{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T06:04:04Z","timestamp":1789365844399,"version":"build-2803163510"},"reference-count":21,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T00:00:00Z","timestamp":1789344000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:p>Rwanda\u2019s primary and secondary schools serve about 4.7 million learners, creating an important platform for child and adolescent health. Rwanda has school-health policies, referral arrangements, and strong primary health care (PHC) and community systems, but it lacks a standardized, funded, and clinically regulated function consistently responsible for school-linked first response, referral coordination, and follow-up. This Perspective argues that this continuity gap at the school PHC interface deserves explicit attention and proposes a School Health Officer (SHO) as one model to test within existing PHC structures. We outline a bounded SHO scope, map the mechanisms through which the role could contribute to the six WHO health system building blocks, and identify safeguards related to workforce capacity, financing, data governance and role clarity. Rather than assuming national scale-up, we propose a risk-stratified pilot that compares feasible delivery configurations and assesses access, referral completion, workload, equity, safety and cost. The purpose is to determine whether a PHC-linked SHO function adds value to existing school-, community- and facility-linked arrangements before wider adoption is considered.<\/jats:p>","DOI":"10.3389\/fpubh.2026.1922178","type":"journal-article","created":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T05:39:33Z","timestamp":1789364373000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Clinically accountable school health: a case for extending primary care into schools"],"prefix":"10.3389","volume":"14","author":[{"given":"John","family":"Mugisha","sequence":"first","affiliation":[{"name":"Rwanda Implementation Science and Health Systems Lab (RISHS Lab)","place":["Kigali, Rwanda"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julius","family":"Niyibizi","sequence":"additional","affiliation":[{"name":"Rwanda Implementation Science and Health Systems Lab (RISHS Lab)","place":["Kigali, Rwanda"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dexing","family":"Zhang","sequence":"additional","affiliation":[{"name":"School of Nursing, Faculty of Health and Social Services, The Hong Kong Polytechnic University","place":["Hong Kong, Hong Kong SAR, China"]},{"name":"Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong","place":["Hong Kong, Hong Kong SAR, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,14]]},"reference":[{"key":"ref1","first-page":"176","volume-title":"Number of Schools by Level of Education","year":"2025"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"100594","DOI":"10.1016\/j.xagr.2025.100594","article-title":"A critical evaluation of adolescent sexual and reproductive health and rights in Rwanda","volume":"6","author":"Habikigeni","year":"2026","journal-title":"AJOG Glob Rep"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"e0004152","DOI":"10.1371\/journal.pgph.0004152","article-title":"\u201cWhere does my menstruation come from?\u201d experiences and costs of menstrual hygiene management among Rwandese school girls","volume":"5","author":"Dodroe","year":"2025","journal-title":"PLOS Global Public Health"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"e0302523","DOI":"10.1371\/journal.pone.0302523","article-title":"Menstrual hygiene management interventions and their effects on schoolgirls\u2019 menstrual hygiene experiences in low and middle countries: a systematic review","volume":"19","author":"Betsu","year":"2024","journal-title":"PLoS One"},{"key":"ref5","doi-asserted-by":"publisher","DOI":"10.2174\/0118744346414066251104080234","article-title":"Prevalence and contributing factors of menstruation-related absenteeism among schoolgirls: a systematic review meta-analysis","volume":"19","author":"Zaman","year":"2025","journal-title":"Open Nurs J"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"100296","DOI":"10.1016\/j.ensci.2020.100296","article-title":"Decentralized, primary-care delivered epilepsy services in Burera District, Rwanda: service use, feasibility, and treatment","volume":"22","author":"Nyirandagijimana","year":"2021","journal-title":"eNeurologicalSci"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"771","DOI":"10.9734\/ajess\/2025\/v51i102531","article-title":"Assessment of the barriers and challenges faced by learners with physical disabilities to enhance their competences in public primary schools in Rwanda","volume":"51","author":"Innocent","year":"2025","journal-title":"Asian J Educ Soc Stud"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"1858","DOI":"10.1186\/s12889-022-14165-x","article-title":"Prevalence of mental disorders, associated co-morbidities, health care knowledge and service utilization in Rwanda\u2014towards a blueprint for promoting mental health care services in low- and middle-income countries?","volume":"22","author":"Kayiteshonga","year":"2022","journal-title":"BMC Public Health"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"e70225","DOI":"10.1002\/puh2.70225","article-title":"Public health achievements in Rwanda: a 21st century transformation","volume":"5","author":"Julius","year":"2026","journal-title":"Public Health Chall"},{"key":"ref10","first-page":"24","volume-title":"Health Sector Strategic Plan (HSSP) V 2024\/25\u20132028\/29: Abridged Version","year":"2024"},{"key":"ref11","doi-asserted-by":"crossref","first-page":"2054","DOI":"10.1056\/NEJMsr1302176","article-title":"The human resources for health program in Rwanda\u2014new partnership","volume":"369","author":"Binagwaho","year":"2013","journal-title":"N Engl J Med"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"1024","DOI":"10.15171\/ijhpm.2018.61","article-title":"Health professional training and capacity strengthening through international academic partnerships: the first five years of the human resources for health program in Rwanda","volume":"7","author":"Cancedda","year":"2018","journal-title":"Int J Health Policy Manag"},{"key":"ref13","volume-title":"WHO Guideline on School Health Services","year":"2021"},{"key":"ref14","volume-title":"National School Health Strategic Plan","year":"2014"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"393","DOI":"10.1186\/s12875-024-02645-5","article-title":"Factors associated with perceived health of school-aged children in rural Rwanda: an opportunity to leverage community health workers to enhance school health promotion and primary healthcare systems linkages","volume":"25","author":"Manzi","year":"2024","journal-title":"BMC Primary Care"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"e055119","DOI":"10.1136\/bmjopen-2021-055119","article-title":"Rwanda\u2019s community health workers at the front line: a mixed-method study on perceived needs and challenges for community-based healthcare delivery during COVID-19 pandemic","volume":"12","author":"Niyigena","year":"2022","journal-title":"BMJ Open"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"e0236255","DOI":"10.1371\/journal.pone.0236255","article-title":"Equity for health delivery: opportunity costs and benefits among community health Workers in Rwanda","volume":"15","author":"Schurer","year":"2020","journal-title":"PLoS One"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"162","DOI":"10.1016\/j.glohj.2024.11.007","article-title":"Burnout and mental distress among community health workers in low- and middle-income countries: a scoping review of studies during the COVID-19 pandemic","volume":"8","author":"Ndulue","year":"2024","journal-title":"Glob Health J"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"e0282717","DOI":"10.1371\/journal.pone.0282717","article-title":"Workload and emerging challenges of community health workers in low- and middle-income countries: a mixed-methods systematic review","volume":"18","author":"Astale","year":"2023","journal-title":"PLoS One"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"328","DOI":"10.9745\/GHSP-D-14-00080","article-title":"Nationwide implementation of integrated community case management of childhood illness in Rwanda","volume":"2","author":"Mugeni","year":"2014","journal-title":"Glob Health Sci Pract"},{"key":"ref21","year":""}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2026.1922178\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T05:39:34Z","timestamp":1789364374000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2026.1922178\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,14]]},"references-count":21,"alternative-id":["10.3389\/fpubh.2026.1922178"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2026.1922178","relation":{},"ISSN":["2296-2565"],"issn-type":[{"value":"2296-2565","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,14]]},"article-number":"1922178"}}