A human rights-based approach to assess disadvantaged mothers' experiences with a nutrition supplementation programme provided at primary health care clinics. : A study from Cape Town, South Africa.

Abstract

Summary A major health problem in South Africa is inadequate nutritional health among infants and young children which contributes to increased childhood morbidity and mortality. The health authorities in South Africa have implemented various health and nutrition programmes addressing this vulnerable group. However, so far there have been few evaluations of these programmes and hence the effectiveness and quality of the programmes are not certain. South Africa has, with its Bill of Rights, one of the world s most progressive constitutions concerning human rights. Furthermore, the country s health and nutrition policies emphasise human rights by stating that programmes are to be delivered within a human rights paradigm. The present study was designed to examine selected components of a nutrition programme in light of this emphasis on human rights. In a human rights paradigm, mothers have the primary responsibility for their children s nutritional health. The State authority is obliged to help the mothers if they are not able to meet their responsibility. Supportive nutrition programmes in the primary health care is one way of helping mothers and their children in doing so. The Nutrition Supplementation Programme (NSP), which was investigated in the present study, is aimed at helping underweight children achieve a normal weight and at the same time strengthen their mothers capacity to better prevent and tackle malnutrition. The study explored aspects of the NSP as perceived by mothers of underweight children, and used a human rights-based approach to gather the data and to assess the NSP against commonly agreed human rights principles for the process of achieving the desired outcome. Participants were recruited on their visits to primary health care clinics in areas of Cape Town where child malnourishment is common, and the data was collected through seven focus group discussions with a total of 28 black and coloured mothers of children included in the NSP. Important findings were that the mothers had received little or no nutrition education and hence showed little knowledge and skills for how to make their children gain weight. Further, many mothers had experienced poor communication with staff members as well as rude comments and lack of respect. It seemed like the mothers currently do not have capacity to act differently from what they are doing; they especially lack motivation and access and control of resources. Also, the way the NSP was delivered in the present clinics resulted in inadequate compliance with certain principles of human rights-based approach. The predominant focus on distribution of supplements and the undesirable attitudes from the staff members especially led to lack of respect for human dignity and limited client participation and empowerment. The South African health authorities are responsible for enabling an environment in the clinics which respects human rights. They should therefore put more focus on the nutrition education part of the NSP in order to enable the mothers to better tackle their children s nutritional situation. The health authorities should also take measures to improve the health workers knowledge of how to do their job of implementing programmes according to commonly agreed human rights principles. This would strengthen the health authorities accountability in this context.