Background: School health program (SHP) is an important component of the overall health care delivery system of any country. In developing countries such as Nigeria where infant and early childhood mortality is high its importance cannot be overemphasized. For this reason and the recent action plan of the Federal Government of Nigeria concerning SHP, the knowledge, attitude and practice of SHP among head teachers of primary schools in a Local Government Area in Nigeria was evaluated. Methods: A pre-tested questionnaire designed to evaluate the knowledge attitude and practice of SHP by the researchers was administered by assistants to 133 head teachers of 104 private and 29 public primary schools in Egor Local Government Area of Edo State, Nigeria. The School premises were also inspected to check provision of pipe borne water, sick bay, toilet facilities and the adequacy of the school environments among other things. Results: None of the head teachers had adequate knowledge of SHP. 93.1% from private compared to 48.3% from public schools had poor knowledge of SHP (χ2 = 56.86, p < 0.05). A favorable attitude was demonstrated by all the teachers. Up to 40.4% of private compared to 31.0% of public schools have SHP. Overall 27.7% of the schools had no toilet facility, 33.3% had pit latrine while 40.0% had water closet. Only 25.6% had hand washing facilities. Regarding health services, 51.0% of private schools compared to 27.6% of public schools perform medical inspection of the pupils. Similarly 39.4% private compared to 3.4% public schools have sick bay (χ2 = 11.11; p < 0.05). A total of 16.5% of the schools undertake medical screening of food handlers/vendors, while 20.2% private compared to 3.4% public schools screen food handlers/vendors (χ2 = 4.47; p < 0.05). Conclusion: The poor status of SHP in Nigeria may be attributed to failure of policy enunciation, poor primary health care base and lack of supervision.