Clare Hanbury

Children's Participation in Health: 100 messages, 100 actions

2012-11-20T14:10:49+00:00

Since the passing of my friend and mentor Professor David Morley (co-founder of The Child-to-Child Trust) and to honour his memory, I've been working slowly at a project about using the mobile phone and the social media to promote children's participation in health. The project is in it's early stages but growing legs!

In a nutshell... for some decades it's been recognised that children in developing countries should not just be viewed as beneficiaries of health initiatives. They are also potentially agents of change themselves.

And a LOT can be done to improve health just with information. Children can be taught essential health messages at school and bring that knowledge home and to their communities. For example, in an area where there are malaria mosquitoes, a child might ensure their younger sibling is sleeping under a bednet and tuck in the bednets to keep their sibling safe. Anyone who has been around primary school age children knows how much children love to collect things (think scouts and badges) and why not a collection of 100 messages and actions! Its also important that we recognise and praise what children are already doing to keep themselves and each other safe and well.

A team of medical students at Cambridge University are helping me assemble the first '100' messages for health experts to assess and approve. There are 10 key messages in 10 key areas of health =100 messages in all. The messages are created in a pithy, short form suitable for delivery by SMS. The messages could be used as they are (probably translated first) or they might be adapted and translated using a more involved process.

The idea too is that each health message links back to a collection of on-line resources (like photos, pictures and even videos) that can be used with children to stimulate and discuss the different topics – so these messages, which are oriented towards children, are also really designed to be delivered to parents and people who work with children. It's the adults or the youth who are more likely to have access to phones etc.

A technical group I am working with, have found a way to make the piloting of this idea virtually cost free...

If you are involved with a health education programme and like this idea then do let me know and we can start a discussion on how to take it forward and test out this idea with the help of the children, parents and educators you know.

Together, let's make children advocates FOR health and let's let no child die from a lack of information.

If you can please join the discussion group, Children For Health on Linked in.

The RISKS of Participation to Children and Young People: The June focus of the Children's Participation Group

2012-11-19T12:48:00+00:00

Here are notes from the last meeting of the Children's Participation Group. there are 8 of us in this group and all of us work in international development with a particular focus on the participation of children and young people. This month the topic we focused on was The Risks to Children and Young People from Participation.

We began the discussion by reminding ourselves of the tools that already exist to help guide organisations and individuals who wish to strengthen of develop participation of children and young people. Links to ethical guidelines (or participation resources containing ethical guidelines) can be found at the bottom of the note to this meeting.

Some of the ideas for keeping children and young people safe and reducing risk that may arise from participation are as follows:

To ensure that organisations working with children and young people have policies and procedures relating to safeguarding and child protection in place and ensure that these are current, up to date and compressive enough to protect children and young people.

We should ensure that children and young people are consulted on processes for keeping them safe in a way that allows their perspective the risks they feel they may face to be incorporated into procedures and along with their views on what could be done about it. A very practical example was given about children being consulted on the logistics of their journey to and accommodation at a participatory workshop. Some of the issues these children faced were risk of attack on the way to the event, the sleeping areas for boys and girls, adults and children.

One of the blocks to promoting children’s participation is that adult say its too risky. Therefore it useful to get perspective from children on this. For example, consulting children on logistics or the participatory activities themselves. It sets the tone and expected practice.

The consultative process needs to be done in an age appropriate and careful way so as not to create anxiety. The impact of the type of questions and tools used to support children and young peoples participation needs to be thought through.

Children and young people need to be made aware of an organisations child protection policies. In addition, there needs to be an appointed child protection lead. Then children are encouraged to report to this person (or use the process outlined in the organisations procedures) if they have any concerns. The lead person needs to be appropriately trained and gender issues taken into account.

A distinction needs to be made between safeguarding (creating safe environments/practice) and child protection (physical abuse, neglect).

We need to recognise that participation is a means to enhance children's self protection - children who have no voice can be targeted for abuse.

Children and young people are not a homogenous group and what may work for one group may not work for others. We had an example of where young people felt hostile to work younger children were doing on conflict and conflict resolution.

One problem about trying to understand the when’s of children’s participation is that developmental psychology theory has a different stance. For example - Piaget, a central representative of 'childdevelopment' can be a start for discussion; main obstacle in his research is that the stages of development are quite fixed.

There are many theories. However we thought that it may be useful if we could work together as a group to update theory on the evolving capacities of the child.

We need to support children who are enabled within a workshop setting to consider how this enhanced skills or increased voice may have an in the ‘real’ world. We need to do this to ensure that they don’t put themselves at risk. This can be hard and especially for children who are especially vulnerable or marginalized and who could be left at grater risk as a result of a project and once the project has ended.

Save the Children Sweden has explored the balance of protection and participation and risks involved. This is documented in an SCS report called 'CultivatingParticipation' available here: http://resourcecentre.savethechildren.se/content/library/documents/participation-virtue-must-be-cultivated.

It’s also important to inform children and young how the information they generate will be used. Any information given to children must be in a child friendly format.

These are sometimes ethical issues around adult agencies approaching children to get information and ideas from them, but lacking the willingness to respond to children’s own agenda.

We talked about the potential to over consult with some groups of children – checks need to be made regarding who has worked with the children before and why and how this information was used.
Check that CP is inclusive and the risks to vulnerable children if they are excluded. Risks can be straightforward or more complex e.g. risks to mental health, self-esteem etc. (sorry not sure i understand this and cant remember what we were talking about here)

Risk of overburdening children to participate and create a situation where due to social desirability children don't dare to refuse to participation.

We need to prepare people to work with children. If working with teachers we need to build in an awareness on the distinctions between teaching and facilitating participatory work with children. A reelection that even when our colleagues KNOW what and how they should do – how easy it is to slip inadvertently into behaviour that they maybe inappropriate but which just come up.

Its important to realise that working with children in a participatory way can be a huge step for some adults who never experienced this as children or were taught how to practice it as adults.

Reflective practice for practitioners is an important place to start. In places where there are deep inequities the ideas that underpin participation are highly challenging to implement and needs developing over the medium/long term.

The best facilitators are often the younger people who have a natural rapport with children. Its important to be alert to natural talent and to nurture and support them with continues training, development and other professional support.
Maybe we need a checklist of criteria for people who are suitable of this work? Involving children in recruitment is useful where possible.

News from Children’s Participation Group Members

We are all doing such varied and interesting work. This includes:

Child participation in Health and SMS messaging
CYP participation in health service design and delivery
CP and how poverty/low income impacts on disabled children’s rights (mainly social, economic and cultural rights)
Helping to set up a counselling group run by children for other children, http://www.crc15.org/
CP and M&E work – Oak foundation project – forthcoming seminars and developing ideas around creating a digital hub for M&E work in CP
Involving CYP in design of organisational assessments using qualitative and quantitative approaches
Internal youth mapping
Regional analysis on community based child protection mechanisms supported by Plan in Asia;
Engaged in M&E of children's participation (Oak funded) pilots with forthcoming webinars;
Preparing for global advocacy with and by children's and young people's representatives on children, youth and peace building in New York in early September;
Preparing training modules on child rights governance and humanitarian practice.
Working on a paper concerning a life cycle approach to children, adolescent and youth participation in peace building
Looking into the world bank’s lifecycle approach 10 + years

Possible actions formulating from the group:

We seem to often return to a need for more clarity or tips on how to use in practice the evolving capacity of child framework and understand how this has changed over time and across cultures. We spoke about looking at reports developed by Bernard Van Leer, on materials that have been developed on peace building and relayed to this. We agreed it would be great to trace a theory of change with children and young people.

Links to ethical guides to children and young people's participation

http://www.ecpat.net/ei/Publications/CYP/CYP_report_Ensuring_ENG.pdf

http://www.unicef.org/adolescence/cypguide/resourceguide_ethics.html

JOIN THE CONVERSATION

You might like to join the conversation by joining the Children For Health Linked in community group.

Children For Health Discussion Group on Linked In

2012-11-15T13:14:00+00:00

I would LOVE any members of this community to join this Children for Health discussion grou p on 'LINKED IN'. If you are not a member of 'linked in' but would like to join the discussion, please post your comments on this blog and I'll shift them over to the group.

Children's Participation in Health: The October Focus of the Child Participation Group

2012-11-12T16:11:29+00:00

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 caregiving 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 caregiving 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.

One of the participants in this group is managing a project that distills 100 health messages for children to learn, collect and share on 10 health tipics and that can be shared using mobile phones and the social media.

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

For any readers interested in engaging with this discussion please ask to join this 'Linked in' Discussion Group - Children For Health..

Mother Child Website

2012-09-25T15:33:14+01:00

Inspiring and probably life-changing discussion with Nand Wadwhani this afternoon...more soon but just for now watch this video and go visit his site health phone.

We Are All Connected

2012-07-15T07:57:41+01:00