Table 3 Structural and social determinants of health inequities, human rights, and their impact on SCY’s social and health inequities

Governance

Article 4 on appropriate measures: state parties shall undertake all appropriate legislative, administrative, and other measures for the implementation of the rights recognized in the Convention.

“The government has no interest; they are being looked at as a problem. The government handles these issues with backwardness, they want to tackle them on the streets and push them home instead of solving things that are attracting them on the streets and creating more systems to prevent them from coming to the streets.”

(Stakeholder 2)

• Political inaction and poor public policies carried out by the state impact SCY’s life circumstances, socioeconomic position, and therefore social and health inequities.

• SCY and their health is not a priority in the government’s agenda, with limited resources allocated to their issues.

• Lack of political will and a disregard of responsibility of the State for the phenomenon of SCY, despite legal obligation as a CRC signatory.

Social Policy

Article 18 on parental responsibility: states are obliged to provide assistance to parents and guardians to prevent children ending up in street situations.

“At the national level we have what we call The Street Family Trust Fund, which is based in Nairobi. It’s supposed to come to the major cities and work together with us so that we can have such programs.”

(County Children’s Officer)

• Inadequate and unimplemented social welfare programs for SCY and their families leaves them without a social safety net.

• On-going structural forces place pressure on households leaving them unable to adequately provide and care for children’s needs.

Public Policy

Article 7 on birth registration and 8 on identity: states should ensure free, accessible, simple and expeditious birth registration is available to all children at all ages and street-connected children and youth should be supported to obtain legal identity documents.

“Some have reached the age of getting IDs, for one to get an ID one has to have a birth certificate and the parent’s IDs so most of these children can’t get them. Also, when they are sick, they don’t get treatment easily so the government should work on that.”

(Community Leader 3)

• SCY lacking identity have difficulties accessing education, health, other social services, justice and family reunification all of which have a long-term impact on their socioeconomic position and health and well-being.

Public Policy

Article 15 on the right to freedom of association and peaceful assembly: states should ensure that street-connected children and youths’ access to public space in which to associate is not denied in a discriminatory way.

“So, like, the county government, what it did, it was, I’ll use that term ‘making it unfriendly for them in town’ so that once you see them even police officers, enforcement officers, they are put in strategic places. So, these children, totally they will not step into the central business district (CBD).”

(Children’s Officer)

• Limiting SCY’s access to public spaces and use of police and other officers to enforce this restriction is discriminatory and contravenes to their right to associate in public places.

• Practices that limit SCY’s access impacts their social, psychological, and physical health if they are unable to associate freely in their social networks or access particular services within restricted public spaces.

Public Policy

Article 20 on the right to special protection and assistance for children deprived of a family environment (44.) types of care: states are the de facto caregiver and are obliged to ensure alternative care to a child temporarily or permanently deprived of his or her family environment. Deprivation of liberty, in detention cells or closed centres, is never a form of protection.

“Ideally, we have programs and activities that we can do, the only challenge we have is resources. The biggest challenge here is if you have to rescue them, you have to take them to a safe place, and you have to find time to engage them and find out why they are on the streets. As we speak now, we don’t have a holding facility. The rescue center is not in a position to hold all street children. The rescue center is not just for street children bit for any child that requires to be rescued because children are also abused in their families.”

(County Children’s Officer)

• Inadequate shelters, rescue centers, and alternative care environments leave SCY without protection, shelter, and other basic needs thereby impacting their health and well-being.

• The use of prison, remand homes/juvenile detention, or cells, are inappropriate alternative care environments and impacts SCY’s social, psychological and physical health and well-being.

Public Policy

Article 20 on the right to special protection and assistance for children deprived of a family environment (45.) applying a child rights approach: states should ensure that children are not forced to depend on the street for survival and that they are not forced to accept placements against their will. States should ensure that State and civil society-run shelters and facilities are safe and of good quality.

There is a case I have witnessed, he came to the streets, but the family is well off, he had no valid reason but just said he liked the streets more than his home. We took him home twice but still went back to the streets. I don’t pity him because he has parents and a home, he claimed it was due to hostility by the parents, but they denied that (Clinical Officers)

• Unsafe, inappropriate and poor-quality shelters and facilities for SCY leave them vulnerable and susceptible to an array of health compromising conditions.

• Forceful placements are psychologically and potentially physically harmful for SCY.

Public Policy

Article 37 and 40 on juvenile justice: states should ensure the use of restorative rather than punitive juvenile justice, and should support protection rather than punishment of street-connected children and youth.

“We don’t get along well with the police because when they go down there, they just want to beat up someone... They go there and beat up people; there are even those who used to rape girls in town.”

(Street-connected young woman 2)

• SCY are targeted with repressive street sweeps and are subject to police misconduct, which exposes them to physical violence, and leaves them with social and health inequities with life-long consequences.

• Physical, psychological and sexual violence perpetrated by law enforcement has a lasting impact on the physical, sexual, and psychological health of SCY.

• Criminal records may impact SCY’s life chances and have long-term consequences on their socioeconomic position thereby affecting their health.

Public Policy / Socioeconomic Position

Article 2 on non-discrimination (25.) non-discrimination on the grounds of social origin, property, birth or other status: states must respect and ensure the rights of street-connected children and youth are upheld without discrimination of any kind.

“We might be seated here and when a police officer comes, he will see us as bad people and starts chasing us and beating us,yet we have not done any wrong. You go to prison for like 6 months, won’t you leave there as a bad person.”

(FGD, street-connected young man)

• Discriminatory practices have life-long consequences on SCY’s socioeconomic position.

• Discrimination leaves SCY without adequate access to social and health services which has a direct impact on their health and well-being.

Public Policy / Socioeconomic Position

Article 2 on non-discrimination (26.) systemic discrimination: states are required to protect street-connected children and youth from direct and indirect forms of discrimination, including disproportionate policy approaches involving repressive efforts, including criminalization, street sweeps, and targeted violence.

“Two weeks ago, we rounded up street children. The community was concerned with the insecurity created by the street children. While street children do not commit all crimes, the situation overtime is problematic because of the numbers of children on the street. My job is to address issues of security. Community stakeholders told me that I should not arrest the street children as the police lack appropriate facilities, my priority is to protect the community.”

(Police Officer)

• Repressive strategies to tackle homelessness may have a direct impact on SCY’s health when they are exposed to or experience violence as a result of round ups and targeted violence by enforcement officers.

• Criminalization of street-involvement may have life-long lasting consequences on SCY’s socioeconomic position.

Socioeconomic Position

Article 28 on education: states should make adequate provision, including support to parents, caregivers and families, to ensure that street-connected children and youth can stay in school and that their right to quality education is fully protected.

“Poverty at home, maybe they don’t have food, money to access education nor materials so the child will decide to go to the streets because he will feel better in the streets by begging from people. Also, maybe the parent did not give the child right to education and the child feels he has nothing to do at home, so they go to the streets to find something to do and earn a living.”

(Religious Leader, Stakeholder)

• A lack of education impacts SCY’s long-term life circumstances and influences their ability to attain employment, and socioeconomic position; thereby impacting their health and ability to access resources to health.

• SCY whom lack knowledge and skills attained through education may have reduced health knowledge, be ill equipped to navigate health services or communicate with health providers.