9.1 Early years of life – Rights of children
Children with disabilities have the same rights as their counterparts without disabilities. These rights should be protected and promoted across settings, from family to services, including health care, education and recreation. Part 3, of the children's Act stipulate children’s rights. The act list 16 rights, which include right to life, right to a name, right to nationality, right to parental care, right to health, right to education and many others as per the bill of Child rights.
Children with disabilities in our society experience violation of their rights in many ways. The extent of violations differs depending on psycho-social and socio-cultural reasons. For example, psycho-social experiences could be situations where a parent after delivery at the maternity ward notices that the child is born with a certain visible disability that then brings shock and emotional distress, which may temporarily lead to feelings of despair, regret, blame and failure to accept the newborn child. While a parent is still in that state of shock, denial and grieving for ‘loss of dream child’ she may be tempted to give the newborn child a name that expresses her state of mind at the time. In most cases the names given to children with disability while their parents haven’t yet accepted the reality of having a child who looks different to the one hoped for, will be names that shows disappointment, expresses emotions of pain, and in some instances portrays some negativity because the names are meant to define or explain the situation at hand, in which the parent does not have control over. However, through the Registrar of Birth and Death, in the Ministry of Labour and Home Affairs, Parents are usually guided and advised on giving children names that do not stigmatises nor demeans the dignity of the child as stated in article 11, under the bill of Child Rights, the Children’s Act.
Violations of children rights due to socio-cultural practices may include instances where children with disabilities are denied opportunities to access education because they are considered misfits or in need of care that cannot be provided if enrolled in mainstream schools. Such excuses that a publicly accepted and considered fair to exclude children with disabilities from mainstream education simple because they have disability and in need of supports, are actual a violation of the right of the child to access education. According to children’s Act, part 3, article 18, “every child has a right to free basic education and a parent or guardian who, without reasonable excuse, denies a child the opportunity of going to school shall be guilty of an offence”. The above clause emphasises the right to education for every child, inclusive of children with disabilities.
There are other cultural practices, also associated with religion that may contribute to children acquiring disabilities, such as denial for children to take immunizations or undergo medical surgeries because they are considered intrusive. However, it is in the best interest of the child to access health care interventions that will nourish the child, prevent the child from acquiring disabling conditions such as polio and other childhood illness.
9.2 Health Services
9.2.1 Prevention of childhood illness and disabilities
The Government of Botswana through the Ministry of Health and wellness is committed to the Expanded Programme on Immunization (EPI), including Poliomyelitis Eradication, Measles and Neonatal Tetanus elimination initiatives, as a pillar for child survival, growth and development. Botswana government introduced under 5 years National Immunization Program in 1969 and the Expanded Program on Immunization was initiated in 1979.
EPI policy state that to ensure equity and social justice in accordance with the National Health Policy, immunizations will be provided to all target populations irrespective of ethnicity, gender, cultural, political, religious affiliation or geographical location. The policy also states that vaccinations will be availed through local public clinics, mobile stops and private clinics in-order to reach all the target population.
9.2.2 The client has the right to:
Receive adequate information on immunisations and its benefits as well as possible side effects
Receive all vaccinations according to the EPI vaccination schedule
Receive vaccinations at any health facility
Privacy
Be informed about possible Adverse Events Following Immunization (AEFI) and when to return
Vaccination status documented
Receive documentation of vaccination received
Submit suggestions or complaints with regards to their visit to the health facility
Responsibilities and obligations of clients and communities
Parents/caregivers have the responsibility and obligation to ensure that all eligible children receive immunisations according to the EPI schedule.
To ensure that communities and clients take responsibility of their own health.
Summary
It is important for pregnant mothers to attend and honour their monthly antenatal health check-ups at their local health facility to get the necessary health checks and medical intervention. This is critical to establish that both the expectant mother and the foetus are healthy throughout the pregnancy to minimise chances of the child being born with some health conditions and cases of maternal mortality. Health conditions that may lead to disability later in life may begin during pregnancy and become more visible in the early years of life.
It is equally important to take the newborn child for monthly medical check-ups where developmental milestones are monitored and any variation to standard growth is assessed and appropriate medical intervention instituted. Early detection of disabilities is important because appropriate rehabilitative interventions can be started early, increasing success of habilitation and rehabilitation programmes.
Article 25, (b) of the UNCRPD states that “States parties shall provide those health services needed by persons with disabilities specifically because of their disabilities, including early identification and intervention as appropriate, and services designed to minimize and prevent further disabilities, including among children and older persons”. It is therefore the obligation of government to make sure that health services are provided in such a way that children with disabilities have specific targeted health services meant to address their health needs.
9.3 Rehabilitation services
Botswana government has outlined health interventions that the government is committed to providing and making accessible to the entire population through the Essential Health Services Package (EHSP) policy of 2010. The EHSP is defined as a set of Health Interventions - promotive, preventive, curative, and rehabilitative, that are to be available to the entire population of a country.
EHSP provides the basic minimum service standards that the country has committed to providing to all its population. In this chapter we will focus on community based rehabilitative services and community level Home based care as outlined in the policy, and highlight services that government pledged to its population, specifically those needed by Persons with disabilities.
Community based Rehabilitation Program
The government of Botswana through the Ministry of Health developed norms and standards for different health services package offered to the public by the Ministry of Health in 2010. According to the EHSP, Community Based Rehabilitation (CBR) is defined as a health care model that promotes active participation of persons with disabilities and family members in developing of a vision for their lives within the society in which they live, identifying the needs and resources of people with disabilities within the community, planning and implementing the vision and monitoring and evaluating its implementation. Botswana adopted CBR approach in the early 1980’s and it has been an integral part of the primary health care services offered through clinics and primary hospitals.
The norms and standards for the community-based Rehabilitation program, as stipulated in the Essential Health services package are as follows:
Medical and surgical supplies and assistive devices are accessed from the nearest health facility.
Day care takers Basic training in early education and can carry out a basic rehabilitation programme under the guidance of a therapist or therapy assistant
Districts have a community-based level of service for rehabilitation, which is provided in partnership with people with disabilities and their caregivers
DHMT representatives at these levels participate in, and actively promote, the shared governance structures, in an empowering way, putting the leadership into the hands of the people with disabilities.
The Health Sector gives technical support to shared governance structures and community-based services.
Health services, including preventative services, curative services and rehabilitation services are provided across all health facilities, and packages differ from the small unit of health services provision, which is the health post, to tertiary comprehensive health services provided by referral hospitals. Basic commodities such as axillary rubbers, rubber ferrules, cane tips, crutches, walking frames and wheelchairs are availed to clients at their respective health facilities through the CBR program and/or Home-Based Care program coordinators.
The way health care services are structured, curative services dominate the health care delivery system, and this leaves little budget for preventative and rehabilitative services. Disability practitioners, advocates and carers need to advocate for provision of rehabilitative services on an equal basis with other health services. Assistive technologies are critical to the improvement of the quality of life for persons with disabilities and they need to be listed as priority items just like medicines.
