Title: Advocacy elements in an Intervention on Child Poverty and Health
Member Involved: CBO, Dutch Institute for Healthcare Improvement, Netherlands
Website: http://www.cbo.nl/
Contact Name: Annemiek Dorgelo and Janine Vervoordeldonk
Context:
Armoede en gezondheid van kinderen (‘Child Poverty and Health’) is an intervention developed in 2000 by the Public Health Service in GGD West-Brabant (Netherlands’ West-Brabant region). The intervention aims to reduce health inequalities by addressing poverty as a causal factor of ill-health. Through a process of identification, referral and checking, extra financial resources are made available for specific health-promoting purposes.
The intervention begins with a routine health examination by a doctor in group 2 of primary schools (age 5-6) and a nurse in group 7 (age 10-11) of the primary schools in the cities involved (e.g. Breda and Oosterhout). Both the doctor and nurse are employed by the Preventive Child Health Care services in the region. As part of these routine health examinations they take three steps: 1) identification, 2) referral, and 3) allowance.
The first step involves filling-out a questionnaire, sent to parents along with the invitation letter to the routine examination. This questionnaire asks questions about whether the family experiences a shortage of money and about the health of the child.
During the routine health examination, the questionnaire is reviewed with the parent(s). On the basis of the questionnaire, discussion and additional information from the routine health examination, the doctor/nurse consider whether there is a risk to the health of the child related to shortage of money.
The second step is referral to the doctor or nurse of the PCH-Poverty and Health team. This takes place if the health of a child is at risk. The task of this team, in a second interview with the parent(s), is to again assess the relationship between poverty and the threat to health. Family finances are discussed and consideration is given to whether and how the health of the child is at risk. A decision is taken concerning whether the child is eligible for an allowance on the basis of this interview.
In the third step a direct allowance is made available to the family for smaller items (sports clothes, etc.) or via special needs benefit. The latter is a structural benefit given by the Dutch government when families live under a certain poverty threshold. Allowances are specific items that are made available either directly (‘direct allowance’) or via an indication for Special Needs benefit (‘indirect allowance’). Direct allowances relate to smaller items (e.g. swimming lessons, sport contributions, sport clothes, etc.). The Breda Local Authority makes a budget available for this purpose that is used directly by the A-team, without further checks by the Social Benefit Service. This speeds up the procedure. A Special Needs (Bijzondere Bijstand) indication counts as socio-medical advice to the Social Benefit Service. This gives the Local Authority a clear basis on which it can allocate a Special Needs benefit, and counteracts the under-use of Special Needs benefits.
Aims:
- Obtain insights on various dimensions of advocacy for health equity in relation to ‘Child Poverty and Health’ in the Netherlands.
- Test and validate the findings in regions of the Netherlands where such interventions have not been implemented, and in the process raise awareness about the value of such an intervention and links between poverty and child ill-health.
Research Methods:
- Document analysis of the thesis of Rots MC (2010), NJI documents (2010) and documents gathered via interviews (e.g. policy papers or project plans) on advocacy elements.
- All the documents will be analysed according to the Six Dimensions of Advocacy.
- Develop an item list and carry out interviews with relevant stakeholders (n=5):
i. Interviews with the intervention owner (n=1),
ii. Interviews with practitioners (municipal health service, youth department) and policymakers connected with the intervention (n= 4),
- All interviews are recorded and transcribed.
- Analysis of the outcomes of steps 1 and 2. Developing the basis for a questionnaire to test the findings in step 4.
- Test findings on stakeholders in regions that have not implemented a similar intervention. Questionnaires (using professional networks) and with possible follow-up telephone calls to obtain in-depth and high-quality responses (n=10).
- Write-up the results of the work in a full report.
Expected Outcome:
- Greater understanding of the advocacy messages that convince Dutch authorities to tackle health inequalities.
- Improved knowledge about how to transfer evidence (types of evidence, packaging, etc.) in the Dutch context.
- Increased knowledge of this intervention in other regions, awareness improved of links between children and poverty through the research, and resources to draw upon for future advocacy efforts.
