HEALTH BELIEFS AND HEALTH SEEKING BEHAVIOUR IN HAYDOM

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FINDINGS RELATING TO STRATEGIES TO COUNTERACT CHILD VULNERABILITY

Participants in this study agreed that there are vulnerable children in Haydom and that they have unmet needs. The researchers observed many children whose needs were not being met during their visits to residents‟ homes. This suggests that vulnerable children represent a significant local problem; while there are some community resources available (as discussed in section 1.2.8) these resources are not fully meeting the needs of all the vulnerable children. This study recommends that strategies to help vulnerable children in Haydom be given serious and early consideration.The literature deals with a wide range of strategies to help vulnerable children and gives considerable attention to volunteer programmes; informants suggested a limited range of strategies, including institutional care, with little stress on volunteer programmes. Informants did provide some suggestions for helping children of alcoholic parents, which do not appear to be mentioned in the literature.

Child initiated strategies: discussion

The literature discusses resilience which can be considered to be a child initiated strategy. Resilience is a broad concept which encompasses interpersonal skills, beliefs and attitudes and external resources; this is discussed in section 4.4. Informants referred to the concepts „perseverance‟ and „working hard‟ as survival strategies employed by vulnerable children in Haydom, discussed Nyerere‟s socialist doctrines emphasised the need to work hard and to be as self-reliant as possible (Halimosa 1980:18-21; Kijanga 1978:6-10; Nyerere 1974:19-24), and the Iraqw have been characterised as people who accept situations, are not proactive and do not expect change (as discussed in section 2.10).  Questionnaire items 9 and 12 addressed the issue of child initiated strategies; item 9 states that “persevering in a bad situation can help a vulnerable child to survive” and „expects‟ a positive response; item 12 states that “being lazy can help a vulnerable child to survive” and „expects‟ a negative response. These items were supported by 88% and 94% of respondents respectively.Informants‟ views reflect the limited resources available to the people of Haydom. When social services are not available and the extended family „safety net‟ may not always function perfectly, the child may have few response options remaining, even in a situation where he is being exploited.

Child initiated strategies: recommendations

While the strategies of working hard and persevering are valuable life skills in the long run, they should be applied in an age-appropriate manner, to avoid the consequence of inappropriate autonomy for developmental stage (as discussed in section 8.2.4.1.4). In the absence of other strategies, they may have some practical merit, but it appears that part of the reason for the existence of these strategies is that children‟s rights are not fully respected, for example child exploitation appears to be little reported, investigated or countered in Haydom. It is recommended that the current government efforts to sensitise Tanzanians about children‟s rights be strengthened, and steps be taken to facilitate advocacy for children (as discussed in section 8.2.2).

Adult initiated strategies 

Adult initiated strategies suggested by informants include providing advice, strategies to help handicapped children and orphans, strategies to help families with a member who abuses alcohol and poverty alleviation strategies.

Advice on developing coping skills: discussion 

The literature refers to developing coping skills in the context of psycho-social support programmes, as discussed in section 5.4.1. Section 6.6.2.1 discusses the willingness of adults to advise vulnerable children; informants suggested that this informal strategy is used in Haydom, although there is no structured psycho-social support scheme in place. Item 36 of the questionnaire states that “adults can help vulnerable children by giving advice”; this item „expects‟ a positive response, and is supported by 95% of the respondents. It is hard to judge the extent and effectiveness of this informal strategy as currently used in Haydom; moreover, if children are being advised to persevere and work hard, it will not address the underlying problem of obtaining rights. Its value may relate to being a point of contact between children and adults.

Advice on developing coping skills: recommendation

This informal strategy could be developed into a more effective and organised strategy, such as a planned psycho-social support programme with trained volunteers, like the “Mama Mkubwa” scheme described in section 5.4.10.2, which provides home visits, practical help and counselling.

Strategies to help handicapped children: discussion 

The literature refers to institutional care for handicapped children, but recommends supported home care (as mentioned in sections 5.3.2.1 and 5.4.10.2). Informants‟ views are discussed in section 6.6.2.2.1; some spoke of home care for disabled children, while many of them suggested the need for institutional care for handicapped children. This view was expressed in item 28 of the questionnaire which states “if handicapped children are not looked after by their families, they should be brought up in a special institution”. This item „expects‟ a positive response; 94% of respondents agreed to the statement. This view appears to be influenced by the fear of handicaps and the inability of handicapped children to provide for their parents later (as discussed in section ). Issues relating to institutional care for vulnerable children are presented in section 5.3, which concludes that although well run children‟s homes may be needed in some communities; orphanages run the risk of psycho-social deprivation. There is a difference between the views expressed in the literature and those expressed by most of the participants of this study.

Strategies to help handicapped children: recommendations

Participants‟ views relating to care of handicapped children suggest the need for community education and advocacy for the rights of handicapped children, as well as surveys to identify neglected handicapped children. When planning strategies for handicapped children, it is recommended that local views be given consideration. However, community sensitisation about the risks of institutional care should be undertaken, and culturally congruent solutions reached that serve the best interests of vulnerable children. This might be the use of fostering or group homes where family care is not possible. 

Strategies to help orphans

The literature reports a wide variety of strategies to help orphans, as outlined throughout chapter 5, such as institutional care, psycho-social support programmes, living with a surviving parent, fostering and adoption, protection of legal rights and voluntary activities to support vulnerable children.

Extended family: discussion

Informants spoke of the extended family as being primarily responsible for orphans (as discussed in section 6.6.2.3.1), which is congruent with views expressed in the literature. Item 6 on the questionnaire states that “the vulnerable child‟s extended family are responsible for helping him/her”, and „expects‟ a positive response; 88% of respondents agreed with the statement. The extended family appears to be acceptable and important in care of vulnerable children in Haydom.

Extended family: recommendations

It is recommended that care of orphans within the extended family should be supported. When orphans are living with economically disadvantaged members of the extended family (such as an elderly grandparent), material support may be needed, for example in terms of food or school fees. If orphans are registered and followed up at village level (as discussed in section 8.3.2.1.2) hardship could be identified early.

Fostering: discussion 

The literature supports unrelated fostering and adoption for orphans; informants agreed that unrelated fostering is possible, but currently unusual, and did not mention adoption (discussed in section 6.6.2.3.2). Item 40 on the respondents‟ questionnaire states: “a volunteer mother who is not related to an orphan can bring him/her up”; this was supported by 95% of the respondents. This suggests that fostering outside the extended family may be a strategy that could be expanded in Haydom.

Fostering: recommendations

If children are cared for outside the extended family, for example by fostering, there would need to be careful supervision to ensure that care was effective and discrimination was not tolerated. Reduction of discrimination against fostered orphans may help to overcome remaining scepticism in the community, particularly in relation to exploitation of unrelated foster children (as discussed in section 6.3.2). Adoption is a strategy that should also be considered in Haydom, but would require considerable community education to be acceptable as it is currently little known. Fostering and adoption need local mechanisms to allow for screening of potential parents and methods of formalising such arrangements.

Institutional care: discussion

Some informants mentioned institutional care as an option for orphans (as discussed in section ), but the literature considers orphanages to be a „last resort‟ measure, although well run children‟s homes appear to avoid the disadvantage of psycho-social deprivation. Local acceptance of institutional care runs counter to views expressed in the literature (as discussed in section ).

Institutional care: recommendations

Education about the risks of orphanage care should be provided if this strategy is considered in Haydom; the monitoring and supervision of the crisis nursery at HLH as an example of institutional care should be continued.

Protecting orphans‟ rights: discussion

The literature stresses the need to protect children‟s rights, and suggests measures such as birth registration, encouraging terminally ill parents to make written wills, succession planning and advocacy to protect inheritance rights (as discussed in section 5.4.9). Although informants reported problems faced by orphans such as exploitation and loss of inheritance, they made little mention of protecting children‟s rights; this may reflect the lack of community understanding of children‟s rights.

Protecting orphans‟ rights: recommendations

It is recommended to put in place a range of measures to protect children‟s rights, as outlined in the literature, and suggested in section. Registration and home visiting of orphans would be challenging, but there is a need to ensure that rights such as the right to education are being protected. Currently available pre-school nurseries in Haydom which are all fee-paying could have free places for young orphans who lack psycho-social support.

Volunteer programmes: discussion

Informants‟ views about the use of voluntary workers in various capacities, particularly for providing psycho-social support for vulnerable children are outlined in section 6.6.2.3.4. Informants noted that volunteer activities are unusual in Haydom, although there is evidence of the value of voluntary programmes in the literature (as discussed in section 5.4.10). It was suggested by some informants that it is difficult to continue to help a needy relative such as a widow, over a prolonged period of time. It was observed that some widows‟ houses needed simple repairs that neighbours or relatives could have managed without any cost. This apparent lack of proactive measures to help needy people in society may perhaps be related to many Haydom residents‟ preoccupation with survival and their own immediate family and problems, for example many informants spoke of the difficulty of getting enough money to send all of their children to school. An alternative explanation for the apparent lack of proactive measures might relate to a fatalistic approach to life (as discussed in section 2.10), but does not appear to be related to lack of organisational or fundraising skills, which are in evidence in community gatherings such as weddings and funerals. Although a daily paid worker may earn less than $2 a day, special church events and weddings raise funds of more than $1,000 from the local population, while providing a sack of maize for a destitute family would cost about $50. Several informants suggested that other people in society might be „Good Samaritans‟ and help to look after vulnerable children, but none of the informants suggested that they would personally be willing and able to volunteer to do more than they are currently doing. Some were already involved in looking after children not their own, but from their extended family.

1. ORIENTATION TO THE STUDY
1.1 INTRODUCTION
1.2 BACKGROUND TO THE PROBLEM
1.3 PROBLEM STATEMENT
1.4 RESEARCH QUESTION
1.5 PURPOSE OF THE STUDY
1.6 OBJECTIVES OF THE RESEARCH
1.7 ASSUMPTIONS
1.8 SIGNIFICANCE OF THE STUDY
1.9 CONCEPTUAL FRAMEWORK AND RESEARCH METHODS
1.10 SCOPE AND LIMITATIONS
1.11 ETHICAL CONSIDERATIONS
1.12 ORGANISATION OF THE REPORT
2. ANTHROPOLOGICAL BACKGROUND TO THE IRAQW AND DATOGA ETHNIC GROUPS
2.1 INTRODUCTION
2.2 OVERVIEW OF CULTURAL GROUPS LIVING IN HAYDOM VILLAGE
2.3 ETHNIC IDENTITY AND HISTORY
2.4 POPULATION SIZE OF THE IRAQW AND DATOGA
2.5 ORGANISATION OF IRAQW AND DATOGA SOCIETY
2.6 HEALTH BELIEFS AND HEALTH SEEKING BEHAVIOUR IN HAYDOM
2.7 IRAQW AND DATOGA TRADITIONAL DRESS
2.8 VALUES OF THE IRAQW AND DATOGA
2.9 SPIRITUAL BELIEFS
2.10 BEHAVIOUR STEREOTYPES OF THE IRAQW AND DATOGA ETHNIC GROUPS
2.11 RELATIONSHIP BETWEEN THE DATOGA AND IRAQW ETHNIC GROUPS USE OF ALCOHOL IN HAYDOM VILLAGE
2.12 VIEWS ON SEXUAL RELATIONS AND ILLEGITIMACY
2.13 ATTITUDE TO CHILDREN
2.14 SOCIETAL CHANGE
3. RESEARCH METHODOLOGY
3.1 INTRODUCTION
3.2 METHODOLOGIES FOR THE DIFFERENT STAGES OF THE
RESEARCH
3.3 SUMMARY
4. CONCEPT ANALYSIS FROM A REVIEW OF THE LITERATURE
4.1 INTRODUCTION
4.2 ANALYSIS OF THE CONCEPT ‘CULTURE’
4.3 ANALYSIS OF THE CONCEPT ‘ORPHAN’
4.4 ANALYSIS OF THE CONCEPT ‘RESILIENCE’
4.5 ANALYSIS OF THE CONCEPT ‘CHILD’
4.6 ANALYSIS OF THE CONCEPT ‘VULNERABILITY’
4.7 ANALYSIS OF THE CONCEPT ‘CHILD VULNERABILITY’
4.8 SUMMARY
5. STRATEGIES THAT HELP VULNERABLE CHILDREN
5.1 INTRODUCTION
5.2 SELF-CARE: CHILD-HEADED HOUSEHOLDS
5.3 INSTITUTIONAL CARE
5.4 COMMUNITY BASED CARE
5.5 OVERVIEW AND SUMMARY
6. ANALYSIS OF QUALITATIVE DATA
6.1 INTRODUCTION
6.2 ANTECEDENTS OF CHILD VULNERABILITY:LACK OF RESOURCES
6.3 CONTRIBUTING ANTECEDENT: INTENTIONAL MISTREATMENT
6.4 DEFINING ATTRIBUTES: DEPRIVATIONS IN A YOUNG INDIVIDUAL
6.5 CONSEQUENCES: LOSSES SUFFERED
6.6 STRATEGIES: DEALING WITH DEPRIVATION
6.7 SUMMARY
7. RESULTS OF QUANTITATIVE ANALYSIS
7.1 INTRODUCTION
7.2 DEMOGRAPHIC CHARACTERISTICS OF RESPONDENTS
7.3 ANALYSIS OF DATA ITEMS
7.4 ANALYSIS OF DIFFERENCES BETWEEN THE POPULATION GROUPS
7.5 SUMMARY
8. DISCUSSION, RECOMMENDATIONS AND CONCLUSION
8.1 INTRODUCTION
8.2 OVERALL FINDINGS: DISCUSSION AND RECOMMENDATIONS
8.3 FINDINGS RELATING TO ANTECEDENTS OF CHILD VULNERABILITY
8.4 FINDINGS RELATING TO CONTRIBUTING ANTECEDENTS OF CHILD VULNERABILITY
8.5 FINDINGS RELATING TO DEFINING ATTRIBUTES OF
CHILD VULNERABILITY
8.6 FINDINGS RELATING TO CONSEQUENCES OF CHILD VULNERABILITY
8.7 FINDINGS RELATING TO STRATEGIES TO COUNTERACT  CHILD VULNERABILITY
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CHILD VULNERABILITY IN THE IRAQW AND DATOGA OF HAYDOM VILLAGE, NORTHERN TANZANIA

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