In Eastern and Southern Africa the matter of child survival and development required education through the cooperation of households, communities, schools, and mobilization of the children themselves. The atmosphere in the schools needs to be changed to a more positive and productive setting. One of the most successful techniques used is child to child programs such as the Uganda Scouts and Guides movement. Recent studies show the importance of early recognition of deficiencies that effect the growth and development of children, the prevention of disease and emotional insecurity, and the development of positive environment for social and intellectual growth. The key to making these programs work includes the following: understanding the situation in each country, monitoring the progress of each program, identifying and rectifying programs as they occur, breaking the sectoral barriers, and recognizing social problems such as higher female illiteracy rates. Strategies to help mobilize the youth and communities include using older children to reach younger ones during vacations, setting up debating teams for youths on health topics, teaming illiterate adults through special programs, posters and drawings with health messages, and requiring religious leaders to provide health messages, and requiring religious leaders to provide health messages in their programs. These messages should contain subjects such as boiling drinking water, teeth brushing, using bathrooms, smoking, diet, and other health subjects.
20 years of instability in government in Uganda has lead to an economic collapse and a breakdown in the health care system. The water system failed, hospitals and equipment collapsed, and doctors and medical personnel left the country. Many children who die or are disabled are victims of lack of education. UNICEF has joined with local religious organizations to fight this problem and educate communities on good health practices, especially immunization for children. Use of the mass media is an important part of this program and private print as well as government television and radio are used. The scouts and guides program with UNICEF trained 1000 on immunization service and they will train 10,000 parents. A child health care center developed, with the assistance of UNICEF, conducts workshops in child survival and trains nurses and medical students. An expert panel sets up curricula for schools which includes the following issues: nutrition, water, sanitation, immunization, common diseases, family health, social problems, accidents, and primary health care. This program has been tested in 20 primary schools, and is expected to become country wide. The Child-to Child program is a world-wide group that teaches school age children to become aware of their health. It also promotes public awareness of child health including physical, mental, and social needs. This program has set up many activities including the following: workshops with teachers, students, parents, and others for health education, hospital visits to children, school cleaning competitions, artist workshops, contracts in other countries such as Norway, time on government television and radio, and book publication.
Malnutrition and infection which strike as many as 40000 African children daily through the use of basic health care measures. The 4 simple techniques are: growth monitoring oral rehydration breast feeding and immunization (GOBI). It is a task of political and social groups to put present technology to work at a reasonable cost and to help communities learn to apply them effectively at the local level. Change from an agricultural culture to an industrial one has caused upheaval but through the development of knowledge and skills at the community level hunger and disease can be controlled. GOBI training should focus on the changing roles of women men and children; changing environments caused by technological innovations and creative parenthood. The community needs intellectual emotional and social skills to be able to take this responsibility. The imagery for GOBI should be symbols of reality and life familiar to the particular community. Training in GOBI strategies need specific expertise in oral rehydration breast feeding immunization and growth monitoring. Child health care must be taken out of hospitals and care centers and put back into the community where a culturally appropriate holistic approach can be carried out.
The importance of health education in primary schools is a major concern in Southern and Eastern Africa. Although health education may not always cause changes in behavior that are needed for survival, it is the first crucial step. Parents, especially mothers with just 1 additional year of schooling results in a reduction of 9/1000 in infant mortality. Since 20% of the total population are in primary schools, if their education reaches 2 other people then 1/2 the country's population would be affected. These schools have the infrastructure that can be used to distribute health services. Since teachers are respected, their influence on the community would be taken seriously, and students are likely to participate in many activities outside the school to promote child survival and development. The basic causes for high infant mortality in Africa are malnutrition and communicable diseases; activities necessary for child survival are, growth monitoring, oral rehydration, breast feeding, and immunization. Female education, nutrition and food production, and family planning are also important elements. In addition, components such as water and personal hygiene, environmental sanitation, psychosocial stimulation and development, and maternal health must be monitored. The educational process must be applicable to real life situations and be taught in an environment where students enjoy learning. In addition to the knowledge, behavioral change must be emphasized. Since teachers see themselves as more in academic roles changes will be needed to make them more effective.
UNICEF-supported work (GOBI/FFF) has proposed to early childhood mortality and disease which are free, relevant and available: 1) growth mortality, which can expose malnutrition before it's too late; 2) oral rehydration therapy for diarrhea which is a major killer and is remedied by rehydration salts; 3) breast feeding, which provides immunity, nutrition at low cost, and warmth, and security, and 4) immunization from measles, TB, diphtheria, tetanus, polio, and whooping cough. GOBI/FFF recommends strengthening female education, providing nutritious food, and providing family planning which involves child spacing. Most children in the east African regions are denied the rights outlined in the 1959 UN Declaration of the Rights of the Child, even though governments do provide some level of care. Kenya, with the highest birth rate, has all departments providing some input into the well-being of the child. Several national programs are supported by UNICEF in concert with the Kenya government. The 3 neediest rural districts receive concentrated resources, and the health department has been reorganized to focus on child survival. Integrated community rural development projects are underway. Basic urban services with be provided in Kisumu Municipality in a participatory process with civil servants which will focus on female headed households with lots of children. The emphasis will be on increasing family income. In order to relieve mothers of some of the work burden, technology in food production, and in water and fuel collection will be introduced. Educational materials for young and old people need to be developed. Greater coordination and utilization of resources need to be implemented to insure that all parents are informed of birth spacing, prenatal care, low cost ways of preventing and managing childhood illnesses, how to promote normal physical and mental growth, and birth control.
