2.12 Answers to activities

Activity 2.1: Advocacy in health services

  1. The first four statements are true, but the last one is not. A child may have had a difficult previous encounter with a health worker, or they might just be overwhelmed by the unfamiliarity of a medical environment. It is up to the health worker to recognise that the child needs reassurance in order to feel safe and that part of that reassurance is in making sure that the child is kept informed, in a way that is appropriate to their age, about what is happening to them. Taking into account the rights of children is good practice, but advocacy takes things a stage further.

  2. In responding to the first statement, you can respond to an individual child who is scared by trying to reassure them. That would be part of your day-to-day role in working with children. But advocacy involves a different approach – rather than dealing with each individual child, you would try and identify the source of the problem and do something to change it. This might involve the following steps:

    • Look at the pattern of how children feel when they have to come to hospital. Do most children feel frightened? If so, what are they frightened of?
    • Is it possible to document the problems they experience? For example, they have never been away from home before; everything feels strange and unfamiliar; they do not know what is going to happen to them; they have no one to ask for help or information.
    • Once you have the information about the sources of children’s fear, you could then use this information to advocate with the hospital administrators and doctors to take action. For example, the hospital could prepare a short information leaflet for every child being admitted; every child could have a named nurse who has special responsibility for caring for him or her and who the child could always approach for information; you could show the child around the ward to let them know where to find the toilets, how to get help if they need it and what the daily routines are.
    • You could then check whether these changes have begun to reduce children’s anxieties and make their experience of hospital less distressing.

    You might recognise that issues, such as the one discussed above, are problems but feel that in some health facilities it would be impossible to address because of lack of time, staff or resources. However, investment of time in advocacy to improve children’s experiences of their health care can lead to fewer demands on health professionals’ time in the longer term. For example, it is easier to treat children who are relaxed and confident than those who are frightened, crying and anxious.

Activity 2.3: Case study

These workers used a mix of different methods to try and advocate for these children. Discussing the issue with the children individually or in a small group and then raising their concerns with the community are examples of quiet advocacy. The workers then moved on to trying to get more attention for the issue by using ‘loud’ techniques such as leafleting and lobbying.

Being part of a specialist organisation Martha, Rahel and Aman probably had much more time and resource available to them than many health workers will. But it will not be appropriate in all cases to try and use many different forms of advocacy. You will need to choose which is likely to be most effective or which you can realistically achieve. Return to the same example and think about how you might be able to respond.

2.11 Self-assessment questions

3 Community mobilisation: practical strategies