Orphans and Vulnerable Children in the Urban Slums of Africa

This project has focused on problems of Orphans and Vulnerable Children (OVC) in urban slums of Nairobi. Purpose: to work with communities to determine and respond to health and social needs of their children under 5. Emphasis: on the development of community-based primary health care including: growth monitoring; nutritional supplementation; immunizations; hand washing; insecticide treated bed nets; oral rehydration therapy; caregiver-child interactions. Priority concern has been focused on recent advances in the science of early childhood development that emphasize the importance of loving, nurturing interactions of caregivers and their children, from birth onward, ensuring that the young children develop foundational social-emotional and cognitive strengths, with life long benefits. In contrast, neglect of children leads to loss of those positive aspects of development with disruptive social emotional outcomes and negative life long consequences. Community responses have been positive, with strong interest in understanding the diversity of caregiver-child attachments, both secure and loving attachments, and insecure and neglectful attachments. Community women have formed groups for sharing understandings of these interactions, working together to improve negative and disruptive attachments. The Project Coordinator (and co-author), Racheal Nduku, a Kenyan woman living in the slum community, has shown remarkable leadership in organizing community involvement in the process of assessing the diverse nature of caregiver-child attachments and encouraging positive and corrective actions. A further issue of serious moral concern is the injustice inherent in the neglect of these children. Fair and just care of these children reaches beyond the usual primary health care initiatives, and calls for fundamental loving and nurturing interactions that enhance the opportunity of the children for a good life. In contrast, the lack of loving care can seriously obstruct the child's opportunity for a good life, being thereby inherently unjust. Here is a prototype for Africa of community-based actions focused on fundamental needs of young children that are essential for their lifelong well-being. Here is -- a new paradigm for primary health care, and also for social determinants of health, and justice, that could be usefully pursued across Africa.