Factors that Limit Implementation of HE Programme to Prevent NCLSDs

Several issues may affect the implementation of the school health educational programmes. These factors may range from the lack of capacity and preparedness of the technical personnel; teaching methods and availability of resources such a time, learning aids and books.

The training and equipping of teachers to interpret and implement any new curriculum is critical to ensure their efficiency and proficiency in implementation of the programme during the teaching process. This is also crucial because it is positively correlated to learning outcomes observed in the learners. Nyamai (2009:165) noted ‘Teachers involved in teaching HIV/AIDS had not been trained to teach the subject and in absence of relevant training to teach HIV/AIDS Education the teachers averred that they used any approaches they thought might be useful.’

Nyamai’s (2009:126) study dealt with a communicable disease that is HIV/AIDS which, may be accompanied with strong emotions and an avalanche of information from electronic and print media involved in advocacy campaigns; but this study dealt with NCLSDs which not much has been empirically researched, documented, publicized nor published, hence revisiting the issue of teachers preparedness to effectively teach this new area of emerging issues was critical. Indeed, a fresh approach as well as new knowledge and skills are of critical concern if teachers’ capacity and efficacy has to be enhanced to equip children with requisite competence to prevent NCLSDs in view of changes in lifestyle.

Lack of preparedness has had adverse effects in terms of quality teaching due to the fact that it cannot bring effective positive learning outcomes in the learning process due to the fact that teachers lack confidence and back up knowledge and skills to be thorough and effective since they do not have prior familiarization/interaction and knowledge of the new content nor essential delivery approaches which are quintessential for effective teaching and evolution of what is taught. It was imperative that, in absence of any other experiential study, then this study examined and assessed the teacher’s efficacy in HE teaching with a view of generating valuable suggestions that can improve efficacy of HE in promoting healthy lifestyles to curb escalating incidences of lifestyle diseases. The study also generated good practices from its empirical findings that can be valuable in improving learning outcomes in teaching primary HE programme.

Moreover, Mwaniki (2010:10), a health expert cum columnist with the Standard Newspaper in article titled surge in diabetes cases ‘worrying’ notes that;

Health experts have sounded an alert over the increased cases of diabetes which afflicts more than two million people in Kenya…out of these cases, more than 20,000 children suffer from the disease, which is the leading cause of heart diseases such as hypertension, heart attack and cancer…the disease is also the leading cause of amputations and eye-related conditions...in Kenya, there has been notable rise in diabetes type 1, which mostly develops in young people; but, 90% of the cases of diabetes is type 2, which is as a result of lifestyle choices…there is virtual silence on the causes and treatment for this killer disease and there is need therefore to carry out sensitization on the factors fuelling the spread of the disease…

In deed the preceding observations made a strong case for this study to critically analyse HE with a view to establishing its adequacy in terms of content, its efficacy in instructional approaches, as well as use of appropriate resources and teachers preparedness with a view of

making realistic and practical suggestions that could be instituted to strengthen the HE teaching to enable pupils avert NCLSDs.

Muia (2001:256) also established that the teachers’ knowledge of the subject was inadequate in some aspects of HE. Teachers revealed that some areas in the syllabus were hard to generate adequate information for teaching purposes and books sent to schools by KIE lacked enough content; indeed in the study one teacher informant reported that ‘the problem with HE content is the lack of resources to back it up since KIE books are too shallow and lack essential details.’ Further, Mandela (2010:210) in a study on gender and HIV/AIDS education in the multicultural context of schools in Kakuma refugee camp and its host community observed that many teachers in the study site lacked knowledge and skills to educate which was due to lack of teacher’s preparedness; indeed it was observed that some ‘teachers lacked linguistic skills to communicate basic concepts in the subject content’; for, example, ‘in a classroom observation, a female teacher consistently used wrong spellings and pronunciations of common words in a subject content.’

Similarly, Otiende, Bennaars and Groenewegen (1997:45) in a study entitled ‘School Health Education Project Research’ found out that there were gaps in the teacher’s knowledge; for example, they noted that ‘the teachers were aware that their knowledge was inadequate as required for classes four and five science and there were no resources to help them to adapt to this kind of knowledge.’ Thus in that study it was reported that the resources required by teachers for effective teaching were limited and this possibly affected their effectiveness in guiding pupils. All these studies revealed that teachers’ lack of up-to- date knowledge was a serious issue. This study diligently explored the situation in HE teaching and teachers’ perceptions of the HE to make viable recommendations to promote healthy lifestyles among primary school pupils to curb NCLSDs.

The challenge for educators and health authorities and communities worldwide is how to impart and meet the health knowledge, skills, practices and needs in today’s children, a task that this study sought to unravel. Ascroft (1994:3) observed that ‘the reality is that for too many children in the third world, their HE needs will go unfulfilled and they will grow up as ignorant as their parents and ready themselves to enter parenthood and perpetuate this ignorance to their children.’ This observation seems to indicate lack of appropriate HE programme is one of the factors that massively contribute to ignorance about healthy lifestyles in many communities in third world. It was critical that this study investigated the status of HE programmes in primary schools in Kenya with a view to making recommendations to remediate the situation. This may enable proactive strategies that can enable young

people who are the future of the society to prevent NCLSDs among themselves and enjoy healthy and productive living.

Lack of exposure to practical, adequate and relevant knowledge is a critical determinant of whether what is learned is translated into not only sustainable but also good practices. One of the preventive strategies to avoid overweight and obesity is regular exercises and body movements. Ithula (2010:22) observed that doing regular daily exercise like ‘walking more than driving increases the number of insulin receptors that develop on body cells’, thereby directing blood sugar to move into the ‘proper cells that will give the body energy and nutritive elements’. By doing this, the blood sugar does not linger in the body to cause dangerous effects such as ‘diabetes and other problems’. This helps to maintain healthy and normal body weight. Further, Ithula (2010:22) notes that use of proper diet and exercise can keep the body in tip-top shape and prevent NCLSDs such as diabetes and stroke.

One of the factors that lead to overweight is lack of precise diagnostic facilities that can help one to determine their Body Mass Index (BMI), which helps one to establish whether one is overweight, or not (Karoki, 2010:91). One way of determining if one is overweight is by calculating Body Mass Index (BMI). BMI gives an indication of whether one has healthy weight in proportion to one’s height. It can be calculated by weight (Kgs) divided by height in square metres. The device can be used to establish whether one is overweight quite early and enable one to adopt preventive strategies to avoid being overweight and attendant problems. Hence, this study aimed at finding out whether schools had equipments to detect overweight and whether pupils had sufficient knowledge to enable them to use them to keep their body weight in check to ward-off problems associated with overweight and obesity (National Heart, Lung, and Blood Institute, 1998:22).

Timberlake (1985:7) observed that ‘Health cannot be guaranteed by provision of health services alone but, freedom from disease will depend on broad economic development, improved food production, safe drinking water, better housing, provision of education and anti- poverty measures.’ The thrust of this observation is that success in education and indeed HE programmes will be determined by the kind of support they get from the school and the community. Timberlake (1985:7) cites the case of Senegal where school health groups have spearheaded campaigns for keeping water clean, careful disposal of wastes, disinfecting latrines and ensured that food sold in school’s is safe.

In Kenya, health clubs formed under a world health organization (WHO, 1996:98) School Health Education Project in Kangundo and Masii areas in 1996 have also focused on self, school and communal health

matters (Otiende, et al, 1997:53). Therefore, it was quite instructive for this study to fill this gap of knowledge by exploring the kind of support that the contemporary schools and communities are offering to support HE education programmes in primary schools to enable pupils to prevent lifestyle diseases in the society. The support given is critical in determining how effective HE programmes can be to curb risky health lifestyles that predispose young people to NCLSDs.

Muia (2001:57) observed ‘locality-specific factors have great influence in health seeking behaviour; such factors as cultural beliefs about illness, availability of herbal and traditional medicine, distance from health centre and HE programmes amongst the parents and the people in a given area’ have great influence in health of people. This observation seems to point out that other factors within and around the school locality determine how learners translate and operationalize the content of the skills and knowledge they acquire in the process of learning. This is a critical gap that this study intended to fill by establishing the determinants of healthy lifestyles among primary school pupils.

Primary schools are ideal setups for the promotion of HE in the contemporary Kenyan society since they represents close to half of the population in society with the onset of FPE. Moreover, a primary school has an important role in socialization, which ranges from benign to active social control. In the process, pupils learn and acquire action- competence. Schoolchildren are a captive audience who can systematically be trained through HE to influence the communities in desired directions (Amref, 1987:24; Muia, 2001:58). Primary schools have more or less replaced traditional institutions as socializing agents in the current parenting lifestyles with working parents particularly in urban and semi-urban communities where parents look upon primary schools to impart habits and discipline including those related to health to prevent diseases, which among many others include emerging NCLSDs.

The teaching and learning approaches adopted in teaching HE are a potent determinant on how effective what is learned is translated into action-competence. Abidha (1994:24) observed that ‘In Kenya, it has been noticed that in schools carrying out child-to-child approach in activities, the children participating are able to become more responsible, learn to help each other, carry health messages to their homes, know good feeding habits, improve cleanliness of school and even limit dangers to road accidents!’ This shows that promoting HE through provision of relevant knowledge with active involvement and support of the learners are critical determinant of the efficacy of HE programmes in primary schools, a concern that this study attempted to review in light of emerging challenges in the health lifestyle problems in society.

Kitsao (1999:8) and Kinoti (2003:84) noted pupils who translated their knowledge in HE into practice were more healthy and showed more responsibility towards the health of others. In the same study, the pupils who received motivation and encouragement from their teachers to practice behaviour conducive to healthy living in the school environment were more likely to do so than those who did not. These findings indicate that given the opportunity, resources and the benefit of HE, children will voluntarily make rational decisions affecting their health. HE knowledge alone is not effective in achieving maximum results; but, that knowledge needs to be supported by an enabling and reinforcing environment within the school and community. Hence, there was need to explore the role of HE in promoting desirable healthy practices in light of emerging social challenges posed by NCLSDs that was be done by conducting this study to fill that dearth of information. Otieno (2011:12), a medical health specialist cum columnist in the Standard Newspaper article entitled ‘Obesity in children’ reports that more than ever before, more of our children and adolescents are overweight or obese; childhood obesity is a worldwide trend that has reached epidemic levels. More than two thirds of these overweight children will become overweight adults. About 80 percent of overweight teenagers will remain overweight as adults. Parental obesity more than doubles the risk of their young child, whether thin or overweight, becoming an obese adult. Genes, therefore, play a role but they are not the only cause. Otieno (2011:12) further observed:

The society supports obesity because it promotes less physical activity and more eating…our children spend a lot of time watching the television, which is a constant advertiser for fast foods and unhealthy snacks…the annual distance our children walk has fallen because they are either driven or bussed to and from schools…schools have fewer opportunities for daily physical activities because of an overloaded academic curriculum…many parents do not perceive obesity as a problem, because they believe that being plump is a sign of wealth and that their child is physically fit…

NCLSDs like childhood obesity are influenced by eating habits and general attitudes to food and lack of physical exercises. Consequently, the concept of healthy food takes into account feeding practices, individual’s perspectives on food, including visual appeal, taste, social aspects, accessibility to fresh, balanced and good quality food, and the sustainable production and distribution of food (Otieno, 2011:14).

Ultimately, such observations underscored the need to review the content of the HE in primary education, in particular at primary school level with a view to identifying curriculum gaps that need to be addressed; a task this study undertook. The study outcomes may be useful in strengthening HE to equip pupils with knowledge, skills and attitudes necessary to prevent NCLSDs. This will not only yield multiple but unending benefits to themselves and the society.

Muia (2001:13) notes that most primary school teachers felt that the school curriculum generally was too broad in relation to the amount of time it was supposed to be covered resulting in teachers being in a hurry to complete the syllabus. It was therefore important for the study to establish the situation in light of emerging issues like NCLSDs.