Background <p>Saudi Arabia’s Healthy Schools Program operates without dedicated school nursing professionals, instead relying on teachers who serve as health advisors. This study addresses the following question: What is the level of readiness for implementing the healthy school program?</p> Methods <p>A cross-sectional design was adopted, and 242 public schools were surveyed using the School Health Index adapted for the Saudi context. Data were collected from health advisors (i.e. teachers without healthcare certification) working at primary, secondary, and high schools. Statistical analyses included descriptive statistics, t-tests, and Spearman correlations.</p> Results <p>Significant deficiencies were identified in physical education and staff health promotion. Specifically, low budget allocations for physical activity and minimal staff wellness initiatives were observed, which are systemic failures. Male students’ schools largely experienced financial disparities, whereas female students’ schools exhibited greater policy implementation and health education. The correlation analysis highlighted a reliance on external workshops rather than sustained clinical care.</p> Conclusion <p>The absence of school nurses has created a leadership deficit, resulting in fragmented services, inequitable resource distribution, and inadequate emergency and chronic care management. Based on this study’s findings, it is recommended that the Ministry of Education adopt a nurse-led model that aligns with the Saudi Vision 2030 goals and international best practices for school programs.</p> Clinical trial number <p>Not applicable.</p>