Trends in Educational StudiesTrends Journal, in EducationalVol 13, Issue 1 Studies Journal (TR ESJ) 2021 Volume 13, Issue 1 June 2021 of Port Harcourt ISSN: 0795-3186 Challenges Facing Teaching of Health in Nigerian

Rimande-Joel, R.(1) & Obiechina, G.O.(2) Department of Human Kinetics and , Faculty of Education, University of Port Harcourt ( 1&2) [email protected](2)

Keywords: Abstract Health education, Health education plays a vital role in ensuring total wellbeing of an Teachers, individual through knowledge acquisition, practical skills and positive Challenges, change in behaviour towards healthful living. One would have concluded . that with its immense contribution towards individual and community wellbeing health education should be all embracing; receiving full support by all, unfortunately that is not the case; the subject is still battling with challenges. The demand for Health Education in Nigeria has been made possible by the vast improvement in the knowledge of methods of prevention and control of diseases as well as the pressing need to find solutions to the aggravated problem of providing medical services. To respond to this need, the concept of Health Education has emerged and schools have been considered excellent places to carryout Health Education because among all organized institutions set up by the society, the is one through which the largest mass of a given age range pass and also because they present the broadest and deepest channel for putting information at the disposal of a country citizens. These challenges include; lack of fund, economic situation, learning materials and facilities, insufficient integration into the school panning, inadequate trained health educators and lack of policies that place a high priority on Health Education among others. In conclusion the importance of the health education cannot be over emphasized as it patent to the continuous growth and development of healthy children, protection against disease, promotion of health and practices of healthful living.

Introduction Health education is the process by which a person systematically acquires the basic knowledge, practical skills, disease preventive and health promotive, and desirable attitudes vital to the total development and growth of an individual and their community. It is the formal aspect

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Trends in Educational Studies Journal, Vol 13, Issue 1 2021 of education for health which is the focus of this paper. It plays a vital role in ensuring total wellbeing of persons through knowledge acquisition, practical skills and positive change in behaviour towards healthful living. Health education is defined as any combination of learning experiences designed to help individuals and communities improve their health, by increasing their knowledge or influencing their attitudes (Johnson, 2010). Health Education has also been described as any combination of planned learning experiences based on sound theories that provide individuals, groups, and communities the opportunity to acquire information and the skills needed to make quality health decisions (Marcus 2012). Areas within this profession encompass environmental health, physical health, social health, emotional health, intellectual health, and spiritual health, as well as sexual and reproductive health education The sound knowledge of health behaviour and practices acquired through health education equips the average youth with good health that could help them to achieve the basic goals of education and make them fit to bring about positive changes to themselves, family and the society at large. Health status of an individual is among the determining factor to achieving success in every aspect of life, which explains why everyone wants to be healthy and will go to any length to be healthy or seek health through whatever means. Hence the important of health to sustainability of life cannot be over emphasized considering life to be fulfilled and productivity. It is significant to mention that in whatever function one finds oneself, the most important factor is good health. If health is lacking, productivity can be seriously undermined, (Basch, 2011). The dividends of health is not just experienced by the individual alone but is extended to the development and reduction in of one’s nation. Increase life expectances contribute substantially to the long term economic development of a country (Brian, Lizette & Chika, 2016). These submissions reiterate the significant of health. Health as a concept is a state of complete physical, mental and social wellbeing of individual and not the mere absence of diseases or infirmities (WHO, 1947). In order to achieve variables in the above definition and ensure a healthy individual health education has to be employed as it has a significant role to play. Health education is a mature profession because it has developed a separate body of knowledge, defined competencies, and certification system for individuals, a code of ethics, a federal occupational classification, and recognized accreditation processes in higher education. Health education is generally aligned with the behavioral and social as one of the core dimensions of public health study and practice. This paper therefore, would be discussed under the following subheadings; the concept of Health Education, the importance of Health Education in the School Setting, the Structure of Health Education in Nigerian Schools - curriculum, resources, Challenges Facing School Health Education in Nigeria and way forward.

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Trends in Educational Studies Journal, Vol 13, Issue 1 2021 The concept of Health Education Education is a force that brings about possible change in an individual life or society. It is the process that enable individuals or group of persons to systematically acquire knowledge, skills, needed for whole development and growth of oneself and his/her community. Education prepares a child to be self-reliant and to be a healthy and productive citizen. Opara, Ejifugha, (2014) affirms that Education for health is a many-sided activity that many people participate, which can be formal, informal or non-formal. Taking place either in schools, communities, vehicles, hospitals, industries, national health education programmes and broadcasting media. Health education is the development of individual, group, institutional, community and systemic strategies to improve health knowledge, attitudes, skills and behavior. It provide a setting in which teachers, parents, and community members partner to help focus on health prevention concepts and to practice life skills in a safe and supportive environment. Health education is defined as any combination of learning experiences designed to help individuals and communities improve their health, by increasing their knowledge or influencing their attitudes (Johnson, 2010). Fasoranti, and Adeyeye, (2015) opined that Health Education helps provide health knowledge, enhance wellness behaviours, promote health situations, facilitate healthful relationship and enables community members make responsible decisions. Health education is a formal or non- formal process of educating and equipping people with knowledge and practical skills to be aware of diseases, it occurrence, prevention and control to enable them make an informed decision to promote their health and live healthfully. Health education plays a crucial role in the development of healthy, inclusive and equitable social, psychological and physical environment. It reflects current best practice, using an empowering, multi-dimensional, multi professional approach which relates to all setting, organizations, including the community, schools, health services and the workplace (Auld, & Gambescia, 2016). The purpose of health education is to positively influence the health behavior of individuals and communities as well as the living and working conditions that influence their health.

The Importance of Health Education in School Setting The goal of health education is to promote, maintain, and improve individual and community health through the educational process. It also plays a vital role in ensuring total wellbeing of persons through knowledge acquisition, practical skills and positive change in behaviour towards healthful living. The sound knowledge of health behaviour and practices acquired through health education equips the average youth with good health that could help them to achieve the basic goals of education and make them fit to bring about positive changes to themselves, family and the society at large.

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Trends in Educational Studies Journal, Vol 13, Issue 1 2021 The settings for health education are important because they provide channels for delivering programs, provide access to specific populations and gatekeepers, usually have existing communication systems for diffusion of programs, and facilitate development of policies and organizational change to support positive health practices. Seven major settings are particularly relevant to contemporary health education these include schools, communities, worksites, health care settings, homes, the consumer marketplace, and the communications environment, (Auld, & Gambescia, 2016). It also constitute an important dimension of health education/health promotion policy and programs and for research about program needs, feasibility, efficacy, and effectiveness. These settings vary in the extent of coverage of and relationships with their respective constituencies, valued outcomes, and quantity and quality of evidence about the effectiveness of setting-specific and cross-setting programs. Health education in schools includes classroom teaching, teacher training, and changes in school environments that support healthy behaviors. Health education in schools setting seeks to foster sound health, knowledge, attitudes and practices both for the preventive and the sufficient curative values. It also empowers people to improve their health seeking behaviours and practices, change their life-styles and use health services effectively (WHO, 2014). Health education is also important when it is considered that large numbers of children come from families that cannot afford the cost of private medical care. This makes the prevention of disease a major role for schools. Taking a settings approach to health promotion means addressing the contexts within which people live, work, and play and making these the object of inquiry and intervention as well as the needs and capacities of people to be found in different settings. This approach can increase the likelihood of success because it offers opportunities to situate practice in its context. Members of the setting can optimize interventions for specific contextual contingencies, target crucial factors in the organizational context influencing behavior, and render settings themselves more health promoting. Health education is a mature profession because it has developed a separate body of knowledge, defined competencies, and certification system for individuals, a code of ethics, a federal occupational classification, and recognized accreditation processes in higher education. Health education is generally aligned with the behavioral and social sciences as one of the core dimensions of public health study and practice (Damilola 2018). The importance of health education in Nigerian schools revealed the following that; 1) A lot of health challenges that occur later in life are caused by lack of information on healthy living by both parents and students. 2) Preventable or treatable infectious disease such as malaria, pneumonia, diarrhea, measles, common cold, and HIV/AIDS account for more than 70% of the estimated one million under-five (5) deaths in Nigeria

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Trends in Educational Studies Journal, Vol 13, Issue 1 2021 3) Malnutrition is the underlying cause of morbidity and mortality of a significant proportion of children under-5 in Nigeria. It accounts for more than 50% of deaths of children in this age bracket 4) Lack of proper and prior knowledge of a child about his or her health could subsequently lead to death.

5) The dangers of tobacco use and substance abuse among individual most especially the youths.

6) Health education promote mental and social health, prevent injury and violence in community

The Structure of Health Education in Nigerian Schools A model learning system is an ideal complex of educational structures, resources, principles and practices that has the capacity to translate educational vision, mission, goals and objectives into the desired learning outcomes. Safeguarding and preserving health has being a matter of concern to the human race. The cultural diversity and over population of man renders plant and animal’s life less resistant to diseases causing their death or reduction. Hence the quest for optimal health since man is not able to maintained optimal health throughout. The environment is polluted as a result of alterations of ecosystem that bring about an unfavourable development in the surrounding arising from human activities. These lead to health problems and unhealthy health practices ravaging the Nigerian School children such as smoking, drug abuse, sexually transmitted infection, HIV/AIDs, and early parenthood among others need to be addressed knowing fully well that a society with healthy children is bound to raise productive adults that would contribute to the development of a Nation, (Marcus, 2012). Good health education motivates the community to take action rather than officials determine their health. Evident shown that a child starts learning some health habits and ways of avoiding certain undesirable or harmful practices from family members immediately after birth. This exercise continues even after a child has gone to school. Schools are therefore ideal settings for health programmes and services (Roudsari, Javadnoori, Hasanpour, Hazavehei, and Taghipour, 2013). The primary school is an ideal place to carry out health education because among all the organized institutions set up by society, the primary school has the largest population of school age children pass. They present the broadest and deepest channel for dissemination of information at the disposal of its citizens. The primary school acts as a focal point to facilitate innovations, education and motivation towards good health, unlike adults, they have boundless energy. Their

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Trends in Educational Studies Journal, Vol 13, Issue 1 2021 minds are open to new knowledge; their attitudes have not yet formed and their practices and behaviours have not yet developed. However, little or nothing is known about health education. Though health education in the lower basic schools syllabus but teachers teach only the hygiene, social or personal health aspect because they lack adequate knowledge of the subject. The broad based school health programme which caters for health instruction, health services, school healthful environment and school community relation is completely absent, (Hashim, Mustafa, Abdouli, et al. (2013). Health education in school setting create the conditions required for educational success and enabling students to acquire the necessary skills to make free and responsible health choices. However, in secondary schools, the need to make health education a full fledge subject has been jeopardized. These set of ’s are unique population given their compulsory attendance at school and required health education curricula in many jurisdictions. A health education curriculum that supports a vision of healthy children is the first step toward helping all students develop to be their personal best, (Igbokwe, 2015). The curriculum is to a learning system what the constitution is to a country. The curriculum is the framework and content of the knowledge, skill, values, attitudes and general orientations as well as the modalities, resources, contexts and other principles that guide their transmission to the learner.

Challenges Facing the Development of Health Education in Nigeria Health education for most Nigeria seem not to make any meaning it is only considered as just another instructional material in Physical and health education in colleges and despite the WHO, United Nations Educational Scientific and Cultural Organization emphasis on the importance of the inclusion of health education in the curriculum of teachers’ training institutions including universities. Still at that, teaching of health education has not receives any prominences in any educational reports (Oshodin, 2014). The major challenges facing the development of health education in Nigeria have been recognize as social, cultural and educational. It is often not a recognized school subject and therefore do not receive much attention in the highly competitive struggle for timetable space, the curriculum is overloaded with academic subjects whose syllabuses require a lot of time to be covered, the 8.4.4 curriculum has continued to be reviewed and one outcome of these revives has led to making optional and not examinable subjects that were traditionally venues for integrating health education topics in the curriculum, the teaching process is performance oriented and so no time is allocated for the teaching of health education topics, which require more time and are practical oriented and , lack of both written teaching and learning materials is another challenge facing the implementing of health education. This is compounded by lack of not having suitably qualified personnel, the absence of health education curricula institutions of learning and the attitudes of Nigerians in

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Trends in Educational Studies Journal, Vol 13, Issue 1 2021 general to health education are major factors (Oshodin, 2014). These identified challenges shall be discussed below. Lack of Funds: This has been identified as one of the challenges of health education. It been observed that most schools cannot effort equipment needed, however, they result in using obsolete ones that can posse danger to the users (Falae, 2018). It is not surprising that neither the Ministry of Health nor Ministry of Education is ready to take responsibilities for the funding school health programme. Even with the schools, most school heads are lacking in this regard. Due to the economic situation of Nigerian it is difficult for the government nor the ministry overseeing health and education to give priority to health education in schools, giving it the funds required (Bernard, 2012). Economic Situation: The present economic situation in Nigeria is part of the challenge of health education. There are so many programme competing for attention in the face of limited resources and as a result of the ailing therefore, it becomes difficult to convince the government to give priority to health education in schools. The dilemma is how to get hold of sufficient funds that will ensure the gap between the amount and quality of needed health facilities, equipment and the available financial support bridge the gap (Damilola 2012). Hence the attention of the government is shifting to want their perceived as of importance’s to the nation which health education is out of the way.

Curriculum Planning and Implementation Health education is one of discipline in Nigerian institutions of learning and facing the challenge from curriculum planning down to its implementation. Unfortunately many societies have failed to give due recognition to health education in their school curriculum forgetting that a healthy and educated child means a healthy and prosperous future. Making the subject to be dependent on another, it has not gained autonomy in the school time table. And so it is either marched with or health science. (Bernard, 2012). Though the Nigerian Federal Ministry of Education since 1985 approved a robust curriculum for health education, it is still faced with the issue of implementation. As since not all schools have implemented it (Okuneye, Idowu, Dansu, Abiola, 2010). Although Nigeria has introduced health education in the school curriculum, traditionally, the school curricula are still not addressing health education issues like water, environmental sanitation, pollution, and hygienic promotion in schools. This can be attributed to lack of facilities and materials and the methods used to disseminate Health Education in schools, which mainly involve integrating instruction concerning health related topics into more traditional academic subjects. There is no doubt that health education exist in Nigerian curriculum. Ekenedo and Ekechukwu (2015) affirm that the discipline has existed in the curriculum for decades, in different forms,

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Trends in Educational Studies Journal, Vol 13, Issue 1 2021 gamuts from hygiene education, health science, and health education or at times combined with physical education. But that worries stakeholders is on the level of effectiveness health education is taught with the aim of influencing knowledge, attitude and behaviour about health.

Inadequate Suitable and Trained Health Educators: Federal Ministry of Education, (2006), observed that the teaching of health education has advanced in developed nations more than the developing countries in which Nigeria is inclusive. He emphasized that most of the personnel handling the teaching of health education as subjects in basic and secondary schools are not suitably qualified. In most cases, teachers who teach and other science related subjects are coopted to teach health education in both basic and secondary schools.

Confusion of who to handle the subject: There is still confusion of who should be designated to handle the teaching of health education. Majority of school administrators held that biology integrated science teachers and other science related subjects teachers can effectively teach health education. Therefore see no need to engaged only professionally trained health educators to carry out the instructions (Bernard, 2012).

Poor Teaching Methods: Children are considered the best agents of change because of their vitality, creativity, mental alertness, lack of prejudices, concern about the environment and distance from tradition. If they learned things related to lifestyle, it contribute to their good health. Often time some of their parents may not be educated, they become a good medium for health education to their family. According to Bernard, (2012) methods of teaching health education are the systematic and organized procedures a teacher uses to determinate knowledge of healthful living in order to influence students health practice, behaviour, attitude and knowledge. He held strongly that teaching health education should involve eclectic method of teaching . But based on his own observation most of the instructors adopt a single method of teaching. Edim, Ogabor, & Odok, (2014) expressed concern about the medium through which teachers pass instruction during the teaching- learning process to the learners. He indicated that teachers should endeavors to use language or idea which are within the level of students understanding.

Absence, Dearth in Facilities and Equipment for Teaching: The teaching of health education should be from known to unknown which requires adequate equipment and facilities in terms of laboratory, films and films ships, tape-recorder, health charts, radio and television, computer, eLearning, and overhead projectors of which are not available in most Nigerian basic and secondary schools. Many scholars have adduced this to the

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Trends in Educational Studies Journal, Vol 13, Issue 1 2021 inadequate funding of education in Nigerian which cuts across all levels of education, (Olatunya Oseni, Oyelami, Adegbenro, & Akani, 2014)

Inadequate indigenous textbooks: Roudsari, Javadnoori, Hasanpour, Hazavehei, and Taghipour, (2013). noted that learning materials that can help to reduce the burden of teachers and also serve as basic resource references in teaching health education were not available. They further observed that adequate textbook places a major role in determining the effective teaching of health education. He stressed that health education cannot be taught successfully without reasonable textbooks that take into cognizance the cultural heritage of the people where it is being used.

Teacher's Preparation for Health Teaching: The methods of teaching health education are the systematic and organized procedures a teacher uses to determinate knowledge of healthful living in order to influence students health practice, behaviour, attitude and knowledge. Teaching health education should involve the eclectic methods of technology but most practicing health education teachers adopt a single method of teaching. Hashim, Mustafa, Abdouli, et al.2013) expressed concern about the medium through which teachers pass instruction during the teaching-learning process to the learners. He indicated that teachers should endeavours to use language or idea which are within the level of students understanding. Studies have identified deficiencies in the training of teachers in Nigeria (Agusiegbe, 2010). This assertion indicate some engage teachers with lacking adequate health knowledge

Way Forward in Health Education The way forward include teaching health education in their curriculum, promote healthy eating and physical activities in the classroom. A sound knowledge of health behaviour and practices acquired through health education equips the average youth with good health that will help them to achieve the basic goals of education and make them fit to bring about positive changes to their lives, family and the society at large. Other values include:

1) Provision of scientific health knowledge in a conducive environment help individual to be able to make and take intelligent health decisions.

2) Ensure the development of desirable health attitude in order to build moral respect and excellent health habits.

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Trends in Educational Studies Journal, Vol 13, Issue 1 2021 3) Protecting individual against communicable diseases and other preventable ones in the school and community at large that will improve physical, social, emotional and spiritual development of the school children.

4) Ensuring the provision of healthy school living and create an environment that supports healthy eating and physical activity by employing policies and practices.

5) Provides an insight into the identification and correction of remediable abnormalities in students

However, an effective implementation of health education at all levels could bring about achievement of expected societal change in the field of economy, productivity, politics and technological advancement.

Conclusion Health is an important factor that influences one’s way of life. It improves personal goals. The importance of health education cannot be over emphasizes as it concerns the continuous growth and development of healthy children, protection against disease, promotion of health and practices of healthful living. The school is one of these agencies through which a comprehensive health education programme can be effectively implemented. The nation can benefit immensely in terms of development, poverty reduction, and increase life expectancy of citizens which at the long run contributes to long-term economic development. However this discipline is faced with a range of challenges. Health education philosophy and practice are based on the fact that human behaviour can be influenced through well-organized health programme of instruction. Indeed health education in Nigeria is faced with a number of problems. Hence there is an urgent need to address these changes so that the discipline can take it proper place in the education curriculum at all levels.

Suggestions The following suggestions are necessary to curb the challenges facing Health Education in Nigeria 1. Health education should be thought as a separate subject note forming part of topics in school subject such as health science, biological science and physical and health education. The teaching of the content should independent of the above listed subject 2. Federal ministry of Education should make a policy that permits only qualified professional of health educators handles the subject

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Trends in Educational Studies Journal, Vol 13, Issue 1 2021 3. There should be budgetary allocation for health education at every level of government to ensure constant availability of materials, and facilities for teaching with continues monitoring.

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