Out of the reach of children? Young people’s health-seeking agency in Africa’s newly-emerging therapeutic landscapes
The dominant view within Western biomedicine is that children are vulnerable and in need of adult protection, while medicines are powerful, dangerous and should be controlled by experts, however, a growing literature suggests that children and adolescents (in both Western and developing-country contexts) often take active roles in health-seeking. Here, we consider young peoples health-seeking practices in Ghana: a country with a rapidly changing therapeutic landscape, characterised by the recent introduction of health insurance, mass advertising of medicines, and increased use of mobile phones. Qualitative and quantitative data are presented from eight field-sites in urban and rural Ghana, including 131 individual interviews, focus groups, plus a questionnaire survey of 1005 9-to-17-year-olds.
This paper shows that many young people take active responsibility for their own (and others) healthcare. However, there is substantial variation in health-seeking practices and associated agency; these processes are shaped by (and also shape) resources available, including economic, social, cultural, psychological, informational and locational forms of capital. Dynamic interactions between resources and health-seeking agency operate within a wider, rapidly-changing therapeutic landscape, which has opened access to a greater range of healthcare possibilities. The paper concludes by considering implications for health and wellbeing, and suggest possible interventions for facilitating young people to seek healthcare safely and effectively.
Changes in Ghanas therapeutic landscape, which mirror those taking place across the continent, are likely to increase young peoples health-seeking agency over coming years. Regulating rapidly expanding pharmaceutical markets and associated advertising is notoriously difficult, which means that children (and adults) have increasingly easy and cheap access to a range of restricted drugs, without necessarily knowing how to use them appropriately. The pragmatic question is how best to facilitate young people to seek healthcare safely and effectively.
Confidentiality and effective, non-judgmental communication are key features of adolescent-friendly services. Ensuring that existing formal health services in Ghana meet the needs of children and adolescents is an important starting point; this will involve investing resources in training and supporting staff to improve inter-generational communication skills and empathetic approaches.
With dramatic recent rises in schooling in Ghana (and elsewhere in Africa), schools offer an important forum for health education and services, and school-based health education should be extended beyond the usual health promotion messages to cover safe and appropriate use of medicines.
User-fees and health insurance also require careful reflection. Finding here indicate that health insurance, which reduces up-front costs of healthcare, might increase urban adolescents independent use of formal, accredited health services. However, many young people are not covered by insurance because their parents cannot afford the premiums. Removing user-fees for under-18s would be an important step to facilitating effective health-seeking and ability to access higher-quality services, in Ghana and elsewhere. However, as we have indicated, user-fees are not the only barrier to health-service use for young people, particularly those living in rural areas. Even with health insurance, for those without effective access to appropriate, affordable services (both formal and informal), good quality healthcare is still as out of reach as ever.