Shortening nurses' working hours, failure to fully implement screening tests and irregularities in documentation are just some of the problems uncovered by the Supreme Audit Office in the Świętokrzyskie province. The audit shows that although most schools formally provide health care, in practice it does not always meet the real needs of students.
Health care in schools fails to meet standards. Results of the NIK audit
Published April 20, 2026 06:52
Health care for schoolchildren in the Świętokrzyskie province was not fully implemented in accordance with current regulations, according to an audit by the Supreme Audit Office covering the school years 2021/2022-2024/2025 (H1). In five of the six audited medical entities, the organization of the work of school nurses at various times deviated from the requirements, which translated into limited access to preventive and care services for children and adolescents.
One of the most frequently cited problems was that nurses' working hours were shortened, that on-call duties were combined, or that they were scheduled outside of school operating hours. It also happened that nurses performed services for other primary care patients during school duty hours. In practice, this meant reduced availability of care for students.
Untapped potential of prevention
Irregularities also applied to screening tests, which are an essential element of preventive health care in schools. In many cases, they did not include all students, and the documentation was incomplete or contained errors. In some schools, tests were not conducted at all among selected groups of students.
Meanwhile, the results of the available data indicate a large scale of health problems. Positive screening tests were reported in 16-45 percent of elementary school students, and in secondary schools the percentage was even higher. The most common were vision defects, postural problems, weight disorders or hypertension.
Despite this, the NIK stresses, in many cases no further diagnostic measures were taken or adequate care was provided for students with abnormal results. This included overweight or underweight children, whose problems were often not monitored.
Students with special needs outside the system
The audit also revealed significant systemic gaps in the care of students requiring special support. Existing regulations do not adequately address the needs of children on the autism spectrum and students in special education without a formal disability evaluation.
According to the NIK, the lack of adequate regulation translates into limited access to increased health care for these groups. The chamber noted that the scale of the problem is significant - students on the autism spectrum make up a significant percentage of children with special educational needs.
Funding in question
Providers participating in the audit unanimously pointed to the underestimation of funding for student health care. In their view, the funds transferred by the National Health Fund did not cover the actual costs of providing services. At the same time, the NIK found that in some cases the shortfalls were due to errors on the part of the institutions themselves, including improper reporting of the number of students or failure to take into account their special health needs. This resulted in underfunding, which, with correct data, could have been higher.
The audit also uncovered improper practices involving some entities requesting additional funds from schools or their governing bodies, despite the fact that the services are publicly funded. In extreme cases, the services were threatened to be discontinued during the school year.
Deficiencies in oversight and reporting
Monitoring the quality of care was also problematic. Students' medical records were often kept unreliably, and the data used for reports contained errors and inconsistencies. None of the inspected providers conducted a systematic evaluation of the quality of services provided.
Irregularities were also shown in reports submitted to central institutions. This is important, because on the basis of them recommendations are formulated for the organization of health care in schools nationwide.
Conclusions and recommendations
The Supreme Audit Institution has sent proposals to the Minister of Health and the President of the National Health Fund for changes in regulations and rules for financing services. They concern, among other things, better consideration of the needs of students with special health requirements and the elimination of improper financial practices.
The report shows that despite the formal provision of health care in most schools, its actual availability and quality remain a challenge. Not only the level of funding, but also the organization of work, the reliability of data and effective oversight of the system are crucial.
Source: NIK
