An Overview of the Situation of Children
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An Overview
of the Situation
of Children - extracted text
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SAARC Conference on
South Asian
CHILDREN
in cooperation with UNICEF
New Delhi, 27-29 October 1986
An Overview
of the Situation
of Children
SOUTH ASIA
Published by the United Nations Children's Fund
for the SAARC Conference on South Asian Children
in cooperation with UNICEF
New Delhi, October 1986
AN OVERVIEW
OF THE SITUATION OF CHILDREN
SOUTH ASIA
Prepared and published
by the United Nations Children's Fund
for the SAARC Conference on South Asian Children
in cooperation with UNICEF
New Delhi, October 1986
Printed at Rekha Printers Pvt. Ltd., New Delhi-110020.
CONTENTS
I.
Introduction
1
II.
Children First: A Development Priority
3
Ill.
Social Factors of Development
(a)
(b)
(c)
(d)
(e)
Education
Nutrition
Health
Sanitation
Communication
6
8
12
15
16
IV.
Mother and Child
19
V.
Policies and Strategies
22
VI.
Structures and Resources
25
VII.
Perspective
27
I.
INTRODUCTION
1.
The situation of children in South Asia varies across a wide range
from adverse circumstances to hopeful conditions. These variations are a
matter not entirely of socio-economic status of the people, but also of
priorities in public policy, and therefore of the level of consciousness
and organization of communities in their particular social and physical
environment. As a result, there are sharp contrasts, as well as
congruencies, in the social factors of development in relation to
children, between the countries and within each of them.
2.
There is, in South Asia, a growing commitment to basic human
development as the fundamental first step to development of any kind.
There are two ways in which this priority is translated to progress on
the ground: first, the governments of South Asia have adopted positive
policies increasingly reflected in programmatic aims, public investments
and national targets.
And second, there are numerous initiatives taken
by groups of people in various parts of South Asia: by concentrating on
developing, right from childhood, the human capacity to cope with
situations, they have succeeded in loosening the hold of poverty.
3.
In the continental context and stage of development of South Asia,
estimates of social indicators are abundant.
It is reasonable to infer
that only around half the number of South Asian children have access to
an essential minimum of environmental protection, nutrition, health care
and learning opportunity. An objective analysis of this situation shows
that this tide of adversity has begun to be contained but can now be
turned towards a trend where no child need die or be denied development.
The turning point is now, the transition need not take long and is within
the material, moral and intellectual means of the countries of South Asia.
4.
It is this abiding conviction that moved the United Nations
Children’s Fund to cooperate with the South Asian Association for
Regional Cooperation in organizing the 'SAARC Conference on South Asian
Children' in New Delhi in October 1986.
5.
This Overview has been prepared by UNICEF for the Conference.
It
draws upon two streams of experience:
First, the responses, past and
present, of each of the seven countries — Bangladesh, Bhutan, India,
Maldives, Nepal, Pakistan and Sri Lanka — to the situation of their
children; and second the global policies and perspectives of UNICEF
translated to, and in good measure derived from, the context of South
Asia. The document seeks to summarize the qualitative aspects of the
2
overall situation as well as to suggest strategic responses to it which
are urgent and feasible.
It is not intended to be a substitute for the
seven Country Reviews independently prepared by national teams and
brought out by UNICEF for the Conference; rather, it should be read with
them.
6.
Development of, and for, children has suffered from ad hoc
programmes and unconnected initiatives,from piecemeal attention to the
social factors of development — like the highly interactive cluster of
education, nutrition, health, sanitation and communication. Nothing
short of a political decision to accord the highest consideration and a
unified direction to the development of the child in all dimensions of
its need can make a difference to the subdued or negative trends of the
past and the present.
7.
Of the many pressing needs of the children of South Asia, some can
be met in a few years — like universal immunization, protection of
breastfeeding and timely and proper weaning; prevention of diarrhoeal
deaths by oral rehydration therapy; control of endemic iodine deficiency
disorders; control of iron deficiency anemia; and supply of safe drinking
water. There are other priorities related to children's development like
preschool and primary learning and support systems of basic nutrition,
health and sanitation, which have a longer gestation. Neither category
of programmes brooks delay. Accelerated progress in both is feasible —
provided policies and strategies, service structures and the basis of
resources are adapted or reshaped to serve the purpose. This again is a
matter for political decision at the highest level.
8.
The analysis starts from a premise that children should be the
first priority of national development planning. And in the light of a
review of different social factors of development, it concludes on an
affirmation of the same principle in relation to basic human development.
The 1000 million people of South Asia could become the prime movers of
accelerated development for all — rather than let their numerical size
be a drag on progress — provided the development process begins with the
400 million children, and accords the highest political priority for
their survival, development and protection. While this is a matter for
national determination, there is need and scope for mutually supportive
ideas and action among and between the seven countries, towards this
common aim. This Overview therefore seeks also to explore possibilities
of inter-country cooperation based on the genius and development
experience of South Asia.
II.
CHILDREN FIRST:
A Development Priority
1.
This paper outlines the case for elevating the political priority
of planning for the needs of children within the national development
process.
It suggests strategic changes to provide an assured space for
children through the stages from policy formulation to planning,
programming, implementation and performance appraisal.
2.
It is timely that this socially critical change happen in the
countries of South Asia, for several reasons:
2.1
The situation of children in South Asia suggests the need for a
reappraisal of responses to it.
Of some 34 million children
born each year in the region, around four million do not
survive their first birthday. Another two million die before
they reach five years. And not all those who survive grow up
into healthy, productive adults.
Beneath this trend is a
complex of allied factors including malnutrition, ill-health
and illiteracy particularly of mothers, common childhood
diseases and various forms of child exploitation. While
problems facing children differ among countries and communities
in the region, they often stem from causes of common origin and
lend themselves to comparable approaches to solutions.
2.2
Studies within and outside the government systems indicate that
the unmet basic needs of the 400 million children of South Asia
can be fulfilled by an appropriate use of the material.
intellectual and political resources in each of the countries,
complemented by mutual cooperation among them in identified
fields.
2.3
There is broad agreement in South Asia that the contemporary
transition from the traditional economy to accelerated
modernization hinges primarily upon the human factor, namely
the quality of the rising generation, which means the wellbeing
and preparation for life of children today.
The time lost in
preparing children for individual and social life cannot be
retrieved.
4
2.4
Programmes for development of children are as much for
enhancing production and investment as for human wellbeing.
Actions in support of children should be a contributing factor
to. rather than an eventual consequence of economic growth.
Indeed, the connection between the mental and physical
development of children and the social and economic development
of nations is clear. National development strategies should
understand the social costs of children not realizing their
potential and the benefits from a child population facing the
future with knowledge and confidence.
2.5
The lingering incompatibility between the economic approach to
development (which rightly views children as the human resource
of the coming decade and as consumers of goods and services
today and tomorrow) and the social approach to development
(founded on concepts of human rights and social values) can be
resolved only at the political level, on the basis of a
holistic approach to child development.
2.6
Experience shows that most problems related to children have
multiple causes. And, a reasonable return on the investments
currently made in services for children can be derived through
an integrated redefinition of human resource development (as
distinct from progress by sector or problem). A unified
national plan is required to meet children's needs across the
functional sectors. Better results are possible within
available resource levels through concurrent and coordinated
inputs as well as active involvement by an informed community.
2.7
Meeting the inter-linked basic needs of the child implies an
exercise of the political will to take human development issues
beyond technical and institutional confines — with each
discipline making its unique and inter-related contribution to
the shared aim.
2.8
A regular exchange of experience on this endeavour would, in
itself, be a fruitful, unique and potentially significant field
of cooperation among the countries of South Asia. For the
first time, the universal application of integrated and
affordable approaches over the range of basic needs beginning
with children, has become a practical political option.
5
3.
Accordingly, the following proposals are submitted for
consideration:
3.1
Enhanced political priority for children in national
development planning for meeting, across functional or
technical sectors, the basic needs of the whole child and of
all children.
3.2
Discussion and agreement among the countries of South Asia, on
a set of objectives and goals for improving the condition of
children in the region.
3.3
Stimulating a process of annual review of the situation of
children in the region, monitoring progress of programmes for
them and exchange of experiences on their development, by
making the subject a regular item on the agenda of the annual
meeting of the heads of State/Government of the member
countries of the South Asian Association for Regional
Cooperation.
III.
SOCIAL FACTORS
OF DEVELOPMENT
1.
Among the insights garnered from the experience of recent decades
of development is the need to raise the priority for human and social
development on par with the priority for economic development; and indeed
to link them up for promotion as aspects of a single organic process. A
fundamental plank of this approach is child survival and development.
2.
In South Asia, by and large, the tendency still remains to approach
social factors (like education, nutrition, health, sanitation and
communication) in technical compartments isolated from one another.
In
making or marring the lives of children, these factors, among others,
mutually permeate.
They are best discussed together, despite their being
distinct as disciplines. This chapter attempts to do that.
(a)
1.
EDUCATION
Situation
1.1
The educational situation in the region as a whole, particularly in
relation to women and children, is mixed.
Islands of excellence coexist
with areas of neglect.
In parts of South Asia, the literacy rates
surpass those of industrialized countries, even in respect of access of
females to learning opportunities. But for these exceptions, the adult
literacy rate (for persons 15 years and above) ranges between 10 and 40
percent. The majority of people in the region cannot read or write and
they constitute nearly half the world's burden of illiteracy. The rate
of literacy for adult females, with the exceptions mentioned, ranges
between 9 percent (or probably less) and 26 percent, representing again a
large chunk of the global load of female illiteracy.
In some parts of
the region, literacy and education have been a priority for public policy
and backed by adequate budgetary support over several decades.
In these
areas the scope for adult literacy programmes has been small and the
environment favourable for maintaining their success.
In the bulk of the
region, adult literacy has repeatedly received government support, but
results have been modest.
1.2
School enrolment figures have been rising at a fair rate throughout
South Asia, but even in countries and areas with high rates of literacy,
the dropout rates for children from the poorer half of the community,
7
remain high due to a number of factors like low priority given to
literacy by parents, the children having to work for a living and various
pressures of material poverty. The educational and learning needs of
children who do not go to school are, by and large, unmet, throughout the
region.
1.3
It is probably true that at any time, at least half the number of
children of primary school age in South Asia, are out of school.
Either
they have dropped out, or they have never been to school. The poor
quality of education and perhaps its irrelevance to the context of their
life and future, seem to be a major cause of keeping away from school apart from the high opportunity costs and the limited access to
educational facility.
In some places, the scarcity of trained female
teachers is a factor inhibiting school attendance by girls. The
qualitative and quantitative aspects of school education remain weak.
The share of expenditure on education in the gross national product
remains low compared to most other developing countries in Asia. The
training of teachers and the relevance of curricula have been areas of
neglect.
By and large higher education has received higher priority at
the expense of primary and secondary education, notwithstanding the
established fact that education has a higher and more durable return than
other investments, and that within education, primary education has a
greater return to society than secondary or college education.
1.4
Preparation for school, or pre-primary learning opportunity, has
not received much attention at the hands of goverments in the region.
It
has been left largely to private initiatives, some of which have taken to
blind imitation of external models or become largely commercial
enterprises.
Even in a country where literacy is quite high, pre-school
facilities cover hardly a fifth of the children between 3-5 years. The
proportion in the other countries is much lower. The lack of these
facilities appear to be a contributing factor to the phenomenon of
dropping out, insofar as large numbers of children from an impoverished
environment are unable to adjust themselves to the transition from home
to school.
1.5
Another area of concern is the substantial neglect, in policy and
practice, of non-formal channels of learning, particularly for adults.
Constraints on government resources need not stand in the way, because
there are examples in the region of non-formal means being developed to
good purpose on the strength of modest local resources.
2.
Response
2.1
Mutual consultations on achieving universal primary education by an
agreed year and work in concert towards this aim by sharing successful
experiences, including the use of a wide variety of communication
channels, are a priority. There is the opportunity and advantage of
learning from one another’s negative and positive experiences.
Appropriate changes in
8
the learning content, process and system would be needed particularly to
relate learning to the improvement of factors like health, nutrition and
sanitation which are support systems for primary education, as well as to
enhance the capacity for productive work. This is not a new direction
and some work has been done in each country. What is needed is an
acceleration of pace.
2.2
Special attention needs to be focused, nationally and collectively
on rapidly raising the educational status of girls and women.
Examples
from within the region show that this is feasible and sustainable and has
a positive impact on human and other development.
2.3
Community centres providing concurrent services like day care for
the infant, learning opportunities for the older child and income
generating activities for the mother at the same premises is an
innovative approach initiated in the region. This could be considered
for more extensive application.
2.4
The preparation for school during the pre-primary age deserves to
be accepted as a policy for universal application. This calls for an
imaginative response to the need for an affordable pre-primary movement
which is relevant to all children including those from low income groups,
and which does not imitate external models nor make universal the
limitations of the existing primary schools.
2.5
The lessons from the rich experience in several countries of the
region in adult education, using non-formal methods, could be applied on
priority to restore to mothers their capacity to acquire and apply
knowledge and skills for child health and their own development.
2.6
Institutional capacity in the region for teacher training and
production of learning materials could be refined and used in a flexible
way in mutual support towards agreed aims. The vast communication
networks have not yet been fully put to use for these purposes.
(b)
1.
NUTRITION
Situation
1.1
Some of the countries are dependent on import for staple foods.
However, the others have shown that food self-sufficiency can be achieved
fairly quickly given appropriate inputs and strategies. Each country in
the region is endowed with the resources, material and human, to produce
enough and more food for all its people, through agriculture, livestock,
fishery and forestry. The pace of progress needs to be hastened.
9
1.2
Food availability does not however imply access for all to food.
This is the meaning of widespread malnutrition in each of the seven
countries, of both children, and adults.
In each country, the lower
income groups fall substantially below the minimum essential calorie
intake level. The proportion of the disadvantaged within these groups
varies between and within the countries, but it is sizeable in all the
seven countries. The protein deficiency levels would not be less — not
to mention critical deficiencies of iron, iodine, vitamin A and other
micro-nutrients.
1.3
To go by trends during recent years in nutritional status, there
are reports from several countries that nutritional deficiencies among
young children from the poorer families is probably increasing. That
this is happening in some cases, in spite of overall improvements in food
production, investment, economic growth and employment, raises a set of
issues related to economic and social policies and programme strategies
applicable to several fields including population planning, migration
into urban areas and exploitation of children.
1.4
In some countries, the per capita availability of foodgrain is
declining.
In more countries, the availability of legumes, the major
source of protein for the lowest income groups, is not keeping up with
the population growth; and the prices are increasing. Also, the
production of coarse grains like millets, consumed mostly by the poor,
tends to dip.
Further, even in countries where agricultural growth is
impressive, the imbalance between zones within the country is striking.
Not only production, but participation in the production process, is
important for large, under-employed rural populations.
1.5
At least in one country, which is partly dependent on food imports
despite its vast agricultural potential, there are indications that the
number of the severely malnourished has increased while the number of the
mildly malnourished has decreased. One estimate, in this context,
suggests that only five percent or so of the national population actually
consume an adequate quantity and quality of food. This percentage will
vary among the countries but the proportion is likely to be a minority in
all of them. The majority broadly share several common features: low
purchasing power, lack of nutrition information and education,
inefficiency of food pricing and distribution policies and, above all,
the absence of an integrated national human nutrition policy.
1.6
With the possible exception of one country, energy deficient diet
is more common among women than among men. And this has a serious
bearing on the well-being of children. The prevalence of iron-deficiency
anaemia among pregnant women is around 40-50 percent for the region.
It
has been established that nearly every country in the region has large
population groups subject to serious deficiency in iodine, threatening
newborns with growth retardation and cretinism. The deficiency of
vitamin A is common, as seen from the heavy incidence of loss of vision
among young children.
10
1.7
A vast number of children under three are clearly deprived of
levels of nutrition needed for their growth and development. The extent
of deprivation is known only in vague, aggregate terms and support
services for response to individual needs are far from established.
Generalizations are difficult, but it is reasonable to infer on the basis
of different estimates, that severe and moderate degrees of childhood
malnutrition in the region would be in the disturbing range of 40 to 80
percent.
This is, of course, linked to anaemia in pregnancy, estimated
to be between 30 and 60 percent.
1.8
There are indications that protein-energy malnutrition affects a
large proportion of children and women, even in areas where indicators
like infant and maternal mortality have improved.
2.
Response
2.1
National policies need to be formulated and implemented as a matter
of priority for nutritional protection of the vulnerable segments of the
people, particularly children and women. This involves identification,
monitoring and control, all of which become tractable at the community
level and with full community involvement.
2.2
Experience in each country related to the interface between
agricultural production and nutritional needs may be exchanged with a
view to generating practical ideas for improving the nutritional status
of children and adults.
2.3
A similar exercise appears necessary in respect of the public
distribution system in all its aspects. The aim would be to establish
countrywide networks with appropriate pricing systems, equal attention to
urban and rural areas, mechanisms for community feedback on efficiency
and arrangements not only for food for general consumption but also for
food specifically suitable for children.
2.4
Access to food is as much a matter of employment and income as of
food availability. Schemes may be promoted, linking food and work,
suitably adapted to particular situations. Such schemes exist in more
than one country operating at different levels of coverage and efficiency.
2.5
Dietary habits and food selection, preparation and preservation
methods could be reviewed in a regional perspective and optimal methods
propagated with a view to conserving nutrients and promoting better
balance in the diet.
2.6
The trend of switchover from farming for seif-consumption to cash
crops works to the detriment of basic nutritional support.
Household
gardens are feasible and deserve to be encouraged by assisting with
techniques and inputs as a matter of state policy.
Both have a bearing
on land reform.
2.7
The response to extensive iron-deficiency anaemia could be
three-fold.
Iron fortification of edible salt and food items like flour;
consumption of iron-rich natural foods; and iron tablets for vulnerable
groups like pregnant women and growing children. Methods of moving ahead
in all the three directions could be considered for mutual cooperation
among the countries.
2.8
The? impact of endemic iodine deficiency on child growth and
learning capacity is well established. On the strength of experience in
the region, it should be possible to iodinate all edible salt within th'e
next five years. The modalities could be worked out in mutual
consultation and support among member countries.
2.9
A two-fold response to vitamin A deficiency is indicated; the
consumption of natural foods containing vitamin A and vitamin A caps.ules
for young children. The production of apprioriate natural foods and bulk
supply of vitamin A capsules could be stepped up in mutual consultation
among the countries.
2.10 The member countries could discuss and agree to implement the
International Code of Marketing of Breastmilk Substitutes and follow Up
with appropriate regulatory and educational methods to protect and
promote breastfeeding.
2.11 Malnutrition of young children in the region is directly related to
late introduction of inappropriate weaning foods. The main response will
have to be an educational and demonstration effort using mass
communication and pilot projects to encourage home preparations using
locally available foods.
2.12 A major factor aggravating malnutrition in children is infection,
particularly from diarrhoea and vaccine-preventable diseases. Diarrhoea
management and immunization are essential to protect child nutrition and
growth.
2.13 Economic adjustment policies by governments faced with external or
domestic financial problems, or in pursuit of free-market-oriented growth
models, have resulted in reducing food subsidies and other forms of
transfer of purchasing power. As these tend to harm the poor and their
children, such policies have necessarily to be invested with a human
concern.
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12
(c)
1.
HEALTH
Situation
1.1
Most of the problems of children and mothers surface in the field
of health, yet their roots run deep in the fields of nutrition,
sanitation and education.
1.2
In the context of South Asia, health and sanitation are
inseparable.
Water-borne diseases are the most common of all childhood
diseases, particularly diarrhoea which takes the lives of upto two
million young children each year in the region. And oral rehydration
therapy has but made a beginning.
Indeed, its discovery and extensive
application has been pioneered in the region. Respiratory infections are
less discussed but only slightly less fatal to young lives. The response
so far has been small and experimental. All the six vaccine-preventable
childhood diseases — diphtheria, pertussis, tetanus, poliomyelitis,
tuberculosis and measles are rampant in the region which may account for
a third to half of child deaths and disability in all of the developing
countries on account of these diseases.
It is interesting that the
vaccination procedure is at least a 100 years old in this region, yet it
is nowhere near 100 percent coverage in immunization for any of the
diseases currently prevalent. There is support for achieving greater
coverage and the technical knowhow is available. But this has to be
matched by political, logistic, communication and management inputs, for
coverage is not only to be raised but sustained on a regular basis and
for an indefinite period.
1.3
In all the countries the infrastructure of the health system is
fairly developed. A good number of health workers at different levels
are in position with a measure of training.
However serious gaps exist
in the management of the system. The professional culture is itself
curative, rather than preventive.
There are, as a general rule, more
doctors than paraprofessionals. The concept of primary health care is
accepted in principle but its promotion in practice comes up against
pre-existing institutional barriers.
1.4
A reorientation of the present health care system towards
preventive and promotional work is the biggest challenge facing the
health administration? in all the countries.
Current health care
coverage, in the sense of access to health facilities, may not exceed
one-third of the population in most of the countries.
In some, it .ould
be far less.
13
1.5
There is little that the conventional health care system does to
tackle the multiple causes of ill-health, which is the synergistic
outcome of factors like malnutrition, infection, unsafe water, poor
sanitation, low education, depressed status of women, early marriage,
frequent child births and lack of health-related education.
In fact, the
functional division of family planning from mother-and-child health is
counter-productive. The insular approaches to programmes related to the
control of malaria, tuberculosis, leprosy and other major diseases of the
region would benefit from an infusion of improved social communication
and blending into the primary health care approach.
1.6
The medical curricula continue to be heavily biased in favour of
curative medicine. Medical personnel are not always willing to provide
professional leadership and guidance to health workers in the rural
interior.
Health planning needs to be strengthened.
So too, training
with a community orientation.
Health management is yet to outgrow its
conventional preoccupation with expansion of institutional facilities for
the ill, with the result that it is unequal to stem the increasing
disease load or respond to zonal variations in the morbidity pattern.
1.7
Even where health services exist, their optimal use remains a major
problem both in towns and rural areas, the main reasons being:
insufficient or absentee medical staff; absence of female personnel to
treat female patients; inadequate medical equipment and supplies and an
apathetic or passive attitude of the community which sees itself as a
recipients of curative services rather than participants in a promotional
effort. More or less each of these problems seems chronic in all the
countries of the region.
2.
Response
2.1
The countries of South Asia could work in mutual support to
accomplish universal immunization of children and pregnant mothers by
1990. The foundations have been laid.
Plans are under implementation.
Lessons are being gathered from a variety of environments.
Experiences
could be shared, constraints identified and resolved. Ways of
accelerating the process could be agreed upon in terms of training,
supplies, technical support and awareness building.
2.2
The countries could affirm their commitment to reduce at least by
half childhood deaths due to diarrhoeal dehydration by 1990 by acting in
concert to propagate oral rehydration therapy at household level, by
transferring relevant knowledge related to home-made fluids, and by
stepping up indigenous production and distribution of packets of oral
rehydration salts. All these are clearly feasible. As part of the
communication process, knowledge relevant to the prevention of diarrhoea
(through safe water and personal hygiene) as well as knowledge related to
the management of diarrhoea has to be disseminated through complementary
channels in a sustained manner.
14
2.3
Successful examples show that acute respiratory infections, which
are a major threat to child life in the region, can be controlled
substantially by the primary health care approach through trained
community workers who can identify the illness, prescribe and oversee
treatment and assure the other elements of primary health care, like
immunization, diarrhoea management, breastfeeding and supplementary
feeding.
This approach complemented by smoke-free cooking and behaviour
change in parents who smoke, has reduced by half child deaths because of
acute respiratory infections among project populations in more than one
country in the region.
The combination of health care and health
education can and needs to be widely promoted in all parts of South Asia
where acute respiratory infection is prevalent.
2.4
Intestinal infestation is extensive in the region. While treatment
is indicated on a far greater scale than at present, preventive measures
like? protected feel and safe water have to be promoted, mainly through
the communication process.
2.5
Cooperation among countries of South Asia would be timely to
accelerate control of other widely prevalent illnesses like tuberculosis,
malaria and leprosy.
2.G
A rational policy to assure the supply of essential drugs is
overdue in South Asia. Only in one country has a bold beginning been
made. The effectiveness of a new drug policy in each country will depend
on its comprehensiveness, among other factors like the enforcement
machinery and level of public awareness. A change in culture on the; part
of producers and distributors is very much at issue, a change in favour
of the consumers, particularly the poor among them. Without this
happening, primary health care is unlikely to make much headway. The two
main concerns are reducing the number of drugs to the essential minimum
and bringing down their prices drastically by rationalizing production
and distribution without relaxing control of quality. This is a field
for consultation and concurrent action by the countries of South Asia.
2.7
A joint realfirmation by the seven countries of South Asia of the
elements of primary health care would be useful for a full acceptance of
the practical implications of the concept and for hastening consequential
changes in the existing health care system including the teaching and
training of medical professionals.
15
(d)
1.
SANITATION
Situation
1.1
A critical aspect of sanitation is the safety of drinking water.
Each of the countries has a programme under the International Drinking
Water Supply and Sanitation Decade, 1981-90. Progress towards the
decadal targets is necessarily uneven, the time target itself being
different for different countries. Substantial progress has been
achieved in providing at least one perennial source of drinking water for
a community of stipulated size. An indication of such progress is
however not a measure of the proportion of people consuming safe water.
This aspect is increasingly reflected in policies better tuned to achieve
the intended purpose.
It would be reasonable to infer that more than
half the population of the region does not presently have access to safe
drinking water.
1.2
As experience is gained in water supply programmes, it has become
clear that sound planning and management, are as much required as
appropriate technology, hardware and engineering skills. For instance
safe water consumed from a container that is not clean defeats the
purpose of providing safe water. Water supply has to be supported by
sanitation measures as well as health related education.
’Software’ is
as important as hardware and training of personnel at each level has to
reflect this balance of priority.
1.3
Sanitation awareness in the region is abysmally low. The 'think
link' between sanitation and health education is tenuous even where it
exists. The desire for change must originate from and be sustained by
the community, rather than by the government. This is particularly true
of human waste disposal at the household level. No country can afford to
have latrines constructed for all the people, much less ensure their
proper use and maintenance. The responsibility rests with the family,
irrespective of the income level. To help poor families, the governments
are providing, on a modest scale at present, incentives like cost
subsidy, models for replication, demonstration projects, and information
and educational materials.
1.4
Sanitation is a matter of imbibing and insisting on a sense of
personal and environmental cleanliness.
It is a function of education
and therefore must be made a primary concern of the educational process
through formal and non-formal channels.
16
2.
Response
2.1
A consensus could be reached through consultations among the
countries of South Asia to assure safe drinking water by an agreed year.
In particular the factors that have hampered progress during the current
decade could be examined with a view to resolve them through mutual
cooperation. A sharing of information on the distinctive experiences and
strengths related to particular techniques, modes of construction,
maintenance and community involvement, would stimulate the climate of
cooperation.
2.2
An allied field of inter-country cooperation would be in the
communication effort necessary to make communities recognize the
relationship between clean water and sanitation on the one hand and
health and nutrition on the other.
2.3
The central issue in sanitation is change of habit on the part of
the community. This can be promoted through social communication and
demonstration projects. A network of knowledge, experience and skills
could be usefully built up among South Asian countries.
2.4
Another area for exchange and cooperation would be a community
based, government-supported approach to the problems of shelter,
sanitation, water and energy in urban slums which today pose a serious
threat to children's development.
(d)
COMMUNICATION
1.
Communication is the trigger of the process of development.
It
extends the horizon of education.
It makes the difference all the more
in areas separated by mountain ranges, deep forests or stretches of sand
or water.
The cost of establishing communication in such situations
increases but it is an essential investment for basic human development.
2.
The communication infrastructure is rapidly developing, because of
the steady expansion of literacy as well as of the radio and television.
It is now possible to get across to people messages in health,
environment, nutrition and education. The challenge is to put them to
use in a manner that two way communication is achieved and the interface
between various modes of communication - the mass media, folk forms and
inter-personal communication - is strengthened.
For example, the mass
media can help in spreading awareness and creating a climate necessary
for change.
Folk forms can reflect specific needs of the area and of the
people and provide local colour and flavour.
Inter-personal communica
tion, as for example, between community workers and the people, can
underline priorities, clarify doubts, provide details and enhance
acceptability of changes in attitude and practice.
17
3.
The child’s right to life is dependent on the parent's right to
know.
Recent research has established that no problem threatens the
survival of the child as acutely and consistently as illness and
malnutrition. On no other front is there a comparable possibility for
making a dramatic impact in an immediate context. The potential for
large-scale prevention of malnutrition and death among children under
five years is based on widest application of a limited number of
practical, low-cost measures, and on placing knowledge of preventive and
remedial measures at the disposal of parents.
4.
The low-cost methods refer, among others, to oral rehydration
therapy, immunization, breastfeeding, birth-spacing, growth monitoring
and improved weaning.
Intensive deployment of these methods can make a
big difference to child survival in South Asia, just as it has already
made an impact in many other countries.
5.
Mass promotion of these methods for protecting children requires a
two-fold approach:
empowering people with appropriate information to tackle some
of their own priority problems;
deploying professional services in support of people's own
efforts.
6.
In respect of the former, communication has a crucial role to
play.
Over the past decade, some vital pieces of health information have
emerged from professional circles.
If these are made known in simple
non-technical terms to parents and to the community, they would be
enabled to protect their children adequately and at minimum cost against
the threat of malnutrition, disease and death.
7.
The success of communication depends on disseminating information
meaningfully, widely and quickly. At present a majority of parents in
South Asia are estimated to be unaware of simple preventive and
corrective means against diseases that kill children in large numbers.
They have a right to access to that knowledge.
8.
Fortunately, the dissemination capacity exists and is available in
South Asia.
In all the seven countries, it is possible to inform a
majority of the population and stimulate them into putting their
knowledge into action. This amounts to linking what science knows and
has discovered and tested, to what people need and what they can readily
apply to their own lives and to the lives of their children.
9.
What is required is to make a conscious, deliberate move towards
mobilizing all available resources for communicating vital messages.
Mass media are only one of the resources to be used. There are countless
.18
others such as schools, educational institutions, religious bodies,
voluntary agencies, social service institutions, professional bodies,
trade unions, industrial houses, publishing houses, advertising agencies,
and of course, the health and other service infrastructure.
10.
Through all these multiple channels, the same consistent message
must go out that disease is preventable and that a young life can be
saved through simple, inexpensive, effective and timely action. The
premise to which this process of mobilization is riveted is that
professional services must ally with a wide range of other institutions
whose capacity to regularly reach the needy population is much greater
than that of the professional services acting alone.
11.
Among the countries of South Asia, there is unexplored scope for
interchange of communication techniques; mutually supportive training
facilities; sharing of learning materials; and generation and exchange of
experiential information and developmental insights on a regular basis.
IV.
1.
MOTHER AND CHILD
Situation
1.1
As a result mainly of historical circumstances, all the countries
of South Asia are victim to the burden and the effects of extensive
material poverty.
By the usual measure of minimum calorie consumption,
about a third to a half of the populations appear to be in poverty. This
condition is a consequence as well as a cause of a variety of factors
that limit life.
It leads to poor food intake, under-nutrition,
ill-health, growth retardation, small body size, slow learning, low
productivity, reduced earning capacity and under-employment. The
obstinacy of this self-perpetuating circle has to be broken at a
strategic point - before child survival and development can be assured.
A focus for possible change in the mother-child life cycle would be the
mother-to-be, the adolescent girl.
1.2
The maternal mortality rate rules high in most countries at average
levels like four to eight per 1000 live births, and in several areas much
more.
Even where the rates are relatively low, the improvement seems not
so much the result of better maternal nutrition but improved health
facilities around the time of birth. Maternal nutrition is the key to the
health and development of the infant.
1.3
Infant mortality rates in most parts of the region are well above
100 per 1000 live births.
Even in a country where the rate is only 30,
there are pockets with almost double the national level. Around four
million children born in the region do not survive their first birthday.
Reductions have come about mainly through control of epidemics and better
care at birth and during the perinatal phase.
1.4
Access to competent health care during, at, and after birth is the
exception rather than the rule in the region. The number of women
delivering in an equipped institution would not be more than 10 percent
on an average. And, delivery at home is handled mostly by untrained
attendants in unhygienic conditions.
1.5
Morbidity patterns of the mother and child during pregnancy and the
first year of birth are known only in broad outline but neonatal tetanus,
diarrhoea, measles and respiratory infections seem to be common.
1.6
Fertility rates are high in the region, except among three to five
percent of the total population of South Asia. The annual rate of
population growth is between 2 and 3 percent for the region as a whole.
The number of births each year is around 34 million. And most of these
births are among the poorer half of the population.
This is a measure of
the maternal depletion that takes place regularly.
20
1.7
The male to female ratio in the population is adverse to women in
many parts of South Asia.
In some parts, this bias is reflected in
female infant mortality.
1.8
There are indications that the traditional store of knowledge and
wisdom related to care during pregnancy and birth and to infant feeding
practices has been considerably weakened.
In this sense the ’old
information order’ has nearly broken down, and a new one is not yet
establi shed.
1.9
This in turn is related to the high levels of female illiteracy in
the region which, on an average, could be around SO percent.
In the
modern context, education is difficult without literacy. And the
prevailing extent of ignorance explains why mothers in urban low income
groups easily give up breastfeeding and why proper and timely weaning is
a frequent casualty. Coupled with the common inability of the mother to
produce enough breastmilk or to procure the right type of supplementary
food, the situation leads to a degree of denial of nutrition to the
newborn and the very young.
1.10 It is only logical to translate the concern for the child into
preparation in advance for its arrival well before birth and even before
conception.
Upto a third or so of all children born in South Asia have a
birth-weight below 2500 grams. This is a commentary mainly on the
nutrition and body size, health and education of the mother and social
practices like early marriage and frequent child births. The number of
low birth weight children born each year would be around 10 million,
distributed among all the countries in substantial numbers.
2.
Response
2.1
Special attention to the nutrition and development of the
adolescent girl is imperative for her to become a healthy mother capable
of delivering a healthy baby. This is a matter as much of material
support as of public awareness at the family level.
2.2
While the nutritional status and growth of the adolescent girl is
linked to social support services in nutrition, education and vocational
training, the problem of unequal access to food within the family appears
to be real, though it may not be universal in the region. This problem
has to be met by a concerted application of social communication methods
in support of women and children, particularly pregnant and nursing
mothers and female infants and girls.
2.3
Monitoring child growth from pregnancy through infancy and early
childhood needs to be promoted as a universal practice in the region, not
in isolation but as part of a composite scheme of literacy and education
21
of mothers, nutritional support and health care for the mother and child,
environmental sanitation and personal hygiene. This cluster of
priorities is to be reflected in the service delivery system. There are
several examples of such services in the region. These could be
expanded, learning from one another.
2.4
The relevance of child survival to limiting family size needs to be
widely propagated, within a design that brings together birth spacing and
maternal and child health into a single programme.
It is significant
that the region has examples of success in bringing down birth rates
through a combination of educational and health facilities,
notwithstanding low per capita incomes. The challenge is in spreading
this process in a similar thrust but accelerating the pace through child
survival on the one hand and contraception on the other, the two being
complementary in an organic sense.
2.5
In raising awareness and knowledge on issues of nutrition for
maternal health and child growth, the extensive sustained use of
complementary communication channels is required, care being taken not to
supplant sound, sometimes underused, traditional practices with which the
region abounds.
2.6
Innovative and positive experiences from countries of South Asia
could be pooled to draw strategic lessons in trageting nutritional
support together with health care and functional literacy to vulnerable
groups including women and children. The activities of non-government
organizations in the field would need to be coordinated with that of
governments, through organized channels of exchange of information and
experience.
2.7
The mother and child must be seen as one, biologically till birth
and thereafter in a familial and social sense. The policies, resources,
strategies and structures required to improve the status of the
mother-and-chiId, and to achieve faster progress in supportive fields,
are briefly discussed later in this overview.
2.8
In most of the directions discussed above, exchange of experience
and practical collaboration among the countries are likely to be more
relevant and productive than similar efforts in relation to countries
outside the region, because of the inherent similarity of the nature and
causes of the problems.
V.
POLICIES AND STRATEGIES
1.
All the countries of the region recognize the priority for children
in the development process. Some of them have national policies on
children to guide policies and programmes relevant to them. However, the
concept of priority for children has not been fully translated to, or
firmly implanted in, national development planning.
2.
The discussion in the chapter 'Mother and Child' started with a
recounting of the variety of factors that perpetuate the circle of
poverty from one generation to the next. A strategic response intended
to decisively influence the mother-child life cycle must necessarily
include a corresponding cluster of inter-related support services:
girls' education
early
stimulation
safer environment
food supplements
growth
monitoring
income opportunity
management
of diarrhoeal/
respiratory illnesses
support to save time/energy
Interventions in
the mother-child
life cycle
preparation for motherhood
immunization
against childhood
diseases
birth spacing
birth attention
proper weaning
breastfeeding
maternal care
23
3.
Programmes for children are not yet a part of a unified national
plan which is essential to meet children's needs across the functional
sectors.
Even at presently available levels of resources, better results
are possible by converging the different inputs to provide concurrent
services using appropriate strategies.
It is at the planning stage that
different disciplines can make their inter-related contribution to
children's development.
4.
If experience in South Asia, and elsewhere, is any guide, the
suggested strategic design can work, only if the development process has
a firm basis in, and a pivotal role for, the community.
It implies
decentralized planning of social support services to make them respond to
area-specific and people-specific needs, with optimal use of local
resources.
It envisages not only close coordination but continuous
interaction between different disciplines, departments and services
through the stages of planning, implementation and evaluation. Among the
other implications of this strategy are concerted action by government
and non-government agencies functioning in the same area; efficient use
of para-professionals and community level workers with strong
professional and government backing; extensive use of social
communication to inform and sensitize communities into action.
5.
A new ethic for children could be promoted in the region in an
ethos of caring. This is necessary to achieve universal coverage of basic
services for children through acceleration of their simultaneous
provision; and through transfer of knowledge relevant to survival,
development and protection of children to the community, using strong and
sustained social communication for different audiences and through
complementary media, methods and messages.
.$■
The countries of South Asia could agree on a set of objectives and
6.
goals in operational terms, for meeting the survival, development and
protection of children in the region in a mutually supportive manner and
encouraging practical exchanges.
7.
The deterioration of the physical environment leading to a decline
in the support to children from natural life support systems like land,
water, air and forest, are matters of growing concern. Often, forces of
economic development accentuate these problems. The answer lies in
striking a balance between economic and ecological considerations, taking
into account social as well as economic costs in the present and for the
future.
8.
A review by each country, and jointly among the countries, of the
effects of the deterioration of the physical environment on the
development of children, could strengthen policy insights for arresting
or abating the damage to children.
24
9.
There are reports from several countries in the region of a
deterioration in the social environment, arising not only from poverty
but also from parental neglect due to long absences such as of migrant
workers.
There are indications that millions of children in South Asia
are exploited in many ways, child labour being the most pervasive.
Most
of these children are not protected by labour legislation, they being
illegally employed or working in the informal sector. There is a close
link between this phenomenon and dropping out from school. While it is
important and necessary to stop child labour as soon as possible,
attention has to focus on the basic needs of children currently working.
The relevance of non-formal systems of learning is heightened in this
context.
10.
The problems of the working child and the wayward child as well as
those related to dangerous drugs and child abuse are increasing in the
countries of the region. At least in one of them, these are recognized
as requiring new regulatory and educational measures. At the present
stage, the countries of South Asia could together seek to identify ways
of promoting the sharing of experiences on problems and solutions.
11.
The UN Declaration of the Rights of the Child (1959) needs to be
translated into an effective convention.
The seven governments could
consider, preferably on an agreed basis, to participate actively in the
current exercise for drafting the convention under the aegis of the UN
Human Rights Commission, to hasten the process for quick and effective
enforcement of the articles of the convention.
VI.
STRUCTURES AND RESOURCES
1.
Public administration systems in South Asia have assumed
directional or direct responsibility for the development of the social as
well as economic sectors.
Considerable effort has gone into reshaping
the administrative structures to respond to the relatively new
functions. This has to be carried forward to its logical conclusion.
The present administrative systems in the seven countries share the
legacy of an acquired culture and can benefit from an exchange of
experience in reforming it as a tool of development.
2.
Considering the weaknesses in the management of national systems
particularly of health and education, special efforts appear to be
necessary particularly to strengthen social development management
capability including planning, formulation, coordination, implementation
and evaluation of projects and programmes, from the national level to the
local community.
3.
The countries of South Asia could consider for extensive promotion,
alternative community-based service delivery mechanisms for clusters of
villages or slums involving: a strong element of representation of the
local community, participation by voluntary organizations including
women's groups, a supportive role by professional bodies from different
disciplines and decentralized mechanisms of public administration to hold
these elements together in an inter-disciplinary sociological approach to
services for children and women.
4.
The resource allocations for the social service sector,
particularly health and education, appear to be unequal to the needs of
accepted objectives. The examples of the more successful developing
countries in Asia suggest the need to enhance outlays in these sectors in
absolute terms and as a proportion of the gross national product.
5.
It is suggested that the countries examine and revise their
budgetary commitments in different sectors with a view to enhancing
resources corresponding to enhanced political priority for children in
national development planning for meeting, across functional or technical
sectors, the basic needs of the whole child and of all children.
6.
It is also suggested that the response of governments to reduced
resources on account of adverse economic factors, could take into account
its social impact on children, particularly from low income groups, in
order to ensure that services for them do not fall below the essential
level.
26
7.
All the countries in the region accord a substantial role to
voluntary organizations in the context of development of children.
The
latter are engaged in this field either exclusively or as part of
development work with wider scope.
It would help the development process
if criteria are established for a viable partnership between government
and non-government agencies, particularly at the community level.
8.
To reflect political priority for children in actual practice, an
administrative mechanism may be considered — to coordinate, monitor and
accelerate services for children through different stages upto the
service delivery point. Such a mechanism would encompass different
departments of government as well as non-government agencies working with
them, and report periodically to the highest political level.
VII.
PERSPECTIVE
1.
What emerges from the analysis in the preceding chapters is a
definite trend of change for the better in the circumstance and condition
of child life in South Asia.
2.
The favourable factors are clear: National policies increasingly
reflect a major lesson of experience that economic and social progress
must move in even step in support of human development. The interests of
children are finding a specific place of priority in the national
planning process.
Broad spectrum programmes in support of children are
beginning to make a difference to children across the different social
service sectors. Within this scheme, child survival and development
priorities are receiving increasing attention. Voluntary groups of
professional people are active in the same field, strengthening people's
hope and confidence in their own ability to overcome the effects of
poverty on their children.
3.
Some of the most resilient ideas on self-reliant development have
come from South Asia. And beyond these insights lie a wealth of
development experience, institutional infrastructure and communication
capacity.
This is why the responses to the situation of children
advocated in this Overview are eminently feasible.
Indeed, they
represent a renewed effort at accelerating ongoing activity, with an
elevation of priority, a sharpening of strategy, a readjustment of
service structures and an effective mobilization of material and non
material resources of the community.
4.
Some of the aims which the countries of South Asia have set”for
themselves can be achieved quickly, some in the medium term, but it is
possible, given the political will and wisdom, to reach basic services
to all children in the region before the close of this century. As
argued in the preceding pages, national determination, mutual cooperation
and collective self-reliance can make this vision come true.
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