Understanding school health environment through interviews with key stakeholders in Lao PDR, Mongolia, Nepal and Sri Lanka.

Studies on health promoting schools (HPS) in low- and middle-income countries (LMICs) are scarce. To contribute to the development of HPS in these countries, we conducted formative research to understand the school environment in Lao PDR, Mongolia, Nepal, and Sri Lanka. Forty-three teachers, 10 government workers and 5 parents participated in three one-on-one interviews and 14 natural group interviews. Six themes emerged that centered on insufficient resources as reasons for suboptimal health conditions. At the individual level, participants mentioned the deficiency of personal resources to cope with cold weather and poor diet. At the school level, the lack of physical resources such as water purifiers and latrines was discussed. Interviewees also pointed out the schools' overdependence on external resources and therefore the lack of sustainability. Last, the shortage of health services at the school and community level was commonly mentioned. Based on these results, we believe that the basic concept of HPSs should also be applied when working with schools in LMICs. In conclusion, there was a lack of perception of the importance of policy and capacity development programs, which are important in developing HPSs. Therefore, future school health programs should stress improving these elements.