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knesset 224.88.(Photo by: Ariel Jerozolimski [file])
Knesset critics: School health reform a bust
Judy Siegel-Itzkovich
Plan required all the ministry's public health nurses to be fired; schools lack full-time nurses.
The Health Ministry's privatization of school health services at the demand of the Finance Ministry - which reduced the number of public nurses on the state payroll and claimed the move would save just NIS 7 million a year - has been a failure so far, according to an 11-page document prepared by the Knesset's research and information center and backed up by Dr. Yitzhak Kadman, director of the National Council for the Child. Kadman protested before a joint session of the Knesset Education Committee and the Knesset Labor, Social Affairs and Health Committee this week against the Health Ministry's April transfer of responsibility for school health services to a for-profit company called the Association for Public Health. All of the Health Ministry's public health nurses were fired and many of them rehired by the association, but none of the schools has a full-time school nurse to provide first aid and vaccinations, conduct various tests and teach health education, as was the norm years ago. With shrinking budgets from the Treasury in recent years, the Health Ministry had to cut back severely on school health services, which then declined in quality and quantity. Instead of one school nurse per 1,700 pupils in 2002, the ratio was 1:2,480 in 2005, while some cities said it was 1:4,000 or even 1:5,000, according to the Knesset document. After being sued in the High Court of Justice several months ago, the Education Ministry (which until April was responsible for providing first-aid to pupils), signed a NIS 25 million deal with Magen David Adom to answer calls and treat injuries in schools as they occurred. Paramedics and medics are required to arrive within 20 minutes of a call. The Education Ministry will soon check to see whether MDA has met its commitment. However, Supreme Court President Dorit Beinisch said alerting MDA was not an optimal solution and that having school nurses permanently on hand was preferable. The Health Ministry spent NIS 70m. on school health services in 2003, but this figure declined to NIS 54m. the following year, while the for-profit association was supposed to provide all services for NIS 64m. a year in 2007. But the ministry's Public Health Services Department, which was charged with supervising the association's work, complained that the association was not filing regular reports as required and not performing what it had committed to doing. Kadman noted that even though schools were bound by the National Health Insurance Law to provide preventive medical services in the schools, the association was not doing this properly. Kadman said many pupils were not being vaccinated as required - for example, half of the children in Rosh Ha'ayin had not received the necessary shots. Dr. Alex Leventhal, director of the ministry's public health services, told the association that the ministry intended to halt its payments for services because it had not met its contractual responsibilities. "The State of Israel today does not have a school health service, but rather a body that runs from place to place to carry out various tasks," he said. A Health Ministry spokeswoman said it was aware of the fact that there were "difficulties" as a result of the privatization and that "it will take time to iron them out. The ministry will do all it can to help" the private association to succeed, she said. Ministry associate director-general Dr. Boaz Lev, who met with heads of the association on Wednesday, said, "I wish that once again there could be a school nurse in every educational institution, but it won't happen. The association is doing a good job, its reports are reliable and it is required to provide health education. If the association is found not to be doing its job, we can open a public tender to replace it. But we do a lot of supervision and have found the association to be flexible and offer better service than the ministry was able to in recent years." He added that the MDA contract with the Education Ministry was not coming at the expense of MDA's usual customers - those who have heart attacks or are injured in road accidents, for example. "Instead, the extra money is allowing MDA to hire more medics and buy more ambulances, and this will improve their services in emergencies," Lev said.
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