CHILD SURVIVAL Kashifa Abrahams - Senior Researcher Child Health Service Programme

Purpose Children’s Institute Background - Why child survival? Child survival in Rights framework Way forward

Mission of CI The Children’s Institute, University of Cape Town, aims to contribute to policies, laws and interventions that promote equity and realize the rights and improve the conditions of all children in South Africa, through research, advocacy, education and technical support.

Current status of Child Survival in SA IMR 60/1000 live births U5MR 95/1000 live births 10 deaths of children under 5 yrs every hour

TRENDS IN CHILD MORTALITY ESAR, COUNTRYU5MR, 1990U5MR, 2004CHANGEEPI COV. Botswana Zimbabwe Kenya Rwanda Swaziland South Africa Zambia Angola Burundi Somalia Uganda Namibia Tanzania (Dar) Ethiopia Lesotho Madagascar168123/9445 OR 7261 Comoros Eritrea Malawi Mozambique AVE, WEIGHTED (unweighted)

Main causes of child deaths Largely preventable HIV/AIDS Diseases of poverty (e.g. diarhoeal disease, malnutrition, pneumonia) Trauma (Road traffic accidents & violence, which include homicide and suicide etc.) Age 0 to 4 years - burns Age 5 to 14 years - MV pedestrian Age 15 to 64 years - firearms Other: neonatal sepsis, preterm births

Out- patient Density

What are human rights? Human rights are about legal rights and legal duties Rights holders: all children under 18 Duty bearers: all government departments Legal instruments: Constitution of South Africa Act 108 of 1996 International law: United Nations Convention on the Rights of the Child and African Charter on the Rights and Welfare of the Child Non-binding agreements: Millennium Development Goals Analyze child survival in terms of rights holders and duty bearers Why work from a rights perspective?

Relationship between international & constitutional law The right to survival exists only in international law. It is incorporated to South African law through the right to life and through the socio- economic rights and through the duty to respect protect and promote. Also international law must be considered

Constitution ‘Everyone has the right to life’ International law DutyState Duty Bearers Duty to Respect the right to life Universal Declaration of Human Rights art 3: ‘Everyone has the right to life’. Covenant on Civil Political Rights art 6: Every human being has the inherent right to life. ACRWC art 5 (1) UNCRC art 6 (1): Every child has the inherent right to life. The State may not take someone’s life. The right is ‘inherent’ and ‘non derogable’. It is the basis of all other human rights because all the other rights depend on the right to life. (Bueren, 1995, Detrick, 1999) Legislature: Must draft laws that prevent and punish State actors who kill people. For example the prohibition of the death penalty is a way in which the legislature gives effect to the right to life. Department of Safety & Security: Police officers or army are not allowed to arbitrarily/ unlawfully kill people. Department of Correctional Services: People may not be killed in detention. J

Duty to Protect and Promote the right to life UNCRC 6(2) ACRWC 5(2) States must ensure to the maximum extent possible the survival and development of the child.* The State must take positive measures to avoid preventable deaths. (Hodgson, 1994) State must ensure that people don’t take other people’s lives. Dept. of Agriculture: ensure food production to avoid starvation. Dept Health measures to avoid death, remediate/cure illness/ disease/injury. Post Mortem and follow up on child deaths Dept of Home Affairs Registration of Births and deaths. Police Services Prevent crime (especially child abuse and domestic violence). Stats SA collect disaggregate data on child deaths Dept of Soc Dev payment of grants and delivery of social services Dept Transport prevent road accidents Presidency ORC Coordinate activities of departments. Dept Water Affairs & Forestry and Local Government Ensure access to clean water and sanitation.

Duty to fulfil the right to life UNCRC 6(2) ACRWC 5(2) States must ensure to the maximum extent possible the survival and development of the child.* Parents are primarily responsible for ensuring their children’s development State must assist parents esp. i.r.t. housing, nutrition health, clothing and education. Dept of Housing healthy and safe living conditions. Dept of Education provide syllables for child and adult education teaching people to ensure survival and development Dept of Environmental Affairs ensure environment for healthy development Dept of Health provide PHC and access to the full range of health services to ensure survival and development, provide assistive devices for children with disabilities Dept of Soc Dev payment of grants and delivery of social services Local Government provision of basic services (water, sanitation, refuse removal, electricity)

What does this mean in practice? All persons under 18 have the right to max. survival and development Binds all government departments and other bodies Analyse the hazards for different age groups to formulate responses

Way forward Acknowledgement & Awareness Mainstreaming – Child Rights-Child Survival & Development Integrated Plan Multi-level, co-ordinated responses Parliamentary Inquiry into Child Survival

Take Home Message Child Survival warrants URGENT attention in South Africa JMC has KEY ROLE to play – to enhancing prospects for survival for the nation’s children