General Comment No. 7

Indicator Set 11: Access to and Use of Health Services

Referring in general to CRC article 24 and General Comment No. 7 (para 27), this indicator addresses:

  • The right to the best possible health care (CRC article 24)
  • The obligation to ensure non-discrimination (article 2)
  • Equality of access to health care (GC7 para. 6), such as provision of services for children in institutions, children who do not speak the official language of a country, both girls and boys, and children with disabilities

This indicator is developed to help collect data on, and reduce child mortality in, both the general population and marginalised groups of young children. Like some other rights, the fulfillment of this right (that is, the equal delivery of health services to children) promotes the realisation of some other fundamental rights, such as:

  • The right to life (CRC article 6 and GC7 para. 10)
  • Protection from violence (CRC article 19 and GC7 para. 36a)
  • Access to education (CRC articles 28–29 and GC7 para. 28)
  • Opportunities for play (CRC article 31 and GC7 para. 34)

As well, this indicator aims to clarify and strengthen the argument for morbidity and preventative measures that avoid morbidity. It refers in particular to the various measures detailed in CRC article 24.2, but also to other strategies supporting children’s welfare (article 26) and standard of living (article 27), as well as the welfare and standard of living of their parents and/or caregivers.

Key Question: With respect to articles 2, 6, 24, 24.2, 26 and 27 of the Convention on the Rights of the Child, what steps have been taken to ensure equitable access to health services of equal and sufficient quality that ensure both the young child’s right to life and health and support to parents and caregivers in their primary responsibilities?

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    Positive agenda

    A policy or strategy, which identifies a desirable state or goals to be achieved, not only the prohibition and prevention of infringements and deficits. Such an approach specifies appropriate means to achieve these goals, including cooperation with partners, and is directed to sustainable effects and not to just momentary improvements.

    Agenda positiva

    Una política o estrategia que identifica no sólo la prohibición y prevención de los incumplimientos y los defectos, sino también un estado deseable o unas metas por alcanzar. Dicho enfoque especifica los medios adecuados para alcanzar esos objetivos, incluyendo la cooperación con los socios, y está dirigida a efectos sostenibles y no sólo a mejoras temporales.

    Young child as a rights holder

    General Comment No. 7 states: Para. (1) "Through this general comment, the Committee wishes to encourage recognition that young children are holders of all rights enshrined in the Convention and that early childhood is a critical period for the realization of these rights."

    El niño pequeño como portador de derechos

    La Observación General No. 7 establece lo siguiente (párrafo 1): "Mediante esta observación general, el Comité desea impulsar el reconocimiento de que los niños pequeños son portadores de todos los derechos consagrados en la Convención y que la primera infancia es un período esencial para la realización de estos derechos"

    Evolving capacities

    Children's capacities rapidly develop in the early years of their lives, in particular by appropriate challenges to their capacities. Research has demonstrated that children can accomplish many tasks earlier than often assumed by adults, when children receive encouragement and support.

    Active social participants

    Children are considered active social participants. From early on children pay attention to adults and children around them, react to gazes, voices and actions and wish to contribute to shared activities. Inclusion of children in interaction and cooperation is the most effective way of children's developing capacities, their sense of self-consciousness and of children's adoption of cultural values and customs. The young child (under 8) has to feel that s/he plays a part, influences her/his immediate and wider environment, has value in her/his own right, and matters within her/his family, neighbourhood, community, day-care centre, pre-primary school and health care centre/hospital, etc. The child has to have access to information and have opportunities to react to information in any way possible within her/his social environment.

    Expression of views

    Children communicate intentions, expectations and emotional states, even when their language is not yet elaborated, by non-verbal expression like facial expressions, gestures, body movements, sounds, mood and physical symptoms. Adults have to learn to pay attention to these different channels of communication. As well, when children later communicate by language adults have to be sensitive to messages that are not perfectly phrased.

    Best interests of the child

    Adults who care for children and assist children in the enjoyment of their rights have to be guided by the child's general interest to develop, learn and enjoy the full rights of a human being living in community with others. Also all minor decisions affecting children directly or indirectly have to be considered with respect to which of the alternatives best serves the general interests of the child. From the earliest years on adults responsible for the well-being and development of the child must try to include the child in the decision-making process.

    Monitor intersectorally cross cutting services

    This includes not only monitoring the impact of actions taken by individual sectors and joint programmes, but also monitoring how programmes and services from different sectors affect each other either positively or negatively.

    All children

    All children includes girls and boys, disabled children and children in need of special protection measures such as: indigenous children; children from different religious and ethnic minorities; migrant, asylum-seeking and refugee children; children affected by/infected with HIV/AIDS; children born out of wedlock; children born outside hospitals; children’s situations based on caregiver status (i.e., parents or caregivers with mental or substance abuse problems); differences in rural and urban settings.

    Universal

    Applicable to all children, without discrimination, without limit, and everywhere, not only in certain locations, and not only in urban settings.

    Isolated children

    Children can be isolated by geographic, economic, social, cultural, or migration status, including refugee, indigenous, and disabled children.

    Rights that require birth registration as a prerequisite

    For example: vaccination, school enrolment, family allowance or any other right that requires birth registration as a prerequisite

    Rights

    For example: vaccination, school enrolment, family allowance or any other right that requires birth registration as a prerequisite

    Participatory decision making

    Shared decision making: information is shared with children to enable them to make real choices, children are listened to, children understood the consequences of the decision, explained why decisions are made in a particular fashion, process is voluntary and inclusive – equal opportunity for participation by all groups of interested children, equal respect for children of all ages, abilities, ethnicity, social background.

    Capacity

    Includes all sorts of capacity, such as: financial capacity to create opportunities for participation; willingness to take children’s views seriously and listen to them; understanding of obstacles and letting children know why their voices may not create change; capacity of the child to articulate her/his views.

    International cooperation

    Art. 4 of the Convention recognises States parties have the right to ask for international cooperation if implementation of children's rights cannot be achieved in view of limited resources. Additionally, it is incumbent upon resource-rich countries to assist others in this regard. The Committee urges States parties to use this legal instrument to address resources requiring obligations of resource rich as well as resource poor countries to include as a separate chapter in their poverty reduction programmes how to ensure the child's right to a standard of living conducive to the development of their capacities and personality.

    International code of marketing of breast milk substitutes

    The code requires from member states of the WHO to adapt legislation to this Code, make the principles of the Code known to the public, to ensure that manufacturers conform to the Code and cooperate with civil society organisations to fully implement the requirements of the Code. Governments shall report annually to the Director-General of the WHO on action taken to give effect to the principles and aim of this Code (Art. 62 of the WHO Constitution). International Code of Marketing of Breast-Milk Substitutes (WHO, 1981).

    Registered Lactation Consultants

    Consultants who have specialised knowledge and clinical expertise in breastfeeding and human lactation (International Board of Lactation Consultant Examiners).

    La Leche League Leaders

    Leaders are accredited by La Leche League to help mothers who wish to breastfeed their babies (La Leche League International).

    Child care practices

    Practices such as early stimulation through body contact, caressing, talking, looking at, singing, playing, and showing, etc.

    WHO standards for health services specific to young children

    WHO standards include: at least 60% of child health workers in first-level health facilities are trained in IMCI/ACSD ( or the equivalent); at least 50% of child health workers in first-level health facilities are suitably trained to integrate child development messages in their care for children; that first-level health facilities have regular supplies of essential drugs for IMCI/ACSD (or the equivalent), or equivalent, available (or to ensure that parents have access to free drugs from another source); that health facilities are regularly (every six months) subject to supervisory visits with case management observation; that community health workers (CHW) have supplies to treat diarrhoea, pneumonia and fever (in countries and districts with operating CHW who are supposed to manage illness); at least 25 % of the districts have health workers trained in counselling for child development; all families, particularly those from marginalised populations, have sufficient capacity, informational and financial, to provide healthy environments for the development of young children.

    Young children's state of development

    A holistic approach to early child development must address all five domains of development: physical; social; emotional; language/cognitive; and communication.

    Health issues affecting young children

    Issues including but not limited to: the benefits of a healthy diet and lifestyle, including nutrition, food safety and physical activity; the consequences of excessive food consumption and unhealthy food choices, for example obesity, diabetes and other risks if applicable within the context of your country; the consequences of excessive alcohol consumption and use of tobacco and other harmful substances; orientation to body parts and a healthy approach to age-appropriate sexuality; mode of transfer of prevalent transferable diseases within the community; safety of child’s physical environment (for example, swallowing objects, stairs, burning, etc.).

    Build capacity within health services

    For example, ensure that: at least 60% of child health workers in first-level health facilities are trained in IMCI/ACSD; at least 60% of child health workers in first-level health facilities are suitably trained in the importance of early stimulation and communication with young children for psychosocial development; first level health facilities have regular supplies of essential drugs for IMCI/ACSD available (or to ensure that parents have access to free drugs from another source); health facilities are regularly (every six months) subject to supervisory visits with case management observation; community health workers (CHW) have supplies to treat diarrhoea, pneumonia and fever (in countries and districts with operating CHW who are supposed to manage illness); community health workers integrate messages on the importance of early communication and stimulation in the care they provide to families; all families, particularly those from marginalised populations, have sufficient information and means to provide healthy environments for the development of young children.

    Awareness of important aspects of early child development as articulated by the convention on the rights of the child

    For example, the young child as a rights holder; the evolving capacities of children; children as active social participants; expression of views by young children; best interests of the child; consistent and stable care during the early years.

    Resources or publications

    For example, leaflets, posters, advertising in mass media, in health centres, in public and private preschools, public transport, in institutions including institutions for children without parental care (including children in conflict with the law).

    Issues related to their health and welfare

    This includes issues such as the benefits of a healthy diet and lifestyle, including nutrition, food safety and physical activity; the consequences of excessive food consumption and unhealthy food choices, for example, obesity, diabetes and other risks if applicable within the context of your country; the consequences of excessive alcohol consumption and use of tobacco and other harmful substances; orientation to body parts and a healthy approach to age-appropriate sexuality; mode of transfer of prevalent transferable diseases within the community; safety of child’s physical environment (for example, swallowing objects, stairs, burning, etc.).

    Child centred

    A child-centred approach, based on the Convention on the Rights of the Child, starts in early childhood education considering the child's experience, feeling and questions, makes children active learners who are solicited to voice their views, and designs education in view of the child's best interests, evolving capacities, and prevailing queries and concerns. The right of the individual child to develop her or his "personality, talents and mental and physical abilities to the fullest potential" (Art. 29 (1) takes priority over demands of economy, global competition and narrow criteria of school preparedness.

    Professional standards

    Standards entail quality education for caregivers and teachers in all kinds of institutions, centres and facilities for young children and in-service training for the staff of such places. These institutions, centres and facilities need competent direction and good equipment in order to effectively and adequately encourage children's exploration, experimentation, play and learning. Involvement of children and their parents is essential.

    Various settings and services for early education

    Various settings and services entail institutions, centres, facilities and programmes established for young children's education according to children's age and need for assistance, parents' requirement for support and living conditions of families.

    Monitor and evaluate the impact of early education programmes

    All institutions and programmes for early childhood education have to be under supervision of a competent administration, which monitors the expansion and the quality of institutions and programmes of early childhood education, including private institutions. Monitoring should use valid criteria in order to assess enrolment, attendance, fees and quality of these institutions and should include transition to school and the first grades of primary school.

    Monitor and evaluate

    All institutions and programmes for early childhood education have to be under supervision of a competent administration, which monitors the expansion and the quality of institutions and programmes of early childhood education, including private institutions. Monitoring should use valid criteria in order to assess enrolment, attendance, fees and quality of these institutions and should include transition to school and the first grades of primary school.

    Evaluation and improvement of human resources

    Human resources can be improved through: inspection of the quality of work done in institutions; regular in-service training; adequate payment compared to similar professional groups; recognition of the importance of early childhood; and due diligence in staff recruitment and retention in order to ensure continuity.

    Children's development

    physical; social; motional; language and cognitive development; and communication skills

    Indicator systems

    Systems such as Multiple Indicator Cluster Surveys (MICS), Demographic Health Surveys (DHS), the Early Development Instrument (EDI), and other indicator systems that aim to collect data for the purpose of understanding a given issue through asking a series of questions.

    Socio-economic stress

    Stress resulting from a family’s low income, unemployment, or lack of proper housing, etc.

    Child rights training programmes

    Child rights training programmes, including but not limited to the following: the importance of optimal, positive parenting /child-rearing or ending all forms of violence against all children in all settings.

    Children In need of special protection

    In most countries this refers to children with disabilities; children of an ethnic origin other than that of the majority; children of minorities and indigenous groups and refugee children. State parties should analyse available data to investigate whether other groups of children exist who do not benefit from measures and programmes on the same level as other children in the country.

    Comprehensive Policy Strategy (CPS)

    CPS can include but is not limited to a policy strategy that: makes it mandatory that professionals working directly with children report cases of suspected violence against children; establishes formal complaints mechanisms; includes procedures to ensure a child rights approach is taken when dealing with all children passing through the justice system (standard operating procedures, codes of conduct and procedural checklists, etc.); guarantees the right of children to confidential legal advice, medical treatment, and psychosocial and other counseling; requires routine post-mortem investigation to determine the cause of all child deaths; and ensures the coordination of measures to promote optimal, positive child-rearing and to prevent and respond to all forms of violence against children of all ages at national and administrative levels, including governorships, municipalities, districts and villages.

    Effective and coherent system of prevention

    An effective protection system, in accordance with General Comment No. 13 para. 57, should have components ensuring enforcement, quality, relevance, accessibility, impact and efficiency including: inter-sectoral coordination, mandated by protocols and memoranda of understanding as necessary; the development and implementation of systematic and ongoing data collection and analysis; the development and implementation of a research agenda; and the development of measurable objectives and indicators in relation to policies, processes and outcomes for children and families.

    Ethical participation of children

    Children’s participation in research projects is ethical when each project, in addition to meeting general research guidelines, meets the following: opportunities to express views about activities that affect children’s welfare are provided to the participating children and these views are respected; the entire data collection process must be supervised to make sure that the best interests of children are protected; the entire process of planning, implementation and analysis of activities is gender-sensitive and provides equal participation chances for boys and girls; additional safety measures are in place to protect the safety and wellbeing of children in especially vulnerable situations (Schenk and Williamson, 2005, pp. 3, 5, 7, 11, 12). Retrieved from http://www.popcouncil.org/pdfs/horizons/childrenethics.pdf

    Impact of awareness-raising campaigns

    For example, due to an awareness-raising campaign, the need for positive child-rearing and putting an end to violence against children is talked about more frequently and more openly in the media as a result of a campaign. The country’s main TV serial drama incorporated a storyline on this. A survey on caregivers’ attitudes towards child-rearing was repeated before and after the campaign and it showed a 65% increase in positive behaviour change towards child discipline.

    Incidents of all forms of violence

    Incidents such as: substantiated cases of violence against children per 100,000 children; homicides of children per 100,000 children; violent crimes (apart from homicide) against children per 100,000 children; sexual and gender-based violence (sexual, physical, mental and socio-economic violence) and harmful traditional practices; health care facility visits (including health centres, doctors’ and nurses’ consultations, hospital and emergency room visits) due to violence against children per 100,000 children.

    Life skills

    Life skills are defined as psychosocial abilities for adaptive and positive behaviour that enable individuals to deal effectively with the demands and challenges of everyday life. They are loosely grouped into three broad categories of skills: cognitive skills for analysing and using information, personal skills for developing personal agency and managing oneself, and inter-personal skills for communicating and interacting effectively with others. (UNICEF http://www.unicef.org/lifeskills/index_7308.html).

    Monitor and evaluate the impact of early education programmes

    All institutions and programmes for early childhood education have to be under supervision of a competent administration, which monitors the expansion and the quality of institutions and programmes of early childhood education, including private institutions. Monitoring should use valid criteria in order to assess enrolment, attendance, fees and quality of these institutions and should include transition to school and the first grades of primary school.

    National focal point

    The country’s national focal point for the WHO, or any other agency, on violence prevention or any other issue.

    Negative portrayals of children

    For example, sensational media coverage of crimes committed by children, and negative and stigmatising language about children (especially certain groups of children).

    Positive portrayals of children

    For example, children shown making responsible decisions, helping themselves, their friends, families and others in their community and in the wider world.

    Prevention and response services and systems

    For example, staff/professional training, with respect to both quality and quantity; independent monitoring and inspection; equitable access to appropriate and child rights-based short and long-term services; inter-sectoral referrals and communications/records access for interdisciplinary case management support for family reunification.

    Preventive programmes and projects

    Such programmes and projects as public awareness campaigns on zero tolerance to violence, non-violent conflict resolution, showing violence is not acceptable, positive parenting programmes, etc.

    Primary prevention of violence

    Addressing the causes that lead to violence (e.g., parents’ unemployment, alcoholism or other substance abuse, social exclusion, etc.

    Recovery and reintegration

    Therapeutic services for child survivors of violence such as: therapeutic day care, individual therapy, group therapy, family therapy, temporary foster care, medical care, etc.

    Sale and trafficking of children

    Sale of and trafficking in young children for the purposes of: the sale of children for remuneration or other consideration; child prostitution whereby a child is used in sexual activities for remuneration or other form of consideration; child pornography whereby a child is engaged in real or simulated explicit sexual activities; sexual exploitation of the child; transfer of organs of the child for profit; engagement of the child in forced labour. For further detail, refer to the “Optional Protocol to the Convention on the Rights of the Child on the sale of children, child prostitution and child pornography” OHCHR, 2000: http://www2.ohchr.org/english/law/crc-sale.htm.

    State and non-State services

    For example, help lines, services offering medical, legal and psychosocial support, pre- and post-natal support services, health worker home visitation services, community-based counselling and support services, therapeutic programmes linked to domestic violence, addictions to alcohol or drugs or other mental health issues, and legal aid programmes.

    Health and development issues affecting young children

    Issues including but not limited to: the benefits of a healthy diet and lifestyle, including nutrition, food safety and physical activity; the consequences of excessive food consumption and unhealthy food choices, for example obesity, diabetes and other risks if applicable within the context of your country; the consequences of excessive alcohol consumption and use of tobacco and other harmful substances; orientation to body parts and a healthy approach to age-appropriate sexuality; mode of transfer of prevalent transferable diseases within the community; safety of child's physical environment (for example, swallowing objects, stairs, burning, etc.).

    Primary prevention of developmental difficulties

    Primary prevention of developmental difficulties includes prenatal care such as folic acid and other supplements; maternal nutrition (pre-, during and post-pregnancy); maternal depression; and pregnancy complications, among others.

    Build capacity

    For example, ensure that: at least 60% of child health workers in first-level health facilities are trained in IMCI/ACSD; at least 60% of child health workers in first-level health facilities are suitably trained in the importance of early stimulation and communication with young children for psychosocial development; first level health facilities have regular supplies of essential drugs for IMCI/ACSD available (or to ensure that parents have access to free drugs from another source); health facilities are regularly (every six months) subject to supervisory visits with case management observation; community health workers (CHW) have supplies to treat diarrhoea, pneumonia and fever (in countries and districts with operating CHW who are supposed to manage illness); community health workers integrate messages on the importance of early communication and stimulation in the care they provide to families; all families, particularly those from marginalised populations, have sufficient information and means to provide healthy environments for the development of young children.

    Basic services

    Basic services include but are not limited to: health, education, social protection, labour, justice, nutrition, water and sanitation.

    Stimulation of young children

    Stimulation of young children including but not limited to: play, sport and music.

    Different aspects of violence against children

    Different aspects of violence against children including but not limited to: violence prevention, impact of optimal positive child rearing, circumstances that hinder the ability of marginalised groups to access services and full enjoyment of their rights.

    Social protection services

    Social protection services include but are not limited to: access to community-based counselling and support if and when families face difficulties with employment, housing and/or child-rearing, and access to therapeutic programmes (including mutual help groups) to assist with challenges related to domestic violence, addictions to alcohol or drugs or with other mental health needs.

    Sale of and trafficking in young children

    Including for sexual purposes and exploitative labour, during the reporting period/last 5 years?

    Disaggregated data

    Data separated or broken down into components of exclusion and marginalisation. Criteria for disaggregated data: gender, disability, urban or rural habitation, ethnic groups, minorities and indigenous groups of children and children in need of special protection for other reasons.