The well being of Children in Africa in the 21st century.

Child wellbeing is all about children being secure, healthy and happy. It is about having opportunities to grow, to learn and to know against a background of positive personal and social relationships. An all encompassing definition looks at child well being as being focused on the full and harmonious development of each child’s personality, skills and talents (The African Child Policy Forum (ACPF), 2008). Early childhood is one of the most critical phases in determining the future of a child’s life and hence the future of the country. Guaranteeing young children the proper conditions for growth will save the state and its services and institutions the expense and energy required to deal with individuals who have not been able to find healthy, productive paths in lives begun so unfavorably (Emily Buchanan, 2008). There is an emerging and  growing consensus that Africa’s problems can be solved only by Africans themselves which has seen African leaders taking measures to extricate themselves from the interrelated problems of conflict, poverty, hunger and distress. Unfortunately however, while Africa may have been served well by leaders of liberation, much of the continent has not had the benefit of leaders of development. For far too long and in very many countries, the continent has seen corrupt leaders.

Most African cultures regard human wellbeing as a consequence and extension of child wellbeing, and therefore accord a unique and privileged position to the child. The child is seen as celestial, a complex social and material being that needs to be handled with great care, considered part of the cosmos even before it is born (Evans 1993, 22 cited in The African Child Policy Forum (ACPF), 2008). African culture takes every child as the responsibility of the community making parenthood a social responsibility, where many people can fulfill the role of parents without having genetic ties to children (Catherine L. Ward et al 2007). Hence the African saying “it takes a whole village to raise a child.”

Infant mortality

Each year approximately one million babies are stillborn; about half a million die on their first day; and at least one million babies die in their first month of life. Yet, it is estimated that 800,000 of these stillbirths and deaths are avoidable (Catherine L. Ward et al 2007). Infant mortality rate are highest in Africa were almost 50% of the world’s deaths of children under the age of five occur in Africa. All this emanates from the fact that some 20% of children aged 12-23 months were not immunized against. The number of births not registered before five years of age stood at 45% thereby impeding effective government planning and programming through the inadequate birth registrations. Child delivery is also another challenge that remains to be tackled as statistics show that, 43% of deliveries were not attended by skilled health worker (UNICEF 2007 cited in The African Child Policy Forum (ACPF), 2008) These births were assisted by traditional birth attendants, relatives and neighbours, while some mothers gave birth alone, sometimes in the bushes. Though minimal, headway has also been made with child deaths attributable to preventable and treatable illnesses being reduced in 44 of the 46 countries of the WHO African Region  and Malawi, Mozambique and Eritrea have managed to lower significantly their child mortality rates over the last 5 years (Emily Buchanan, 2008).

The health of children in Africa

Basic health care in Africa remains unattained and over the next decade, it is estimated by the International Finance Corporation that $25-$30 billion of new investment will be needed in health care assets, including hospitals and clinics to meet the growing demands of the healthcare market in Sub-Saharan Africa, which is set to double by 2016, rising to $35 billion. There are still great disparities in the accessibility of health care services with the poor remaining on the vestige of the public health system, a case in point is in Guinea, where some 48 per cent of all people visiting hospitals and primary health facilities come from the richest fifth of the population, and those from the poorest fifth make up only four per cent of the patient population (Emily Buchanan, 2008) To show just how expensive health services are in Africa and their effect on the poor; when Uganda eliminated user fees at health facilities in 2001, public visits increased by 80 per cent, with half of the increase from the poorest fifth of the population (UNDP 2006 cited in The African Child Policy Forum (ACPF), 2008). Children from poor family backgrounds who remain excluded from essential services are cursed to a life where they die from curable diseases, an example is HIV/Aids from mother to child before and during the natal period which can be avoided through the mothers attending the PMTCT programme, however a shocking 96% of HIV positive women in Africa remain excluded from the programme because of supply shortages and lack of income-support measures, millions of Africans remain excluded from essential services. Regardless of these staggering facts, it is estimated that six percent of deaths of children in Africa are due to HIV/AIDS (WHO 2006 cited in The African Child Policy Forum (ACPF), 2008)  malaria accounts for 25 per cent of deaths of children under five in sub-Saharan Africa and more than 2,000 African children die of malaria daily (Nicola Jones 2006) hence more children die from malaria which is curable as compared to HIV/AIDS which is not.

Some headway has however been made as the decade has seen exclusive breastfeeding among children under six months of age has increased remarkably in many sub-Saharan African countries over the last 10 years. Exclusive breastfeeding for the first six months of life has the potential to avert 13 per cent of all deaths under five in developing countries, making it the most effective preventive method of saving children’s lives (UNICEF 2007 in The African Child Policy Forum (ACPF), 2008). Very encouraging results have been achieved in totally eradicating or reducing to insignificant levels the burden of diseases like leprosy, Guinea-worm disease and river blindness (WHO 2006 in The African Child Policy Forum (ACPF), 2008). In the fight against poliomyelitis, despite outbreaks in Angola, Cape Verde and the DRC in 2000, most countries (31) have maintained polio-free status for more than three years. According to WHO, Overall measles deaths have declined by more than 50 per cent on the continent since 1999.

Various hindrances in the achievement of accessible and efficient health care systems in Africa chief of which is government commitment to the actual improvement which starts from budgetary allocations for the health sector, which determines the quality of service offered by health institutions and inversely the number of people who can assess it, the more the state invests, the cheaper the service delivery and the more people can assess it including the poorer sectors of society. The basic average spending on health in Africa vwas nine per cent of the total government expenditure in 2004, and often as little as two per cent (Yehualashet Mekonen, 2009). In 2004, only four countries – Burkina Faso, Liberia, Malawi and Rwanda – lived up to the pledge made by African governments in Abuja in 2001 to increase spending on health to at least 15 per cent of their annual budgets.

The high cost of medicines is also another hindrance to service delivery in the sector, medicines account for the second-largest portion, after salaries, of overall health budgets in African countries (Nicola Jones 2006).Furthermore, prices for new medicines for the most prevalent diseases -HIV/AIDS, tuberculosis and malaria- are often extremely high yet these mainly affect Africa who can not meet the demands of her populations. Africa is also faced with a major skilled workforce in the health fraternity and the worst part is that Africa trains an adequate number however the out-migration of health workers to richer nations is draining valuable human resources for health in poor countries. In the midst of this deadly shortage, about ten million Africans, most of them highly educated professionals, constitute an invisible nation residing outside Africa that is equivalent to the entire population of Tunisia (Emeagwali 2003).

Children’s Basic Nutrition

The amount and quality of available food is a basic factor not just for survival, but for good health. About 60 per cent of under-five mortality in some parts of Africa is attributable to malnutrition (African Union 2007 cited in The African Child Policy Forum (ACPF), 2008), and those undernourished children that survive to adulthood have increased risk of heart disease, diabetes and renal damage. Malnutrition affects growth and has a direct impact on labour productivity. Child malnutrition has steadily declined in Africa, to 28 per cent in 2006 (WHO 2007); and there was more than a four-fold increase in two-dose coverage of vitamin A supplementation between 1999 and 2005 (African Union 2007 cited in The African Child Policy Forum (ACPF), 2008). According to WHO, some 4.1 million children in sub-Saharan Africa had low birth weight (i.e. less than 2,500 grams at birth) in 2000-2006. Niger had the highest percentage of underweight children, at about 44 per cent. Children of low birth weight are 20 times more likely to die in infancy than heavier babies, and those who survive may be more susceptible to infectious diseases and inhibited growth and cognitive development. Nutrition of children is also affected by increase in food and fuel prices which renders basic commodities expensive, for every one per cent increase in the price of food, food consumption expenditure in  developing countries decreases by 0.75 per cent. Inevitably it therefore means that, higher food prices will cause the poor to shift to diets that are even less nutritionally balanced, with adverse impacts on health in the short and long run (von Braun 2007 cited in Catherine L. Ward et al 2007).

Water and Sanitation

Access to adequate sanitation is the other critical factor in child survival. With improved sanitation, overall child mortality can be reduced by about a third. Regardless of this fact, in countries such as Ethiopia, Rwanda and Uganda, four out of five children either use surface water or have to walk more than 15 minutes to find a protected water source (UNICEF 2004 cited in  ACPF, 2008) In Eritrea and Ethiopia, coverage figures were nine and 13 per cent respectively. No wonder, then, that these two countries have some of the highest child death rates from diarrhoea in the world. Water and sanitation resources must be accompanied by hygiene awareness and related measures to ensure that children are not exposed to pathogens. Basic measures in ensuring hygiene include the use of latrines, washing hands after defecation and before eating or preparing food, proper disposal of faeces, protecting water sources and cooking food thoroughly. There is also a budgetary relationship with accessibility of water and sanitary services in that universal access to even the most basic water, sanitation and hygiene facilities would reduce the financial burden on health systems in sub-Saharan Africa by about US$ 610 million, which represents about 7% of the region’s overall health budget. To show the appalling the condition of Africa’s water and sanitation, 33% of the population are not using improved drinking water sources with an average 62% using inadequate sanitation facilities.

Access to adequate shelter

Having a house is a crucial aspect of ensuring the dignity of humanity; however adequate housing encompasses more than just the four walls of a room and a roof over one’s head. It fulfils deep-seated psychological needs for privacy and personal space; physical needs for security and protection from rough weather; and social needs for basic gathering points where important relationships are forged and nurtured. According to statistics Africa falls far short in ensuring that her children have adequate shelter since more than 198 million children are said to be living in one or more forms of severe shelter deprivation in sub-Saharan Africa (Nicola Jones 2006), with about 32 million children living on the ‘street’. The violence, panic and confusion typical of forced evictions subject children to recurring nightmares, anxiety and distrust (Centre on Housing Rights and Evictions 2006). The impact of eviction on family stability and on children’s emotional wellbeing can be devastating; the experience has been described as comparable to war for children in terms of the developmental consequences ( ACPF, 2008) An important point to note is that a child deprived of housing will be deprived of many other basic rights, such as the rights to health, education, protection from economic exploitation and abuse, and the right to a legal identity and citizenship.

Education of Africa’s children

There has been impressive progress towards achieving education for all in Africa, particularly in those countries that have abolished school fees as shown in the case of Kenya which removed school fees for primary education in 2003, some 1.3 million children enrolled for the first time (African Union 2007 cited in  ACPF, 2008). Other countries like Algeria, Tunisia and Malawi have nearly achieved 100 per cent net enrolment ratios; Tanzania achieved a 91.4 per cent net enrolment ratio in 2005. Though some countries are making impressive steps forward in the education sector, the region as a whole is found to be slumping as in 2005, only about 66 per cent of primary school age children in sub-Saharan Africa went to school (Emily Buchanan, 2008). Another example is in 2004, the net enrolment rate in Djibouti stood at 29 per cent for girls and 36 per cent for boys at the primary level; the corresponding ratios for Niger were 32 per cent for girls and 46 per cent for boys ( ACPF, 2008). Much attention in Africa is given to primary education to the almost total neglect of secondary education According to UNICEF, only 27 percent and 23 per cent of children of secondary school age attend secondary school in east and central Africa and eastern and southern Africa, respectively (UNICEF 2007 cited in  ACPF, 2008). There are several explanations for slow progress on the education front. Limited budgetary commitment is one, but there are others, such as school fees, hidden costs such as uniforms, lunch expenses and mandatory contributions to community development funds, as well as the lack of basic facilities such as adequate sanitation, have further contributed to the exclusion of children from poor backgrounds in general, and girls in particular. The issue of quality has been clouded by a preoccupation with meeting numerical targets and the political desire to proclaim high levels of achievement in school enrolment. The irrelevance of the curriculum, high teacher-pupil ratios, low teacher salaries and reluctance to teach in rural areas are draining the quality of schooling in Africa (Executive Summary of Teacher Development, cited in African Union 2007a) for example the median pupil-teacher ratio for sub-Saharan Africa was 43 in 2004. In Congo (Brazzaville) there was one teacher for 83 pupils, and in Chad there was one teacher for 69 pupils (Nicola Jones 2006). The low quality of education, the failure of the education system to take account of the absorptive capacity of the economy and the theoretical nature of the skills taught together result in minimal employability of African graduates. Thus the African education system is “geared towards churning [out] job-seekers rather than job creators” ( ACPF, 2008)

Access to information

Wider access to media like TV, Radio, newspapers and the internet, in a child-friendly and ethically sound format, is of paramount importance in allowing the meaningful participation of children in socio-economic life. Access to the media is a vital vehicle in creating awareness about children’s needs, and in facilitating opportunities for children to participate in society, yet 39 per cent of children in sub-Saharan Africa have no access to television, radio, telephones or newspapers (Nicola Jones 2006).According to a children and youth poll conducted in eight countries in the eastern and southern Africa region, only 34 per cent of children reported home ownership of television though there was higher radio coverage (62 per cent). Vital information such as issues ranging fro HIV\AIDS, sexual abuse, drug abuse, child trafficking among others are learnt through the mass communications paths-radios and television therefore it is not surprising that in some countries, such as Ethiopia, as many as 95 per cent of children know nothing about drugs and related prevention methods. A staggering 45 per cent of children in the region reported to know next to nothing about HIV/AIDS (ACPF and UNICEF 2007 cited in  ACPF, 2008), all because they lack that medium of communication.

Orphans

Africa to date remains the continent with the greatest number of orphans, according to UNICEF, the total number of children in sub-Saharan Africa reached 48.3 million at the end of 2005. By 2010 an estimated 53.1 million of the region’s children are expected to be orphaned (Catherine L. Ward et al 2007) A large number of orphaned children are forced by circumstance and end up in child-headed households, a phenomenon that is growing very rapidly throughout the continent (ACPF 2008). orphaned children are less likely to have access to health care, education, are more likely to be nourished and stunted and they usually have worse educational outcomes as compared to non-orphans. Orphaned children’s access to school is not only vital for their future, but important for their psychosocial development. Schools can provide children with a safe, structured environment, the emotional support and supervision of adults, and opportunities to learn how to interact with other children and develop social networks (Yehualashet Mekonen) they are more likely than other children to end up on the streets or engaging in hazardous work in commercial agriculture, domestic services, commercial sex work and street vending. In Congo (Brazzaville), almost one half of street children are orphans (ACPF 2008). A 2002 rapid assessment in Addis Ababa, Ethiopia showed that more than three quarters of domestic workers were orphans (Kifle 2002 cited in ACPF 2008)

Children with disabilities

Children with disabilities remain on the outskirts of society, their needs remain secondary to those of the rest of society especially in Africa where resources are limited. It is estimated that as many as 35 per cent of two to nine year-olds in Djibouti and 31 per cent in Central African Republic live with at least one reported disability (i.e. a disability of cognitive or motor functions, a seizure problem, or a disability of vision or hearing) From birth, children with disabilities are often excluded from access to the support for development that all children need. They may be kept in the dark, denied attention, affection and physical contact, and denied ordinary movement and language stimulation. Discrimination often leads to a lack of recognition of disabled children’s equal humanity by their families, peers and communities, as well as reduced access to basic social services, especially education and health services to harmful traditional practices including early marriage and Female Genital Mutilation

Child victims of violence

Violence against children is a widely pervasive and deeply disturbing problem especially in Africa which has been cursed with incessant conflicts which tend to inevitably include these children as combatants as well as victims, either way the children remain subjects to exploitation. The form violence takes ranges from physical violence – such as beatings – to psychological and sexual violence including verbal abuse and rape, to harmful traditional practices including early marriage and Female Genital Mutilation (UN 2006) African attitudes towards children can be somewhat contradictory, as much as they are considered as precious beings, children are seldom treated with sensitivity, consideration or respect in their everyday life because they are not viewed as whole human beings with all the rights that adults have rights. Much of the violence against children takes place in the home environment and is perpetrated by family members where traditions and customs find expression and are put to practice It is at the family level that violence and harmful traditional practices are legitimised and played out before being passed on to following generations. What can also lead to grave lifelong health complications is the phenomenon of early marriage. Some 42 per cent of women between 15 and 24 were married before 18 in Africa (UN 2006) Studies show a strong association between child marriage and early childbirth, partly because girls are pressured to prove their fertility soon after marrying (Nicola Jones 2006). Female Genital Mutilation (FGM): Often referred to as ‘female circumcision’ UNICEF estimates that in sub-Saharan Africa, Egypt and Sudan, three million girls and women are subjected to FGM every year (UN 2006). FGM is abominable, not only because it is cruel, but because it has deleterious effects on the health of women and their infants. Women who have been subjected to the practice are significantly more likely to have complications during childbirth.

War-affected children

War and armed conflicts expose children to extreme forms of abuse and violence and in the African context millions of children are caught up in conflicts both as targets and instruments of war (UN 2006) Girls face particularly high risks in armed conflicts in the form of sexual violence, including forced prostitution, sexual slavery, forced impregnation, forced termination of pregnancy, forced sterilisation, indecent assault, and trafficking (International Committee of the Red Cross 2006 in ACPF 2008). Many combatants appear to regard rape as a “spoil” of war (Amnesty International 2004. Apart from the trauma associated with rape and sexual violence, the children born of rape are subject to extreme social pressure and exclusion. Child soldiers are subject to brutal punishment, hard labour, cruel training regimes, torture and sexual exploitation.  Many are given drugs and alcohol to agitate them and make it easier to break down their psychological barriers to fighting or committing atrocities (United Nations (2006)). The limited budget allocated for child-related programmes is partly due to the direct and associated costs of war, they have ravaged social and economic infrastructures; they have also eaten away the lion’s share of public budgets in order to finance war efforts at the expense of social sector investment. Estimates show that wars stripped about US$ 20 billion a year from African economies between 1990 and 2005 (The African Child Policy Forum (ACPF), 2008)

Though largely inadequate in addressing the needs of its children, Africa over the past decade has done a lot in an attempt to cater for its children in comparison to the previous decades. A lot more can be achieved in the next decade as can be attested by the declining number of  conflict in the previously war-torn regions of Africa which should-all things being equal-see an increase in budgets for public services such as health care, more investment in the education system. Despite this progress, the state of child wellbeing in Africa remains a source of enormous concern. Open and vulnerable children remain society’s outcasts and their needs remains secondary to the rest of the communities needs. Millions of people are excluded from essential services. Too many poor people and too many children die from avoidable diseases; millions of children die or fall sick for lack of food and safe drinking water. A huge and growing orphan population has been created because of war and the HIV/AIDS pandemic. Nearly half of Africa’s children live in some form of housing deprivation, and a large population of children with disabilities remains underserved, hidden and almost invisible. Therefore a whole lot more needs to be done for Africa’s children if their needs are to be met holistically.