From Vision to Reality Assessment of School Health Programmes in Public Primary Schools in Ibrahim Kodbur District Hargeisa Somaliland to Advance SDG 3.8 and 4.1

From Vision to Reality Assessment of School Health Programmes in Public Primary Schools in Ibrahim Kodbur District Hargeisa Somaliland to Advance SDG 3.8 and 4.1 | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article From Vision to Reality Assessment of School Health Programmes in Public Primary Schools in Ibrahim Kodbur District Hargeisa Somaliland to Advance SDG 3.8 and 4.1 Omar M. Omar, Sundus K. Abdi, Yasmin Abdirahim Mohamed, Khader Ahmed Hassan, and 9 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7686740/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background The School Health Program (SHP) plays a pivotal role in safeguarding student health and supporting academic achievement. Despite its global significance, limited data exist regarding SHP implementation in Somaliland. This study provides the first comprehensive assessment of SHP in public primary schools within the Ibrahim Kodbour district of Hargeisa. Methods A cross-sectional descriptive study was conducted in all three public primary schools in Ibrahim Kodbur, Hargeisa, Somaliland. Data were collected using an interviewer-administered observational checklist based on WHO and UNICEF frameworks, assessing four components: healthful school environment, school feeding services, skill-based health education, and school health services. Scores were computed and categorized as poor (0–49%), fair (50–59%), or good (60–100%). Descriptive statistics were generated using SPSS version 21. Results The overall mean SHP score was 50.4/127 (47%), indicating poor implementation. Healthful environment scored moderately (mean: 46.8%), while school feeding services (3.6/11) and school health services (9/26) were suboptimal. Skill-based health education was completely absent across all schools (0/17.5). Only two schools had health personnel, and none conducted routine health screenings or had fully equipped sickbays. Sanitation infrastructure relied entirely on pit latrines, with no sewage systems in place. Conclusion SHP implementation in the studied schools is inadequate, with critical gaps in health education, feeding programs, sanitation, and healthcare services. Targeted interventions, including personnel training, infrastructure improvement, and policy enforcement, are urgently needed to promote student health and educational success in low-resource settings. Figures Figure 1 Introduction Schools and school systems present an astonishing chance to connect with kids who require medical attention(1). The World Health Organization encourages school health programs as a tactical way to reduce significant health risks for young people and to involve the education sector in initiatives to alter the political, social, educational, and economic factors that influence risk (2). Health education, physical education, health services, nutrition services, counseling, psychological, and social services, a healthy environment, school-site health promotion for staff, and family and community involvement are the eight elements of the Coordinated School Health Program, which aims to promote health in schools (3). The School Health Program (SHP) is a vital part of the overall healthcare delivery system in any country. Next to the family, the school is the primary institution responsible for the development of young people all over the world. The school has direct contact with more than 95 percent of the nation’s young people aged 5–17 years, for about 6 hours a day, and for up to 13 critical years of their social, psychological, physical, and intellectual development (4) The WHO Global Health Estimates state that there is a severe need for health promotion, preventive, and health care services for children and adolescents based on global data on their mortality and morbidity (5) It is impossible to overestimate the importance of a School Health Program (SHP) in a developing nation like Nigeria, where baby and early childhood death rates are startlingly high. Schools are the main institutions in charge of young people's development worldwide, second only to the family. However, research among head teachers in the southwest region shows that the SHP in Nigeria is still severely underdeveloped, especially in public primary schools and rural locations (6). As same as in Ethiopia over the last twenty years, many educational facilities have been constructed across the nation, but several communicable, nutritional, and congenital health problems are prevalent among school children. As an example, one the studies in this issue of EJHS revealed that more than 25% of school-age children had active trachoma. School health program help address these basic health needs of these children (2) Despite the recognized importance of School Health Programs (SHPs) globally, and no prior study has assessed SHP in Somaliland and there is no similar study conducted; thus, the main aim of this study was evaluating the school health program in public primary schools in Ibrahim Kodbur district, Hargiesa, Somaliland. Therefore, this study focuses on filling this gap by examining the current state of health services in these schools. This research will provide valuable insights that can inform policy and practice, ultimately contributing to the improvement of student health and educational outcomes in the region. The objective of this study was to assess the services and facilities provided for the SHP in public primary schools in Ibrahim Kodbur District in Hargeisa, Somaliland. The study assessed the following areas: healthful school environment, the school feeding services, the skill-based health education facilities, and the school health services in public primary schools in Ibrahim Kodbur District, Hargeisa, Somaliland. Methods Study area The study was conducted in Hargeisa, the capital and largest city of Somaliland, situated in the Maroodi-Jeh region in the northwest of the country. Hargeisa lies at about 1,334 meters above sea level in the Galgodon (Ogo) highlands, giving it a relatively mild climate compared with other Somali cities. Administratively, the city is divided into several districts, including Ibrahim Kodbur, which was the specific focus of this study. Hargeisa is also the political, economic, and educational center of Somaliland, with a population estimated at between 1.2 and 1.5 million people. These characteristics make it a suitable setting for examining the implementation of School Health Programmes (7, 8). Study design and period A descriptive cross-sectional survey was conducted from February to March 2025. Sampling method The district was selected purposively based on school size, accessibility, and willingness to participate. There are three public primary schools in the Ibrahim Kodbour district, Hargeisa, Somaliland, and all three public schools in the district were included in the study. Data collection method The study instrument was a validated observational checklist adapted from (6). We interviewed using a self-administered technique, only with school administrations (principals, head teachers, and deputies), the students and other staff members were excluded. The checklist consisted of the following sections: demographics, questions to assess a healthful school environment (72.5 points), school feeding services (11 points), skill-based health education (17.5 points), and school health service (26 points). The total score obtainable was 127 points. Upon completion, the scores for each school were summed up, and the percentages computed. A score of 0-49% was poor, 50-59% fair, and 60-100% good. Data analysis SPSS version 27 was used for analysis, and summarized using descriptive statistics. Data was presented using frequency tables and a chart. Results introduction Three head teachers from all three schools participated in the study. The schools were established between 1991 and 2002. The student populations in the schools ranged from 1020 to 1613 with 22 to 38 teaching staff and two to four non-teaching staff per school. Healthful school environment: At all three schools, wearing shoes was compulsory for students and staff. Only 1 school had a plain grass sports field for soccer. The other 2 schools didn't have any sports playground. Only one (33.3%) of the schools had a wash hand basin available in front of the toilet, and all schools had stored water available. One school got its water supply from borehole facilities outside the school. Two schools had a tape water facility present. All schools (100%) had waste bins available, but none of the schools had any dustbins in the classrooms. One of the schools had waste bins in the classes made from a used Jerry can. Open dumping was the refuse disposal method practiced by all the schools. Table 1: sewage and toilet facilities Variables Frequency (n=3) Percentage Availability of sewage disposal 0 3 0 100 Type of toilet facility water closed/septic tank Pit/trench 0 3 0 100 Gender differentiated toilets Available Not available State of toilets and toilet area Good Fair Poor 2 1 1 1 1 66.7 33.3 33.3 33.3 33.3 All three schools included in the study had some form of toilet facility available. However, none of the schools had sewage disposal systems in place. Regarding the type of toilet facilities, all three schools (100%) used pit latrines or trench toilets, with no school having a water-closed or septic tank toilet system. Gender-differentiated toilets were present in two of the three schools (66.7%), while one school (33.3%) did not have separate toilet facilities for boys and girls. In terms of the condition of the toilets and surrounding areas, the situation varied across the schools. One school (33.3%) had toilets in good condition, another had toilets rated as fair (33.3%), and the third school had toilets in poor condition (33.3%). This indicates significant disparities in hygiene and maintenance of toilet facilities among the schools (see Table 1). In Figure 1, all the schools (100%) had buildings with strong walls and roofs, reflecting good structural integrity. However, none of the buildings were equipped with fire-resistant materials, indicating a gap in fire safety preparedness The floor conditions were favorable in all three schools (100%), with flat and non-glossy surfaces that reduce the risk of slips and falls. Similarly, ventilation was found to be both adequate and controllable in all schools, ensuring a healthy indoor air environment. Lighting was uniformly good across the schools (100%), providing a conducive learning atmosphere. With regard to ceiling insulation, all schools (100%) had properly ceiled classrooms, which contributes to thermal comfort and reduced noise intrusion. In terms of seating comfort, all schools (100%) had sufficient seating arrangements for both pupils and teachers, ensuring that everyone was properly seated during lessons, which is critical for attention and participation in learning (see figure 1). Table 2: health care system of the school Variables Frequency (n=3) Percentage (%) Personnel Available Not available 2 1 66.7 33.3 Type of personnel Health assistance/trained first aider Sickbay/clinic personnel 1 1 33.3 33.3 Routine health appraisal Conducted Not conducted 0 3 0 100 Treatment facilities Available Not available 1 2 33.3 66.7 Type of facilitate First aid Sickbay/clinic 1 1 33.3 33.3 The health care systems in three primary schools reveal significant shortcomings. Health personnel were present in two schools (66.7%), while one school (33.3%) had none. Only one school (33.3%) employed a health assistant or trained first aider, and there were no dedicated sickbay or clinic personnel in any of the schools. Additionally, routine health appraisals were not conducted, indicating a lack of structured health monitoring. Overall, the findings highlight critical gaps, emphasizing the urgent need to enhance health care infrastructure in primary schools by providing qualified personnel, implementing regular health assessments, and ensuring access to basic treatment facilities (see table 2). Table 3: quantitative assessment of school health program Component Maximum score obtained School 1 School 2 School 3 Mean Healthful school environment 72.5 54.5 53.5 32 46.8 School feeding services 11 4 4 3 3.6 Skill-based health education 17.5 0 0 0 0 School health service 26 14 13 0 9 Total score 127 72.5 70.5 35 50.4 Percentage (%) 100% 57% 56% 28% 47% From the quantitative assessment, the three schools evaluated had an average total score of 50.4 out of a possible 127, translating to 47% in the overall implementation of the school health programmer (Table 3) Healthful school environment: The mean score obtained across the three schools for a healthful school environment was 46.8% out of a maximum of 72.5. School 1 scored 54.5, School 2 scored 53.5, and School 3 had the lowest score of 32. This suggests a generally moderate level of provision for a healthful school environment, with School 3 lagging significantly behind the others. School feeding services: All three schools received the same score of 4 out of a possible 11, resulting in a mean score of 3.6. This indicates uniformity in the provision of school feeding services Skill-based health education: None of the schools assessed scored in this component, with all three schools obtaining 0 out of a possible 17.5. This reflects the complete absence of structured skill-based health education programs and supporting materials across the schools. School health services: There was a noticeable disparity in this component. School 1 scored 14, School 2 scored 13, and School 3 scored 0 out of a maximum of 26. The mean score was 9, indicating that while some schools had partial health service provisions, others had none at all, which significantly impacted the overall effectiveness of this component. Discussion This study assessed the status of School Health Programmes (SHPs) in public primary schools in Ibrahim Kodbur District, Hargeisa. The findings revealed substantial gaps in sanitation, feeding services, health education, and school health services. These deficiencies indicate that SHP implementation in the district is inadequate to protect pupil health and support educational achievement. An effective SHP is a crucial component of healthcare for children's overall development. The evaluation of sanitation facilities revealed that all schools relied exclusively on pit latrines, with no sewage disposal systems in place. Although some toilets were in fair condition (33.3%), the dependence on simple pit latrines raises significant health concerns (100%). Similar findings have been reported in Ethiopia and other African settings where pit latrines dominate school sanitation infrastructure ( 4 , 9 ). Such facilities often increase the risk of environmental contamination and faeco-oral disease transmission ( 2 , 9 , 10 ). In Hargeisa, the absence of sewage systems and limited investment in school WASH infrastructure may explain these conditions. Poor sanitation contributes directly to absenteeism, gastrointestinal infections, and reduced learning capacity ( 1 , 3 ) School feeding services were almost absent, with a mean of 3.6, with all schools scoring poorly on this component. Comparable gaps have been described in Nigeria ( 11 ). but this contrasts with countries like Kenya and Ethiopia, where structured national school feeding schemes are in place ( 5 , 12 ). Research demonstrates that school feeding improves enrolment, attendance, and performance( 12 – 14 ).The absence of such services in Hargeisa schools is likely linked to the lack of a national policy and reliance on household resources. Without school meals, children from food-insecure families may attend classes hungry, undermining concentration and academic progress ( 6 , 14 ). Perhaps the most critical finding was the complete absence of skill-based health education in all schools. This indicates that children are not being equipped with essential life skills related to hygiene, nutrition, and disease prevention. Similar weaknesses have been reported in Nigerian schools ( 15 ) found that health instruction was poorly implemented in Southwest Nigeria, while ( 16 ) reported limited training, poor teaching methods, and a lack of instructional aids in Bonny Local Government Area. The World Health Organization stresses that life skills–based health education is essential to foster positive health behaviours ( 17 ). Its absence in Somaliland leaves children vulnerable to preventable risks and limits their capacity to adopt lifelong healthy practices. The absence of routine health appraisals in all schools further reflects a neglect of essential health monitoring. School health services were also underdeveloped. Only two schools had any form of health personnel 66.6%, none conducted routine screenings, while one (33.3%) operated without any. Additionally, only one school (33.3%) employed a trained health assistant or first aider, and none had a dedicated sickbay, highlighting poor preparedness for health emergencies. This reflects trends observed in Nigeria, where many schools lack trained health staff and medical facilities( 11 , 18 , 19 ). Ethiopia has similarly highlighted the absence of organized SHPs in primary education ( 2 ). In Somaliland, weak collaboration between the health and education sectors may explain this gap. Without trained personnel and routine screening, schools are ill-prepared to manage emergencies or detect health problems early. Overall, the inadequate implementation of SHPs undermines both child health and educational outcomes. Poor sanitation and lack of services expose pupils to illness, while the absence of feeding and health education reduces attendance and learning performance. These deficiencies threaten progress toward SDG 3.8 , which calls for universal access to essential health services, and SDG 4.1 , which seeks inclusive and equitable quality education for all ( 20 , 21 ) The results highlight several policy implications. In the short term, schools should train teachers as first aiders, establish basic sickbays, and collaborate with NGOs to introduce feeding programmes. In the longer term, Somaliland requires a national SHP policy with clear funding mechanisms, integration of health education into the curriculum, and prioritization of WASH infrastructure. Such reforms are essential to ensure that schools contribute effectively to child health, development, and educational success. Conclusions This study assessed the status of School Health Programmes in three public primary schools in Ibrahim Kodbur District, Hargeisa. The findings showed that the programmes were poorly implemented across all key components. Sanitation facilities are limited, sewage systems are absent, and school feeding services are absent. Health education is not incorporated into the curriculum, and school health services are weak. This lack exposes children to preventable illnesses, undermines their learning capacity, and hinders their ability to manage emergencies. The study highlights the importance of improving the health environment in schools for achieving international commitments, such as Sustainable Development Goal 3.8 on universal health coverage and Goal 4.1 on inclusive, quality education. Immediate measures include training teachers in basic first aid, establishing simple sickbays, and piloting school feeding schemes. A comprehensive national School Health Programme policy is needed, supported by adequate funding, health education integration, and improved WASH infrastructure. Limitations This study is limited by its small sample size, focusing on only three primary schools in Ibrahim Kodbour district, Hargeisa, which may not reflect broader trends in Somaliland. Data collection could be subject to reporting biases from school staff, and the lack of longitudinal data restricts insights into the long-term impact of health services. Additionally, the study mainly assessed basic health services, excluding other aspects like mental health support and health education, and resource constraints may have led to incomplete participation or data collection. Declarations Acknowledgements We would like to acknowledge Dr Sa’ad Ahmed Abdiweli. For his invaluable guidance, support, and encouragement throughout this study. His expertise, insightful advice, and constant motivation played a pivotal role in the completion of this research. I am deeply grateful for his mentorship and for the time and effort he dedicated to helping me develop and refine this work. Conflicts of interest The authors have no conflicts of interest to disclose. Funding No funding in any form was received for this research. Ethical approval The study was conducted with informed consent from respondents. Ethical approval was obtained from the University of Hargeisa with Ref: CMHS/UoH/130-25, the center of research and community service Health committee, and permission was obtained from each school. Participation was voluntary, with benefits explained to participants, and no risks were involved. Clinical trial number: not applicable. Consent to participate Before the data collection, informed consents was obtained from the research participants to their participation. Participants were given fully informed the benefits, danger and any procedure or risks, their participation was voluntarily. Consent to publish All participants provided consent for their anonymized data to be utilized for publication. Any identifying information was removed. Data availability The datasets are available from the corresponding author on reasonable request. References Nordstrand MA, Saxe DS, Mohammed MA, Adam MB. Health and disease among Somali primary school children in Hargeisa. Global Health Action. 2019;12(1):1598648. Haileamlak A. The need for initiation of school health program in Ethiopia. Ethiop J Health Sci. 2013;23(1):vi. Kazemitabar M, Moghadamzadeh A, Habibi M, Hakimzadeh R, Garcia D. School health assessment tools: a systematic review of measurement in primary schools. PeerJ. 2020;8:e9459. Ademokun OM, Osungbade KO, Obembe TA. 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The Sustainable Development Goals Report. 2023. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7686740","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":539377549,"identity":"85b58a31-afcb-43ae-9217-194b41188b24","order_by":0,"name":"Omar M. 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Keise","email":"","orcid":"","institution":"Haramaya University","correspondingAuthor":false,"prefix":"","firstName":"Ahmed","middleName":"A.","lastName":"Keise","suffix":""},{"id":539377560,"identity":"8b2c1415-a263-43a6-b785-16b6bf8774a7","order_by":11,"name":"Mohamed Abdinasir Hashi","email":"","orcid":"","institution":"Haramaya University","correspondingAuthor":false,"prefix":"","firstName":"Mohamed","middleName":"Abdinasir","lastName":"Hashi","suffix":""},{"id":539377561,"identity":"0a1ceccc-8c12-4b66-abc2-43cb7c10ab07","order_by":12,"name":"Saad Ahmed Abdiwali","email":"","orcid":"","institution":"Pan African University Life and Earth Sciences Institute (including Health and Agriculture)","correspondingAuthor":false,"prefix":"","firstName":"Saad","middleName":"Ahmed","lastName":"Abdiwali","suffix":""}],"badges":[],"createdAt":"2025-09-23 01:24:30","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7686740/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7686740/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":95259625,"identity":"27b10780-2640-45e5-af9b-fbdd6f1a314d","added_by":"auto","created_at":"2025-11-06 04:08:39","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":76187,"visible":true,"origin":"","legend":"","description":"","filename":"FromVisiontoRealityAssessmentofSchoolHealthProgrammesinPublicPrimarySchoolsinIbrahimKodburDistrictHargeisaSomalilandtoAdvanceSDG3.8and4.1One.docx","url":"https://assets-eu.researchsquare.com/files/rs-7686740/v1/24dedffe255a2e12777cefeb.docx"},{"id":95259622,"identity":"0b50befd-8ec2-4159-ae96-6aa9aaf93173","added_by":"auto","created_at":"2025-11-06 04:08:38","extension":"json","order_by":1,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":13070,"visible":true,"origin":"","legend":"","description":"","filename":"91f751a87873442992267613bc5c593c.json","url":"https://assets-eu.researchsquare.com/files/rs-7686740/v1/d547e2a95551a616fd10d957.json"},{"id":95259624,"identity":"f57ca6f0-eeb8-47ef-934b-706fc4d69016","added_by":"auto","created_at":"2025-11-06 04:08:38","extension":"xml","order_by":2,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":69280,"visible":true,"origin":"","legend":"","description":"","filename":"91f751a87873442992267613bc5c593c1enriched.xml","url":"https://assets-eu.researchsquare.com/files/rs-7686740/v1/c815baccc1e8621e6b5ebc57.xml"},{"id":95259623,"identity":"389346c7-83fc-4bad-a162-d39063dab622","added_by":"auto","created_at":"2025-11-06 04:08:38","extension":"xml","order_by":4,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":65102,"visible":true,"origin":"","legend":"","description":"","filename":"91f751a87873442992267613bc5c593c1structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-7686740/v1/9d8b9f413731ed9dcb861cca.xml"},{"id":95259626,"identity":"ff143884-cf88-4aa4-b3ae-3f69c5c1faba","added_by":"auto","created_at":"2025-11-06 04:08:39","extension":"html","order_by":5,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":77905,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7686740/v1/28c496aa6caffba63377691b.html"},{"id":95259621,"identity":"6dca2623-baab-4657-8493-b94888643ab1","added_by":"auto","created_at":"2025-11-06 04:08:38","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":111084,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003einfrastructures\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7686740/v1/03bd4eb50b3dc8e1565d0b4f.jpg"},{"id":99321401,"identity":"945493e4-9c50-401f-b978-ef69966a0a32","added_by":"auto","created_at":"2025-12-31 16:39:23","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1142594,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7686740/v1/662b4667-d985-474f-be59-d0ee8534ad9d.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"From Vision to Reality Assessment of School Health Programmes in Public Primary Schools in Ibrahim Kodbur District Hargeisa Somaliland to Advance SDG 3.8 and 4.1","fulltext":[{"header":"Introduction","content":"\u003cp\u003eSchools and school systems present an astonishing chance to connect with kids who require medical attention(1). The World Health Organization encourages school health programs as a tactical way to reduce significant health risks for young people and to involve the education sector in initiatives to alter the political, social, educational, and economic factors that influence risk (2). Health education, physical education, health services, nutrition services, counseling, psychological, and social services, a healthy environment, school-site health promotion for staff, and family and community involvement are the eight elements of the Coordinated School Health Program, which aims to promote health in schools (3).\u003c/p\u003e\n\u003cp\u003eThe School Health Program (SHP) is a vital part of the overall healthcare delivery system in any country. Next to the family, the school is the primary institution responsible for the development of young people all over the world. The school has direct contact with more than 95 percent of the nation\u0026rsquo;s young people aged 5\u0026ndash;17 years, for about 6 hours a day, and for up to 13 critical years of their social, psychological, physical, and intellectual development (4)\u003c/p\u003e\n\u003cp\u003eThe WHO Global Health Estimates state that there is a severe need for health promotion, preventive, and health care services for children and adolescents based on global data on their mortality and morbidity (5)\u003c/p\u003e\n\u003cp\u003eIt is impossible to overestimate the importance of a School Health Program (SHP) in a developing nation like Nigeria, where baby and early childhood death rates are startlingly high. Schools are the main institutions in charge of young people\u0026apos;s development worldwide, second only to the family. However, research among head teachers in the southwest region shows that the SHP in Nigeria is still severely underdeveloped, especially in public primary schools and rural locations (6). As same as in Ethiopia over the last twenty years, many educational facilities have been constructed across the nation, but several communicable, nutritional, and congenital health problems are prevalent among school children. As an example, one the studies in this issue of EJHS revealed that more than 25% of school-age children had active trachoma. School health program help address these basic health needs of these children (2)\u003c/p\u003e\n\u003cp\u003eDespite the recognized importance of School Health Programs (SHPs) globally, and no prior study has assessed SHP in Somaliland and there is no similar study conducted; thus, the main aim of this study was evaluating the school health program in public primary schools in Ibrahim Kodbur district, Hargiesa, Somaliland. Therefore, this study focuses on filling this gap by examining the current state of health services in these schools. This research will provide valuable insights that can inform policy and practice, ultimately contributing to the improvement of student health and educational outcomes in the region.\u003c/p\u003e\n\u003cp\u003eThe objective of this study was to assess the services and facilities provided for the SHP in public primary schools in Ibrahim Kodbur District in Hargeisa, Somaliland. The study assessed the following areas: healthful school environment, the school feeding services, the skill-based health education facilities, and the school health services in public primary schools in Ibrahim Kodbur District, Hargeisa, Somaliland.\u003c/p\u003e"},{"header":"Methods ","content":"\u003cp\u003e\u003cstrong\u003eStudy area\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was conducted in Hargeisa, the capital and largest city of Somaliland, situated in the Maroodi-Jeh region in the northwest of the country. Hargeisa lies at about 1,334 meters above sea level in the Galgodon (Ogo) highlands, giving it a relatively mild climate compared with other Somali cities. Administratively, the city is divided into several districts, including Ibrahim Kodbur, which was the specific focus of this study. Hargeisa is also the political, economic, and educational center of Somaliland, with a population estimated at between 1.2 and 1.5 million people. These characteristics make it a suitable setting for examining the implementation of School Health Programmes (7, 8).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStudy design and period\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA descriptive cross-sectional survey was conducted from February to March 2025.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSampling method\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;The district was selected purposively based on school size, accessibility, and willingness to participate. There are three public primary schools in the Ibrahim Kodbour district, Hargeisa, Somaliland, and all three public schools in the district were included in the study.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData collection method\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study instrument was a validated observational checklist adapted from (6). We interviewed using a self-administered technique, only with school administrations (principals, head teachers, and deputies), the students and other staff members were excluded. The checklist consisted of the following sections: demographics, questions to assess a healthful school environment (72.5 points), school feeding services (11 points), skill-based health education (17.5 points), and school health service (26 points). The total score obtainable was 127 points. Upon completion, the scores for each school were summed up, and the percentages computed. A score of 0-49% was poor, 50-59% fair, and 60-100% good.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSPSS version 27 was used for analysis, and summarized using descriptive statistics. Data was presented using frequency tables and a chart.\u0026nbsp;\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003eintroduction\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThree head teachers from all three schools participated in the study. The schools were established between 1991 and 2002. The student populations in the schools ranged from 1020 to 1613 with 22 to 38 teaching staff and two to four non-teaching staff per school.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eHealthful school environment:\u003c/strong\u003e At all three schools, wearing shoes was compulsory for students and staff. Only 1 school had a plain grass sports field for soccer. The other 2 schools didn\u0026apos;t have any sports playground.\u003c/p\u003e\n\u003cp\u003eOnly one (33.3%) of the schools had a wash hand basin available in front of the toilet, and all schools had stored water available. One school got its water supply from borehole facilities outside the school. Two schools had a tape water facility present.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAll schools (100%) had waste bins available, but none of the schools had any dustbins in the classrooms. One of the schools had waste bins in the classes made from a used Jerry can. Open dumping was the refuse disposal method practiced by all the schools.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1: sewage and toilet facilities\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003eVariables \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 213px;\"\u003e\n \u003cp\u003eFrequency (n=3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 258px;\"\u003e\n \u003cp\u003ePercentage\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003eAvailability of sewage disposal\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 213px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0\u003cbr\u003e\u0026nbsp;3\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 258px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0\u003cbr\u003e\u0026nbsp;100\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eType of toilet facility\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003ewater closed/septic tank\u003c/p\u003e\n \u003cp\u003ePit/trench\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 213px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e0\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e3\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 258px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e100\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGender differentiated toilets\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eAvailable\u003c/p\u003e\n \u003cp\u003eNot available \u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003cstrong\u003eState of toilets and toilet area\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eGood\u003c/p\u003e\n \u003cp\u003eFair\u003c/p\u003e\n \u003cp\u003ePoor \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 213px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e2\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e1\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e1\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e1\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e1\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 258px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e66.7\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e33.3\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e33.3\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e33.3\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e33.3\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eAll three schools included in the study had some form of toilet facility available. However, none of the schools had sewage disposal systems in place. Regarding the type of toilet facilities, all three schools (100%) used pit latrines or trench toilets, with no school having a water-closed or septic tank toilet system.\u003c/p\u003e\n\u003cp\u003eGender-differentiated toilets were present in two of the three schools (66.7%), while one school (33.3%) did not have separate toilet facilities for boys and girls.\u003c/p\u003e\n\u003cp\u003eIn terms of the condition of the toilets and surrounding areas, the situation varied across the schools. One school (33.3%) had toilets in good condition, another had toilets rated as fair (33.3%), and the third school had toilets in poor condition (33.3%). This indicates significant disparities in hygiene and maintenance of toilet facilities among the schools (see Table 1).\u003c/p\u003e\n\u003cp\u003eIn Figure 1, all the schools (100%) had buildings with strong walls and roofs, reflecting good structural integrity. However, none of the buildings were equipped with fire-resistant materials, indicating a gap in fire safety preparedness\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe floor conditions were favorable in all three schools (100%), with flat and non-glossy surfaces that reduce the risk of slips and falls. Similarly, ventilation was found to be both adequate and controllable in all schools, ensuring a healthy indoor air environment.\u003c/p\u003e\n\u003cp\u003eLighting was uniformly good across the schools (100%), providing a conducive learning atmosphere. With regard to ceiling insulation, all schools (100%) had properly ceiled classrooms, which contributes to thermal comfort and reduced noise intrusion.\u003c/p\u003e\n\u003cp\u003eIn terms of seating comfort, all schools (100%) had sufficient seating arrangements for both pupils and teachers, ensuring that everyone was properly seated during lessons, which is critical for attention and participation in learning (see figure 1).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;Table 2: health care system of the school\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariables\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrequency (n=3)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePercentage (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePersonnel\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eAvailable\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eNot available\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e2\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e1\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e66.7\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e33.3\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eType of personnel\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eHealth assistance/trained first aider\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eSickbay/clinic personnel\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e1\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e1\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e33.3\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e33.3\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRoutine health appraisal\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eConducted\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eNot conducted\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e0\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e3\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e0\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e100\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTreatment facilities\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eAvailable\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eNot available\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e1\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e2\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e33.3\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e66.7\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eType of facilitate\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eFirst aid\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eSickbay/clinic \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e1\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e1\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e33.3\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e33.3\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eThe health care systems in three primary schools reveal significant shortcomings. Health personnel were present in two schools (66.7%), while one school (33.3%) had none. Only one school (33.3%) employed a health assistant or trained first aider, and there were no dedicated sickbay or clinic personnel in any of the schools. Additionally, routine health appraisals were not conducted, indicating a lack of structured health monitoring. Overall, the findings highlight critical gaps, emphasizing the urgent need to enhance health care infrastructure in primary schools by providing qualified personnel, implementing regular health assessments, and ensuring access to basic treatment facilities (see table 2). \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3: quantitative assessment of school health program\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"634\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eComponent\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMaximum score obtained\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;School 1\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSchool 2\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSchool 3\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHealthful school environment\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e72.5\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e54.5\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e53.5\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e32\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e46.8\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSchool feeding services\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e11\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e4\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e4\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e3\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e3.6\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSkill-based health education\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e17.5\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSchool health service\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e26\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e14\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e13\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e9\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal score\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e127\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;72.5\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e70.5\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e35\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e50.4\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePercentage (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e100%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e57%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e56%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e28%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e47%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eFrom the quantitative assessment, the three schools evaluated had an average total score of 50.4 out of a possible 127, translating to 47% in the overall implementation of the school health programmer (Table 3)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eHealthful school environment:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe mean score obtained across the three schools for a healthful school environment was 46.8% out of a maximum of 72.5. School 1 scored 54.5, School 2 scored 53.5, and School 3 had the lowest score of 32. This suggests a generally moderate level of provision for a healthful school environment, with School 3 lagging significantly behind the others.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSchool feeding services:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll three schools received the same score of 4 out of a possible 11, resulting in a mean score of 3.6. This indicates uniformity in the provision of school feeding services\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSkill-based health education:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone of the schools assessed scored in this component, with all three schools obtaining 0 out of a possible 17.5. This reflects the complete absence of structured skill-based health education programs and supporting materials across the schools.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSchool health services:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThere was a noticeable disparity in this component. School 1 scored 14, School 2 scored 13, and School 3 scored 0 out of a maximum of 26. The mean score was 9, indicating that while some schools had partial health service provisions, others had none at all, which significantly impacted the overall effectiveness of this component.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study assessed the status of School Health Programmes (SHPs) in public primary schools in Ibrahim Kodbur District, Hargeisa. The findings revealed substantial gaps in sanitation, feeding services, health education, and school health services. These deficiencies indicate that SHP implementation in the district is inadequate to protect pupil health and support educational achievement. An effective SHP is a crucial component of healthcare for children's overall development.\u003c/p\u003e\u003cp\u003eThe evaluation of sanitation facilities revealed that all schools relied exclusively on pit latrines, with no sewage disposal systems in place. Although some toilets were in fair condition (33.3%), the dependence on simple pit latrines raises significant health concerns (100%). Similar findings have been reported in Ethiopia and other African settings where pit latrines dominate school sanitation infrastructure (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). Such facilities often increase the risk of environmental contamination and faeco-oral disease transmission (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). In Hargeisa, the absence of sewage systems and limited investment in school WASH infrastructure may explain these conditions. Poor sanitation contributes directly to absenteeism, gastrointestinal infections, and reduced learning capacity (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e)\u003c/p\u003e\u003cp\u003eSchool feeding services were almost absent, with a mean of 3.6, with all schools scoring poorly on this component. Comparable gaps have been described in Nigeria (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). but this contrasts with countries like Kenya and Ethiopia, where structured national school feeding schemes are in place (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). Research demonstrates that school feeding improves enrolment, attendance, and performance(\u003cspan additionalcitationids=\"CR13\" citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e).The absence of such services in Hargeisa schools is likely linked to the lack of a national policy and reliance on household resources. Without school meals, children from food-insecure families may attend classes hungry, undermining concentration and academic progress (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e).\u003c/p\u003e\u003cp\u003ePerhaps the most critical finding was the complete absence of skill-based health education in all schools. This indicates that children are not being equipped with essential life skills related to hygiene, nutrition, and disease prevention. Similar weaknesses have been reported in Nigerian schools (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e) found that health instruction was poorly implemented in Southwest Nigeria, while (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e) reported limited training, poor teaching methods, and a lack of instructional aids in Bonny Local Government Area. The World Health Organization stresses that life skills\u0026ndash;based health education is essential to foster positive health behaviours (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). Its absence in Somaliland leaves children vulnerable to preventable risks and limits their capacity to adopt lifelong healthy practices.\u003c/p\u003e\u003cp\u003eThe absence of routine health appraisals in all schools further reflects a neglect of essential health monitoring. School health services were also underdeveloped. Only two schools had any form of health personnel 66.6%, none conducted routine screenings, while one (33.3%) operated without any. Additionally, only one school (33.3%) employed a trained health assistant or first aider, and none had a dedicated sickbay, highlighting poor preparedness for health emergencies. This reflects trends observed in Nigeria, where many schools lack trained health staff and medical facilities(\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). Ethiopia has similarly highlighted the absence of organized SHPs in primary education (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). In Somaliland, weak collaboration between the health and education sectors may explain this gap. Without trained personnel and routine screening, schools are ill-prepared to manage emergencies or detect health problems early.\u003c/p\u003e\u003cp\u003eOverall, the inadequate implementation of SHPs undermines both child health and educational outcomes. Poor sanitation and lack of services expose pupils to illness, while the absence of feeding and health education reduces attendance and learning performance. These deficiencies threaten progress toward \u003cb\u003eSDG 3.8\u003c/b\u003e, which calls for universal access to essential health services, and \u003cb\u003eSDG 4.1\u003c/b\u003e, which seeks inclusive and equitable quality education for all (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e)\u003c/p\u003e\u003cp\u003eThe results highlight several policy implications. In the short term, schools should train teachers as first aiders, establish basic sickbays, and collaborate with NGOs to introduce feeding programmes. In the longer term, Somaliland requires a national SHP policy with clear funding mechanisms, integration of health education into the curriculum, and prioritization of WASH infrastructure. Such reforms are essential to ensure that schools contribute effectively to child health, development, and educational success.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThis study assessed the status of School Health Programmes in three public primary schools in Ibrahim Kodbur District, Hargeisa. The findings showed that the programmes were poorly implemented across all key components. Sanitation facilities are limited, sewage systems are absent, and school feeding services are absent. Health education is not incorporated into the curriculum, and school health services are weak.\u003c/p\u003e\u003cp\u003eThis lack exposes children to preventable illnesses, undermines their learning capacity, and hinders their ability to manage emergencies. The study highlights the importance of improving the health environment in schools for achieving international commitments, such as Sustainable Development Goal 3.8 on universal health coverage and Goal 4.1 on inclusive, quality education. Immediate measures include training teachers in basic first aid, establishing simple sickbays, and piloting school feeding schemes. A comprehensive national School Health Programme policy is needed, supported by adequate funding, health education integration, and improved WASH infrastructure.\u003c/p\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eLimitations\u003c/h2\u003e\u003cp\u003eThis study is limited by its small sample size, focusing on only three primary schools in Ibrahim Kodbour district, Hargeisa, which may not reflect broader trends in Somaliland. Data collection could be subject to reporting biases from school staff, and the lack of longitudinal data restricts insights into the long-term impact of health services. Additionally, the study mainly assessed basic health services, excluding other aspects like mental health support and health education, and resource constraints may have led to incomplete participation or data collection.\u003c/p\u003e\u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe would like to acknowledge Dr Sa\u0026rsquo;ad Ahmed Abdiweli. For his invaluable guidance, support, and encouragement throughout this study. His expertise, insightful advice, and constant motivation played a pivotal role in the completion of this research. I am deeply grateful for his mentorship and for the time and effort he dedicated to helping me develop and refine this work.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflicts of interest\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors have no conflicts of interest to disclose.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo funding in any form was received for this research.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical approval\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was conducted with informed consent from respondents. Ethical approval was obtained from the University of Hargeisa with Ref: CMHS/UoH/130-25, the center of research and community service Health committee, and permission was obtained from each school. Participation was voluntary, with benefits explained to participants, and no risks were involved. Clinical trial number: not applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eBefore the data collection, informed consents was obtained from the research participants to their participation. Participants were given fully informed the benefits, danger and any procedure or risks, their participation was voluntarily.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to publish\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll participants provided consent for their anonymized data to be utilized for publication. Any identifying information was removed.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets are available from the corresponding author on reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eNordstrand MA, Saxe DS, Mohammed MA, Adam MB. Health and disease among Somali primary school children in Hargeisa. Global Health Action. 2019;12(1):1598648.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHaileamlak A. The need for initiation of school health program in Ethiopia. Ethiop J Health Sci. 2013;23(1):vi.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKazemitabar M, Moghadamzadeh A, Habibi M, Hakimzadeh R, Garcia D. School health assessment tools: a systematic review of measurement in primary schools. PeerJ. 2020;8:e9459.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAdemokun OM, Osungbade KO, Obembe TA. A qualitative study on status of implementation of school health programme in South Western Nigeria: implications for healthy living of school age children in developing countries. Am J Educ Res. 2014;2(11):1076\u0026ndash;87.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eOrganization WH. Global standards for health promoting schools. WHO: Geneva, Switzerland.; 2018.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAlafin B, Oluwaseyitan A, Izang AJA, Alausa KO. An appraisal of the School Health Programme in primary schools in a rural community in Nigeria. Ethiop J Health Dev. 2019;33(3).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003e(EUAA) EUAfA. 2.2.1. Overview in COI Report \u0026ndash; Somalia: Country Focus may 2025.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003e(ALGASL) AoLGAoS. District Profile: Hargeisa 2024 [Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.algasl.org/district-profiles/hargeisa\u003c/span\u003e\u003cspan address=\"https://www.algasl.org/district-profiles/hargeisa\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGraham JP, Polizzotto ML. Pit latrines and their impacts on groundwater quality: a systematic review. Environ Health Perspect. 2013;121(5):521\u0026ndash;30.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eFund UNCs, Organization WH. Progress on drinking water, sanitation and hygiene in schools: special focus on COVID-19. World Health Organization; 2020.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSanni UA, Airede KI, Anigilaje EA, Offiong UM. Assessment of school health services in primary schools in Gwagwalada area council, Federal Capital Territory, Nigeria. Pan Afr Med J. 2022;41(1).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBundy DA. Rethinking school feeding: social safety nets, child development, and the education sector: world bank publications; 2009.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAhmed AU. The impact of feeding children in school: evidence from Bangladesh. 2005.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAurino E, Tranchant J-P, Sekou Diallo A, Gelli A. School feeding or general food distribution? Quasi-experimental evidence on the educational impacts of emergency food assistance during conflict in Mali. J Dev Stud. 2019;55(sup1):7\u0026ndash;28.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAdeyemi E, Olatunya O, Fayemi O, Anidobe C, Adeyemi F, Adebami O. An assessment of school-based health instruction among primary schools in Ido/Osi Local Government Area Southwest, Nigeria. Niger J Clin Pract. 2022;25(11):1838\u0026ndash;45.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAlex-Hart B, Akani N. Evaluation of school health instruction in public primary schools in Bonny Local Government Area, Rivers state. Nigerian J Paediatrics. 2014;41(4):365\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eOrganization WH. Skills for health: Skills-based health education including life skills: An important component of a child-friendly/health-promoting school. Skills for health: skills-based health education including life skills: an important component of a child-friendly/health-promoting school2003.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eOyinlade O, Ogunkunle O, Olanrewaju D. An evaluation of school health services in Sagamu, Nigeria. Niger J Clin Pract. 2014;17(3):336\u0026ndash;42.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKuponiyi OT, Amoran OE, Kuponiyi OT. School health services and its practice among public and private primary schools in Western Nigeria. BMC Res Notes. 2016;9(1):203.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eOrganization WH, Educational UN, Educational UN, Scientific, Organization C. Making every school a health-promoting school: Implementation guidance. World Health Organization; 2021.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eNations U. The Sustainable Development Goals Report. 2023.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-7686740/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7686740/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eThe School Health Program (SHP) plays a pivotal role in safeguarding student health and supporting academic achievement. Despite its global significance, limited data exist regarding SHP implementation in Somaliland. This study provides the first comprehensive assessment of SHP in public primary schools within the Ibrahim Kodbour district of Hargeisa.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eA cross-sectional descriptive study was conducted in all three public primary schools in Ibrahim Kodbur, Hargeisa, Somaliland. Data were collected using an interviewer-administered observational checklist based on WHO and UNICEF frameworks, assessing four components: healthful school environment, school feeding services, skill-based health education, and school health services. Scores were computed and categorized as poor (0\u0026ndash;49%), fair (50\u0026ndash;59%), or good (60\u0026ndash;100%). Descriptive statistics were generated using SPSS version 21.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eThe overall mean SHP score was 50.4/127 (47%), indicating poor implementation. Healthful environment scored moderately (mean: 46.8%), while school feeding services (3.6/11) and school health services (9/26) were suboptimal. Skill-based health education was completely absent across all schools (0/17.5). Only two schools had health personnel, and none conducted routine health screenings or had fully equipped sickbays. Sanitation infrastructure relied entirely on pit latrines, with no sewage systems in place.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eSHP implementation in the studied schools is inadequate, with critical gaps in health education, feeding programs, sanitation, and healthcare services. Targeted interventions, including personnel training, infrastructure improvement, and policy enforcement, are urgently needed to promote student health and educational success in low-resource settings.\u003c/p\u003e","manuscriptTitle":"From Vision to Reality Assessment of School Health Programmes in Public Primary Schools in Ibrahim Kodbur District Hargeisa Somaliland to Advance SDG 3.8 and 4.1","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-11-06 04:08:34","doi":"10.21203/rs.3.rs-7686740/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"f592eb61-93e8-469b-8d26-97be87ac6dc4","owner":[],"postedDate":"November 6th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-12-31T14:53:55+00:00","versionOfRecord":[],"versionCreatedAt":"2025-11-06 04:08:34","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7686740","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7686740","identity":"rs-7686740","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}