From ‘stepchild of primary healthcare’ to priority programme: Lessons for the implementation of the National Integrated School Health Policy in South Africa

Maylene Shung-King


In this article, I explore the South African 2003 National School Health Policy (NSHP) and the revised 2012 Integrated School Health Policy (ISHP). I examine whether the shortcomings in the development, content and implementation of the 2003 NSHP, and the context in which it was implemented, have been addressed adequately in the 2012 ISHP. The shortcomings include poorly structured relationships among key policy actors; an absent policy translation process resulting in insufficient understanding and prioritisation of school health by district and facility managers; and poor support and training of nurses. Insufficient capacity and resources, compounded by inadequate referral service capacity, resulted in the inequitable coverage and quality of the service and caused nurses to refer to school health as ‘the stepchild of primary healthcare’. The comparison of the 2003 and 2012 policies is guided by the policy analysis framework of the Walt and Gilson policy triangle, which considers the policy context, process of policy development, policy actors and the policy content as key dimensions to successful policy development and implementation. I draw on an evaluation of a six-year implementation period (2003 - 2009) of the 2003 NSHP, which revealed the implementation challenges with the related explanatory factors. I provide lessons from the evaluation of the 2003 NSHP, highlight the policy changes in the new 2012 ISHP and finally highlight key opportunities, and remaining challenges, for the implementation of the new 2012 ISHP. 

Author's affiliations

Maylene Shung-King, Health Economics Unit, School of Public Health and Family Medicine, University of Cape Town, South Africa

Full Text



school health; policy analysis; service development; 2003 National School Health Policy; 2012 Integrated School Health Policy

Cite this article

South African Medical Journal 2013;103(12):895-898. DOI:10.7196/SAMJ.7550

Article History

Date submitted: 2013-09-26
Date published: 2013-10-02

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