Clinically accountable school health: a case for extending primary care into schools

Rwanda's 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.