Programme on Substance Abuse
July 1993 (WHO/PSA/93.7)

A One-Way Street?
Report on Phase I of the Street Children Project

Part 8 of 9

This report is reprinted in nine parts with permission of the World Health Organization, Programme on Substance Abuse, 1993. The document is not a formal publication of the World Health Organization (WHO), and all rights are reserved by the Organization. The document may, however, be freely reviewed, abstracted, reproduced and translated in part or in whole, but not for sale nor for use in conjunction with commercial purposes.

The views expressed in documents by named authors are solely the responsibility of those authors.

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10. It is recommended that each participating organization acknowledge and respect the United Nations Convention on the Rights of the Child.

11. It is recommended that the safety of street children and workers, and ethical standards of practice be ensured and reported on in the implementation of the Street Children Project at a local level. Where implementation of the project, or any part thereof, increases such risks, implementation should be reviewed.

12. Recognizing particular cultural contexts and limitations, it is recommended that any moral biases evident in the way focus groups are conducted or in strategic plans be examined and, where possible removed.

13. It is recommended that organizations serve the needs and interests of street children and establish clearly stated policies as a basis for actions concerning drug use, HIV infection and other important health problems among street children.

--For review on project methodology and instruments--

14. It is recommended that there be a reduction in the number of questions in the menus, thus increasing flexibility for preventive interventions during focus groups. The second Geneva meeting could begin discussion on reduced lists, after suggestions before the meeting from the participating organizations and PSA. In focus groups, emphasis should be on collecting information on current context of drug use and information which assists intervention and preventive strategies.

15. It is recommended that validity checks be incorporated within the data collection instruments.

16. It is recommended that a reduction in emphasis on the collection of statistics occurs. They are useful, but should be kept to a minimum so that the main energy of the project goes into services and community development. It is reasonable if organizations have statistical/research back up to continue this task, and so are not diverted from their task. Process/action/operational research is based more on a model which collects up to date information from street children, not on large, definitive surveys, where important sub-groups requiring special attention may become overlooked. A way of validating data may be that after a focus group, one participant, selected at random be individually interviewed and the information compared.

17. It is recommended that the appropriateness of other rapid assessment methodologies for the project be investigated.

18. It is recommended that a simple data collection format be developed allowing for local data organization, analysis and interpretation. Participating organizations can use whatever method they choose to collect data (refer to guidelines for rapid assessment, etc. to ensure that data is as good as one can get), but report in a similar format. For example: the 10 drug categories of PSA levels of use of these drugs; injecting - how frequent; changes in drug use and injecting; major reasons for leaving home; and so on. A final decision may be reached at the second phase meeting, after previous circulation by PSA of suggestions from participating organizations. The format should be in a table format sent to each organization for them to fill out that is simple and quick to complete.

19. It is recommended that simple, practical guidelines for local evaluation be developed and promoted.

--Focal issues - street children--

20. It is recommended that participating organizations maximize street children participation; not just in the collection of information for a needs analysis, but also in the design of focus groups, their content, and reporting on the outcomes.

21. It is recommended that street children be involved, as appropriate, in the development of Strategic Plans, should be represented on the Community Advisory Committee, and play an active role in the evaluation process.

22. It is recommended that a holistic approach be maintained, but with a special emphasis on and strategies for targeting risk behaviours including drug use and unprotected sex. This recommendation comes from reports that indicate rates such as: greater than 20% of street children were intoxicated while having sex with opposite and same sex partners and clients (Manila, age range 8 to 19); 44% claiming having been forced to have sex, 81% not using condoms of the over 53% who reported being sexually active, 60% not knowing what safe sex is, 31% of the girls reporting having had a child and 19% having had an abortion (Rio, average age 13.9 years); and 79% of males reporting sexually transmitted diseases and 16% claiming to have at least one child (CYP, Lusaka).

23. It is recommended that special attention be given to prevention and interventions related to the use of organic inhalants. This need is considered to be urgent due to the almost universal use of such substances by street children in developing countries which are themselves dangerous. Strong links should form between the Street Children and Solvent Abuse projects of PSA.

24. It is recommended that "resilient" street children (those in difficult circumstances and yet who do not use drugs become a focus of investigation. Their stories could inform future strategies and should be collected.

25. It is recommended that interventions developed should draw on the strengths and resources of street children themselves, utilizing such approaches as self-organization by street children and self-help groups.

26. It is recommended that the potential benefits of issuing identification cards to street children involved with participating and other organizations be considered, as a possible means of enhancing access to services and as an aid if children come into contact with the authorities. Any potential risks associated with such a strategy should be determined.

27. It is recommended that more attention be given to exploring the reasons for separation from the family of origin and the impact of various issues associated with the separation. For example, age, developmental stage, specific circumstances of the separation.

28. It is recommended that attention be given to activities which strengthen families from which street children come to aid return to the family of those children willing to do so. In addition, attention needs to be given to the recruitment of host families.

--For recruitment and training of street educators--

29. It is recommended that some decisions be made as to criteria for the selection of street educators. Most projects used professionals with street education experience. There is a need to consider the use of ex-street youth, and how these may be integrated into some services due to lack of education and training. This decision needs to take into account the very sensitive and painful material that emerges during the focus groups, and the capacity of the facilitator to deal with this as it arises. Co-working (professional and ex-street child) may be the means for gaining the best of both.

30. It is recommended that strategies, resources and guidelines for the training of Street Educators be identified, developed and tested. In establishing the format and content of this training, the CYP Africa Centre Lusaka courses and those of NEPAD in Rio and GEDI in Mexico City may be useful. Consideration will also need to be given to whether such training should be in the form of a course leading to a formal qualification, or be provided as continuing education/in-service. How to assist older ex-street children with minimal education to access training is a significant issue for consideration.

31. It is recommended that educational/preventive resources which are developed to assist street children be developed locally if possible, with maximum involvement at all stages of production by the street children themselves. Any internationally produced resources should be assessed for cultural sensitivity, relevance and portrayal of biased or stereotypical images.

32. It is recommended that the second phase of the project focus on the training needs of street educators and others working with street children.

33. It is recommended that participating organizations explore opportunities for improving the safety of street educators and protecting them from harassment.



No NGOs in Rio de Janeiro were able or willing to directly participate, due to a variety of reasons which mainly related to the political situation of street children and service provision in Rio, particularly fears for the safety of staff and the children. As a consequence, Nucleo de Estudos e Pesquisas em Atencao ao Uso de Drogas (NEPAD) was approached to undertake the project and they agreed. Although NEPAD does not primarily work with street children, it provides clinical and prevention services to this population. Further to this, it was thought to be an appropriate agency to involve in the project because of its research capacity.

NEPAD is a multipurpose, multidisciplinary institution, with university affiliations, which addresses issues related to illicit and licit psychoactive substances. The institution has 4 divisions:

a) Primary prevention and training. Activities include: the development and provision of education and training courses for professionals and non-professionals in the public and private sectors; development and provision of informational resources for schools and other sectors of the community; and the provision of information on drugs to individuals and groups.

b) Clinical services. Services cover alcohol and other drugs, including: social and welfare assistance; ambulatory care service with individual, family and group therapy, with a psychotherapeutic approach; consultation service to inpatients at the university hospital; and rehabilitation/resocialization programmes.

c) Epidemiology and applied research. Activities include: epidemiological research relating to the use of psychoactive substances; data collection and analysis with regards to the clinical service of NEPAD; collaborative research with other institutions, including WHO; and the provision of information relating to current research findings, both regionally and internationally.

d) Administration and planning.

NEPAD has a multidisciplinary staff of approximately 30, including psychiatrists, psychologists, nurses, medical epidemiologists, educators, social workers, administrators and secretarial staff.


Caritas Egypt is the implementing agency. Its main office is in Cairo with another in Alexandria. Caritas International is an international NGO, originally founded 100 years ago in Italy by a group of Jesuit priests, now represented in approximately 120 countries around the world. Although non-sectarian, most staff and consultants to Caritas Egypt are from various Christian denominations. Caritas Egypt has five sectors of activity, each with a range of specific programmes or projects:

a) Help and Emergency

b) Medical and Social Rehabilitation

c) Promotion and Education

d) Economical Development

e) Sensitization Multiplication

Staff come from many disciplines, such as, medicine, nursing, psychology, social work, education, welfare and youth work. The PSA Street Children Project is managed through the Drug Control Programme of the Medical and Social Rehabilitation Sector, although the establishment of a separate programme for street children is under consideration. Volunteers from Caritas Youth were central in the implementation of the Street Children Project.


Project Alternatives, in Tegucigalpa, is the participating NGO. It is a community-based primary health care/social services programme serving street children and their families in the major market areas and central city streets of Tegucigalpa. Project Alternatives, is one of the projects sponsored by the Tulane-Honduras Collaborative Programme under the auspices of the Tulane University Medical Centre, School of Public Health and Tropical Medicine and conducted in collaboration with Honduran private, public and nongovernmental institutions. The first services were offered in mid-June 1990, and to date over 1,800 youth and 350 relatives have been enrolled in the project.

The major beneficiaries of services are: a) market vendors - in school and out of school, b) street children - drug users and non-drug users, and c) adult and sibling relatives of the above groups.

Project Alternatives offers the following services: First Aid, Primary Health Care, Health Education, Nutrition Supplementation, Recreational Activities, Non-formal Education, Youth Clubs, Sports Clubs, Psychology Casework, Special Events, Social Casework, Individual and Group Counselling, Market-based Schools for parents (mothers), and a Mobile Library.

The Project staff comprise: a physician-nurse team; 2 psychologist-social worker teams; five teams of two persons each involved in street education; two full time volunteers; and students in preventive medicine, psychology, social work and nursing of the National university.


The Technology and Social Health (TASH) Foundation, based in Bombay is the implementing agency. The Street Children Project is being piloted in Bombay and Ludhiana. TASH has been working on a range of projects for over two years, including the training of social workers and undertaking consultancies on youth health.

The aim of TASH is to study and document the impact of new technology, urbanization and development on social health. It focuses on disadvantaged groups, such as children, youth, women, the aged and the exploited. Emphasis is placed on action research, community involvement and development, and the application of new technologies within the area of social health. A particular consideration for interventions designed for street youth has been the improvement of their physical environment and earning capacity.

In Bombay the Street Children Project has been called the GUDDU (Lovely/One Who Does Good) Project. "Station Kids", that is those who spend most of their day around railway stations and who live in nearby slums (jhoppadpatti) or sleep on stations such as those on the Central (e.g. Kurla, Chembur, Govandi and Mankurd) and Western (e.g. Borivalli) Lines some distance from central Bombay and "Slum Children" (e.g. from Adarsh Nagar and Indira Nagar) became the focus.

In Ludhiana in Punjab State, the Street Children Project has been called Chun Ghar (Home of the Moon) and TASH will work in collaboration with the Department of Social Welfare of the Punjab Government.


The Mexican National Council Against Addictions (CENADIC) of the Secretary of Health supervised the project implementation. The Departamento del Distrito Federal (DDF) was the overall coordinating body, with assistance from the Fideicomiso de Apoyo para los Programas en Favor de los Ninos de la Calle, Sistema Nacional para el Desarrollo Integral de la Familia and UNICEF. A structure had been created, the Comision para el estudio de los runos callejeros (COESNICA) to design research methodologies and coordinate field investigations. The implementing NGO for the PSA project was Promotion of Social Development (PSD), whose first project, in association with UNICEF and seven NGOs working with street children, targeted street children. PSD aims to establish treatment centres, including psychotherapy, drug detoxification and rehabilitation, increase public awareness of social problems related to substance use, train street educators, and develop income generating projects.

Programa Jovenes por la Salud, a rehabilitation and treatment programme of DDF also participated.


Three groups are collaborating to implement the Street Children Project in Manila by providing moral and technical support to the implementing agencies.

a) National Council for Social Development. The main coordinating body for NGOs which provide social services in the Philippines. It is an umbrella organization for approximately 320 NGOs. The National Council for Social development selected three organizations for implementation of the Project. Families and Children for Empowerment and Development (FCED); Maryville Urban Development Foundation; and Masigla Foundation Incorporated.

b) Childhope International. Childhope, an international NGO working with street children projects in different parts of the world, was to document the project, including collation and analysis of data.

c) Dangerous Drugs Board. DBB is the highest policy making and coordinating body of the Philippines Government on all matters pertaining to drug abuse prevention and control. It is involved in policy making, training and educational activities. DBB was to translate and validate the project documents and train the street educators in the project methodology.

The three implementing agencies have outreach street education programmes:

a) Families and Children for Empowerment and Development (FCED) was established in 1984 to undertake a street children/youth and family services project in identified urban poor areas of Penafrancia, Paco and Pandacan in Metro Manila. FCED focuses on the process of community organization and development to achieve a sustainable solution to the problem. Its aim is to establish effective community structures that are initiating, implementing and evaluating community programmes and projects to meet the needs of street children and their families. FCED covers barangays with a population of 23,750 in some of the most impoverished communities in Metro Manila. The primary targets are street children aged 7 -15, and high risk youth between ages 16-19.

Activities include: Community Organization, Income Generation, Health Services, Values Clarification and Alternative Education, Child Minding Centres, Effective Parenting Education, Educational Assistance Programme, and Street Education.

b) Maryville Urban Development Foundation, established 20 years ago, has a Community Development Project in Barrio Malibay, Pasay City. Malibay, with a population of about 30,000 is one of the most depressed areas of Metro Manila, with 70% of residents below the poverty line. The Community Development Centre was established in 1974 to address the basic needs of the community. The project aims to alleviate poverty and to create opportunities for development and gainful employment.

Activities include: Education for Children and Families, Health Services, Income Generation Projects, Family and Community Non-formal Education, and a Street Children Programme, which includes a sponsorship scheme to allow access to education.

c) Masigla (Makataong Simulain Para Sa Ikagagaling ng mga Kabataan) is a foundation for street children founded in 1988 and located in Ermita, Manila. In meeting its objectives of protection, meeting basic needs, health enhancement, advocacy, education and re-integration, Masigla has established three group homes which offer shelter, surrogate parents, education, recreation, social skills training, health services, and income generation. These residential units are in the Pasay, Makati and Malate districts of Manila. Case management is by a multidisciplinary rehabilitation team, which includes social workers, a psychologist, a psychiatrist, a physician, special education teachers, art therapists, houseparents, students, and religious and civic groups of volunteers.


The Zambia Red Cross Society is the implementing agency, in collaboration with and using the Street Kids International (SKI) Drop-ln-Centre at Garden Compound and Chitukuku Primary School in Mtendere Compound.

SKI is an NGO based in Toronto, Canada. It established a drop-in-centre and outreach programme in Lusaka for street children in September 1990. The programme, funded through SKI, is administered through a partnership between SKI and the Zambia Red Cross Society. This programme provides direct service delivery to street children in Garden Compound, Lusaka. Since opening the centre, SKI has been in contact with 4,000-5,000 street children.

Zambia Red Cross Society is involved in a range of youth projects, with a focus on community development, youth participation, and youth training. Zambia Red Cross has youth groups in 53 districts throughout Zambia. These groups are involved in a range of activities, including recreation, education and vocational training. Zambia Red Cross is also actively involved in activities related to HIV and AIDS, with a "youth to youth" dialogue used as a strategy for preventive education and support.

The Commonwealth Youth Programme (CYP) Africa Centre, the regional body of the Commonwealth Secretariat focusing on youth and development and professional youth work training for Commonwealth countries in Africa indicated a desire to join in the Street Children Project and made funds available to utilize the methodology in Mtendere and Matero Compounds, Lusaka. This represents the first CYP Africa Centre project specifically targeting street children.

CYP and Zambia Red Cross are involved in the Mtendere Anti- Drugs School Project, started in 1987 with initial support from Rotary, which is a community based prevention project targeting children in grades five to seven at Chitukuko Primary School in Mtendere Compound.


Le Programme de Portage - Portage Foundation. Le Programme de Portage is a drug treatment agency, operating rehabilitation centres in the Provinces of Quebec and Ontario. It operates ambulatory, short-term, residential and mid-term residential formats. It is also involved in the rehabilitation of pregnant drug dependent persons, and women with small children. Internationally, it is involved in collaborative relationships in Italy, Portugal, Switzerland, Bermuda, the Philippines, and others.


Brazil: Dr Evelyn Eisenstein M.D., Assistant Professor of the University of the state of Rio de Janeiro (Paediatrics and Adolescent Medicine), and Dr Maria Thereza Costa de Aquino M.D., Assistant Professor of the University of the State of Rio de Janeiro (Psychiatry) and Director of Nucleo de Estudos e Pesquisas em Atencao ao Uso de Drogas (NEPAD)

Egypt: Dr Samir Nicholas Sobhi M.D., Head Department of Psychiatry, East Town General Hospital, Alexandria, member Drug Committee, CARITAS, Egypt; Mr Magdi Garas, Co-Director CARITAS Cairo

Honduras: Dr Donald C. Kaminsky M.D., Associate Professor, Tulane University School of Public Health and Tropical Medicine, and Executive Director of "Project Alternatives"

India: Dr Usha S. Nayar Ph.D., Professor and Head of the Unit for Child and Youth Research, TATA Institute of Social Sciences, and Honorary Director (Research), TASH Foundation, Bombay; Mr Ramachandran Nayar, Chairman, TASH Foundation, Bombay

Mexico: Dr Augustin Velez Barajas M.D., Psychiatrist. Deputy Director, International Matters of the National Council Against Addictions

The Philippines: Dr Cornelio Banaag M.D., Chairman of the Department of Psychiatry, University of the Philippines, and Associate Professor of Psychiatry at the University of the Philippines College of Medicine

Zambia: Mr Augustine Lesa, Street Kids International and Zambia Red Cross Society; Dr Richard Mkandawire, Director, Commonwealth Youth Programme, Africa Centre

Canada: Dr Peter Vamos, Executive Director, Le Programme de Portage, Montreal

World Health Organization Programme on Substance Abuse: Mr Hans Emblad, Director Dr Mario Argandona, Medical Officer Dr Andrew Ball, Medical Officer Ms Penny Ward, Secretary Mr John Howard, Consultant


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