Child Survival: Children’s Institute and IDASA briefings

Meeting report

IMPROVEMENT OF QUALITY OF LIFE AND STATUS OF CHILDREN, YOUTH AND DISABLED PERSONS JOINT MONITORING COMMITTEE
9 June 2006-
CHILD SURVIVAL: CHILDREN’S INSTITUTE AND IDASA BRIEFINGS

Chairperson: Ms W S Newhoudt-Druchen (ANC)

Documents handed out:
Children’s Budget Unit Report on Advancing Children’s Rights through Rights-Based Budgeting
Children’s Institute presentation on Child Survival
Idasa Budget Information System, February 2006
National Youth Development Policy Framework Mid-Term Reviews

SUMMARY
The Children’s Institute of the University of Cape Town briefed the Committee on Child Survival and Child Health Services, and Idasa provided an overview of the Children’s Budget Unit, which sought to monitor the realisation of children’s socio-economic rights, enshrined in Section 28 of the Constitution, through budget allocations.

Members expressed concern that the Children’s Institute presentation focused on problems with child health in the Western Cape rather than on the national situation, and suggested that comparative analysis should be carried out on infant mortality rates in South Africa and other countries. The Committee discussed the reliability of statistics on child deaths, such as those deriving from the National Demographic and Health Survey, and their applicability at national and provincial levels. Members further suggested that diseases of poverty could be prevented through education and social development projects.

MINUTES

Children’s Institute presentation on Child Survival
Ms Kashifa Abrahams, senior researcher at the Child Health Service Programme, Children’s Institute, said that the mission of the Children’s Institute was to contribute to policies, laws and interventions that promoted equity, realized the rights, and improved the conditions of all children in South Africa, through research, advocacy, education and technical support. She detailed the current status of child survival in South Africa, indicating that the main causes of child deaths (HIV/AIDS, diseases of poverty, and trauma) were largely preventable. The work of the Children’s Institute was carried out from a human rights perspective that made children under 18 rights-holders and government departments their duty bearers according to international and constitutional law. The way forward for child survival included the mainstreaming of child rights and child development programmes, as well as co-ordinated responses across government departments.

According to statistics on infant mortality, for every 1000 births, 60 children died. Within a day or hour, ten children under the age of five were dying of preventable diseases. It was important to look at the infant mortality rate, as this indicated the status of the country’s population growth rate. In the context of poverty, the main cause of infant mortality was disease. Other causes included burns affecting children between the ages of 0 and four.

Referring to a geographical diagram of out-patient density, the areas where there were high incidents of diarrhoea were pointed out. This was caused by lack of access to water, sanitation and housing. Although health facilities were important, access to basic social services, such as water, sanitation and housing was essential.

From a rights perspective, the key issues for children were based on the Constitution. South Africa had ratified the United Nations Convention on the Protection of Children’s Rights, and had made a non-binding agreement to commit to the Millennium Development Goals. The right to survival was provided for in International Law, and had been incorporated into South African law in relation to the right to life.

Duties in terms of the Constitution and issues around basic services were important when looking at the causes of disease. More important was to look at the key role of various government departments in facilitating this process, which in turn will enhance the prospects of survival of children. In practice this would imply that Statistics SA would have to collect and provide information. The Department of Health would play a key role in terms of service delivery, and the Department of Transport would have to play a role in ensuring safety on roads, which directly impacted on motor vehicle accident claims. It was also expected that the Office on the Rights of the Child would research enhancing the prospects of child survival. The Human Rights Commission would play a monitoring role. There was a need for a more integrated approach when addressing child survival.

Looking at the way forward, she noted that children continued to die at an alarming rate. While government departments had an important role to play in mitigating poverty, there was currently no integrated plan across government departments, although there had been discussions between the Departments of Social Development and Health. The voice of civil society was equally important.

Discussion
Mr Molefe (ANC) commented that according to the statistics there had been a decrease in the number of deaths during childbirth, and asked why in South Africa there were still numerous deaths occurring. There seemed to be inadequate information regarding the causes of these deaths. The delegation was asked to comment on the real challenges and whether the problem of infant mortality was partly due to a lack of partnerships.

Ms F Batyi (ID) stated that she was part of the Portfolio Committee on Health, and that progress had taken place in preventing maternity-related deaths. She requested that further research be undertaken to gain information from the Department of Health.

Ms Batyi commented that the presentation should have included a more global picture, and it seemed to focus mainly on the Western Cape. There was a need for more comparative analysis to be done. It was pointed out that a missing element of the presentation was the issue of liquor-related deaths, as drinking during pregnancy also caused death. There had been no discussions regarding the drowning of children, and education and the safety of children at schools were further areas of concern.

Ms T Tobias (ANC) asked why diseases of poverty were occurring. If the deaths were related to preventable diseases, why were they occurring and not being dealt with? In order to meet the challenges of child diseases, social education could be used to change lifestyles and manage diseases properly, while universities could play a role in developing social projects.

Ms Abrahams responded that there were both main and underlying causes of children’s deaths. She acknowledged that it was not just government departments that should play a role, but education of the community was also important, as well as responses to poverty. Non-government organisations and Community-Based organisations (CBOs) played an important role in the community.

The delegation was asked to comment on whether there were institutions such as theirs in other provinces.

Ms Tobias commented that education in the community was vital, and an integrated approach was required. In particular, she highlighted the critical role of civil organisations in this regard.

Ms J Chalmers (ANC) asked the delegation to provide a breakdown of the statistics for each province, and questioned the reasons for the continuous downward trend despite an improvement in health and clinics.

Ms Abrahams replied that the Children’s Institute had published a substantial discussion paper, which provided provincial breakdowns. The Department of Health interventions were not the only interventions, to prevent death, as there was a responsibility on other departments such as Transport and Water Affairs. Despite many clinics, safe water was not available everywhere, and therefore death by diarrhoea would still occur.

A Member suggested that there should be a breakdown of all 54 health districts in order to determine what the problems were. He commented that the infant mortality rate in Khayelitsha had decreased, as more health facilities had been made available.

Ms Abrahams responded that the reason for the decrease of deaths in Khayelitsha was the good mother-to-child transmission programme, which was in place.

A Member sought clarity on who would have responsibility for the way forward, because an integrated approach was needed. Would the responsibility be with the Children’s Institute or the Committee?

The Chairperson commented on teenage pregnancy being on the increase and how the issue of child survival affected this, and asked whether the various clinics were capacitated to provide necessary information.

Dr Maylene Shung-King, Director: Children’s Institute, replied that according to research conducted by Stellenbosch University, teenage pregnancy was not increasing. Adolescent-friendly clinics were not operating well, as there was great pressure on the health sector, and much needed to be done to improve the health of adolescents. The prevention of mother-to-child transmission was not working adequately except in the Western Cape, where the programme in Khayelitsha was working well.

In terms of the way forward, Ms Abrahams noted that it was not the responsibility of the Children’s Institute to organise an integrated plan, but only to provide information and guidance to civil society.

Responding to questions around TB and asthma, Ms Abrahams said that because TB was linked to HIV, there were difficulties with getting data which related specifically to TB separate from HIV. Asthma was not a major cause of death, but was a chronic disease.

Responding to a question on why there was no prevention of mother-to-child transmission, Ms Abrahams said that there were two kinds of prevention: general intervention such as mitigating poverty and unemployment, and education of mothers and care-givers.

Ms Abrahams said that there needed to be more in-depth discussions with the Office on the Rights of the Child about mainstreaming children’s issues. These discussions were ongoing.

Responding to queries regarding the reliability of statistics, Ms Abrahams said that the census and demographic health surveys, using collective modelling, came to a particular mortality rate, and this was done for a range of countries. It was acknowledged that information systems needed to be improved by liaison with different departments.

The issue of an inquiry had to be looked at in terms of the separation of powers and the capacity of the legislature to conduct this inquiry. Discussions with other portfolio committees such as Social Development and Health were also needed. More comparisons should be made with other countries to compare patterns.

Dr Shung-King said that all the statistics presented were national statistics, representing the national infant mortality rate. Referring to the geographical map in the presentation, she said that the purpose was to understand what was happening to diarrhoeal disease in the areas, which were served only by the Red Cross Hospital. The aim was to understand why children, particularly in the Western Cape, were suffering from so much diarrhoeal disease, and what the underlying causes were. The map showed that the areas of high concentration were mostly in informal settlements where water and sanitation was a real problem, and where the disease could not be prevented by putting in place more hospitals and clinics. This situation was the same at a national level.

She explained that all work done by the Children’s Institute was primarily at a national level, where there were many collaborators that the Institute worked with.

Ms Abrahams said that the Institute looked at issues at a local government level across nine cities. In many of the Integrated Development Plans (IDPs), health and children’s issues did not stand out as a key issue.

Regarding the reliability of statistics, national information from other countries was taken from the credible Lancet journal. There was a need to improve information systems around child death issues, and liaising with all role-players, such as the Medical Research Council, was important. Statistics and information was only one aspect of improving the prospects of child survival.

Concerning Department of Health information, the National Demographic and Health Survey [a survey every five years] was started in 1998. The results of the 2003 survey were not available, as it was being analysed by the Medical Research Council, for the purposes of an official report to the Department of Health. The survey included only preliminary results and therefore could not yet be used. During 2000, the Medical Research Council used modelling, where different sources of data were used in order to estimate child deaths, and these figures showed a definite increase in the deaths of children under the age of five. The upward trend was primarily due to the HIV epidemic.

Irrespective of statistical modelling, the levels of death were still unacceptably high. Many causes of death were preventable. Regarding the need to show comparisons, Brazil and Vietnam were looked at as examples, where the infant mortality rate for children under five was lower than for SA. Better understanding was needed on a provincial level.

Concerning deaths caused by alcohol-related incidents, South Africa had the highest rate of foetal alcohol syndrome, which caused intellectual disabilities and not necessarily death. There were measures to prevent this. General interventions included increasing employment and education, as well as educating society in general. Further mechanisms would include improving services to women, such as water and sanitation. Many of these issues had not yet been dealt with. Medical intervention should be made in collaboration with many key departments.

Idasa Children’s Budget Unit presentation
Mr Mario Claasen, Advocacy Co-ordinator in the Children’s Rights Unit at Idasa, introduced the key projects and the purpose of the project, which was to look at child-based budgeting within a rights-based framework. An overview of the objectives of the Children’s Budget Unit (CBU) was given. The project had an international focus, especially on Africa. Looking specifically at research at the CBU, information was provided on national and provincial programmes, and budgeting processes.

Work was being done in a rights-based framework, where the focus was on socio-economic rights. The rights-based framework was informed by the United Nations (UN) Convention on the Rights of the Child, which South Africa has ratified, as well as the African Charter on the Rights of the Child. South Africa had to report every second year on the rights of the child to the UN Committee. The Convention stated the obligation for state parties to assist parents to ensure the rights of children. There was a further obligation on parents towards children. However when parents were poor and had no access to services, it had to be determined when the state should intervene. The private sector had a facilitating role to play.

The concept of a right-bearer implied that when a child enforced his or her right, he or she will then become a beneficiary. Civil Society had a role to play in terms of advocacy and the delivery of services. Article 12 of the United Nations Convention stated that children should be part of decision-making process. Participating as an individual empowered the child.

The minimum core debate implied that basic rights should be given and that rights were progressive. The reasonableness test provided guidelines to government on what its programmes should entail. In terms of research methodology, the programme was developed at national level, and looked at whether the information contained in the budgets was accurate. There is a reliance on CBOs and civil society to deliver programmes.

Capacity Building on Rights-Based Budgeting included the training of organisations and the way in which they should seek to benefit beneficiaries. Training was participatory, and there was a belief that local money should be utilized at every level. The objectives included allowing children to be involved in monitoring’ especially at a local level, as well as improving participation and research skills. The Peer Facilitator Model included 6 or 7 children from different constituency groups, who then became facilitators of groups. There were 25 peer facilitators. The programme was very interactive and entertaining.

The Reference Group made decisions about the project and provided direction. The group comprised of representatives from the constituency bodies, and held meetings on a quarterly basis.

The Committee was further briefed on children participating in Governance Project , in particular the impact of the programme on a child, Stanton Scholtz, who participated in this programme.

Stanton’s Story
Stanton explained that he was an 18 year-old from Atlantis who had become a father at a young age, which caused him to be discriminated against by the teachers at his school. Gangsterism had also forced him to leave school. These factors had influenced his access to an education. When he was 15 years old, he was introduced to Molo Songolo. Three years later he participated in the Idasa programme and has been involved in the programme for one year. He enjoyed this experience which has also allowed him to meet new people and to travel, and he found the experience of working with disabled persons fulfilling. During February, a camp was held which looked at Linking Budgets and Rights. After the camp a report back was done to organisations and other children were then trained.

Stanton provided a report back on what he had learnt. Such as how to link budgets and rights, and how government allocates budgets and rights. He described his experience of arranging a constituency workshop as challenging. Idasa provided him with the opportunity of being a researcher, and he has been involved in the CBU Project.

Describing his experience in Brazil, he said that programmes and presentations presented there are far more advanced. In Brazil, the youth are already involved in work at the local ward committee and engaging in local budgets. Therefore the focus is to plan more advanced presentations and to work with local ward committees in order to be involved in local budgets.

Discussion
Ms Tobias expressed excitement for Stanton as a youth leader and questioned how Brazil was able to participate at ward level, as this was a struggle in South Africa. Therefore it is an important issue. She further suggested that a partnership should be formed with other youth organisations such as the ANC Youth League in order to see filtering on the ground level.

Ms Batyi thanked the youth speaker for his input and further emphasised the need for a partnership. She queried whether in terms of Gauteng there were similar projects, which would allow the youth to participate, as there were many issues, which affected the youth at a local level.

A Member suggested that for future presentations, real figures should be provided in order to provide the department with benchmarks in accessing whether the work is being done properly.

Mr D Gamede (ANC) sought clarity on whether this presentation was merely an introduction.

The Chairperson replied that Idasa had requested a full day for the presentation, but due to time constraints the presentation had to be summarised. She gave the assurance that there would be other sessions and the figures from different departments were required for future sessions. She emphasised the need for a study tour in South Africa in order to determine what is happening in the child sector.

A Member commented on the need to endorse initiatives to stem school related violence and that the Committee should look at this. He queried the absence of the Children's Resource Centre, which was a key organisation and should be working more closely with the Children’s Institute.

The response was that this project had been done only with certain organisations. There was no intentional exclusion of some organisations.

The Chairperson commented about Stanton's story that there is a challenge of bringing awareness to teachers to abstain from saying negative things.

Ms Tobias commented on the issue of funding and suggested that street collection should be seen as a means of funding, and from an organisational point of view, there should be involvement.

Mr Claasen commented that he hoped that a training workshop could be done around budget analysis which will focus on health and education. Training would look at budget allocation and expenditure, there would also be a focus on the social sector department, because this affected children directly in terms of their rights.

The meeting was adjourned.