Tài liệu Monitoring Child Well-Being pdf

MONITORING CHILD WELL-BEING

EDITED BY ANDREW DAWES, RACHEL BRAY & AMELIA VAN DER MERWE

A SOUTH AFRICAN RIGHTS-BASED APPROACH

CHILD INDICATORS

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Published by HSRC Press

Private Bag X9182, Cape Town, 8000, South Africa

www.hsrcpress.ac.za

First published 2007

ISBN 978-0-7969-2177-2

© 2007 Human Sciences Research Council

The views expressed in this publication are those of the authors.

They do not necessarily reflect the views or policies of the Human Sciences Research Council (‘the Council’) or indicate

that the Council endorses the views of the authors. In quoting

from this publication, readers are advised to attribute the

source of the information to the individual author concerned

and not to the Council.

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Contents

Tables and figures vi

Foreword vii

Preface ix

Acknowledgements xix

Acronyms and abbreviations xxi

PART 1 Rationales for indicator development

SECTION I Concepts and contexts

1. Monitoring the well-being of children: historical and conceptual

foundations 5

Rachel Bray and Andrew Dawes

2. A rights-based approach to monitoring the well-being of children

in South Africa 29

Rachel Bray and Andrew Dawes

3. Conceptualising, defining and measuring child poverty in South Africa:

an argument for a multidimensional approach 53

Michael Noble, Gemma Wright and Lucie Cluver

4. Neighbourhood indicators: monitoring child rights and well-being

at small-area level 73

Catherine L. Ward

SECTION II Child survival and health domain

5. Monitoring child health 93

Haroon Saloojee

6. Monitoring child and adolescent mental health, risk behaviour

and substance use 111

Alan J. Flisher

7. Monitoring child unintentional and violence-related morbidity

and mortality 129

Amelia van der Merwe and Andrew Dawes

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SECTION III Education and development domain

8. Monitoring children's rights to education 147

Linda Chisholm

9. Early childhood development and the home-care environment

in the pre-school years 159

Linda Biersteker and Jane Kvalsvig

10. Monitoring childhood disability 191

Marguerite Schneider and Gillian Saloojee

11. Monitoring specific difficulties of learning 213

David Donald

SECTION IV Child protection domain

12. Monitoring the well-being of street children from a

rights perspective 233

Catherine L. Ward

13. Monitoring the worst forms of child labour, trafficking

and child commercial sexual exploitation 247

Lucie Cluver, Rachel Bray and Andrew Dawes

14. Monitoring child abuse and neglect 269

Andrew Dawes and Mihloti Mushwana

15. Monitoring the situation of children in statutory care 293

Jackie Loffell

16. Monitoring children in conflict with the law 329

Lukas Muntingh

17. A monitoring dilemma: orphans and children made vulnerable

by HIV/AIDS 359

Andrew Dawes, Amelia van der Merwe and René Brandt

PART 2 The indicators

Neighbourhood indicators 373

Indicators for monitoring child health 379

Indicators for monitoring child and adolescent mental health 393

Indicators for monitoring child injury morbidity and mortality 401

Education indicators 413

Indicators for monitoring early childhood development 419

Indicators for monitoring childhood disability 445

Indicators for monitoring specific difficulties of learning 451

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Indicators for monitoring street children 455

Indicators for monitoring child labour, trafficking and commercial sexual

exploitation 461

Indicators for monitoring child abuse and neglect 469

Indicators for monitoring children in statutory care 487

Indicators for monitoring children in conflict with the law 503

Indicators for monitoring orphans and children made vulnerable

by HIV/AIDS 527

Appendices

Appendix 1 Convention on the Rights of the Child 537

Appendix 2 South African Constitution: the Bill of Rights 554

Appendix 3 African Charter on the Rights and Welfare of the Child 566

Appendix 4 Key terms associated with indicators and monitoring 580

Appendix 5 Characteristics of effective indicators for child rights

and well-being 582

Appendix 6 Summary of South African data on child health indicators 583

Appendix 7 South African EMIS indicator domains 587

Appendix 8 Indicators for juvenile justice as developed by UNICEF 592

Appendix 9 UNICEF recommended indicators for orphans and

other children made vulnerable by HIV/AIDS 593

References 595

Contributors 635

Index 639

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Tables and figures

Tables

Table 1.1 Goals for child well-being and well-becoming, and their indicators 26

Table 2.1 Millennium Development Goals and indicators that apply to child rights

and well-being 30

Table 5.1 Millennium Development Goals and indicators that apply to child

health 95

Table 5.2 Infant, under-five mortality and neonatal mortality rates,

South Africa, 1998 97

Table 5.3 Predicted changes in South African infant mortality rates,

1998–2002 97

Table 5.4 Leading underlying causes of death among children aged 0–14 years,

South Africa, 1997–2001 (expressed as percentage of all deaths) 98

Table 5.5 The anthropometric status of children aged 1–9 years, South Africa,

1999 101

Table 5.6 South African child health-related data sources 105

Table 8.1 Adapting the UNESCO indicator approach 158

Table 9.1 Articles of the South African Constitution (SAC), CRC and AC relating

to key rights domains 161

Figures

Figure 2.1 A conceptual framework for a rights-based approach to monitoring

child well-being 45

Figure 3.1 A multidimensional conceptualisation of child poverty 61

Figure 9.1 The uneven pace of child development with rapid progress at different

times in different domains 171

Figure 15.1 Children’s movement into care 301

Figure 15.2 Processes and outcomes following needs and risk assessment 302

Figure 16.1 Overview of child rights architecture 331

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Foreword

South Africa has a proud history when it comes to the struggle for child rights. It

was young black South Africans, many of them children, who played a leading role

in the country’s liberation. The denial of children’s rights under apartheid, and the

brutal treatment of those who resisted, spawned a deep child rights consciousness in

those who were to make the new state, as well as a commitment to putting children

first so as to ensure their well-being and positive development. The South African

Bill of Rights is unique in granting children in South Africa specific rights that are

aligned with international instruments such as the United Nations Convention

on the Rights of the Child (CRC) and the African Charter on the Rights and

Welfare of the Child (AC). Law reform in the interests of children has followed

these developments and Save the Children has played its part in supporting these

developments. As this piece is written, the first section of the new Children’s Act has

been approved by Parliament, and subsequent sections over which provinces have

authority will now be dealt with by the House of Provinces – the nation’s second

legislative chamber.

All these developments are to be celebrated. However, it remains the case, as this

book will show, that the majority of children in South Africa still face serious threats

to their survival, health, development and participation. More than 50 per cent live

in poverty, and infant mortality is reversing past gains as AIDS takes its toll.

Significant numbers of children are affected by abuse and violence, and services

intended to assist them are stretched beyond the limit. In spite of massive injections

of funding, the education system still fails to produce good outcomes in areas such

as literacy and mathematics – both key areas for child and national development.

It is not sufficient for children’s rights to be legislated. We need to know how well the

country is doing in meeting its obligations to children. That requires indicators and

a system for monitoring the situation of children that is rigorous, rights oriented

and evidence-based.

Both the CRC and the AC require countries to report in this regard but, more

important than international surveillance, the country needs to monitor its progress

in regard to the well-being and development of children. Indeed, this has been a

major focus of the South African government’s call for improved monitoring of both

the situation of children and of service delivery.

This volume is dedicated to supporting that process. It provides a framework for

monitoring the situation of children, the quality of the environments in which they

live and grow, as well as their access to services and their quality.

Save the Children has supported the research and publication of this volume in

partnership with the Child, Youth, Family and Social Development Research

Programme of the Human Sciences Research Council of South Africa. It has been

a long road over several years, with contributions from scholars, government

stakeholders and many others. The system designed and presented here is unique

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in going beyond monitoring child status or outcome. It is designed to monitor the

performance of duty-bearers as well – a crucial component of a monitoring system

that seeks to bring about change in children’s lives and development. This is a

reference work. Unlike other multi-authored collections, the editors have ensured

that the chapters are all aligned to the indicator framework presented in Chapter 2,

making for a coherent system across all the domains covered in this comprehensive

volume.

Eva Carhall

Regional Representative, Southern Africa Regional Office,

Save the Children Sweden

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Preface

Background

Perhaps the first question to ask of a book of this nature is, why do it? The answer is

simply that if we want to know how our children are doing and the extent to which

our policies and interventions are making a difference to their well-being and

outcomes, we need a conceptually grounded and evidence-based approach. South

Africa has never had a consistent and comprehensive approach to monitoring the

situation of children.

The primary objective of the volume is to fill this gap. We set out with our many

collaborators (see Acknowledgements) to develop a conceptual framework and

recommendations for a comprehensive set of indicators for monitoring the well￾being of children (including adolescents)1

and to contribute to the development

of reliable indicator data at all levels of government.

Our approach is of course not the final word. Indeed, other conceptual frameworks

exist from which we can learn and which can be compared with what we have

developed here. The indicators we recommend are not fixed. Indicator systems are

dynamic – they must respond to change in the policy and research environments as

well as in society at large.

Policy-making is an ideological business. People in government who develop policies

and programmes are guided by the political ideologies of the day, whether these be

neo-liberal, social democrat or socialist. The same applies of course when it comes

to making law and policy for children and families.

The United Nations Convention on the Rights of the Child (CRC – see Appendix 1

in this volume) is an unashamedly ideological instrument that seeks to change the

way in which the world conceptualises childhood and the manner in which State

Parties to the Convention provide for the survival, health, social security, protection

and development of children. The very act of fixing the end of childhood at 18 years

in the CRC and the South African Constitution is an ideological rather than a

technical move. The many changes to law and policy for children in South Africa

since the end of apartheid are the product of the strong child rights ideology that

took root in the period following the Soweto youth uprising of 30 years ago. These

changes were consolidated in the development of a National Programme of Action

for children in the mid-1990s, the ratification of the CRC, and the inclusion of

specific children’s rights in the Constitution. Most recently, the Children’s Act

(No. 38 of 2005) and the associated Children’s Amendment Bill (No. 19 of 2006),

and the Child Justice Bill (No. 49 of 2002), are examples of a legislative programme

that foregrounds children’s rights and a particular ideology of childhood – an

ideology that carries with it an image of what childhood should be like as well as

provisions for the reciprocal obligations of the state in making this childhood

possible (see chapters 1 and 2 in this volume).

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During the apartheid era, policies for children and conceptions of childhood were

grounded in racist ideology. Notoriously, black children were considered to need far

less support for development than white children – mainly because their capacities

were regarded as inferior – hence the provision of inferior and separate education

for black children.

The post-apartheid constitutional order ensures the rights of all children to the same

dignity and equality within a single approach to childhood. Enormous strides have

been taken by government to improve children’s situation.

This volume takes its ideological cue from the child rights ideology that is rooted in

the South African Constitution, the CRC and the African Charter on the Rights and

Welfare of the Child (AC – see Appendix 3 in this volume). In taking a rights-based

approach we make clear that it is not just the status of children (or child outcomes)

that is important to measure, but also the contexts within which children grow and

develop. For it is only through looking carefully at how these contexts shape child

outcomes that we learn where intervention is needed (where and how action should

be taken). A key element of that context is the policy environment. As will be seen,

the indicators developed for all the domains covered in the volume include both the

policy environment and children’s developmental contexts.

The timing of this initiative is important. We are a new democracy in rapid social and

economic transition with many challenges for children and those who care for them –

particularly in the spheres of education, poverty and the HIV/AIDS epidemic. These

conditions will have a major impact on family and community well-being, and the

ability of these structures to provide the basic conditions for child survival and the

promotion of positive child outcomes. Under such conditions, data to inform

targeted service and programme provision will become increasingly important.

At the same time, the new political order has the potential to present far more

developmental opportunities for children as systems of delivery are strengthened

and developments in health, education and social services proceed.

It is therefore equally important to monitor whether these initiatives are reaching

children and households and the extent to which the situation is improving as

desired in policy goals.

Finally, Cabinet has charged all levels of government with monitoring policy and

delivery. In our view, the monitoring system must ensure that the state and its

officers are held accountable for responsibilities as duty-bearers in regard to the

legislative and policy environment they have constructed for children.

In this regard, we require indicators and an approach to monitoring the situation of

children that can ascertain whether initiatives of the state are:

• Effective – they have the outcomes intended, promote children’s rights in line

with the Constitution and other relevant instruments, and are doing more good

than harm;

• Efficient – are using limited public resources to best effect; and

• Service orientated – to meet citizens’ needs and expectations for children’s well￾being and development.

This volume seeks to contribute to such a venture.

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The story behind the book

It has been a long and complex, but most rewarding journey. The idea for the project

took root a number of years back in the editors’ concerns about the availability and

quality of data on children in South Africa, as well as its relevance to our ability to

monitor the situation of children and the state’s response to the predicament of

children. These concerns were shared by several colleagues with whom many

discussions were held. Among them, the more prominent were Linda Richter of the

Human Sciences Research Council (HSRC), Theresa Guthrie (formerly with the

Children’s Institute and the University of Cape Town), Marian Jacobs (also formerly

at the Institute and now Dean of Health Sciences at that university), and Rose

September (based at the University of the Western Cape). An initial scan of the data

environment provided by Guthrie was presented at a meeting held in Cape Town in

early 2003. Further work on available data sets was carried out by Rachel Bray

(2002). Bray notes that there are missing links in existing data and methods. Her

points remain germane. For example, she states:

we have no national survey data on the health status of children aged 6–14 years.

Consequently there is a significant gap in knowledge about the risk factors to

health faced in middle childhood associated with economic poverty, living

conditions or social stability. There are no national data on the health and safety

of certain groups of children known to be particularly vulnerable such as

homeless street children and children living in institutions. One reason for this is

that national household surveys exclude homeless and institutionalised children

because they do not belong to ‘households’ as defined in the survey design.

(2002, p. 24)

She notes further that the ‘consequences of these gaps are severe limitations on our

ability to analyse relationships between children’s social and physical environment,

and outcomes in terms of short and long-term well-being’ (2002, p. 48).

Furthermore, household surveys do not take sufficient account of the need to

establish the way income is spent and the extent to which children benefit.

One of the reasons we have limited data for understanding children’s lives is that

they have largely been excluded from the research process. South Africa lags behind

many other areas of the world in terms of including children in research. Thus,

children themselves need to be included as participants in surveys. It is most

commonly the practice for adults to respond on behalf of children (in part because

of ethical considerations), and it is well known that the accounts of children and

adults often differ – particularly in sensitive areas such as sexuality. Importantly,

Bray cautions that:

the extent to which children are able to engage with the topics under research is

constrained firstly by the logistical demands of very large surveys and secondly

by the use of methods that do not allow children to define problems as they see

them. (2002, p. 49)

Richter reinforces a number of Bray’s points, noting that:

it is clear that there are a large number of indicators of children’s health,

development and well-being that we, in South Africa, do not yet have any

preface • xi

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mechanisms to measure, especially more qualitative or subjective indicators

generally associated with children’s well-being. (2002, p. 2)

She goes on to cite the National Programme of Action’s End of Decade Report on

Children:

Continued data collection and research on children is a vital initiative. Little

reliable data is available from the past and South Africa is committed to creating

and monitoring relevant data and information on children. (2002, p. 17)

At the outset of this project, it was quite clear to us that the data environment of

relevance to child policy was very limited (although improving all the time), and

that conceptual, technical and methodological work was required to improve the

state of research policy and programme-related data on South African children.

During our process, contact was made with members of national government

(including the Office on the Rights of the Child) and provincial government,

particularly the Office of the Premier in Gauteng, and the Department of Social

Services and Poverty Alleviation in the Western Cape. These engagements increased

our understanding of the priorities of government and the administrative data

environment.

Studies conducted on behalf of the Gauteng premier (Dawes, 2003) and the Western

Cape government (Dawes, Biersteker et al., 2006; Dawes, Willenberg et al., 2006)

were invaluable in shaping our model and familiarising us with administrative data

systems. They also assisted us to become more familiar with how government works.

Coming from academia, we still have much to learn, but we were able to begin to

build the bridge that is necessary in this work between the research and policy

communities.

Our encounters with the administrative data environment were sobering indeed,

forcing us to become more realistic as to what we imagined could be achieved using

administrative data sources. Although there was a lot of promise and efforts under

way to improve the situation, problems with information systems, as well as data

accessibility, collection and quality, were all very evident.

Interactions with university colleagues both in South Africa and abroad, as well as

engagements with local and international non-governmental organisations such as

the United Nations Children’s Fund (UNICEF) – in South Africa, East Africa and

New York – and Save the Children Sweden, all contributed to the project as it

unfolded over the past three years.

A project of this nature costs money. We were most fortunate that Linda Richter,

Executive Director of the Child, Youth, Family and Social Development Research

Programme, supported the project and the allocation of seed funding from the HSRC

parliamentary grant to get the project off the ground and cover a range of networking

and other development costs. This is a most appropriate use of the grant – the

production of social science research in the public interest. Save the Children

Sweden provided the funding (sourced from the Swedish International Development

Cooperation Agency) required to commission the research to bring the project to

completion and publication. Save the Children Sweden is an inspirational world

leader in the child rights field. Dialogue with these colleagues was deeply informative

and influential.

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The development of the volume

As will be evident from the introductory chapters, the volume does not purport to

be the definitive text for monitoring children’s rights in South Africa. That would be

a task for child rights lawyers and related specialists, which we are not. Rather, it is

well-being that is the primary focus, and the volume presents a rights-based approach

to monitoring child well-being. Where the rights base enters the picture is when

indicators are developed to monitor government’s delivery of services to which

children have a right and which are required to promote their well-being and

development.

The volume differs from the usual format of an edited collection. All the domains

for which indicators were developed (and hence the chapters) followed an identical

approach, as outlined in the conceptual framework developed for the purpose (see

below and Chapter 2). The indicators in all the chapters use the same indicator types

and, where appropriate, the same indicators are incorporated across domains. For

example, the same measures of poverty, adult literacy and disability incorporated in

the Early Childhood Development (ECD) and home-care domain are included in

other contributions.

The first step in our process was to develop the conceptual chapters (chapters 1

and 2).

Next, experts were commissioned to provide contributions that drew on this

conceptual base to ensure a common structure. Each was to be informed by the

conceptual framework and to cover all five indicator types (see below) where

possible. Authors were requested to provide a concrete and practical proposal for the

most conceptually sound, practical and cost-efficient way to measure and monitor

the indicators for a specific domain. A brief policy and rights review and an

evidence-based rationale for the indicators and measures included were required for

each chapter, and local reliable and accessible data sources were to be cited as far as

possible. This was a very challenging task which, for many domains, could not be

achieved due to the state of the data environment.

Authors were required to provide two indicator sets: core and additional (in some

instances only a core set was appropriate). The core set for each chapter captures

priorities that must be measured, and for which at least some data should be

available from administrative sources. The additional set includes less high-priority

indicators, for which data are more difficult to obtain. Authors were also asked to

supply comment on data availability and quality as well as recommendations for

improvements.

Once the chapters were submitted, each was subjected to peer review and then

revised in light of the reviewers’ comments.

It is a bad idea to develop indicators in a vacuum. The next step of the project

involved sharing indicators in each domain with colleagues in the policy

environment through a series of intensive round-table meetings specific to each

domain (for example child education). The author, the reviewer of the chapter,

policy-makers and the editors participated. The proceedings were summarised and

provided to the author for further revisions as needed.

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Once the revisions were complete and the editors were sure that the child well-being

aspects of the volume had been rigorously reviewed, each contribution was

scrutinised by child rights legal experts. They provided comment on the extent to

which the chapters were informed by the appropriate legal and children’s rights. This

was an interesting process which revealed the considerable differences in approach

used by the child rights community and those who study children’s outcomes and

situations, be they psychiatrists, economists or paediatricians. On rare occasions we

found a blend of expertise. Where necessary, the chapters were revised a third time

to incorporate these comments.

Finally, the entire volume was subject to review (see Acknowledgements) by

international experts and final tweaks to content were undertaken.

As we were wont to say, this is the most reviewed volume on the planet! Despite the

effort and seemingly endless circle of reviews, all the commentaries were of

considerable value in strengthening the final outcome.

We believe that this contribution has been subject to sufficient review and

consultation to provide a starting point for a rights-based approach to monitoring

the situation of South African children and their well-being.

The structure of the volume

The volume is divided into two parts. Part 1 offers rationales for indicator

development, and Part 2 provides the indicators themselves. Part 1 comprises four

sections. Chapters 1 and 2 of Section I provide the conceptual underpinnings of the

volume. In Chapter 3, the authors review different approaches to child poverty

measurement and comment on their relative merits. The chapter argues for the use

of a multidimensional, child-centred approach that incorporates both absolute and

relative poverty components, as well as measures of multiple deprivations for

children (rather than simply income poverty). This model has subsequently

informed small-area indices of multiple deprivation for children in South Africa.

A number of contributions to the volume point to poverty as a major risk to child

well-being and outcomes. This is particularly evident in the context of child health,

injury, ECD, education, and in the child protection section of the volume. In these

instances a generic poverty indicator has been included. The indicator does not take

into account multiple deprivations as described in Chapter 3. This is because provinces

currently use a variety of approaches and we wished to leave the definition open.

All children live in households that are situated in some form of community, be that

an urban neighbourhood, an informal settlement, or a village. Families and children

are affected by the nature of the human environment that surrounds them. The

influence of the family is displaced to an extent by other sources as children grow

up and occupy other social spaces and institutions, such as schools. Older children,

particularly adolescents, spend increasing amounts of time outside the home

environment, and in their neighbourhoods. While neighbourhoods may have many

positive features for child development, some create risks for children. Chapter 4

explores these issues and draws on international literature to examine the role of the

neighbourhood quality in either supporting or undermining children’s development.

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It draws on the sociological literature relating to community structure and transition

as well as on the psychological research on neighbourhood effects on children’s

development at different points in the lifespan. The evidence is clear that

interventions to support vulnerable families in high-risk areas to improve child

protection and promote positive outcomes are gaining recognition. Indicators for

monitoring the key positive and negative neighbourhood level factors are most

useful for providing information on areas that require particular targeting for

intervention, including the availability of services to support family and child

well-being and development.

In subsequent sections of the volume, domains are grouped in terms of their

complementarity. They were chosen because they include issues of key concern for

children in South Africa, and because they are all required for monitoring purposes

by the UN Committee on the Rights of the Child, the AC, and UNICEF’s State of the

World’s Children reports. The sections reflect rights domains of survival, health,

development and protection, and the indicator domains are those commonly

deployed internationally (see chapters 1 and 2).

Section II (Child survival and health domain) includes chapters on child health,

child mental health, and children’s exposure to injury and violence.

Section III (Education and development domain) includes ECD and the home and

institutional settings (ECD facilities) that support children’s development. Also

included in this group are education, specific difficulties of learning and children

with disabilities. The cluster provides indicators for monitoring children’s capacities

and abilities starting in early childhood, and taking into account the particular

difficulties of those children whose development is challenged by disability. The

section also explores the key issues of monitoring access and quality of services to

children from ECD facilities (Chapter 9) through schooling (Chapter 8) and

including learning and other supports for children with special education needs

(chapters 10 and 11). This group is particularly important to track given the neglect

of children with disabilities.

Section IV of the volume provides indicators for the child protection domain. As is

well known, appallingly high numbers of children in South Africa are exposed to

violence and abuse, and significant numbers enter the justice system. Here we draw

on the approach of UNICEF in clustering categories of very vulnerable children

together – those who are abused and neglected (Chapter 14), working children and

those subject to commercial sexual exploitation (Chapter 13), children living on the

streets (Chapter 12), and those in trouble with the law (Chapter 16). Apart from

those in the judicial and correctional systems, those subject to abuse, neglect

and exploitation require particular support and services. Many will require the

intervention of the state. Chapter 15 provides a comprehensive approach to

monitoring children in statutory care. The statutory care indicators are designed

both to track the numbers of children involved, and the quality of services and care

they receive. This section of the volume draws strongly on the Child Justice and the

Children’s Act (No. 38 of 2005), and the associated Children’s Amendment Bill (No.

19 of 2006) to inform indicators for monitoring the performance of duty-bearers.

The HIV epidemic is increasing child mortality in South Africa (see Chapter 5).

Monitoring this indicator provides important information of the extent to which the

preface • xv

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