The Reconstruction and Development Program (RDP) of South Africa and Mental Health of Children

By Zodidi Tshotsho, PhD

INTRODUCTION

Children and youth account for over 50% of the South African population of approximately 43 million people. The majority of these children and youth are from disadvantaged backgrounds and the majority of these children fall under the category of children with special needs. They grow up in poverty, have been subjected to physical, emotional, and/or sexual abuse, have experienced or witnessed various forms of violence in their families and communities; and some are addicted to alcohol and habit-forming drugs. Such children are at risk of various mental health problems. Examples of such problems are anxiety states; attention deficit hyperactive disorders; post-traumatic stress disorders; behavioral and antisocial disorders; and depression resulting in suicide.

The coming into power of the Democratic Government in South Africa heralded a new belief system with regard to children. The government considers the needs of the children to be paramount throughout its development strategies, policies, programmes and services. One such programme is, The Reconstruction and Development Programme (RDP).

THE RECONSTRUCTION AND DEVELOPMENT PROGRAM (RDP) of SOUTH AFRICA

The Reconstruction and Development Programme (RDP) of South Africa is a government programme that focuses on redressing the social imbalances created by the apartheid government to the majority of the population of South Africa (Initial Country Report of South Africa: Convention on the Rights of the Child: 1997:17).

The RDP contains a series of national goals for children, which form the basis of a cross-sectoral national programme of action. These RDP goals provide strategic guidance, priorities, and specific targets that should inform and guide the efforts of all sectoral ministries and provincial authorities, in collaboration with civil society organizations, local authorities, communities and individuals concerned with children. These goals also serve as a means to entrench the rights of the child.

The goals, which are of specific relevance to mental health needs of children, are as follows:

First, to provide improved protection of children in especially difficult circumstances and tackle the root causes leading to such situations. Children in especially difficult circumstances (CEDC) in South Africa involve a number of distinct groups, sometimes overlapping. These include: children displaced by political violence; children who are victims of crimes, including murder, kidnapping, and rape, as well as domestic abuse; children in custody; homeless or “street” children; children living in institutions or foster care; child laborers; disabled children and AIDS orphans.

The second goal is the ratification of the Children’s Rights Convention. (Children, Poverty and Disparity Reduction: Towards Fulfilling The Rights of South Africa’s Children, (1995), by The National Institute for Economic Policy (NIEP).

In June 1995, the South African Government ratified the United Nations Convention on the Rights of the Child (CRC). By ratifying the CRC, South Africa pledged itself "to improving the general well being of the children of South Africa and to ensuring that all children have the right to develop physically and mentally to their full potential, to express their opinions freely, and to be protected against all forms of abuse and exploitation.” The ratification of the CRC led to the first democratically elected president of South Africa, Nelson Mandela, pioneering the principle of the First Call for Children in South Africa, which focuses on improving the general well being of children, (Initial Country Report of South Africa: Convention on the Rights of the Child: 1997:14).

THE RDP AS A FRAMEWORK FOR OTHER LEGISLATION AND POLICIES

Mental health of children and adolescents in South Africa is directly and indirectly alluded to in many legislation and policies.  The RDP has given direction to the development of various legislation and policies, which directly and indirectly impact on the mental health services of children and adolescents.  Examples of such legislation and policies are: First, The Constitution of the Republic of South Africa, 1996; Section 28 of the Constitution, emphasizes the right of the child to protection from physical and emotional abuse of any form.

Second, The National Program of Action (NPA) for Children. The goals to enhance the survival, protection and development of children in South Africa, guided the development of the framework of the National Programme of Action for Children (NPA). The government developed a National Programme of Action for Children (NPA) thus reinforcing the “call for children first” based on the goals of the Convention. The NPA is an integrated framework of all the policies and programmes developed by government departments, nationally, provincially, as well as by the Non-Governmental Organisations (NGOs), to promote the well being of children as embodied in the Convention. The Cabinet approved the NPA in April 1996, (National Programme of Action for Children in South Africa: Framework: 1996).

Third, The White Paper for the Transformation of the Health System in South Africa (1997):
According to the White Paper for the Transformation of the Health System in South Africa (1997), the Directorate: Mental Health and Substance Abuse is responsible for successfully improving and promoting the psychosocial well-being of all communities as an essential ingredient in the implementation of the RDP. Some of the functions of the National Directorate of Mental Health and Substance Abuse as listed in the White Paper include:

First, the development and promotion of specific programmes addressing substance abuse, child abuse and the management of the victims of violence, in collaboration with other sectors;

Second, planning and promoting specific services for the mentally handicapped in collaboration with the relevant stakeholders and users of the services.

The National Health Policy Guidelines for Improved Mental Health in South Africa
In the National Health Policy Guidelines for Improved Mental Health in South Africa, one of the key priority areas identified in the intervention framework, is the Services for Children. It is indicated that the priority for mental health services for children should be prevention and that the services need to be integrated into general primary-health care. Areas of special focus are: first, prevention of delays in emotional and intellectual development through interventions with mothers, by working with mothers and empowering them to do “what comes naturally,” that is mother-child bonding.

Second, introduction of Life Skills Education for children and adolescents is critical to such issues as substance-abuse prevention, teenage pregnancy, HIV/AIDS prevention, violence reduction, and child abuse. The development of such skills is crucial to the promotion of both physical and mental well being. It is therefore important that such programmes should be integrated as part of the school curriculum. Third, prevention of Fetal Alcohol Syndrome can be implemented by helping pregnant mothers through education and support. The dangers of drinking during pregnancy must be highlighted through campaigns involving the public media. Each mother who comes for family planning and antenatal care should be informed of the consequences of drinking during pregnancy.

Another legislation which has a direct bearing on the mental health of the child is the The Child Care Amendment Act (1996) brings the 1983 Child Care Act in line with the new Constitution and the Convention, by enhancing measures to protect children and promote their rights.

Lastly, the framework for a National Drug Master Plan of the Drug Advisory Board includes policy formulation aimed at reducing the demand and supply of illicit drugs. Currently prevention forms part of the Life Skills’ program in schools and forms part of the new Schools Curriculum 2005.

In his first opening address to Parliament in 1994, the first President of the democratically elected government of South Africa, Mr. Mandela, specifically singled out alcohol and drug abuse among social pathologies that needed to be combated. He referred to alcohol and other drug abuse as a major cause of crime, poverty, reduced productivity, unemployment, dysfunctional family life, political instability, the escalation of chronic illnesses, such as AIDS and TB, injury, and premature birth (Drug Master Plan, 1998).

A National Strategic Action plan (NSAP) for the Prevention of Substance Abuse among the youth in South Africa was developed by the South African Alliance of Prevention of Substance (SAAPSA) in 1999. The aim of SAAPSA is to encourage networking amongst all organization, government, and civil society, concerned with substance abuse in South Africa. The NSAP serves as a framework for the prevention of projects and actions geared at the primary prevention of substance abuse among children, young people, and young adults (from age 5 to 35) as well as a reference tool on a national, provincial, local and community level of health care.

Children and adolescents with drug and alcohol problems have higher rates of other mental health problems, as well as infants born of mothers who abuse alcohol and drugs during pregnancy. Children and adolescents who abuse alcohol and drugs are prone to violence, road accidents, and disruption at school career. Drug prevention forms part of the Life Skills’ program in schools and forms part of the new Schools Curriculum 2005.

PROGRAMS IN RESPONSE TO THE RDP’S GOALS

Violence Prevention Programs
Some children and adolescents in South Africa have witnessed and/or have been perpetrators of various forms of violence during their formative years and are not familiar with peace and love. Such children are more vulnerable to mental health problems.

If such children are mismanaged, such emotional problems develop into definite psychopathologies. Examples of common psychopathologies are mood disturbances, such as depression, which in some instances ends in suicide, or anxiety states such as post-traumatic stress disorders (PTSD) and behavioral disorders.

Programs for violence prevention have just been introduced and are still at the pilot phase. These programs are age specific and are based on the preventive approach. The main focus is on building skills and empowering carers, teachers, children and adolescents. The programs, which have been introduced on a pilot scale, are as follows:

• Training Mothers/Carers in Skills to Promote Positive Interaction between them and their Infants;
• Training Teachers and Students in skills to prevent violence in school

Promoting Positive Interactions Between Carers and Their Infants (Carer-Infant Bonding):
This program focuses on primary prevention of violence. This program is known as the carer-infant bonding. Its main goal is to promote positive interactions between carers and their infants. The program is run as a joint venture between public institutions and the private sector. The focus is on training Primary Health Care Professionals, as well as community volunteers to assist mothers, especially those who are at high risk of abusing their infants, in effective parenting skills. Carers are assisted with skills and knowledge in child development, nurturing, loving, protecting, nutrition, health, proper hygiene, stimulating, and generally meeting the basic needs of the child. 

It is hoped that by introducing this program, the rate of abuse of children by their own carers will decrease. Children who have been adequately nurtured are themselves unlikely to become perpetrators of violence. Trained Primary Health Care Professionals will be able to identify and intervene with mothers or carers who are at risk of abusing their infants. The same is expected of community volunteer workers within their own communities.

Violence Prevention in Schools
The second leg of violence prevention in children and adolescents, is a program, which is being piloted in schools.  The school provides a site that has the potential to reach large numbers of children and adolescents as the majority of children and adolescents attend school. Health services provided in schools reach a large number of children and adolescents. Schools that promote mental health of children need to ascribe to the ideals described in the UN Convention of the Rights of the Child, that is, schools that promote peace, dignity, tolerance, freedom, equality and solidarity.

The Democratic government of South Africa has already addressed some of these problems including the high illiteracy rate. Inequities in the education system have been stopped. An integrated National Primary School Nutrition Programme was implemented in most provinces in 1994, within the first 100 days following the inception of the new democratic government. The nutritional programmes in schools are an attempt to combat malnutrition and to help meet one of the basic needs of the child. Adequate nutrition does contribute to, in addition to physical development, cognitive and intellectual performance of the child.

More schools have been built to accommodate children, some of whom were previously taught under the trees, not because of overall lack of accommodation, but because of discriminatory laws in education.

South Africa has lately experienced escalation in violence in schools. Violence takes place among teachers, teachers and students, and students themselves. The violence prevention program, which has been introduced recently as a pilot project, focuses on training teachers and students in social skills and in anger management.

CONCLUSION

The promotion of mental health of children and the prevention of mental health-related problems cannot be the responsibility of the Department of Health alone. Mental health promotion and prevention needs a multi-sectoral approach and the involvement of Non-governmental Organizations. The RDP framework seems to be the best tool to get various governmental departments to focus on addressing the mental health needs of children.  Currently there is an increase in the commitment to meet the mental health needs of children in line with the Convention on the Rights of the Child.

REFERENCES

1. ChildCare Amendment Act, 1991.

2. Children, Poverty and Disparity Reduction: Towards Fulfilling the Rights of South Africa’s Children, 1995 by The National Institute for Economic Policy (NIEP).

3. Collins, P. Y. & Susser, E. S. 1999. Epidemiological strategies to address World Mental Health Problems in Underserved Populations–A Task Force Report. Mental Health Services in the Developing World. International Journal of Mental Health. Vol. 28. No.2.

4. Dawes A. et al. (1997). Child and adolescent mental health policy. In D. Foster et al. (eds), Mental Health Policy Issues for South Africa. Cape Town: Medical Association of South Africa Multimedia Publications.

5. Department of Health. (1997). White Paper for the Transformation of the Health System in South Africa. Pretoria: Government Gazette, vol. 382, no. 17910.

6. Draft Mental Health Policy Guidelines (1997).

7. Modern Standards and Service Models: Mental Health – National Service Framework. NHS. September 1999.

8. National Programme of Action Steering Committee, (1997). Convention on the Rights of the Child. Initial Country Report: South Africa. Pretoria.

9. The Convention of the Rights of the Child, November, 1997.

10. The Constitution of the Republic of South Africa, 1996.

11. World Health Organization: Improving the psychosocial development of children—programmes for enriching their environment. 1993 Division of Mental Health World Health Organization, Geneva.