text: Yelena Jetpyspayeva , exclusively for Gazeta.kz
Who is to secure you and your kid's health care if there is no hope for state medicine? We asked Anel Kulakhmetova, children's rights specialist and independent consultant, about social status of children in Kazakhstan.
In 2006-2008 she worked as a national consultant with UNICEF (UN Children's Fund) in Astana and Almaty. In December 2006, helped in organization of the First Child Protection Forum for Central Asian countries (the forum was organized by the Ministry of Education and Science with UNICEF support). Currently, she is doing her research in the University of Giessen, Germany, on Volkswagen Foundation grant. In September this year she is planning to continue her education in the USA.
Gazeta.kz: Anel, how would you describe social status children have got in Kazakhstan?
Anel Kulakhmetova: In the beginning of the 1990s all countries of Central Asia ratified the UN Convention on the rights of the child, therefore demonstrating high priority of child and family protection issues for the state.
Moreover, the government of the Republic of Kazakhstan has introduced a national program "Children of Kazakhstan" for 2007-2011, the Committee on the rights of children was established under the Ministry of education and science. Moreover, the government submitted the 2nd and 3rd combined periodical report on the situation of children in the RK in compliance with requirements of the UN Convention on the rights of the child.
However, there is a wide spectrum of problems existing in Kazakhstan. The 1990s have negatively influenced the situation of children and their families. The number of children in the institutions is going up. The fact itself that children (who in many cases have both parents) are in boarding schools or orphanages is very disturbing.
The other problem is stigmatization and discrimination of children with special needs. Violence in the family, child abuse, child labor, situation of children with HIV/AIDs, juvenile delinquency are among many priority problems of the national government.
Gazeta.kz: What steps the government and organizations do to improve children life conditions in the country?
Anel Kulakhmetova: As it was mentioned earlier there is a government program on child protection, the Committee working on child protection issues was created under the Ministry of education and science. Moreover, there is an institute of Ombudsmen on human rights, as well as there is a number of international organization, including UNICEF and ILO-IPEC, and number of NGOs trying to solve problems mentioned earlier.
Gazeta.kz: What measures you think should be taken to improve the situation?
Anel Kulakhmetova: One of the current issues is the lack of single national organization responsible for coordination of all efforts in the area of child protection. For example, there is no Ministry of children or child protection in Kazakhstan, while the Committee of child protection is a part of the Ministry of education and science, and therefore, child protection issues are responsibility of the number of line ministries (the scheme that was inherited by all former Soviet republics), including Ministry of education, Ministry of health care, Ministry of internal, Ministry of justice, etc.
The situation with data is a result of the existing structure. When one is trying to see the general picture in the area of child protection, data is among the first problems. To get one number (e.g. number of children in the institutions) one has to get in touch with different organizations. In some cases the numbers provided by national ministries differ from each other.
The lack of monitoring system is another issue. In number of Western European countries there is so called institute of Ombudsmen on child rights, the independent institution that can influence the existing situation. Several years ago there were negotiations on introduction of such institution in Kazakhstan.
Gazeta.kz: What positive steps were already taken?
Anel Kulakhmetova: First of all, Kazakhstan ratified important international conventions including UN Convention on the rights of the child. The acceptance of the national program also helped to improve the situation. The government has introduced alternative forms of child upbringing including foster care and guardianship to resolve the institutionalization of children.
The Ministry of education and science is trying to integrate children with special needs into the society. There are psychologists and social pedagogues in schools across the country. With the support of international organization there are social centers supporting children and families at risk.
Are the measures taken by the government and international organizations enough to change 'children business' in Kazakhstan for better?
Only by March journalists from "We choose Caravan, Caravan chooses us" newspaper have written about children's mortality rate in Kzyl-Orda oblast where only during 2 months of 2009 about 60 newborns died in an age 0-1 year.
Head of oblast department of health care, Gulnur Serekova, whom the newspaper quotes, says that the monitoring of children's mortality is non-stop process where every dead case is observed carefully. And everything to prevent dead cases is to replace state health care bodies staff with professionally educated gynecologists, neonatologists, pediatricians. They need about 70 of them.
According to Committee department on public medicine service providing control in Kzyl-Orda region statistics, 40% of all complains for low-quality medicine service the department gets are about mother and child health protection. According to special commission check results, gathered for extreme situation, 9 complaints were addressed for investigation to law-enforcement bodies, 3 were instituted as legal proceedings.
Even tough the situation seems to be very well explained: how can the new-born and women recently confined medical service quality high enough if the education level and wage level comparing to living expenses level are too low?
As a result we do not have 40% of accoucheurs and gynecologists, in a country side we have 60% less we have to have. For each 10 thousand of inhabitants there are only 2 medical specialists; for each 1 thousand of children we have 1,2 of children doctors. At the same time there are 76% of pregnant women that are sick, some of them have even 2-3 serious diseases.
This is a situation Kazakhstan has in the south where it is enough just to remind the Shymkent situation where medical negligence happened about 3 years ago led to 40 children infected with HIV. At the end there was a scandal, about 600 people fired, 54 legal proceedings initiated, 143 possible blood donors checked as well as about 3000 children. With one remark: it was done once the tragedy has happened. And all the conventions, programs, agreements, observations did not help and save unprotected children and their mothers from oversight and carelessness of those whom we have to (and sometimes we do not have other choice!) entrust our lives and lives of beloved people, to those who had given the Hippocrates vow.
It is sad that even Wikipedia giving simple definition of the Hippocrates vow slanders: "Hippocrates vow is a common name for the vow given by anyone that willing to become a doctor. It is a thing patients generally appeal trying to motivate doctors to help when they are not willing (or patients think they are not willing)."
North Kazakhstani region also does not seem to be good in medical terms. "Women on North Kazakhstan go to maternity houses overcoming a fear. Millions of tenge given as state subsidies to support a program of mother and child mortality rate decrease do not protect as well as do not work", - writes journalist Irina Lopatko about the region where during the year since a state program was introduced children mortality rate increased by one third (from 122 dead cases by 2007 to 193 dead cases by 2008).
Thinking of a phrase told by the Minister of Health, Zhaksylyk Doskaliyev, quoted by the journalist, hairs stand on end. Try to read and grasp the meaning: "74% of children mortality rate today happen because of so-called 'organizational moments': no in-time registration, no show-up on time, no regular prophylactic and medical attendance".
And the only thing left from the child's life lasted minimum 9 months of the life of the whole family before it happened is a percentage rate in state statistics on a republican scale.
Two years ago UNICEF sounded the alarm and declared that children mortality rate in Kazakhstan more than five times higher then the similar figure in developed countries where mortality rate is six dead cases per every 1000 newborns. In Kazakhstan the coefficient of children mortality two years ago was equal to 31,8 dead cases per 1000 newborns, a coefficient of children death probability in age of 0-5 is equal to 36,3 dead cases per 1000 newborns with slight changes for urban inhabitants and growth by 1,4 time for country side.
According to UNICEF, the highest children mortality rate in Kazakhstan by the moment the research was done was fixed in Zhambyl oblast (55,39 dead cases per 1000 newborns) and in Akmola oblast (41,36); the lowest - in Astana (6,17), Mangistau oblast (11,35). The highest children mortality by age of 0-5 coefficient was fixed in Zhambyl oblast (65,83), Akmola oblast (49,07); the lowest - in Astana (6,79), Mangistau oblast (12,42).
Meanwhile, UNICEF declares children mortality rate in age of 0-5 decrease in the world as a whole. "Children mortality in the world decreased from almost 13 mln by 1990 to the record figure of 9,7 mln by 2006; during the same period children mortality rate in age of 0-5 in Central, Eastern Europe and CIS decreased by two times", - stated in press-release.
It is a pity to ascertain that Kazakhstan has different tendency. In spite of international organizations and independent consultants initiatives as well as state executed programs in a field of health care, negative tendencies are redoubled year by year in a backward proportion to state welfare level.
This year the Planet Earth celebrates one again the International Children's Protection Day. This international holiday long time ago became for journalists and medical men the ordinary occasion to attract the attention to the problem that during other 364 days seems to be insignificant comparing to everyday hot-spot news.
This year the international holiday will be celebrating its 59 anniversary. 59 years of fight for the attention of large scale politicians and state leaders with only one aim: to let them know that children rights, life and health protection should take the first place in any society.
In the meantime such a priority exists not even in every family still...
Details: UNICEF works among more than 150 countries and territories helping children to survive and grow from very young to youth age. Being the biggest worldwide vaccine to developing countries supplier, UNICEF supports programs protecting children health and food, providing clean water and sanitary, qualitative elementary education to all boys and girls, protection children from violence, exploitation and HIV/AIDs. UNICEF activities is fully financed by voluntary private persons, companies, foundations and governments donations.
Photo by rian.ru
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