Submitted by: Send comments to

Recommendations

• 
  Proper access of these children to the hospital and admission whenever required
  
• 
  General cell for guidance for street children and counseling in the case of sexual abuse
  
• 
  Separate OPD for street children (12 hrs), separate protocol funding
  
• 
  Sensitization of this issue to the hospital employees (class I to class IV)
  
• 
  NGOS should be oriented about hospital systems and its functioning
  
• 
  Role of MSW in this issue should be specified
  
• 
  Facilities should be made available during off hrs
  
• 
  Facilities should be made free of charge
  
• 
  After care should be improved and supervision should be done by referral and FU
  
• 
  List of NGOS who will collaborate with municipal/ government/ hospitals and health posts
  
• 
  NGOS should bear the cost of resources of this purpose
  
• 
  Data should be kept by NGOS and hospitals
  

• 
  Use health posts for routine care of the children
  
• 
  Since government does not issue identity cards for these children, this responsibility should be taken by NGOs
  
• 
  Since most of the health problem are related to the food they eat he suggested that this children should go to the temples, churches etc which provide food
  
• 
  These children should take the help of the police who sit at the register counter as well as a unit of JAPU should be present in every hospital to help the children.
  

The meeting concluded with a vote of thanks by Ms Arokia Mary and dissemination of report of meeting in the coming days was mentioned to the audiences. She also shared about a follow-up consultation to be organized in the month of February in KEM hospital (probably), where more NGO activists and PSM departments of other hospitals could be invited for finalization of this draft policy.

2) Second consultative meeting on “Guidelines towards Comprehensive Health Services for Street Children - Individuals from various organizations were present for the meeting including eminent Doctors and HOD's of PSM department of Sion, KEM and Nair hospital and representatives of various NGO's. Thirteen street children were also invited for the meeting.

Following the introductory sessions by YUVA team, Mr Denny John, shared the findings of the study conducted.

NGO

3. Strategies (innovative solutions, implemental, collaboration, corporate sector)

1. 
   Strengths of :
   

• 
  Provide basic health facilities
  
• 
  Provide awareness on cleanliness/ nutrition
  
• 
  Provide education about drug addiction
  
• 
  Referral system
  
• 
  Organize health camps
  
• 
  Provide health education
  

• 
  Relationship building through games and activities
  
• 
  Counseling and orientation
  
• 
  ability to provide basic medical Aid
  
• 
  provide education and training
  
• 
  Organize growth and development programmes (Picnic, camps etc.)
  
• 
  repatriation
  
• 
  Awareness in society at urban and rural level
  

• 
  Awareness in society through TV, newspapers and Radio
  

2. 
   Improvement areas:
   

• 
  Child friendly approach
  
• 
  Counseling and guidance
  
• 
  Strong networking/ intercommunication within police and municipal authorities
  
• 
  After care center to be put in action
  
• 
  Emergency cases and HIV infection cases should be handled with care and free of cost.
  

3. 
   Strategies
   

• 
  Common understanding between government and non governmental organizations about vulnerable groups and child rights
  
• 
  Introduction of I- cards
  
• 
  Provision of First aid in case of emergency
  
• 
  Fee wavier for issuing a case paper
  
• 
  Police registration.
  
• 
  referrals
  
• 
  Financial support by public health department
  
• 
  Discharge and after care center.
  

1. 
   Strengths of:
   

• 
  Knowledge and sensitivity of the problem
  
• 
  Ability to provide medical aid
  
• 
  Outreach programme and outreach services
  

• 
  Flexibility while working
  
• 
  Focus agenda
  
• 
  Availability of funds: NGO's can easily approach funding agencies and get funds approved without many difficulties.
  
• 
  Ability to pressurize the government and policy makers and advocate for rights
  
• 
  Trustworthy: people generally tend to trust the intentions of NGO's and do not suspect their efforts.
  

• 
  Can be a good role model and play and important role in raising awareness among the street children.
  

• 
  Have the power and can control the children.
  
• 
  Improvement areas
  
• 
  Censor board intervention: Street children are often negatively portrayed my media especially in movies. This reflects a wrong image of the street child and hence the censor board must intervene and ban such projections of a street child.
  
• 
  Coordination among various organizations for achieving a common goal. all the organizations function efficiently individually and no organizations be it an NGO or a Hospital functions sub standardly , and a coordination between them is imperative in achieving common goals and objectives.
  
• 
  It is also imperative to spread awareness among the stake holders.
  

• 
  Child protection cell: such a unit is active in Nair hospital and it must be replicated in other public hospitals also.
  
• 
  Resource directory: formulate and dissemination of resource directory consisting information about various NGO's/ practitioners/ associations.
  
• 
  Case paper could bear a child line stamp a practice similar to the one adopted in Nair hospital.
  
• 
  Network of individuals who are committed to work for the cause of street children should be available on the Internet for easy accessibility.
  
• 
  Involvement of local corporaters/Mayor in policy making
  
• 
  Signboards with information of hospitals, dispensaries to be displayed on railway stations and platforms.
  
• 
  A network of railway officials such as JAPU to be deployed at railway stations.
  
• 
  In medical colleges at least one person should be identified who is motivated to work for the cause of street children.
  
• 
  Effort should be made to repatriate and rehabilitate street children.
  

• 
  Training manpower to deal with health issues of street children
  
• 
  Facilitating hospital admission, investigations, referrals and specialist services for street children.
  
• 
  Outreach activities like health camps can be organized in partnership with NGO's
  
• 
  PSM department can hold meetings with Corporation authorities for better facilities for street children
  

• 
  Obtaining funds and facilities from reputed organizations such as WHO/ UNICEF
  
• 
  Framing policies and planning for health programmes for street children
  
• 
  Conducting surveys and research in the area of health of street children.
  

• 
  Establish rapport with street children
  
• 
  Creating health awareness among street children
  
• 
  Arrange health camps with government/ private health facilities
  
• 
  care for special needs of the children
  
• 
  Act as a link between street children and health facilities
  

• 
  Highlight issues of street children
  
• 
  Identify and highlight lacunae in health care of street children by government/ private hospitals and create awareness among people
  
• 
  Act as a watch dog
  
• 
  Can highlight specific issues of harassment and neglect
  

• 
  Identification of runaway children and efforts to repatriate them.
  
• 
  Help in arranging medical care of sick children
  
• 
  Identify exploitation among street children and intervene
  

2. Improvement areas

• 
  Attitude if class IV employees and other staff towards street children
  
• 
  Regular and effective follow up of action initiated and loss of momentum and interest be avoided.
  
• 
  Collaborations with other sectors and looking at a broader picture
  
• 
  Media to be sensitive and cautious while reporting about street children
  
• 
  Motivate JAPU
  

3. Strategies:

• 
  Child care and child line units be initiated in hospitals coordinated by the PSM department
  
• 
  Issuance of ID cards by local area police department to street children which can be used in hospitals and health facilities to facilitate health care.
  
• 
  Dividing the city into three or four zones based on the population and distribution of street children and an NGO be allotted to each zone to take the responsibility of the street children of that zone.
  
• 
  Identifying families to take care of uncared street children (foster homes)
  
• 
  Sensitization of hospital staff towards the problems of street children.
  
• 
  Involvement of local corporaters.
  

4. Advocacy

• 
  Formation of a joint representative committee consisting of HOD of PSM depts. NGO representatives, Journalists and media persons and street children themselves to speak with high authorities.
  
• 
  Such committees can insist government authorities to issue orders to all hospitals and health facilities to treat street children in an acceptable manner.
  

• 
  Provision of a identity card with a lifetime validity and it should be valid in the hospital as well as in the railway.
  
• 
  Wavier of case paper fees.
  
• 
  Provision of health facilities in Bhagvati hospital similar to the ones available in Nair and Sion hospital
  
• 
  Awareness on cleanliness and hygiene and provision of sanitary and bathroom facilities
  
• 
  Awareness and education about drug and alcohol addiction
  
• 
  Provision of safe and portable drinking water.
  

At the end children raised a few important questions and seeked their answers. The questions raised were:

• 
  “ Till the time we are minors, we have shelter facility but where do we go after we are 18 years of age,”
  
• 
  “The constitution mentions that every child has the right to education then why are the street children ignored?”
  
• 
  “We do not posses any proof of identity, what do we do?”
  
• 
  “Why do the policemen take bribe from us when we earn money by selling things in the local trains?”
  

The core group once formed will continuously give their time and energy to take this movement ahead.

• 
  Wavier of user fee
  
• 
  Formation of a committee to work for this movement.
  

• 
  Issuance of ID card
  
• 
  Formation of a child care unit
  
• 
  Provision of sanitation facilities
  
• 
  updating the resource directory and circulating it
  
• 
  Sensitization of hospital staff towards better treatment of street children, different sensitization modules be used for different employees.
  

• 
  Interlinkages with DWCD, ICDS, EDN local corporaters etc.
  
• 
  Providing after care
  
• 
  Lias with organizations which provide vocational training. the street children could be sent for such training s for capacity building.
  
• 
  Provision of special services for children with disability/ special needs. and unmarried mothers.
  

The Right to Survival is a pre-requisite for the realization of all other rights including social, economic, cultural, civil, and political rights. Right to health is a right to life, right to live with dignity, and right to livelihood. In the Constitution of India, health is still not recognized as a fundamental right of citizens. The fundamental right to health would mean making the right to health care a legally enforceable entitlement. In the Alma Ata declaration, provision of universal, comprehensive primary health care was seen as the key to attaining health for all as part of overall development. Poverty contributes to undernourishment and ill-health. Thus there is a need to see health as being central to sustainable human development and formulating a national health policy with a detailed plan and timetable for realization of the core right to health care.

Street children with either the complete or partial lack of social structures are amongst the most vulnerable. Left on their own to survive they are exposed to a number of health and nutrition hazards. Added to this the need to work to earn and survive exposes them to hazardous environments and occupations. Being vulnerable and uncounted, they are part of an “invisible” population, invisible in most government schemes and programmes at city-level.

Mumbai city sees a huge influx of migrants, many of them being street children. Very few NGOs and government agencies in the city work towards repatriation and rehabilitation of street children back to where they belong. This results in many of the children ending up on the streets, many of them along with their families. The vulnerability of these children renders them unhealthy in many ways resulting in sickness and ill-health. With the existing public health infrastructure burdened by the burgeoning populations, many of the street children find it difficult to access public health services. Added to this is the lack of knowledge and ill-literacy among most of them. Coupled with lack of self-confidence and fear, makes them abhor usage of health services even more.

The Municipal Government of Mumbai city being the largest and most resourceful among the agencies to implement health services should strive towards providing comprehensive health services to these children. These government services should be supported by various NGOs who are working towards improving the health of such street children. Along with this, there is need for the general public and media to support such initiatives.

Let us not forget the old idiom that “today’s children are the future citizens of the country”. The health of the nation depends of the health of today’s children. Street children too form a part of this generation. It will depend on a responsive government, and network of supportive NGOs, media and general public to ensure that the health of these street children are provided in Mumbai, the city of dreams.

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www.karmayog.com. Accessed on 30 November 2007

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Ntozi J DM, Ahimbishwe F E, Odwee J O, Ayiga N and Orakut N F (1999), Orphan Care: The role of the extended family in Northern Uganda, in, The Continuing African HIV/AIDS Epidemic, Orubuloye I O, Caldwell J and Ntozi J P (Eds), Canberra, Australia, Health Transition Center

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X: List of Annexes
Annexure 1: Checklist for Children living on Streets
Date of Survey:
Conducted by: Name _____________________________________________

Organisation __________________________________________

1. Name of the area/street/settlement
2. Type of street child: 2.1. alone / 2.2. living with family/2.3 other members on street

2. 
   Name of child
   

4. Age of the child

6. Where does the street child conduct the following activities?

i. Living (during most part of the day for resting, eating etc)

ii. Bathing/Ablutions

iii. Sleeping
7. Has the child suffered any sicknesses in the past year? Yes/No (Please describe)
8. If yes to (7), what did the child do?

i. Visited a health facility

ii. Did not visit a health facility
9. If yes to 8 (i), how did the child go to the health facility

i. Alone

iii. Older street child

iv. Other street population members

v. NGO

i. Public Hospital/Dispensary (Name)

ii. Private Hospital/Nursing Home/Dispensary (Name)
11. If yes to 8(ii), please mention reason for not visiting a health facility?

11.1. Didn’t get leave from employer

11.2. Didn’t have elders to accompany

11.3. Didn’t have money to pay for any expenses

11.4. Got medicines from nearby pharmacy

11.5. Ignored it

14. Did you pay any bribes at the public health facility? Yes/No, If Yes, amount

15.1. Laboratory Tests

15.2. Diagnostic Tests (X-ray, CT-Scan, MRI)

15.3. Hospitalization

15.4. Medicines
16. Did you complete the course of treatment prescribed? Yes No
17. If Yes, what are the expenses incurred?
18. If No, reasons for discontinuation?
19. What are your expectations from the health facilities in the city?
20. Does the street child use any sort of tobacco/gutkha/solution/drugs etc

Thank you for participating in the survey

1. 
   Name & area of location of the Health Post
   

2. 
   Ward:
   

3. 
   Population covered by the Health Post:
   

4. 
   Health Post is A/B/C/D type facility
   

Section I- Availability of Services

6. Staffing Pattern

Yes No

• 
  All six days
  
• 
  Alternate days
  
• 
  Two days
  

6.4. Please mention the timings of availability of MO in Health Post

6.5 Other staff available at the health post

Staff	Available		If Yes No. of days	If Yes No. of hours
	Yes	No
Pharmacist
ANM/MPW
Lab Technician
Any other staff

7. List down the pediatric formulations (syrups) of all the medicines available at the Health Post.
8. Equipment available to monitor growth of children (0-6 years) (Pl Tick)
8.1 Growth charts Yes No

8.2 Weighing Scale Yes No

8.3 Height Chart Yes No
9. Is the weighing scale in working condition (Pl Tick)
Yes No
10. Please note down the type of weighing scale available at the Health Post.

Sling-type Ground-type

11. Immunization & Vitamin supplements available at the Health Post.

(Response in Yes or No)

11.2. OPV

11.3. Measles

11.4 Tetanus

11.5 Vitamin A

11.6 Iron Supplement

12.1 Dog bite

12.2 Snake bite

12.3 Minor burns

12.4 Minor injuries

12.5 Pneumonia

13. Number of children visiting the OPD per day

14. Number of children vaccinated per week by the Health Post

15. Number of children treated per week by the Health Post

17. If yes then how many have been sent to

• 
  Public Facilities
  
• 
  Private Facilities
  

3.3.1) Did not know regarding visit to hospital

3.3.2) Did not get time from work

3.3.3) Had no one to accompany to the hospital

3.3.4) Did not bother
3.4) Has the pregnant woman/mother heard of ICDS programme/Anganwadi/Balwadi? Yes/No
3.5) Has the pregnant woman/mother received/visited any services through Anganwadi/Balwadi? Yes/No

4) Details of delivery and costs

4.1) Has the woman delivered in the last 2 years? Yes/No

4.4.1 Savings

4.4.2 Contributions from relatives/friends

4.4.3 Sale of assets (please describe)

4.4.4 Borrowings (please describe)

4.4.5 Others (please describe)

4.6) Does the woman know/has been informed about Janani Suraksha Yojana? Yes/No (If yes, please ask source of information)

4.7) What do you expect from the government in terms of health services provision? (Please describe)

When I first started to work on this research project I wasn’t sure how it will shape up in the end. Although having lived in Mumbai city for most of life, for me street children were just a part of the milieu of this city. I had never interacted with one before embarking on this research study and I was completely at jitters when I started my field visits to meet some of these children in areas where they lived, worked and played. During the journey of getting this research paper ready I was supported by a lot of street children. One name stands out is Babloo, who is usually seen on Platform 8 of Dadar Station. This boy made me look at street children in a different light and even now when I am near that area I make it a point to search for him, but most times he is found away at work.

This research study wouldn’t have seen the light of day for the patience and continuous support of Ms Arokia Mary, Child Rights Coordinator, YUVA, Mumbai. I am equally indebted for the support and love that I received from other members of YUVA team in Mumbai, namely, Mr Raju Bhise, Ms Phoebe Simon, Mr Santosh Damale, and Mr Maju. I also wish to thank Mr K T Suresh, Executive Director, YUVA, Mumbai, for entrusting this assignment to me.

Looking forward to working with you all. Let us together contribute for improving the lives of street children living in Mumbai.