“Hunger is worse than this virus,” says Chaltu, a 12-years-old girl from Ada’a Woreda, Oromia Region in Ethiopia. She was explaining why her mother, the breadwinner of the family, still has to go out to earn a daily wage even during the lockdown.
Tigist, a 16-year-old girl from Addis Ababa, explains that: “Street children, orphans and children in rural areas can’t afford hand sanitizers,” even though they have had to continue going out and for work, just so they can eat.
“I’m scared every time my parents, who are labourers, go out to earn a living,” says 16-year-old Liyou, a member of the children’s parliament in Guraghe Zone in Ethiopia. She is resigned to someone in her family getting infected sooner or later.
“This makes me sad,” says Tsion, whose family is in a similar situation. Tsion, a 16-year-old girl, is a leader of Fikir Behibret, a child-led initiative in Addis.
These are a few voices from a group of more than 50 children in Ethiopia who we recently interviewed about their experience of the COVID-19 pandemic. Their collective anxieties and fears have made us even more determined to ensure the government adopts a child-centred approach in its COVID-19 response. We believe the design and implementation of any programme should be informed by the views of children and those most affected by the direct and indirect impact of any policy. The Ethiopian government, like all others around the world, has not done this in its COVID-19 response.
Ethiopia’s response so far
Ethiopia’s COVID-19 response has been commendable in many ways. The government´s early response was swift in curbing the spread of the pandemic by quarantining travellers from abroad, closing schools, suspending public gatherings, imposing stay at home orders and social distancing, and temporarily closing places of worship. These measures were unfortunately short lived and not enough was done to raise awareness and share information in communities about the disease.
But it quickly became obvious that it’s impossible to impose a lockdown and social distancing measures without adequate social protection schemes in place. People living hand-to-mouth will still have to go out to make a living to survive. Both the infection and death rates have steadily risen.
The challenge to the health system
The pandemic is having a damaging impact on the country’s health system. The delivery of essential services – such as antenatal care visits, facility births, immunisation services and access to reproductive health services – has slowed down. The Ministry of Health’s Monthly Analytic Report for April 2020 shows that there have been disruptions in various essential health services compared with the 8-month average prior to COVID-19:
- The number of children treated for pneumonia and diarrhoea decreased by 19% and 3% respectively.
- Immunisation coverage decreased by 6%.
- Post-natal care service coverage decreased by 3%.
Listening to children
All the children we spoke to were aware of the adverse impact of COVID-19 on their education and the ease with which it could spread if social distancing was not followed. Almost all of them were worried about how their parents and other poor families would cope if they could not earn a living.
While the children seemed to be aware of the dangers of COVID-19, according to them, large numbers of adults in their communities were sceptical about the disease and its dangers, choosing to believe religious leaders who said that COVID-19 was a curse from God that would soon pass with adequate prayers.
By contrast, the children themselves did not give credence to this idea. During the dialogue, it also became clear that children largely relied on television and radio for COVID-19 messaging compared to adults.
Our conversation with children has helped us realise that both government and civil society organisations are missing a great opportunity to harness children as agents of change in the COVID-19 response. More so than ever, we are certain that children should not only be the target of humanitarian and development responses, but must be at the centre of planning, implementing and monitoring them.
Governments and decision-makers should allow for children to engage in and feed into ongoing accountability processes.
Any COVID-19 response should start from what children say. For example, by listening to children we learned that it’s critical to:
- Inform and help children to pass on COVID-19 messaging to their families and communities.
- Build children’s confidence so that they can challenge their families and communities when they choose to listen to misinformation.
- Listen to children about their need for financial and food support as a way of preventing their families from going out to earn a living and putting themselves and others at risk.
- Focus on protecting girls as they face the extra burdens of abuse, overwork, and loss of education during the lockdown.
What does child-centred social accountability in health mean?
Being accountable to children means first of all listening to them. It means putting children’s interests at the heart of health planning, budgeting, and monitoring. And carving out a space for them to engage meaningfully.
Empowered and well-informed children and communities are in a strong position to claim their health entitlements and ensure faster progression towards achieving the right to health. Involving children in accountability processes can improve the delivery of health services. Children are able to identify and monitor weaknesses and gaps in the health system, such as:
- how their families are treated when they go to a health facility
- whether their families were charged user fees
- if health workers were available at the facility
- whether medicines which they needed were available.
Children see things that adults often don’t. This extra pair of eyes can be invaluable in strengthening health systems – provided planners are willing to listen.
What have we done so far?
Along with our civil society partners, we’ve adopted child-centred social accountability (CCSA) programming as a strategy to improve the delivery of essential services for the most deprived children. More than 70 CCSA groups are engaged in monitoring delivery of health, education and protection services for children. We have seen that CCSA groups have increased access to health and education services for the most deprived children through influencing budget allocations and monitoring spending. Save the Children has established and supported 6 CCSA groups in Afar and Somali Regions, which are engaged in monitoring the performance of essential health services, and who report to health officials at local, district and regional levels.
Based on learning from children, we recommend that government, parliamentarians, and policy-makers:
- Acknowledge children’s parliaments and community-based children’s groups as key stakeholders during the COVID-19 response and as they aim to ‘build back better’
- Let children’s parliaments and community-based children’s groups know about the latest healthcare issues and support them to inform their families and communities
- Respect and engage children and child-led community groups in planning, delivering, and monitoring the COVID-19 response.
- Consult child-centred civil society organisations (CSOs) who work closely with children, on all aspects of the COVID-19 response.
- Engage children and child-centred CSOs to monitor the delivery of essential services, identify gaps, engage in dialogue with health service providers and advocate for issues that should be prioritised in health sector plans and programmes.
- Listen to children and child-centred CSOs about the critical importance of maintaining routine and essential health services during the COVID-19 response.
All quotes from children have been taken from the Report ‘Rapid assessment on the views of children and their primary care givers on COVID-19’, May 2020, Save the Children Ethiopia Country Office.
