title: Interrelatedness of child health, protection and well-being: an application of the SAFE model in Rwanda.
abstract: This study examines the core components of children's basic security and well-being in order to examine issues central to improving child protection in Rwanda. Sources of data included 15 focus groups with adults, 7 focus groups with children ages 10-17, and 11 key informant interviews with child protection stakeholders, including representatives from international NGOs, community-based groups, and the Rwandan Government, all of which took place in April and May of 2010. Participants painted a complex picture of threats to children's basic security in Rwanda. Three key themes were pervasive across all interviews: (1) deterioration of social and community cohesion in post-genocide Rwanda; (2) the cascading effects of poverty; and (3) the impact of caregiver illness and death on the caregiving environment. Consistent with the SAFE (Safety/freedom from harm; Access to basic physiological needs and healthcare; Family and connection to others; Education and economic security) model of child protection, participants rarely elaborated on a child protection threat independent of other basic security needs and rights. Findings suggest a need for integrated approaches to child protection that recognize this interrelatedness and extend beyond issue-specific child protection responses. This study contributes to a growing body of work highlighting the interrelated nature of child protection threats and the implications of adaptive and dangerous survival strategies that children and families engage in to meet their basic security needs. Analysis of this interrelatedness provides a roadmap for improving policies and implementing integrated and robust child protection strategies in Rwanda and other settings.
authors.affiliation: Department of Global Health and Population, François-Xavier Bagnoud Center for Health and Human Rights at the Harvard School of Public Health, 651 Huntington Ave., 7th Floor, Boston, MA 02115, USA. Theresa_betancourt@harvard.edu
authors.forename: Theresa S
authors.initials: TS
authors.lastname: Betancourt
authors.forename: Timothy P
authors.initials: TP
authors.lastname: Williams
authors.forename: Sarah E
authors.initials: SE
authors.lastname: Kellner
authors.forename: Joy
authors.initials: J
authors.lastname: Gebre-Medhin
authors.forename: Katrina
authors.initials: K
authors.lastname: Hann
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Kayiteshonga
mesh_terms: D000293:Adolescent; D000328:Adult; D017028:Caregivers; D002648:Child; D002669:Child Welfare; D054540:Child, Orphaned; D016638:Critical Illness; D017144:Focus Groups; D015658:HIV Infections / Q000150:complications / Q000523:psychology; D006708:Homicide / Q000523:psychology; D006801:Humans; D007407:Interviews as Topic; D011203:Poverty; D012432:Rwanda; D012449:Safety; D012931:Social Environment; D012940:Social Problems