Introduction: A healthful school environment is that which embraces the health and safety of learners and other members of the school community. Undergoing pre-school medical examination (PSME) is not only necessary to screen for previously undiagnosed health conditions and subsequent recognition of those with special care but it is also imperative to have base-line health information about the pupils. This study seeks to elucidate the practices and determinants of school health services (SHS) in Osun state. Methodology: In the cross-sectional descriptive study, a total of 229 heads of schools (102 primary and 127 secondary) in Osun state were interviewed using a selfadministered questionnaire. Data were analyzed with SPSS version 16. Level of significance was set at p-value of 0.05.

Results: All the respondents were aware of SHS with 114 (50.7%) having good knowledge. Although up to 209 (91.3%) are aware of PSME and 188 (83.6) agreed that it was necessary, only 46 (20.1%) have their pupils undergo PSME. Most schools (76.8%) provide toilet facilities mainly of the pit type. Overall knowledge of SHS was good in 114 (50.7%) of the respondents. Medical services are provided through First Aid box