Exactly one year ago today, a group of experts for whom child participation is a passion and key driver, discussed the whole idea of Child Participation in Health. This group is convened by the Children for Health director, Clare Hanbury and is held approximately once every 6 weeks. Here are the notes from this discussion which we thought of special interest to our CfH community.

Theme of main discussion: children’s participation in health – identifying and overcoming resistance.

Within some child focused agencies there is often increased focus on children’s participation in child protection and education, but less focus in the health sector. In the health sector and in emergency work there is often a tendency to see children’s participation as less relevant, especially in terms of a timely, fast response that is needed to save lives. Despite the existence of excellent resources on children’s participation in health, especially through 30 years of the Child to Child Approach which is focused on children’s participation in health, many of these rich and useful child friendly health education materials are not known or used by health practitioners.Reasons for this were reflected upon and include:

• The orientation of health practitioners is medical, so when you are looking at doctors or health workers they are looking at it from their own specialised knowledge. Doctors may be more influenced by other medical practitioners, thus we need to get other doctors on board to advocate and convince them about children’s participation in health.

• Health staff in many INGOs currently have a key focus on maternal and child health (MDG3) engaging with women and infants under the age of 5 years. Thus, in terms of participation many health practitioners suggest that children under the age of 5 years are too young to be involved.

• While elder siblings often spend significant time as caregivers for their younger siblings in many parts of the world, their care-giving role is often not acknowledged or valued in terms of the need to engage with children as caregivers when undertaking health awareness or health interventions. While it is seen as normal for children to help take care of their younger siblings, the children have no status as caregivers.

• The new generation of health workers may not be aware the effectiveness and relevance of engaging children in health campaigns and health activities at household (and other) levels.

In terms of solutions to help convince health practitioners (doctors, health workers, health staff) about the relevance and importance of children’s participation and child centred approaches to health education and health promotion. Key strategies that are helpful include:

• Ensuring partnerships between health and education staff at every stage and at every single level – this has been a key feature of Child-to-Child Approaches to children’s participation in health education and health work. However, it can be difficult to bring two sectors together – e.g. education and health – we need to recognise this. It requires a lot of operational good will and efforts.

• Identifying champions – high level doctors and health workers who can advocate and influence their peers to value children’s participation and to involve children and young people in health initiatives.

• During training workshops on children’s participation in health draw upon medical practitioners’ expertise. In the process they also become exposed to potential that children and young people have.

• Use the ‘like to like’ principle – if you are advocating to the Ministry, you need to get someone from the Ministry involved to promote the idea.

• We need to identify ‘big hitters’ in terms of global health work who can advocate and champion.

• In the ‘Children investment fund’ and many other donors like The Gates Foundation there is a real focus on evidence based practice. We can look to see where entrance points may be for children to make a contribution to see how children’s participation can be included. We can promote use of the framework on monitoring children’s participation to gather outcomes and evidence concerning children’s participation in health. For example, a project in Mozambique project will look at how school age children can have an impact on reducing chronic under-nutrition in under 5 years.  This focus is there as during the scoping assessments the staff involved recognised the role older children play in taking care of younger children, including feeding younger children and infants.

• We need to identify and/or support the development of powerful videos which clearly illustrates children’s role as caregivers of younger children.

• PRA tools such as a ‘day in the life of’… or ‘pie charts of time spent in daily activities’ were used more 15 years ago than now, but they remain useful tools to identify the different roles and responsibilities of different people in the household. Such tools can help family and community members really ‘see’ and recognise the roles that children are playing in care-giving of their younger siblings. Use of such PRA tools, and the revelations that it can lead to can be important entry points to further opportunities for children’s participation in health work.

• Identify issues that are at the heart of family and community life.  Nutrition-related issues uncovered during a recent assessment with children, teacher training students and in the community include the following:
  • Myths and beliefs about food, what motivates food choices e.g. taste, price, availability, habit, and rituals.
  • Power dynamics at meal times e.g.  – what male members of the household demand; recipes; habits; food combining; preparation; preservation; balance between snacks and meals; meal logistics and timings; food preparation; feeding practices; weaning; the introduction of weaning foods – timings and food used; the diet of breastfeeding mother; portion size;
  • Community support to get knowledge about food; traditional birth attendants and grandmother’s role;
  • Food allocation and gender issues; food serving; attending to eating during meals and portion size.

For children to be at the front line of improving nutrition for themselves and each other requires great sensitivity such that the roles of the parents are not undermined or challenged in ways that are inappropriate or potentially damaging. Each family’s circumstance and needs are unique and participatory methodologies are especially suited to meeting different needs. However it takes great skill and particular sensitivity to facilitate this process.

• A decade ago UNICEF’s creative communication (cartoons) ‘Meena’ (in Asia) and ‘Sarah’ (in Africa) were effective increasing awareness of the roles of girls, promoting child rights and non-discrimination. Meena/Sarah could be revived and/or newer modern versions can be developed and disseminated through social media and networking sites.

• It would be helpful to have the publication, ‘Children for Health’ online as a free supplementary resource for ‘Facts of Life’.

• A dynamic hub for sharing information, experiences and stories is needed. Stories of most significant change need to be documented and shared as they can inspire others, and others can learn from their experiences. For example, the story of the boy who helps prevent the spread of cholera can inspire others to act and to support children’s participation in health.  There was a paediatrician who went to an orphanage during the Rwanda emergency where there were Rwanda children – acute case of cholera – he organised a competition with children on hand-washing and it had a significant effect on the cholera. He was staggered by what children could do and had achieved

• We can encourage child focused international agencies working on health to ensure that there national offices have access to child friendly health materials.

• We need to build capacity building on children’s participation into emergency preparedness for different sector staff, including health and nutrition staff.

Please do send us any comments or insights you have from reading this post.