Problems and prospects of implementing the health promoting schools concept in northern Nigeria

Issue addressed: This paper examines the problems and prospects of implementing the health promoting schools (HPS) concept in government primary schools and Koranic training schools in northern Nigeria. Method: A HPS pilot project, documented as a case study, was initiated in four schools in northern Nigeria in January 1996, but found to be unsustainable by April 1997. An analysis of factors contributing to this unsustainability was then undertaken. Results: This paper highlights the limitations experienced in the implementation of the HPS concept in northern Nigerian society. The barriers appear to arise primarily from social, cultural, political and economic factors that form the context within which the project was initiated. A poorly developed health and education infrastructure, the low priority accorded health education and chronic underfunding have led to a markedly unsupportive environment for health. The initiation of such public health interventions as hookworm chemoprophylaxis seemed to offer the best of possible entry points, since this noticeably facilitated collaboration with even the most uncooperative stakeholders. Conclusions: Attempts to implement the HPS concept in public and Koranic training schools in northern Nigeria are bound to fail unless the prerequisites for its implementation are put in place. Such a move requires radical changes in the economic, health and education sectors. In the interim it is suggested that appropriate entry points be utilised to facilitate and maintain collaboration with other stakeholders. So what? The paper highlights strong links between health promotion on one hand and religion, culture and socioeconomic determinants of health on the other, and shows how the generalisability of a given health promotion initiative may be constrained or facilitated by economic and sociological factors. (author abstract)