ACCESS TO HEALTH CARE BY STREET CHILDREN IN THE URBAN CONTEXT OF N'DJAMÉNA, CHAD

Street children are one of the new categories of social actors resulting from the rapid urbanisation of cities of the South. Among the numerous problems they have to face daily, there are also obstacles related to disease and access to health care. This paper describes at the example of N'Djamena (Chad), their health problems as well as efforts to provide better health care through an action research approach. Rapid urbanisation in the South and the growth of economic and social disparities and contradictions within urban societies produces new actors. Among the most visible people, are marginalised groups such as the disabled, drug addicts and street children. Since 1994, the Support Centre for International Health of the Swiss Tropical Institute (STI) accompanies two associations (Association Pour la Protection des Enfants de la Rue au Tchad, APPERT; Association Amies des Drogues au Tchad, ATAD) in their efforts to prevent social exclusion and reintegrate street children. This happens through action - research activities within the project "management of deprived urban areas by their inhabitants" financed by the Swiss National Science Foundation and the Swiss Agency for Development and Cooperation (Ndiaye, 1999; Yemadji et al, 1999; Wyss, 1999) The approach of social work in an open milieu is favoured for contesting the exclusion of street children and young adults. This approach consists of contacting and accompanying the children in their natural living conditions and of developing jointly community based answers to their situation. Activities rely most importantly on the situation of boys as the exclusion of girls is more hidden, less visible and more difficult to tackle. The approach tries also to take into consideration and to encompass the whole range of problems: scolarisation, violence, nutrition, working conditions, repression, etc. but also health related aspects and access to health care.