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This essay is part of the series “Five Years of NEP 2020: From Vision to Reality”
The National Education Policy (NEP) 2020 envisions an integrated, student-focused education system that integrates academic learning with physical and mental well-being. It also acknowledges that healthy and well-nourished children learn better. This vision for policy varies from nutritional supplementation (through universal mid-day meals) to socio-emotional assistance, representing a paradigm shift towards overall Indian school improvement. Five years on, these ambitious health mandates have witnessed varied implementation in India’s widespread school network, and have experienced both progress and ongoing challenges.
Health Mandates and their Implementation
Regular Health Check-ups and Immunisation
NEP 2020 categorically calls for all school children to undergo a yearly health check-up, with 100 percent immunisation, monitored through “health cards” for each student. On the ground, this has been supplemented by taking advantage of continuous interventions under the Ministry of Health and Family Welfare (MoHFW). The Rashtriya Bal Swasthya Karyakram (RBSK), a national programme for child health, deploys mobile health teams to aided and government schools to carry out annual examination of children in the 6-18 years age group. They screen children for general health problems (vision/hearing, nutritional status, anaemia, etc.), refer, and intervene early. Under RBSK, almost 20 crore (200 million) children were screened at the school level in the year 2022-23, a herculean effort as per NEP’s appeal for check-ups annually.
The centrally-sponsored PM POSHAN (mid-day meal) scheme was overhauled in 2021 with more emphasis on nutrition, though the breakfast component has experienced tepid take-off.
Schools have also been used as vaccination centres; for instance, mass immunisation against measles-rubella has been carried out through schools to progress towards NEP goals of universal child immunisation. While systematic immunisation coverage in schools remains irregular, emphasis on periodic follow-up has institutionalised an interface between schools and preventive care. In Jammu and Kashmir alone, more than 12 lakh (1.2 million) government school students received health cards under a post-NEP initiative to monitor their progress, vaccinations and screenings.
Health and Nutrition Monitoring
NEP suggested that the mid-day meal scheme be expanded to pre-primary level students and breakfast be included in addition to lunch. The centrally-sponsored PM POSHAN (mid-day meal) scheme was overhauled in 2021 with more emphasis on nutrition, though the breakfast component has experienced tepid take-off. A parliamentary committee cleared school breakfasts, and was seconded by the Ministry of Education (MoE), but the Ministry of Finance turned down the idea initially, given the annual outgo of about INR 4,000 crore. While most states wait for the Centre to lead on school breakfast schemes, Tamil Nadu has already launched one. Although a national rollout is still under debate, the NEP has prompted better health tracking in schools through regular height, weight, and haemoglobin measures from students, mapping them on health/nutrition cards.
Wellness Clubs and Health Education
NEP promoted setting up Health and Wellness Clubs at all three levels — schools, school complexes, and districts — to encourage students to participate in physical fitness, sport, and wellness activities outside the classroom. This was then followed by the Central Board of Secondary Education (CBSE) mandating all its affiliated schools to set up Health and Wellness Clubs in 2019-2020, and providing manuals to help incorporate activities. Most schools now maintain functional wellness clubs, which commemorate events such as International Yoga Day, host health check camps, and collaborate with local health organisations. For example, CBSE’s “Fit India School” ranking has encouraged schools to upload the operation of wellness clubs and sports activities.
The latest figures report that 7.12 lakh teachers have been appointed as Health and Wellness Ambassadors in 35 States/UTs, and 26 States/UTs have launched classroom health activities under the programme.
NEP has also included “health, nutrition, physical education, fitness, wellness, sports, sanitation and hygiene” as subjects/skills required to be taught to all students. Therefore, topics like preventive care, healthy diet, mental health awareness, and hazards of drug use are being introduced through age-specific material. One of the prime programmes has been the Ayushman Bharat’s School Health and Wellness Programme (SHWP), which equips two teachers of each school as “Health and Wellness Ambassadors” to lead weekly interactive sessions on 11 key themes of health education. The latest figures report that 7.12 lakh teachers have been appointed as Health and Wellness Ambassadors in 35 States/UTs, and 26 States/UTs have launched classroom health activities under the programme.
Challenges in Implementation
Despite being vision-forward, the actual rollout of the health provisions of NEP 2020 in schools has been a huge challenge. Inter-ministerial coordination between the Ministry of Health and the Ministry of Education under the Ayushman Bharat School Health Programme has been challenging, particularly in balancing priorities and structures across governments at various levels. Most states delayed the rollout because they were attempting to appoint nodal officers and rationalise training, finance, and reporting structures. While staff shortages are an intrinsic problem, current teachers must also navigate additional health directives alongside demanding curricula such as the Happiness and Desh Bhakti programmes in Delhi. Health Ambassador roles are, in practice, more symbolic than substantive, and few schools have regular health lessons or a formal accountability system to ensure delivery.
While staff shortages are an intrinsic problem, current teachers must also navigate additional health directives alongside demanding curricula such as the Happiness and Desh Bhakti programmes in Delhi.
No less concerning are the chronic shortfalls of funds and large inter-state differentials that limit effective rollout. Though there are some programmes like mid-day meals and RBSK that are more established, all the other NEP health programmes have no budgetary provision. The schools then become dependent on local ad hoc initiatives or on corporate funding for implementing initiatives such as wellness clubs or maintenance of health records. In addition, while urban and private schools can work in association with healthcare experts and avail parental donation, rural schools lag behind. The gap is unsettling: while states such as Haryana and Rajasthan have trained more than 90 percent of intended teachers, others like Uttar Pradesh and Chhattisgarh are far behind, leaving children’s access to health education largely dependent on where they live and their families’ income levels.
However, the gaps and challenges identified above indicate that goodwill is insufficient: dedicated support and structural reform are required to enable “wellness to work” effectively in schools. Among the following are a few key policy recommendations on how best to leverage schools for health equity:
- Digitise and Integrate Health Records: Shifting from paper “health cards” to electronic health records (EHR) for all students has the potential to significantly improve continuity of care. Every student could be given a health ID (making use of the national ABHA digital health IDs) so that their screening results, immunisation status, and referrals are electronically documented and securely transferred between schools and healthcare providers. Computerised records would enable tracing of students who transfer from school to school and ensure proper follow-ups. Computerised records would also enable data analysis to recognise trends (for example, anaemia or vision issues in a particular school) and inform
- Strengthen School Wellness Clubs: Health and Wellness Clubs need to be established not as busywork but as participatory, student-initiated forums making healthy living “cool” and integral to school culture. Schools can be encouraged to allocate funds and a weekly time slot for club activities such as morning yoga classes, sports matches, cleanliness campaigns, and talks from local physicians.
- Develop Health Education and Counselling Capacity: In order to truly enhance health outcomes and equity through schools, we must equip the professionals on the frontline — school staff and teachers — with improved skills, knowledge, and capacity. This can begin with training: basic counselling competencies and health education should be integrated into teacher preparation programmes and in-service training. For example, instructors may be trained to recognise the most prevalent signs of malnutrition or stress in children and provide initial counselling or referral. Wherever feasible, specialist professionals must be employed. Even though it may not be feasible in the near future to have a full-time counsellor or nurse in every school, one health and counselling professional for each school complex or cluster could be designated, who can visit and be on call for consultations. Central schemes could offer incentives to states to hire school counsellors, particularly in high-priority schools. Additionally, India can utilise telemedicine and technology to support counselling services. The National Tele-Mental Health programme (Tele-MANAS) already has cells in 36 States/UTs and has handled nearly 20 lakh (2 million) counselling calls. Schools can be integrated into the network so that tele-counsellors can be contacted by students or teachers for guidance in challenging cases or emergencies.
As India moves forward, a neutral, outcome-focused approach is key: rather than new policy rhetoric, the emphasis should be on effective implementation and innovation on the ground. By enhancing coordination, investing in people and technology, and sharing best practices among states, schools can truly become engines of health equity.
K. S. Uplabdh Gopal is an Associate Fellow with the Health Initiative at the Observer Research Foundation.
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