Does the availability of such a screening process for RHD merit its automatic inclusion into the mass screening programme of the ISHP? Recent debates on the implementation of the current ISHP point to the need to reduce, rather than increase, mass screening.
It is here that the ISHP in partnership with schools can play a crucial role.
 A well-functioning ISHP has a crucial health promotion and ongoing monitoring and support role.
Medical input into developing an ISHP at school occurred more frequently among pre-K students (48.4%) and middle to high school students referred to the school physician consultant (47.7%) than for elementary students (31.1%), [chi square](2, 215) = 6.35, p = .042.
The higher frequency of school physician consultant assistance in developing an ISHP for students in preschool, middle school, and high school as compared to students in elementary school may be related to demands these children face as they enter a new environment.
Their distrust of adults and institutions, transient nature, low self-esteem, lack of documentation, and concern for daily survival are all reasons that can contribute to their disconnection from services (De Rosa et al., 1999; ISHP
policy for testing clashes with current recommendations governing children's participation in HIV prevention research.
The model used in this study is aligned with the suggested model outlined in the ISHP
, and the results suggest that the on-site approach is popular and acceptable to learners.
Pertinent differences between the two policies are summarised in Table 1 and the implications of these for the 2012 ISHP implementation are highlighted.
The 2012 ISHP is fundamentally similar to its predecessor in its content, but differs in high-level support, the overall implementation context and in the strength of key relationships, in particular that between health and basic education.
The prioritisation of quintile one and two schools by the 2012 ISHP potentially will ameliorate the low coverage and narrow the inequity gap.
The significant expansion in the 2012 ISHP of both the numbers of children that should be screened and the conditions which they must be screened for, therefore require careful contemplation and planning, as referral services will take a long time to catch up with the demand from increased screening outputs.