World Health Organization · 1st edition, 2025 · 162 pages
Step-by-step guidance for policy-makers, planners and managers to establish, strengthen and sustain comprehensive school health services as part of health-promoting schools.
- Issuer
- World Health Organization
- Edition
- 1st edition, 2025
- Audience
- Policy-makers, planners and managers responsible for school health and school health services at national, sub-national and local levels; secondary audiences: SHS providers, researchers, development partners, civil society organisations
- Evidence
- Evidence-informed implementation strategies based on systematic reviews of facilitators and barriers to SHS implementation, systematic review of national normative documents, and international needs assessment; builds on 2021 WHO guideline on school health services (GRADE-rated recommendations)
- Reviewed
- 16 Oct 2026 · GMJ
What this guideline says
GMJ summary
This WHO–UNESCO implementation guidance provides a practical roadmap for establishing and strengthening school health services (SHS) as a core component of health-promoting schools. It addresses the gap between knowing what to deliver (covered in the 2021 WHO guideline on school health services) and understanding how to implement, sustain and improve these services in diverse contexts.
The guidance is organised around eleven priority areas identified through international needs assessment: building common understanding of SHS; making the investment case; preparing and planning; building leadership; ensuring supportive policies; securing student and carer participation; improving access and coverage; developing the SHS workforce; ensuring enabling physical environments; improving quality; and strengthening data systems and monitoring.
Recognising that countries have vastly different starting points—from no formal SHS to well-established comprehensive programmes—the guidance applies the principle of progressive realisation, offering implementation strategies, country case studies and practical checklists that can be adapted to local contexts, resources and health system structures.
Key points
For clinicians — doses and thresholds as stated in the guideline
- School health services are defined as health services provided to students by health care or allied professionals, either on-site (school-based) or in the community (school-linked), under formal arrangement between education and health institutions
- Comprehensive SHS should address at least four health areas from: sexual and reproductive health (including HIV), communicable and noncommunicable disease management, oral health, nutrition, physical activity, mental health, injury prevention, violence prevention, and support for disabilities and sensory issues
- SHS activities span health promotion, health education, screening (and referral), preventive interventions, clinical assessment, health services management and support for other components of health-promoting schools
- Implementation follows a five-step cycle: convene a multi-disciplinary task force; conduct needs assessment and landscape analysis; develop a plan aligned to global standards; implement at appropriate levels; monitor progress and identify improvements
- Inter-ministerial collaboration between health and education is essential, ideally supported by formal memoranda of understanding, co-chairing arrangements, joint task forces or dedicated governing bodies with clear roles and accountability
- Supervisors of SHS personnel should hold the same or similar professional health licensure as frontline workers to accurately assess competency and provide appropriate professional oversight
- For every US$ 1 spent on SHS, the return on investment is doubled; interventions such as deworming, vaccination, vision screening and provision of spectacles offer excellent cost-effectiveness and high benefit–cost ratios
- Ninety percent of countries have some type of SHS programme, but coverage is higher in high-income countries; in low- and middle-income countries, only US$ 2 billion of the US$ 210 billion invested in education annually is allocated to health and nutrition needs of school-age children
Application of the global guidance in countries with various experience of implementing SHS
Table extracted from the guideline
| Experience level | Context | Priority actions |
|---|---|---|
| No or limited experience | No national policy on SHS; donor projects may exist but SHS not included | Make context-specific investment case; establish intersectoral coordination team including students/parents; conduct needs assessment; decide priority package (WHO guideline); develop 1–2 year implementation plan; ensure SHS part of broader school health; evaluate and extend |
| Some experience | National programme mandates school nurses in schools >1000 students; only 40% coverage; services limited to entry and grades 4 and 7 check-ups | Make case for strengthening and expanding access; identify resources for underserved areas; revise package based on evidence (WHO guideline) and emerging priorities (e.g. mental health); expand by adding interventions, increasing frequency or including drop-in services; reinforce intersectoral coordination; support districts with capacity development; strengthen links to broader school health |
| Extensive experience | Clear national SHS policy recently reviewed/updated; operationalised in all districts but variable implementation quality | Conduct gap analysis of current policy; update service package and expand delivery models (e.g. drop-in, teleconsultations); strengthen accountability through better indicators/targets; reinforce sub-national coordination mechanisms; support sub-national authorities with training, manuals, tools; facilitate prospective learning between districts/schools |
Source: World Health Organization, Making every school a health-promoting school: implementation guidance for school health services. Reproduced in summary form.
From the guideline
Verbatim
“For every US$ 1 spent on SHS, the return on investment is doubled.”
Editor’s perspective
Why this matters for Georgia and the region
Prof. Giorgi Pkhakadze, MD, MPH, PhD
Editor-in-Chief, Georgian Medical Journal · Chair, Public Health Institute of Georgia · WHO consultant, health and migration
As Chair of the Public Health Institute of Georgia, I view this guidance as particularly timely for our region. Georgia has legacy school medical infrastructure but would benefit from aligning it with contemporary evidence on comprehensive school health services, especially for emerging priorities such as adolescent mental health, noncommunicable disease prevention and sexual and reproductive health. The recommendation I would stress to Georgian colleagues is the need for formal inter-ministerial collaboration between our Ministries of Health and Education, with a clear memorandum of understanding defining roles, resources and accountability—currently this coordination is often informal and fragmented. One realistic implementation caveat is financing: while Georgia has made substantial progress in universal health coverage since 2013, explicitly integrating school health services into the State Healthcare Programmes with sustainable, earmarked funding will require careful costing, piloting and political commitment, particularly to ensure equity of access between Tbilisi, regional centres and rural mountain communities.
ORCID 0000-0001-7609-4515 · Perspective written for the GMJ Guidelines Library, 16 Oct 2026
Applicability
Georgia and the South Caucasus
For Georgia and the South Caucasus, this guidance offers a structured framework to formalise and strengthen school health services within the broader context of health-promoting schools. Countries in the region typically have some legacy infrastructure from Soviet-era school medical services but often lack contemporary, evidence-based comprehensive SHS aligned with current child and adolescent health priorities (mental health, noncommunicable disease prevention, sexual and reproductive health). National programmes would need to conduct landscape analysis to assess existing school-based provision, clarify the respective roles of ministries of health and education, secure sustainable financing (potentially integrating SHS into universal health coverage schemes), and ensure the school health workforce has updated competencies in areas such as psychosocial support, chronic disease management and adolescent-friendly service provision. Given decentralisation of health and education governance in many countries in the region, particular attention should be paid to sub-national operational guidance, managerial capacity-building and equity of access between urban and rural schools.
Questions this guideline answers
Quick answers
What is the difference between school health services and health-promoting schools?
School health services (SHS) are one of eight core components of health-promoting schools. SHS specifically refers to health services provided to students by qualified health care professionals (such as nurses, doctors, dentists, psychologists) either on school premises or through school-linked community services, under formal arrangement between education and health institutions. Health-promoting schools is the broader whole-school approach encompassing government policies, school policies, governance, curriculum, partnerships, social and physical environments, and health services.
How comprehensive should school health services be, and where should countries start?
Comprehensive SHS address at least four health areas from a menu including sexual and reproductive health, communicable and noncommunicable diseases, oral health, nutrition, physical activity, mental health, injury and violence prevention, and support for disabilities and sensory impairments. Countries with no or limited experience should start by making an investment case, conducting a needs assessment to identify local priorities, selecting a feasible initial package from the WHO guideline on school health services based on available resources, and planning for progressive expansion. Even with limited resources, countries can begin with high-impact, cost-effective interventions such as vaccination, deworming, vision screening or micronutrient supplementation.
Which ministry should lead school health services—health or education?
There is no single model. SHS can be led by the ministry of health, the ministry of education, or jointly managed under a memorandum of understanding. What matters is clear governance with defined roles, regular coordination mechanisms (joint task forces, co-chairing arrangements), legislative frameworks that mandate and fund SHS, shared strategic plans with common goals, and accountability at all levels. Successful examples exist across all three models. The key is ensuring that SHS personnel receive appropriate professional supervision from someone holding similar health qualifications, and that both sectors commit resources and prioritise SHS within their respective budgets and plans.
How can countries ensure sustainable financing for school health services?
Sustainable financing requires legislative or policy commitment with earmarked funding, not reliance on short-term grants. Successful models include: specific budget line allocations for SHS in either health or education budgets; integration into national universal health coverage or insurance schemes (as in Togo); cross-sector cost-sharing between health and education ministries; framing SHS as preventive investment with demonstrated return (US$ 2 for every US$ 1 spent); starting with high-impact interventions and expanding progressively as benefits are demonstrated; and including funding not only for personnel but also for equipment, supplies, training, supervision, data systems and maintenance.
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- Issuer
- World Health Organization
- Type
- Standards
- Edition
- 1st edition, 2025
- Status
- Current
- Published
- 2026-05-04
- Languages
- English (original)
- Scope
- Global; applicable to all countries establishing or strengthening school health services
- Audience
- Policy-makers, planners and managers responsible for school health and school health services at national, sub-national and local levels; secondary audiences: SHS providers, researchers, development partners, civil society organisations
- Pages
- 162
- Licence
- CC BY-NC-SA 3.0 IGO
- ISBN
- 978-92-4-011896-6
- Evidence
- Evidence-informed implementation strategies based on systematic reviews of facilitators and barriers to SHS implementation, systematic review of national normative documents, and international needs assessment; builds on 2021 WHO guideline on school health services (GRADE-rated recommendations)
- Record history
- Created 16 Oct 2026 · updated 16 Oct 2026 · next check Apr 2027
Making every school a health-promoting school: implementation guidance for school health services. Geneva: World Health Organization; 2025. Licence: CC BY-NC-SA 3.0 IGO.GMJ Guidelines Library records are original summaries written by the GMJ editorial team from the issuer’s published document and reviewed by a physician. They do not replace the full guideline. The document is the copyright of its issuer and is linked, not hosted. Spotted an error or a newer edition? Tell the Guidelines Desk.
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