of Human Resource Development (HRD) covers 11 core themes including managing emotional and mental health, navigating interpersonal relationships, and promoting the safe use of internet and social media.

While the Ministry of Health wishes to impart education about biological and emotional wellbeing, it is reluctant to use the word sex. “In multiple iterations of the syllabus, drafts of which went to and from the Health Ministry to the HRD Ministry and NCERT, the word ‘sex,’ was systematically removed as it was considered to be a taboo. Instead, we have called it life skill-based education,” the official added.

Teacher handbooks are the main instrument for implementation of the curriculum, with the HWAs guiding classroom discussions and role-play. The syllabus uses an algorithmic approach, with tools such ‘OLA: Observe, Listen, Ask’ for students to help navigate conversations. There are also management-based problem-solving techniques, putting the power into the hands of students, by helping them see choices, challenges, and possible consequences. Students are encouraged to discuss feelings through the process, while involving classmates, who create a safe space for them to have conversations.

One of the case studies describes a situation where a boy in class 11 expresses his love for a girl through a card he sends her. She is confused, because she wonders if their friendship will survive if she does not respond to his advances. The class is asked to hold space for her, while she makes her decision. Students are exposed to approaches in dealing with conflict like anger, avoidance, pretending to ignore, attacking, and are encouraged to work together to find a solution.