Express Healthcare

Need for more child-friendly spaces in India’s response efforts

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Prarthana Sen, member of the Indian Association for Asian and Pacific Studies (IAAPS) and former researcher at the Observer Research Foundation (ORF) explains that child-friendly spaces reflect cultural sensitivity as they are built in adherence to the local norms and values of a concerned place. Its staff is also selected from amongst those affected, and also those hailing from the surrounding host communities. This is done to maintain the children’s familiarity with their community and culture and to make them feel at ‘home’

Child-friendly Spaces (CFS) provide a safe space for children to learn and play around in, in the event of any emergency or crisis. Such an arrangement enables children to maintain their daily routines, without having to face any disruptions in their everyday lives, lending support to their mothers and caregivers in the process. It was back in 2004, that the first of such spaces came to be set up by UNICEF India in the backdrop of the devastating Indian Ocean Tsunami.

A 2004 UNICEF USA report reveals how ‘safe havens’ were provided for the affected children in India by ensuring recovery from disaster-induced trauma via education, play and psychosocial support.[1] However, despite its success, Child-Friendly Spaces remain far from normalised and in light of India’s ongoing post-pandemic recovery, it emerges as a necessity in meeting the special needs of children and their mothers. In light of the increasing frequency of natural disasters coupled with complex public health emergencies such as the COVID-19 pandemic, such spaces could serve as an effective tool for improving the quality of care in India’s healthcare settings. 

The medical team in such spaces at the district level can include local General Practitioners (GPs), Nurse Practitioners (NPs) and Physician Assistants (PAs). They must speak the local language, and be aware of the community structures, in addition to being trained for diagnosing medical conditions and rendering prompt treatment. Mental health workers also form a part of the team in Child-friendly Spaces to ensure a comfortable and secure place for children within the affected communities.

At the village level, Anganwadi Workers (AWWs), Auxiliary Nurse Midwives (ANMs) and Accredited Social Health Activists (ASHAs) can be trained to assess and provide the required health services. These community health workers could play a significant role in ensuring antenatal care during pregnancies and provide skilled care during childbirth within such spaces. Psychosocial support must also be provided to these health workers working in direct contact with the affected communities.

Setting up such ‘spaces’ 

Child-Friendly Spaces reflect cultural sensitivity as they are built in adherence to the local norms and values of a concerned place. Its staff is also selected from amongst those affected, and also those hailing from the surrounding host communities. This is done to maintain the children’s familiarity with their community and culture and to make them feel at ‘home’.

Mental health workers in such spaces could include psychologists, therapists, counsellors, child protection specialists, teachers, and researchers among others. One encounters children of many diversities in a Child-Friendly Space, be it differences in religion, language, age, culture, ethnicity, socioeconomic status, disability, and/or gender. Thus, mental health practitioners must display sensitivity to the various kinds of existing diversities in these spaces and be prompt in their efforts to render Psychological First Aid (PFA) as and when required.

Practitioners are also expected to be well-versed in the basics of first aid. Child-Friendly Spaces may even appoint emergency care providers that follow the usual medical practices of the communities that the children belong to, so that they do not feel much of a difference from their usual daily lives, even in the event of an ongoing crisis.

Sometimes children in Child-friendly Spaces may be suffering from a medical or neurological condition, and this must be taken note of during the registration process. Practitioners must also have a record of this, along with the medication required for treating the same. They must also be aware of any activities that a child must avoid to not aggravate his/her medical condition.

Most children in vulnerable communities suffer from various kinds of waterborne diseases, and their treatment is of topmost priority. To maintain high standards of hygiene in Child-Friendly Spaces, regular checking takes place for still and unclean water sources like open drains, leaking pipes and wells within and around the premises to prevent the rise of vector-borne diseases like dengue, malaria, Japanese encephalitis and the like.

In addition to this, regular health assessments take place in Child-Friendly Spaces. Practitioners must ensure that a child always has his/her medication, and have knowledge of how to administer it. Health assessments may be done through a team of doctors, paramedics, and nurses available at the nearest health facility or even mobile medical vans with doctors and paramedics.

Basic health assessments are conducted to prevent common diseases like dehydration, diarrhoea and conjunctivitis. Care is also taken to ensure that children are not present too close to each other, to prevent any potential outbreak of communicable diseases like chicken pox, measles and hepatitis, as they are found to be quite common among children of all ages.

Sanitation and hygiene assessments for young mothers and girls may be carried out by Lady Health Visitors (LHVs), ASHA volunteers and others, to ensure an effective response to their gender-specific health needs. Services could include counselling on complementary feeding and the distribution of menstrual hygiene kits comprising sanitary napkins and underwear.

Child-Friendly Spaces may also conduct vaccination drives to ensure continuity in building a child’s immunity, even in times of crisis. In such spaces, deworming and immunisation drives can be carried out by general practitioners, physician assistants, Anganwadi Workers and ASHA volunteers, already involved in monitoring the Child-friendly Spaces. Such practitioners are made aware of the concepts of child protection, child rights and how to maintain a child-friendly environment during deworming and vaccination drives.

As seen in a report by the Centre for Youth and Social Development (CYSD), Child-Friendly Spaces can also be used for doling out nutritious food supplies and raising nutritional awareness while carrying out vaccination drives, as seen in the case of the Child-Friendly Spaces that were set up in six villages in Odisha’s Puri district, in the aftermath of Cyclone Fani.[2]

Concluding Remarks

Governmental involvement in setting up Child-Friendly Spaces can only be seen in its recent efforts, and remain confined to the railway sector as part of its anti-human trafficking operations. For instance, in May 2022 a Child-Friendly Space was created at the Pune railway station. This initiative can be seen as a part of Operation ‘Nanhe Farishtey’– a child-rescue initiative entrusted to the Railway Protection Force (RPF) of the South Western Railways (SWR). A central feature of Operation Nanhe Farishtey involves utilising CCTV surveillance to prevent child trafficking. Rs 500 crore under the Nirbhaya fund has already been allocated for this initiative[3] but the funds allocated for building the child-friendly shelters remain unknown.

The RPF has also launched Operation Action Against Human Trafficking to rescue human trafficking victims. The Ministry of Home Affairs (MHA) allocated a financial grant of Rs 98.86 crores from the “Nirbhaya Fund” to the Anti Human Trafficking Units (AHTUs).[4] Though these units have adopted a child rights sensitive-approach in their dealings with trafficked victims, the funds for victim support and contingencies like food, clothing, psycho-legal support and medicines include a small grant of a lakh per year, and for a duration of up to three years.[5]

In August 2021, the Ministry of Railways collaborated with the Railway Women’s Welfare Central Organisation (RWWCO) and the Prayas Juvenile Aid Centre (JAC) Society NGOs to set up Child Help Desks (CHD) and Short Stay Shelters in six railways stations in Danapur, Guwahati, Ahmedabad, Samastipur, Delhi and Jaipur.[6] The shelters provided basic services like medical aid, nutrition and psycho-social support. Though the building infrastructure, water and electricity for these shelters would be provided by the Indian Railways, the cost of water and electricity would have to be borne by the NGOs. Such instances of insufficiency in fund allocation reveal how Child-Friendly Spaces are yet to become a priority concern in the Indian government’s agenda.

In terms of disaster management efforts, barring Child-friendly Spaces established by non-governmental entities like UNICEF, World Vision and Save The Children in select states like Bihar, Assam, Odisha, Kerala and Gujarat, there are hardly any government initiatives in India that cater to this concern. In 2018, after the UNICEF held workshops emphasising the creation of Child-Friendly Spaces in Assam’s relief shelters in the wake of its devastating annual floods, the Assam government did take initiative by coming up with a draft guideline for its establishment in the state[7] but its progress has not moved beyond the planning stage. Public funding allocated for this initiative remains unknown, as it continues to remain in a state of limbo.

References:

[1] UNICEF, “2004 Indian Ocean Earthquake and Tsunami,” UNICEF USA, https://www.unicefusa.org/mission/emergencies/tsunamis/2004-south-asia

[2] CYSD, “Transitional Space For ‘Fani’ Affected Children,” Centre for Youth and Social Development, https://www.cysd.org/transitional-space-for-fani-affected-school-children/

[3] Ministry of Railways, “A whopping Rs 500 crore from the Nirbhaya fund will be spent on installing CCTV cameras at railway stations,” Twitter, July 13, 2016, https://twitter.com/railminindia/status/749408171576307712?s=46&t=3BorjmhkeY5DN8mQ7d_7Zg

[4] Ministry of Home Affairs, Government of India, https://www.mha.gov.in/sites/default/files/Scheme-AHTU-SS-271011.pdf

[5] Ministry of Home Affairs, Government of India, https://www.mha.gov.in/sites/default/files/Scheme-AHTU-SS-271011.pdf

[6] Ministry of Railways, Government of India,https://indianrailways.gov.in/railwayboard/uploads/directorate/Transformation_Cell/Circulars/Pilot_310818.pdf

[7] Assam Disaster Management Authority, “Workshop on Child Friendly Spaces on 14th November 2018,” National Informatics Centre,  http://sdmassam.nic.in/download/Workshop%20Note.pdf

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