What do children say?
Research undertaken in Tanzania with children and young people for this module clearly revealed that many children experience unfriendly and unhelpful responses when they visit health facilities. The older boys in the research said they go on their own to get medical attention but the doctors disregard them. They can stay for a long time without being seen by anyone and are called truants if they turn up in school uniform. The following quotes are real examples of their experiences.
At school I got a sudden headache. I went to the nearby clinic but they ignored me thinking I was playing truant. When I went home to inform my mother, she was out. As my condition was getting worse I had to go to my sister. When I told her she took me to the hospital run by nuns who admitted me with serious malaria. My sister then called my mum to tell her I had been admitted. What would have happened if I did not have a sister? Since mum is at work, I could have died… just because they ignore children.
(From the consultation undertaken in Tanzania for the development of this module)
I had forgotten that my meds were finished and my grandmother did not remind me. When I got to school, I remembered and went to the dispensary where I usually take the meds. I left at 9 in the morning but no one was concerned until I was the only person left. Then they turned to me and asked, ‘You, child, what do you want? Why aren’t you speaking?’ When I told them I had come for my meds because I didn’t take them, they told me ‘Come with your grandmother’. It was 1 o’clock and I was so hungry but I had to go back to my grandmother and come back with her.
(From the consultation undertaken in Tanzania for the development of this module)
It is clear that some children and young people suffer very poor experiences at health facilities (which in turn can actually endanger their health). It may be that you think the two young people would not have this experience where you work. If they would then now that you understand children’s rights and their importance, you can adapt your own practice and challenge the practice of others where necessary.
Many health facilities are very busy and under-resourced but being child-friendly is not just about resources. Research that was done in many countries around the world concluded that:
Even in the most disadvantaged health facilities there were many examples of excellent care, but everywhere there was care that can only be described as very child-unfriendly.
…it is usually more dependent on the health workers responsible than on the resources available.
(Nicholson and Clarke, 2007, p. 14)
A well-resourced city hospital may be very frightening for children because of the environment and attitudes of the staff. A poorly resourced rural facility could be a model of supporting the rights of children if staff have made efforts to make children feel safe and at ease.
Activity 4.1: Case study – An unaccompanied child
A young boy is brought into a clinic by a man. The man says to the nurse on duty that he found the child crying on the road near the clinic. The child looks sick and possibly neglected and he thinks that he should bring him to the health facility. He wants the staff to help the child and take him back home. The child is about 7 years old and is able to talk. The staff at the health facility insist they cannot help the child without the parents or guardians being present.
Questions:
- As a health practitioner how would you go about helping this child given the fact that he was unaccompanied?
- Who else would you involve in managing this case?
Discussion
- In health facilities, health workers should be easily accessible to children whether accompanied or not. Health workers should always take the best interest of the child as paramount, checking on their circumstances and establishing their health status and other related issues that affect the child’s well-being. It is important to involve a young child’s family where appropriate but this should not prevent help being given at the time. The health workers should develop an attitude of making children who come to their facilities comfortable, and help children to express themselves.
You will know from your study in the last session that children sometimes come to health facilities when they have been abused and neglected by their parents, guardians and those with whom they stay. According to the laws in your country, health workers are very important in identifying abuse and neglect and reporting this to the relevant authorities.
- As a health worker you can also involve others beyond the immediate care of the child, both other practitioners and social workers or psychologists if they are available. If there is a problem that requires work with the community, you can approach the community leaders and work with them to trace the parents or resettle children like the one in the case study. The community can be supported in ensuring that cases of neglect by parents/guardians can be prevented and that the well-being of children in such communities can be promoted.
4.3 What does the term ‘child-friendly health services’ mean?