Memorandum submitted by Francesca Simms,
The European Children's Trust
A BRIEF INTRODUCTION
TO THIS
MEMORANDUM
The European Children's Trust (formerly The
Romanian Orphanage Trust) is an international non-governmental
organisation based in London. It was formed in 1990—in the
post Ceausescu era with the aim of alleviating the plight of children
in Romania. Ceausescu's regime had left a legacy of many children
abandoned by their parents to inadequate orphanages often referred
to as "dying rooms".
Since 1990 The Romanian Orphanage Trust has
evolved into The European Children's Trust working in countries
of eastern Europe and Central Asia to help build child welfare
systems to supersede the former institutionalised systems of childcare.
The aim is for the new services to be adopted by the local authorities
in order to become truly local services. The Trust has experienced
at first hand the circumstances of children with HIV/AIDS with
inadequate care systems and how the onset of HIV/AIDS impacts
on the economic viability of families and consequently the economic
viability of a country.
The Trust's core competence is in preventing
the break-up of vulnerable families in situations of dire poverty
and extreme social hardship. Its experience is that state orphanages,
which are home for children affected by HIV/AIDS are:
— less humane than a family-based system;
— more expensive than a family-based
system; and
— more damaging in the long term in
economic and humanitarian terms than a family-based system.
While The Trust's work has been solely in eastern
Europe, the former Soviet Union and Central Asia, and while it
does not possess an in-depth knowledge of the issues in southern
Africa, it feels that it can offer the Committee points for discussion
specifically regarding the institutionalisation of children in
Africa as a reaction to the problems caused by HIV/AIDS and the
long-term economic effects of this institutionalisation. There
is potential for long-term micro- and macro-economic disruption
in southern Africa, if this emerging problem is not dealt with
now. While the social backdrop in Africa is very different from
that in eastern Europe, there are many analogies between the issues
that The European Children's Trust's faces in eastern Europe and
the issues in southern Africa.
Francesca Simms is unique in that she has worked
with The European Children's Trust and has also worked in and
written extensively on Africa. The European Children's Trust would
like the members of The International Development Committee to
benefit both from The Trust's experience and from Francesca's
knowledge and hands-on experience of the issues faced in the countries
concerned.
The mission of The European Children's Trust
is:
"to promote reformed child care systems
in central and eastern Europe to meet the need of every child
to grow up in a family." Its operating principles are:
— children have a future; orphanages
do not.
— family-based care is better than
institutional care.
— responsibility for the welfare of
children rests with national bodies using local resources.
As Francesca demonstrates in this report, these
principles may well be vital for the continued development of
the countries the Committee is due to visit.
The Trust recommends these principles as the
basis for work of a far more wide-ranging nature, which impact
on the issues that the International Development Committee is
now studying in Africa in order to ensure the future stability
in these countries.
Daniel A Casson, Strategy Development Manager
The European Children's Trust
THE NEED FOR CULTURALLY APPROPRIATE SYSTEMS
TO ASSIST ORPHANS OF AIDS VICTIMS IN AFRICA
EXECUTIVE SUMMARY
1. It is estimated that 16.3 million people
have died of AIDS since the beginning of the epidemic and the
vast majority have been in Africa where it is said to have "killed
40 years of hard won social progress" (Maldavo 1999). The
AIDS pandemic amounts to a global emergency, particularly in sub-Saharan
Africa, where it has created an orphan crisis of epic proportions
requiring nothing less than an emergency response. The turn of
the millennium has seen 11.2 million children orphaned by AIDS,
95 per cent of them in sub-Saharan Africa. Furthermore the numbers
are increasing fast and are predicted to reach more than 13 million
by the end of 2000 (UNICEF/UNAIDS 99). These children are the
neediest of the needy: not only do they struggle with their own
grief, but often face severe poverty, as well as stigma and discrimination.
It was estimated that in 1997 there were 360,000 living AIDS orphans
under the age of 15 in Zambia. 180,000 in South Africa, 150,000
in Mozambique and 270,000 in Malawi (UNAIDS/WHO 1998). For any
country to meet the needs of such an unprecedented number of children
in need of care requires careful planning and the proactive development
of culturally appropriate and cost effective strategies and services.
2. Traditional African extended family and
community care systems provide economic incentives to excellence
in child care and cost effective solutions to the care of children
in need and elderly persons, but are in need of support and further
development. The magnitude of the numbers of orphans of HIV/AIDS
victims puts immense strain on already stretched systems. Due
to a lack of support, there is a real danger that the traditional
extended family system of care will break down altogether under
the unprecedented burden—resulting in a social humanitarian
and economic crisis.
3. In the absence of adequate support to
traditional systems, institutions to care for children in need
continue to be built. These are cost ineffective, concentrating
scarce resources on the few who have access to them; they are
psychologically damaging and alienate children from extended family
support systems, creating the future dependency of both the children
and the elderly relatives for whom they would have been responsible.
Furthermore it is argued that by competing with traditional systems,
there is a danger that these will be destroyed.
4. It is recommended that proactive support
and development of traditional extended family and community care
systems, in partnership with traditional leaders, local communities,
families and children, is urgently required to enable the development
of appropriate community-based resources as well as beneficial,
cost effective and culturally appropriate individual care plans
for AIDS orphans. Formulation of National Policy for orphans is
recommended and a coalition to work towards these aims. Education
programmes are required to promote prevention of AIDS, dissipate
stigma and raise awareness of needs. To enable family-based care
and protect the rights of AIDS orphans requires prevention of
social differentiation and poverty and reallocation of resources
to meet the fundamental needs of children. This will require individual
care plans enabling access to income generating projects, employment
or material aid, psychosocial and systemic support, education,
community-based resources, and resources to trace families of
lost or abandoned children. Such action is urgently required to
prevent the destruction of traditional social care systems resulting
in millions of destitute children and elderly persons requiring
care at a cost quite out of the question for a developing country.
AFRICAN CHILD
REARING AND
SOCIAL SUPPORT
SYSTEMS
5. Although there are variations in different
cultures and countries within southern Africa, the extended family
system of care predominates and has been observed by a number
of researchers to appear to minimise destitution amongst all members
of society and ensure that children are cared for within the extended
family (Gay 1980, Murray 1981, Barker 1973, Poulter 1976).
6. For example, in the child care system
of the Basotho of South Africa and Lesotho, it is fundamental
to the system that children are not the property and responsibility
of their parents, but belong to the whole extended family of one
lineage and are the responsibility of the whole extended family
of both lineage's (Poulter 1976, Gay 1980). The extended family's
responsibility is stressed in Sesotho ethical code (Matsela 1979)
and is obligatory according to Sesotho Customary Law, as are children's
reciprocal obligations to any relative who has contributed in
any way towards his care or education (Poulter 1976). The reciprocal
obligations of children in terms of a corresponding share of future
wage support, care or the bride wealth paid on a girl's marriage
to those who have reared her, are sufficiently valuable and essential
to survival in old age, that all family members frequently compete
to have a share in the care and education of a child. It is very
rare for a child to lack willing care givers in Basotho society.
Furthermore it is in the interest of all relatives
that each child has the best possible care, education and ethical
rearing so that they develop into wise, caring, employable and
marriageable adults, well able to fulfil their reciprocal obligations
and to care for their relatives in return. The system therefore
provides economic incentives to excellence in child rearing as
family members cooperate to provide the best possible care and
education for each child. Babies grow up with a close relationship
with their primary care giver, usually their mother, who carries
the baby on her back and sleeps with him/her at night. This enables
the child to have centred care and breast feeding on demand until
weaning—traditionally at about two and a half years of age.
During this time and later, the child develops other close relationships
and receives attention from "bome" (many mothers) within
the extended family.
7. The child's attachment needs therefore
are well catered for by shared care in traditional Basotho society.
Fostering of children within the extended family is very common,
and merely represents a shift of primary care giver within the
extended family care. Thus shared care provides continuity of
relationships in situations of hardship when the mother may not
be present. Grandmothers frequently foster children to enable
their parents to earn to support both the children and their grandparents.
Traditional child rearing practice is child-centred and all family
members generally participate in the indigenous education of each
child providing by example, projects, and encouragement a thorough
education in essential living and income-generating skills, child
rearing, agriculture, care of animals, ethics, philosophy, poetry,
music, pottery and art and generally also a trade. Principles
of contribution and caring for other members of the family and
wider community are strongly stressed in traditional education
and religion. Delinquency or mental health problems amongst youth
were reported to be rare before western influences exerted pressures
on these systems (Matsela 1979). Transfer of bride wealth cattle
(bohali) to a girl's family on her marriage also acts as an "insurance
policy" for the girl and her children, since in times of
hardship they are entitled to support from her relatives and the
bohali cattle are means to provide this. It has been observed
by a number of researchers that now, as throughout recorded history,
marriage without "bohali" is unthinkable for most Basotho
women, although payments are now sometimes in cash (Ashton 1967,
Poulter 1976, Gay 1980).
8. Thus by a system of responsibilities
and reciprocities which have developed over the centuries "The
extended family provides a marvellous security for those for whom
otherwise there is no security at all. The extended family is
a net wide enough to gather the child who falls from the feeble
control of neglectful parents, it receives the widow, tolerates
the batty, gives status to grannies" (Barker 1973).
9. The village chief has the ultimate responsibility
for orphans, who are normally automatically fostered in the extended
family, often by the grandmother (Gay 1980, Simms 1996). For children
in need the chief generally fulfils his role by calling an extended
family or community group conference to formulate an appropriate
care plan for the child within the extended family.
RECENT STRESSES
ON EXTENDED
FAMILY CARE
SYSTEMS
10. However, in many African Countries,
the extended family and community care system persists under enormous
strain. The influence of more individualistic philosophies from
the West, socio-economic pressures, increased geographic mobility
and urbanisation, lack of confidence in the strengths of traditional
systems and values and the introduction of western systems of
law, land allocation, religion, education and the institutional
care of children all challenge and erode the traditional systems
of care which appear to have been so successful in preventing
destitution and emotional need considering the resources available.
They are systems which, if destroyed, cannot be easily reconstructed
and the likely result is an increasing cycle of destitution, unnecessary
suffering and expense. It is frequently stated that extended family
systems of care are breaking down, and the extent of this breakdown
differs from area to area. Although the equitable distribution
of wealth in traditional Basotho society has been disrupted by
western influences creating a class of "new poor" without
the means to provide for the subsistence needs of their children,
further analysis of recent pressures on the Basotho child rearing
and social support system prior to the HIV/AIDS crisis suggests
that, the extended family system of care continues in most cases
to provide care givers for all children. The inability of some
to finance the care of their children needs to be distinguished
from the inability to provide actual care for them (Murray 1981).
11. This was supported by analysis of case
studies of Basotho children admitted to children's homes for abused,
needy or disabled children from which is was revealed that nearly
all were in fact admitted for financial reasons, either because
the family were unable to meet their subsistence needs or (in
situations of poverty) for financial advantage. In either case
the children's needs could have been more appropriately met at
far less expense whilst they benefited from living with their
own families. None lacked care givers willing and able to provide
care for them (Simms 1985, 1988). Admissions to institutional
care which could have been prevented by the provision of material
aid to the family have long been considered unethical (Short 1956).
12. Children's homes which often provide
comparatively advantaged material conditions of care and free
education, without corresponding claims on a share of the reciprocal
obligations of the child, were found to have been misunderstood
by some families, who sought admission for their children for
perceived advantages. The psychological disadvantages of the institutions
which had inadequate staffing ratios to enable substitute parenting
and normal psychological development were less visible. Traditional
extended family child rearing has evolved over the centuries to
generally provide good child centred rearing and provision for
children's attachment needs. However, unaware of research in child
care methods, they do not always recognise the merits of their
own child rearing systems, nor the damaging psychological effects
of other more materially-advantaged care. Many of the children
in institutions lost all contact with their extended family-their
only future "social security system" nor did they learn
adequate skills to survive as adults outside the institution.
Psychologically damaged they were not able to benefit much from
their education either and were likely to be permanently dependent
on the institution. Although some families requested that their
children were returned to them, this was sometimes not allowed
by the staff of the institutions and once admitted the children
were permanently institutionalised. This also resulted in the
poorest families losing their future source of care and wage support
(Simms 1985, 1988, 1996).
13. The care of children in large institutions
is an outdated western model dating from before research by the
World Health Organisation in the mid-twentieth century into attachment
theory and the psychological needs of children (Bowlby 1956).
Although some of the findings have been modified, the central
argument that "the care of children in large groups does
not meet their needs for normal psychological development"—still
holds today. "Institutional care is an insufficient and damaging
form of care that should not be imposed on developing countries"
(M Mead 1962). The introduction of such children's homes to Africa
is particularly inappropriate because they compete with and threaten
to destroy traditional extended family systems of care, the destruction
of which could result in millions of children and elderly people
requiring such care in the future.
14. However, the most persuasive argument
against the use of children's homes as a solution to children's
needs in the developing world is one of cost. The cost of keeping
one child in even a very damaging institution in Africa has been
estimated to be as much as providing total and comprehensive support
for an average family of 5.2 persons, or assisting the families
of over 1,000 children with income generating projects (Simms
1985, 1988, 1996). The cost of a children's home providing adequate
ratios of staff to children to minimise the disadvantages of this
form of care is even more expensive. In UK such homes cost approximately
£41,600 per child per year.
THE NEED
FOR SUPPORT
TO EXTENDED
FAMILIES AND
COMMUNITIES TO
ENABLE THEM
TO CONTINUE
TO CARE
FOR CHILDREN
IN DIFFICULT
CIRCUMSTANCES
15. However, without the urgent provision
of substantial alternative help to support extended families and
communities in the care of their children, particularly in view
of the magnitude of the AIDS orphan crisis, there are likely to
be soon millions of children requiring care in institutions or
living destitute on the streets. It is estimated that in Malawi
there are already 75,000 children living on the streets of Lusaka
alone and many of these are sexually exploited (UNICEF/UNAIDS
1999). Thus, although it is generally accepted in principle that
institutional care of children is not appropriate in Africa (UNICEF/UNAIDS
1999), unless proactive, planned alternative support to the extended
family is vastly increased, children's homes are likely to continue
to be built as a quick-fix solution to the problem, thereby storing
up problems in the long-term.
Case studies of children admitted to children's
homes from Basotho families prior to the AIDS epidemic found that
resources needed to prevent such admissions were the following:
income generating possibilities-employment or material aid for
families-support and assistance in enabling the development of
appropriate care plans for children within the family-community-based
rehabilitation and education facilities for disabled children-police
to trace families of lost or abandoned children-temporary foster
care for children until families were traced—education of
the community in needs of disabled children—support for
the community and extended family system of care (Simms 1985,
1988, 1996).
NEEDS OF
AIDS ORPHANS
16. The HIV/AIDS crisis brings new needs
of huge proportions. Neither words nor statistics can adequately
capture the human tragedy of children grieving for dying or dead
parents, stigmatised by society through association with HIV/AIDS,
plunged into economic crisis and insecurity by their parents death
and struggling without services and support systems in impoverished
communities. Haworth (studying the effects of AIDS on 116 Zambian
families) highlights the process that children often go through
before being orphaned. They have often had to care for one or
both parents whilst their illness progressed and often with inadequate
pain relief, knowing that they suffered from a "shameful"
disease. This resulted in trauma and stigmatisation at school.
The process can last five years as first father, then mother,
then younger siblings die, during which time they may receive
little guidance or support as the family is preoccupied with death.
They may experience a second round of losses as they move to the
care of an aunt or uncle who also become ill and die. Sudden poverty
means they cannot attend school so they are deprived of status
as well as parents. Often adolescent girls become unpaid servants
and there is added danger of sexual harassment. Children often
find themselves taking on the role of mother or father or both
as their parents die—doing household chores, looking after
siblings, farming and caring for dying or ill parents. Children
who live through their parent's pain and illness frequently suffer
from depression, stress and anxiety. Many children lose everything
that once offered them comfort, security and hope for the future.
17. There is considerable evidence that
children separated from their parents are placed at increased
risk (Pringle et al 1966, Rutter and Madge 1976, Wolkinde and
Rutter 1985) and that unresolved childhood bereavement results
in higher incidence of mental ill health (Simms 1983). Children
who have suffered multiple losses are more vulnerable. Some African
cultures have well developed informal customs to provide support
in bereavement (Simms 1986). However, stigma may prevent AIDS
orphans from benefiting from such support. Orphans run greater
risks of being malnourished and stunted than children who have
parents to look after them. They also may be the first to be denied
education when extended families cannot afford to educate all
the children of the household. A study in Zambia showed 32 per
cent of orphans in urban areas were not enrolled for school as
compared to 25 per cent of non orphans. Increasingly children
whose parents are dead accumulate ever greater burdens of responsibility
as heads of households when a grandparent or other care giver
dies. They suffer social isolation due to stigma and irrational
fear—they are often denied access to school or health services
as well as inheritance and property. Often emotionally vulnerable
and financially desperate orphaned children are more likely to
be sexually abused and forced into exploitive situations such
as prostitution as a means of survival. As a result they are at
risk of being infected with HIV themselves.
POSITIVE CLIMATES
FOR AIDS
ORPHANS TO
FACILITATE COPING
18. Gabarino et al (1992) found that a child's
resilience is better after about 11 and children under three are
most vulnerable. The following factors can create an environment
conducive to coping:
a consistent supportive positive relationship
with a primary care giver, and as well as a primary care giver,
additional care givers within the extended family. These care
givers should model resilience by reassurance and encouragement
and helping children to process stress. Community social networks
are important and ideology such as a religious belief contributes
to resilience as does a supportive educational environment.
EFFECTS OF
AIDS ON FAMILIES,
COMMUNITIES AND
THE ECONOMY
19. The families and communities who provide
these needed supports are also devastated by the magnitude of
deaths from AIDS. The extended family networks of aunts, uncles,
cousins, and grandparents, are an age old safety net for children
in need that has long proved itself resilient to even major social
changes. This is unravelling rapidly with soaring numbers of orphans
in affected areas. Capacity and resources are stretched to breaking
point, and those providing care already are impoverished, often
elderly, and might themselves have depended financially and physically
on the support of the very son or daughter that has died.
20. AIDS also weakens the infrastructures.
As those dying are usually in their most productive years, many
schools, hospitals, private industries and civil services are
short staffed due to HIV/AIDS. National Budgets are stretched.
By 2005 health sector costs for treatment and care of HIV/AIDS
victims are likely to be one third of total Government Health
spending costs. In the private sector AIDS-related costs are expected
to amount to one fifth of profits and the World Bank estimated
the losses one per cent gross domestic product growth a year.
For families caring for someone with the disease resources quickly
evaporate. Studies on the Ivory Coast, for example, show that
when a family member has AIDS, average income falls by 52 to 67
per cent whilst expenditures on health care quadruple, (UNICEF/UNAIDS
1999). Such families urgently require assistance to create funds
necessary for them to continue to provide the care that orphans
need.
RECOMMENDATIONS FOR
DEVELOPMENTS REQUIRED
TO MEET
THE CHALLENGE
OF THE
ORPHANS CRISIS
Government Strategies to Protect AIDS Orphans
Policies to Protect Rights of AIDS Orphans
21. AIDS orphans are the most vulnerable
of children because of the stigma they suffer in addition to all
their other disadvantages. Governments need to actively pursue
policies which ensure that the rights of such children are protected.
This involves transferring resources, and developing services
and systems for AIDS programmes and to support extended families
in caring for orphans, enabling the rights of women and children
to be fulfilled and ensuring that every child in need, and particularly
every AIDS orphan has an appropriate care plan to address these
needs.
Political Will
22. Most important in addressing the AIDS
crisis and the crisis of caring for AIDS orphans is political
will. Uganda's high level response and outspoken acknowledgement
of the crisis, remains a model to be emulated in most other hard
hit countries.
Education programmes to Promote Prevention, Dissipate
Stigma, and Raise Awareness of Needs of Victims and Orphans of
AIDS
23. Most essential are education programmes
concerning prevention, to dissipate stigma and to increase awareness
of the needs of AIDS orphans and their families. Unfortunately
some governments have been reluctant to face up to the seriousness
of the problem and communicate this to the Public. Few young people
receive the information they need about AIDS and its transmission.
In many places schools provide no reproductive health education.
A study in Kenya found that 36 per cent knew of no way they could
try to protect themselves against AIDS and 32 per cent did not
know that a healthy looking person could have HIV or AIDS. In
sub-Saharan Africa more than half of women give birth before they
are 20. In South Africa a study showed that 9.5 per cent of pregnant
girls under the age of 15 were HIV infected.
24. In this climate denial persists and
with few testing facilities UNAIDS estimates that nine tenths
of those with HIV are not aware of this. Ignorance breeds unfounded
fears and discrimination so that infected people are too ashamed
to admit this. Those who do sometimes suffer beating, being thrown
out of their homes or being deprived of their children (UNICEF/UNAIDS
1999).
25. Use of the radio, which reaches all
parts of the country, has played a key role in educating the public
about AIDS in Uganda and young people have always been a prime
focus of many of the countries' AIDS programmes. Teaching school
children more understanding and humane attitudes to victims and
orphans is beneficial.
Attention to Emotional Needs of AIDS Orphans
26. It is essential to address the emotional
needs of children devastated by their parents' death and sometimes
also by the death of younger siblings. They need support and often
individual as well as systemic family counselling. If they do
not live with their extended family to benefit from the broad
education provided in the family unit, then alternative education
programmes are needed to empower them through learning life skills.
Developments to Protect the Rights of Woman and
Children in the HIV/AIDS Crisis
Prevention of Social Differentiation and Poverty
and the Reallocation of Resources to Meet the Fundamental Needs
and Rights of Women and Children
27. AIDS disproportionately effects the
poorest and most disadvantaged in developing countries. Governments
could go a long way to meeting fundamental needs of their people
by shifting resources into basic social services such as primary
health care, nutrition, low cost water and sanitation and basic
education instead of secondary education and advanced health care.
In many African countries social differentiation is increasing
and many families are not financially able to meet even the most
basic needs of their children. For example in Zambia 80 per cent
of the country's rural population is considered to be living below
the poverty line, more than 50 per cent of children are chronically
malnourished and large numbers of families are forced to ration
food. It has been estimated the 42 per cent of all young Zambian
children have stunted growth. (UNICEF/UNAIDS 1999).
28. The front line on the war on poverty
and underdevelopment must be the struggle for economic justice
and growth. The fundamental issues of woman's rights, land reform,
disarmament, income distribution, job creation, fairer aid and
trade policies and more equitable international order remain the
fundamental detriments to children's survival, health and well
being. However, whilst that war is being waged there is a need
for a second front—giving parents in poor communities the
knowledge and financial support to protect their children against
the worst effects of poverty in their most vulnerable and vital
years of growth—so breaking the self-perpetuating cycle
of poor growth, and lowered potential by which poverty of one
generation casts its shadow on the next. Many industrialised countries
have a minimum material "safety net" in the form of
a social security system. This is not possible for most developing
countries, but a more elementary safety net in the form of minimum
food entitlements, primary health care, elementary education,
safe sanitation and clean water could be put in place now. However,
the UNICEF report recommends an even more basic and immediate
goal to provide basic protection for the world's most vulnerable
children, the cost of which is politically and financially minimal
in relation to the benefits such protection would bring. In addition
to an immunisation programme, education of children's parents
about child nutrition, breast feeding, and oral rehydration therapy,
the report recommends that children's growth is monitored and
parent's given, where necessary, the means to prevent the malnutrition
of their children. It is calculated that this would improve child
health so dramatically as to halve rates of death, disability
and malnourishment (Grant 1985).
29. Governments, nationally and internationally
must encourage a more equitable distribution of wealth and aim
to create an environment where children can realise their rights.
This includes rights to survival and development, to the highest
possible standard of health, to education and to protection from
abuse and neglect. This requires the generation of the political
will to achieve this and reallocation of resources. This would
benefit AIDS orphans as well as other children in need.
Reformation of Law
30. Many orphans are cared for by widows
(often their grandmother). Some laws are in need of reform such
as inheritance laws, which in some cases prevent widows from inheriting
their land, which may be their only source of income. Advocacy
is required for women and children who may not be aware of the
legal rights that they do have.
Resources on a Large Scale
31. Human, financial and organisational
resources are needed on a massive scale if affected countries
are to prevent the AIDS orphan crisis from overwhelming services
and breaking down millions more families and social support systems.
Support for the Extended Family System of Care
32. Developments should aim to support and
develop the traditional extended family and community care systems.
There have been many encouraging initiatives that have developed
in a number of African counties, but these are still in their
early stages and are small in comparison to the enormity of the
problem.
Care Plans for Orphans Developed in Partnership with
Children, and Families
33. Africa has a concerning history of the
development of culturally inappropriate western systems which
undermine traditional social support systems (Murray 1976, Gay
1980, Simms 1996). To ensure that the services developed are appropriate
it is important that they are developed in partnership with the
countries, communities, families and children concerned. Traditionally
problems such as the care of a particular child were solved by
family or community group conferences overseen by the village
chief. It is suggested that this may well be a model that could
beneficially be developed further. Family group conference methods
(recently introduced to UK from New Zealand) involve first the
identification of the needs of the child concerned and any resources
that may be available. Then the extended family and other relevant
people chosen by the child and family meet to formulate a care
plan to meet these needs, identifying which of available resources
are needed to implement the plan. The child chooses an advocate
to help represent his/her wishes and support the child during
the meeting. Provided that the plan adequately addresses the identified
needs it is then accepted for implementation. A plan formulated
by the family is more likely to be adhered to and succeed. Such
a model ensures partnership and may be relevant in many cases
for identifying appropriate care plans for AIDS orphans.
Community-Based Resources and Services Developed
in Partnership with Children, Families and Communities and Traditional
Leaders
34. It is also beneficial if community-based
resources, services and policies can be developed by or in partnership
with the communities concerned and if they utilise traditional
roles and responsibilities of chiefs and village or community
leaders. The Social Welfare Department of the Government of Zimbabwe
piloted such a model of community-based orphan care in Masvingo
Province in 1994. This district of 165,879 people is divided into
three areas and 94 villages and governed by traditional leaders:
Chief Charumbira, sub-chiefs and village leaders. The orphan care
programme was structured to utilise the traditional roles and
responsibilities of these leaders, who have the authority to mobilise
their people and resources in times of crises and emergency. Chief
area committees composed of the area sub-chiefs, advisors and
village leaders were established in each of the three areas. These
committees address policy and planning issues and guide village
activities. Local activities are carried out by village committees
made up of village leaders and community members. Most of the
work is done through community volunteers. Villagers now ensure
that orphans are properly fed, clothed and housed. Volunteers
even take over children's household chores so that they can attend
school. Every villager was asked to donate a small amount of money
to pay primary school fees and for food in the drought period.
Villagers also pool labour and monetary resources to develop communal
gardens and wood lots to generate income. The committees were
trained by the Child Welfare Forum and are responsible for identifying
orphans, recording information about them including needs and
ensuring that care plans are made to meet these needs where possible,
referring to appropriate agencies where necessary and, if beyond
the capabilities of the area committees to the state social services.
11,000 of the 11,514 orphans were cared for by a relative, usually
a woman, widowed and often the grandmother.
35. Zimbabwe has developed different pilot
schemes for urban areas and on commercial farms—where there
are many immigrants and extended families have been replaced by
a new structure of community. Here, if the preferred placement
of a child in the extended family is not possible, children are
placed in their sibling group with foster parents in the children's
immediate community.
36. Malawi has also been successful in recognising
early on that because communities are in the best position to
identify their own needs, they would play an important role in
addressing the AIDS crisis. One of the Government's main strategies
therefore has been to promote and support community-based programmes.
37. In the development by community organisations
(eg NGOs and churches) of community-based resources to support
the particular needs of children and families in the area, where
possible this should utilise existing traditional systems such
as those of the village chiefs as in the pilot scheme in Zimbabwe.
38. Community organisations can be assisted
in developing needed community-based resources by:
Training in methods of partnership—Organisations
can be helped to work in partnership with children, families and
communities targeted, to analyse what services are required to
meet the needs of orphans in the area, to design these services
and implement them. Where appropriate they can also be trained
in the use of family group conferences to enable individual care
plans for family-based care to be made in partnership with the
child and extended family concerned.
Identification and replication of successful
initiatives—Many examples of good initiatives have developed
on a small scale around Africa. These need to be analysed to identify
those successfully meeting needs, which then could be publicised
and replicated elsewhere, after suitable modification, if the
particular community considers it to be appropriate.
Training for Organisations—Less
experienced organisations can receive training, policy guidance,
financial support or management.
Formulation of a National Policy for Orphans
39. An important step in addressing the
crisis is the formulation of a National Policy for AIDS orphans
and a coalition of relevant people and organisations to progress
work towards these aims. This policy needs also to be formed in
partnership with traditional leaders, communities, families and
children involved. In Zambia community members have been largely
responsible for initiatives, but also a strong collaborative effort
between the Government, NGOs, community-based organisations and
churches with support from UNICEF has helped strengthen the orphan
programme. Malawi has a National Orphan Care Task Force since
1991 which established The National Orphan guidelines in 1992.
These have served as a blueprint to encourage and focus community
efforts to support orphans. From lessons learnt from these the
Government will develop a National Orphan Care Policy.
Support of Extended Families and Communities in
the Care of Orphans
40. Extended families and communities need
to be facilitated in making an appropriate care plan for every
orphan or child in need to enable them to live in their own family
by the provision of the necessary resources and support to make
this possible.
Resources to trace families of lost and abandoned
children and temporary foster care whilst this is achieved.
41. For some children, such as those who
are lost or have been abandoned, first their families need to
be traced and then it can be investigated whether there is a relative
who could care for the child if given appropriate support. Recording
next of kin by hospitals so that families of orphans can be found
is important. Also needed are resources to trace families of any
children who are abandoned, lost, or who are living on the streets,
so that rehabilitation with their families can be attempted. Short
term foster placements are needed for children whilst this is
done. Cases have been noted in Africa where healthy babies who
were cared for in hospitals after being abandoned, have become
malnourished (Simms 1985). Even in temporary alternative care,
babies, in particular, need to bond to a foster carer to minimise
psychological damage. (Bowlby 1952, Pringle 1980).
A Care Plan for Every Orphan
42. A care plan for each orphan is needed
to identify a care giver in the extended family and a support
system. The needs of the orphan and those who try to care for
him/her need to be assessed and an appropriate plan made to provide
help required to meet their needs. Each child should have a named
person who is responsible for the social work tasks of ensuring
an appropriate care plan is made, carried out and regularly reviewed
to ensure that the child's needs are met. The care plan may involve
the provision of:
(i) income generating projects, employment,
loans and material aid—the means to prevent families
with orphans living in severe poverty. This could involve employment
or income generating projects, material aid loans or assistance
in growing food.
(ii) psychosocial support—psychosocial
support to families including where required, bereavement work.
(iii) systemic support—systemic
support to families to enable them to create family dynamics which
are mutually supportive in difficulties and promote children's
mental health. Systemic support can also be used to facilitate
wider members of the community in providing a supportive environment
for orphans.
(iv) practical assistance—orphans
and their families may benefit from practical help from community
volunteers.
(v) ensuring access to education—enabling
orphans to attend school so that their future wages can break
the poverty cycle.
(vi) ensuring access to medical and health
care.
(vii) community based resources—referral
to any available community resources needed.
43. If these measures still do not enable
a suitable placement for an orphan in the extended family then
locally based foster care in the child's own community, keeping
siblings groups together for mutual support, would be the next
best alternative. Other measures that have been used include paying
a care giver to look after a family of orphans in the family home,
giving support to child-headed households and small "family
group homes"—about seven children cared for by paid
care givers in the children's immediate community. These solutions
are not ideal, but certainly preferable to care of children in
large institutions. However research suggests that when an extended
family is not able to care for children, in reality the problem
is usually the money to finance this care, not lack of an available
care giver (Murray 1980, Simms 1985, 1988, 1996). In cultures
where caring for children is the means to ensuring one's future
survival and social security, it seems unlikely that any extended
family member would not willingly care for a child, if they were
provided with the financial means to do so and other necessary
support. Employment is generally difficult to find in impoverished
areas and particularly if the alternative care considered involves
paying someone else to care for the child, paying a relative a
wage instead to do this task might well enable family based care.
However, even the provision of more limited resources to enable
the family to meet the child's needs would normally suffice. Case
studies of children who have been provided with alternative care
from their extended families in Africa prior to the HIV/AIDS crisis,
suggest that this could in every case have been prevented had
sufficient resources been made available to the family. If this
is still the case then this is more cost effective as well as
usually much more beneficial for the child (Simms 1985, 1988,
1996).
CONCLUSION
44. The AIDS orphan crisis needs to be recognised
as a global emergency and responded to as such. Resources are
urgently needed to support extended families in caring for AIDS
orphans and other children in need and to reinforce children's
rights by changing the underlying conditions of underdevelopment
and inequalities which perpetuate poverty from one generation
to the next.
45. The consequences of not developing culturally
appropriate services to support the extended family and community
care systems in caring for these children are too serious to contemplate
as the social structure of Africa crumbles resulting in enormous
suffering and destitution. This will potentially have an irreversible
impact on the development of these African economies and will
halt their continuing development.
Francesca Simms, Social Work and Child Care Consultant
The European Children's Trust
January 2000
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