Child gauge: Prioritizing child and adolescent health

One in 31 children in South Africa will die before their fifth birthday. It is a sobering reality as International Human Rights Day was observed on Tuesday 10 December and on the occasion of the 30th anniversary of the United Nations Convention on the Rights of the Child, which sets out the rights that must be realized for children to develop to their full potential.

Greater investment in the health of children and adolescents is needed to ensure that the other 30 children can thrive and reach their full potential. Over the past 10 years, South Africa has made tremendous progress in reducing under-five mortality and HIV deaths, from 79 deaths per 1,000 live births in 2004 to 32 deaths per 1,000 in 2017.

Yet most children still die from preventable causes such as neonatal conditions, HIV, diarrhoea, pneumonia and injuries. South Africa must pay greater attention to the health and development of children who survive and address the burden of malnutrition, HIV, violence and mental health issues.

The South African Children’s Gauge 2019which was published on December 10, explores how investing early in children’s health offers the greatest returns on child and adolescent development and has the potential to produce a triple dividend in improving child health today, the adults they will become tomorrow, and the health and development of the next generation of children.

This 14th annual report on the situation of children in the country is published by the Children’s Institute (CI) of the University of Cape Town (UCT). The theme of the 2019 report – “Child and adolescent health: leaving no one behind” – is a call to prioritize child and adolescent health and to place children at the heart of the health system.

Intervene early

In the foreword to the report, First Lady Dr Tshepho Motsepe said: “The science is clear. If we are to promote cognitive development, break intergenerational cycles of poverty and violence, and stem the growing epidemic of obesity and non-communicable diseases, we must invest early – starting in the first 1,000 days of life. of a child and continuing adolescence. Investments during these two sensitive periods of development are the most profitable. »

Adopting a life course approach and intervening early to protect children from adversity interrupts intergenerational cycles of poverty, violence and ill health.

Intervene outside the clinic

Lori Lake, communications and education specialist at the Children’s Institute and one of the editors of the 2019 edition of the South African Child Gauge, explained: “Over the past decade, we have made progress in reducing child poverty and improving children’s access to services, so there is a solid foundation on which to build. However, nearly 60% of children still live below the poverty line, 30% do not have access to running water on site and nearly 20% live in overcrowded households.

These types of living conditions make it extremely difficult for families to meet the basic needs of children and protect them from harm.

It is therefore not surprising that 27% of young children are stunted, 42% have experienced some form of physical, sexual or emotional abuse, approximately 10-20% of children suffer from a mental health problem which can be diagnosed as depression, anxiety or a substance. use disorders, and 37% of young people do not have a job, education and/or training.

This situation is compounded by poor access to health services, with 20% of children having to travel long distances to reach a health facility.

“Over the past decade, we have made progress in reducing child poverty and improving children’s access to services.

“We need to recognize that healthcare professionals have a responsibility for children’s health that extends beyond the walls of their clinic or hospital,” Motsepe said.

“We need to know where the children come from and who they live with. We need to understand the challenges they face and put in place care plans that build on existing strengths to promote and protect children’s health as they return to their homes, schools and communities. .

There is therefore an urgent need to look beyond individual behavior and address some of the social and structural determinants of child health.

Intervene in politics

South Africa’s Minister of Health, Dr Zweli Mhkize, has pledged to prioritize three areas to improve child health: achieving universal health coverage by implementing National Health Insurance (NHI ), better community engagement and mobilization through community health workers, and identification of critical periods for intervention, namely the first 1,000 days and adolescence.

“Having not met our [United Nations] Millennium Development Goals to reduce maternal and child mortality, it is particularly important that we carefully monitor progress towards achieving the Sustainable Development Goals – we dare not take our eyes off the ball. This edition of the Child Gauge can play an important role in monitoring progress, identifying gaps and suggesting corrective actions,” he said.

According to Professor Anthony Westwood and Dr Wiedaad Slemming of UCT and the University of the Witwatersrand respectively, the NHI initiative offers an opportunity to improve long-term care for children, but only if the “care package proposed includes long-term healthy children. rehabilitation and rehabilitation services are strengthened at district level to support the large number of children with LDHC and disabilities – especially those in rural areas where services are very limited.

A new vision of child and adolescent health

“A child-centered health system requires a clear vision that goes beyond treating illness and injury to promote optimal health, nutrition and development; responds to the complex care needs of children with long-term health conditions; engages with children and families with the utmost care and respect; and includes them as active partners in healthcare and decision-making,” said Maylene Shung King, Associate Professor at UCT.

Such a vision should inform the development of an essential package of health services, as well as norms and standards for medicines, equipment and infrastructure, to ensure that child and adolescent health receives an equitable share of resources. . It also requires the reorientation and training of health and related professionals to build a child and adolescent health workforce.

Over the past 10 years, South Africa has come a long way, but there is still a long way to go. Strong leadership and child champions will be needed at all levels of the health system to close the gap and ensure that all children in South Africa can thrive.

Children’s health is everyone’s business.

the South African Child Gauge is produced in partnership with UNICEF South Africa; the Center of Excellence in Human Development of the Department of Science and Innovation and the National Research Foundation (DSI-NRF) at the University of the Witwatersrand; The Standard Bank Tutuwa Community Foundation; and the Desmond and Leah Tutu Legacy Foundation.

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