Comparative study on school health promotion in Switzerland and Malaysia: qualitative evidence

BACKGROUND: The Ottawa Charter emphasized schools as a central location for health promotion. In particular, a holistic approach involving all members of a school and the school community is considered desirable for school health promotion (SHP). School principals are seen key players in SHP implementation, but little is known about how contextual factors such as the governance of health and education affect their roles. The project aims to study the governance mechanisms and contextual factors affecting SHP implementation in schools in two national contexts: in Malaysia and Switzerland. METHODS: 18 principals were interviewed in expert interviews. The interviews were transcribed verbatim and analyzed with MAXQDA using qualitative content analysis with deductive and inductive categories. RESULTS: Results indicate that there are significant differences in how Malaysia and Switzerland govern SHP. In Malaysia, there are clear structures and responsibilities for SHP. The health and education sectors work closely together, with top-down decision-making on a national level. In contrast, Switzerland has no governmental policy regarding SHP for schools with SHP organized mainly by NGOs. It appears that in Switzerland, decisions regarding SHP are made more bottom-up and at the local level, typically by municipalities. Malaysia has a very distributed leadership model, with a school leader specifically responsible for student affairs and SHP at each school. Enablers of SHP include clear structures and well-defined responsibilities, while a lack of time and staff are among the primary barriers to successful implementation. CONCLUSIONS: The governance and policies of SHP are very different in Malaysia and Switzerland. Clear structures and high centralization in Malaysia are contrasted by very high autonomy and a federal structure in Switzerland. Advantages and disadvantages of these differences in educational governance will be discussed within the presentation.