First supplementary memorandum submitted
by Francesca Simms, The European Children's Trust
EXECUTIVE SUMMARY
1 (a) The HIV/AIDS pandemic amounts
to a global emergency particularly in view of 11.2 million children
orphaned by AIDS at the turn of the century, 95 per cent of whom
are in sub-Saharan Africa (see paragraph 1 of previous memorandum).
Extended family networks of relatives are an age-old safety net
for children (and adults) in need that has long proved itself
resilient to even major social change. This is unravelling rapidly
with soaring numbers of orphans.
(b) Unless traditional extended family and community
care systems are supported and developed to provide for this unprecedented
number of children needing care, there is a likelihood that these
systems will break down altogether causing a human and economic
crisis of epic proportions as the social support systems of Africa
are irreversibly destroyed (see memorandum of January 2000
particularly paragraphs 2, 3, 44 and 45). This may also be
true of developing countries in other parts of the world as they
also rely on extended family members to care for children separated
from their parents (Tolfrey 1995).
(c) The introduction of cost ineffective
and damaging systems of institutional care for children (the
introduction of which is escalating in response to the AIDS-related
orphan crisis) is perhaps the most serious threat to children's
rights in the developing world. Not only do they concentrate scarce
resources on the few who have access to this damaging form of
care, but they also undermine traditional extended family and
community care systems, thus accelerating their destruction. Public
education into the needs and rights of children and the importance
of the family in meeting these are needed to prevent people seeking
inappropriate institutional solutions to their problems.
It is also necessary to control inappropriate admissions to institutional
care. However most essential is the advancement of both developmental
and responsive preventative measures to make such care unnecessary.
2. The magnitude of the AIDS orphan crisis
is such that only if International Organisations combine in a
concerted effort to support and develop culturally appropriate
and cost-effective services to support families and communities
in caring for AIDS orphans, is there any hope of averting a disaster
of epic proportions. The irreversible destruction of these age-old
social support systems resulting in millions of unsupported children
and disabled and elderly persons, would be a global disaster in
human and economic terms. This would potentially have an irreversible
impact on these economies and halt their continued development.
THE IMPACT
OF HIV/AIDS ON
DEVELOPING COUNTRIES
THE
EFFECT OF
WORKFORCE ILLNESS
AND MORTALITY
ON THE
LIVELIHOODS AND
ECONOMIC ACTIVITY
OF DEPENDENT
HOUSEHOLDS, INCLUDING
THE ECONOMIC
CONSEQUENCES OF
THE GROWTH
IN THE
NUMBERS OF
AIDS ORPHANS.
3. (a) Children and orphans of AIDS victims
are the neediest of the needy as they grieve for dead or dying
parents and siblings. Whilst struggling to take over the parents'
roles, they are stigmatised by society through association with
HIV/AIDS, plunged into economic crisis and insecurity by their
parents' death, and struggle without services in impoverished
communities (see paragraphs 16 and 17 below). Traditionally
in Africa and other developing countries orphans are cared for
by extended families. However these families are also devastated
by the number of deaths due to AIDS, the loss of many of the generation
with maximum earning capacity who would have financially supported
them and the demands made by the soaring numbers of orphans needing
care (see paragraphs 19 and 20 of the previous memorandum).
(b) Without urgently needed resources for services
to support extended families and communities in providing this
care (see paragraphs 21-43 of the previous memorandum),
extended families will increasingly be unable to continue to care
for orphans, who will join the ever increasing numbers of children
destitute on the streets or admitted to damaging and cost ineffective
institutions. The economic consequences of not providing such
community development resources is too serious to contemplate
because of:
(i) the enormous immediate cost of institutional
care, (see paragraph 14 of the previous memorandum), and
(ii) the long-term potential human and
economic cost of the break down of the traditional extended family
and community care system resulting in millions of children, and
disabled and elderly persons needing care in institutions in the
future. This is likely to have a catastrophic permanent impact
on the future development of the economies concerned.
THE
IMPACT OF
HIV/AIDS ON THE
BUDGETS OF
DEVELOPING COUNTRY
GOVERNMENTS (INCLUDING
A CONSIDERATION
OF THE
COST OF
DRUGS AND
THERAPIES).
4. Economists at the World Bank conservatively
estimate the impact on countries with high HIV rates to be loss
of 1 per cent gross domestic product growth each year (UNICEF/UNAIDS
1999). The enormity of the impact on budgets should traditional
social support systems be irreversibly destroyed by the pressures
of the escalating AIDS orphan crisis can only be speculated. There
is an urgent need to budget to provide resources for AIDS prevention
programmes and to support extended family and communities in the
care of orphans, to prevent the far greater effect on budgets
of the failure to do so.
5. (a) The cost of institutional care is
unrealistic in the developing world and concentrates scarce resources
on the few who have access to this inappropriate and damaging
form of care. (It has been estimated that the cost of keeping
one child in even an inadequate institution could totally supported
an average family of 5.2 persons or could have assisted the families
of over 1,000 children with income-generating projects (Simms
1985, 1988, 1996).
(b) Furthermore, research suggests that it is
lack of money to finance the care of the children, not lack of
available care givers, which has led to institutionalisation (Simms
1885, 1988, 1996, Tolfrey 1995) (see paragraph 11 previous
memorandum). Institutions draw to them children who would
normally be cared for in the community and compete with traditional
systems accelerating their break down. Institutional care providing
adequate levels of substitute parenting (in UK costing approximately
£41,600 per child per year) is impossibly expensive for the
developing world. Children reared in large groups in institutions
with inadequate levels of substitute parenting, suffer psychological
damage and long-term dependency. This results in the need for
further expenditure on therapies and their permanent future care
and support, as well as that of the dependent adults they would
have supported. Furthermore deprivation cycles develop as children
damaged by inadequate institutional care are unable to meet the
psychological needs of their own children, who may also therefore
need alternative care and therapies (M Rutter & N Madge 1976).
THE
IMPACT OF
HIV/AIDS ON THE
ACHIEVEMENT OF
INTERNATIONAL DEVELOPMENT
TARGETS.
6. DFID international development targets
are directly impeded by the HIV/AIDS pandemic:
(a) Better Health for poor people.
AIDS disproportionately effects the poorest
and most disadvantaged in developing countries.
(b) Can a billion people be lifted out of
poverty?—economic growth, equity and security?
The AIDS pandemic is said to have "killed
40 years hard won progress" (Maldavo 1999). Unless adequate
resources are provided for prevention of HIV/AIDS and community
development solutions to provide good care of orphans, it is likely
to escalate fast—destroying economic growth, increasing
social differentiation and threatening social security because
of the magnitude of the resulting crisis.
(c) Poverty eradication and the empowerment
of women.
The HIV/AIDS crisis disproportionately effects
those in poorest communities, and disproportionately effects women,
and it increases social differentiation and the incidence of severe
poverty. The poorest families lose wage earners, have increased
health costs and have to shoulder the financial burden of caring
for orphans of relatives (see paragraph 19 and 20 previous
memorandum). Much of this burden falls on women and often
widows, who are therefore prevented from earning a wage. Inheritance
laws in some cases prevent widows from inheriting land, which
may be the only source of subsistence or income. Without needed
support to care for AIDS orphans, the poorest affected families
will be unable to finance their care and education and so will
possibly lose to institutions the next generation of wage earners,
who would have provided their future financial support.
(d) Human rights for poor people.
Victims of HIV/AIDS, mainly from poor communities,
and their relatives often suffer stigma, social isolation and
may be denied access to services (see paragraph 17 of previous
memorandum). AIDS throws its victims and their families into
economic crisis and severe poverty and results in larger proportions
of the population being unable to meet their basic subsistence
needs or attain their basic rights to services. The increase in
sexual abuse of young girls as a result of the HIV/AIDS pandemic
is a matter of concern, particularly as many of them will become
infected with HIV/AIDS themselves.
(e) Universal primary education.
Many children orphaned due to HIV/AIDS-related
deaths are unable to attend school for reasons of finance or stigma.
Moreover children caring for dying parents, as well taking over
responsibility for the parent's roles, may not have time for school
(see paragraphs 16 and 17 of the previous memorandum).
THE
EFFECT OF
HIV/AIDS ON THE
POLITICAL AND
SOCIAL STABILITY
BOTH WITHIN
DEVELOPING COUNTRIES
AND IN
THE REGION.
7. African extended family and community
care systems provide economic incentives to excellence in child
rearing and for centuries have provided a social structure that
has been remarkably successful in meeting needs of all members
of the community considering the difficult economic circumstances
involved (see paragraphs 5-9 of the previous memorandum).
The unprecedented pressures caused by the HIV/AIDS pandemic and
the AIDS-related orphan crisis threaten to irreversibly destroy
this social stability resulting in a global disaster in both human
and economic terms. The extent of such a crisis might also threaten
political stability both within developing countries and regionally.
This may also be true of other countries in the developing world,
since all have historically relied on extended family support
systems for children (Tolfrey 1995).
THE RESPONSE
TO THE
EFFECTS OF
HIV/AIDS ON DEVELOPING
COUNTRIES.
THE
IMPLICATIONS FOR
TRAINING BUDGETS
AND PROGRAMMES
IN BOTH
THE PUBLIC
AND PRIVATE
SECTORS.
8. Education programmes are needed to enable
prevention of HIV/AIDS, as well as to protect young girls in particular
from sexual abuse, to dissipate stigma and to increase awareness
of needs of AIDS victims, orphans and their families, including
more understanding of the psychological needs of children to enable
their normal development, and the successful evolution of traditional
systems to meet these needs. Education programmes should utilise
all channels including targeting young people in schools and the
wider public by widespread use of radio (see paragraphs 23-25
of the previous memorandum). Education and training programmes
are needed in community development approaches to meeting needs
of orphans within their families by support and development of
traditional extended family and community care systems (see
paragraphs 32-41 of the previous memorandum).
THE
RESPONSIBILITIES
OF AND
OPPORTUNITIES FOR
THE PRIVATE
SECTOR TO
ENGAGE IN
HIV/AIDS EDUCATION
AND PREVENTION.
9. (a) Community development approaches
to meeting needs of AIDS orphans within their families and communities
can be facilitated in a developing country by the private sector
by training and consultancy to a National Co-ordinating body responsible
for the development and implementation of a National Policy for
orphans and also to community organisations, traditional community
leaders, area and village committees and local volunteers. Training
should include the methods of development of policy, and community-based
resources and services to meet the needs of orphans in partnership
with the children, families, communities and traditional leaders
concerned, including analysis of which services are required,
and designing and implementing these services.
(b) Examples of successful initiatives elsewhere
could be beneficially analysed, publicised and, where appropriate,
replicated after appropriate modification. Organisations could
receive training, policy guidance, financial support or management
where needed (see paragraph 38 of the previous memorandum).
Training would include formulating, implementing and reviewing
a suitable care plan for each orphan to enable his/her needs to
be met within the family and community, by working in partnership
with the child, family and community concerned possibly using
family and community group conference methods (see paragraphs
42 and 43 of the previous memorandum.).
The human and legal rights of those living with
aids in developing countries.
10. (a) Victims of HIV/AIDS, their children
and relatives are currently suffering many abuses to their human
rights which need addressing. Onset of the illness often throws
families into severe poverty, in which their rights to adequate
sustenance and access to even the most basic services are denied
(see paragraphs 19 and 20 of the previous memorandum).
The children and orphans of AIDS victims suffer in particular
(see paragraph 17 of the previous memorandum). Victims
and their relatives also suffer abuse of human rights due to stigma
including sometimes beatings, being thrown out of their homes
or deprived of their children. Widows and orphans of AIDS victims
are often denied access to health services and school for reasons
of stigma as well as inheritance and property, (see paragraph
17 of the previous memorandum).
(b) Not only do orphans have to struggle with
their grief having cared for their parents and younger siblings
whilst they died, but they frequently have to assume the roles
of their dead parent, whilst struggling with the onset of dire
poverty, lack of availability of essential services, social isolation,
humiliation and sometimes abuse as a result of stigma. If admitted
to inadequate institutional care they suffer psychological damage
and lack of development to enable their future independence, whilst
being alienated from their extended family—their only future
"social security system".
THE
RESPONSE OF
THE INTERNATIONAL
COMMUNITY AND
IN PARTICULAR
DFID, THE UN, EU,
WORLD BANK
AND IMF TO
THE ABOVE
ISSUES.
11. (a) It is crucial that the International
Community is proactive in AIDS prevention and in meeting the AIDS
orphan crisis by community development solutions, enabling an
appropriate care plan to be implemented to meet the needs of each
orphan within the family and community. The alternative is ever
increasing numbers of orphans destitute on the streets, or collected
into damaging and expensive institutional care. This would result
in an ever-increasing cycle of millions of damaged and dependent
children and adults needing such care in the future as traditional
support systems are destroyed.
(b) The introduction of outdated and inappropriate
western policies of the institutional care of children, which
is escalating with the AIDS orphan crisis, is possibly the most
serious threat to the children's rights in the developing world.
The prevention of institutional care only becomes a priority when
the disadvantages of such care are perceived. Therefore knowledge
of child development and the likely effects of separation and
institutionalisation are essential. Public education on the needs
and rights of children and the importance of the family in meeting
these is important in dissuading parents from seeking inappropriate
institutional solutions to their problems. Peoples' organisations,
local political structures and community groups may have a particular
role to play here. Changes in legislation may be required to prevent
inappropriate admissions to institutional care. However most essential
is the development of preventative intervention strategies which
make such care unnecessary.
12. States which are signatories to the
UN Convention on the Rights of the Child have an obligation to
provide prevention services to families:
"The family . . . should be afforded
the necessary protection and assistance so that it can fully assume
its responsibilities within the community".
It is not sufficient to pay lip service to children's
rights while ignoring the plight of countless children who are
vulnerable to family breakdown.
13. Preventative intervention strategies
to meet the needs of AIDS orphans and other children in dire need
can be broadly divided into developmental and responsive. Both
are needed and there is considerable overlap between the two.
Developmental approaches address a wide range of family and community
circumstances which may ultimately lead to family breakdown. Responsive
prevention however attempts to divert children away from the need
for alternative care by responding to specific problems.
14. The most fundamental measures to support
extended families in the care of AIDS orphans and prevent institutionalisation
are those which ensure that the basic needs of children and families
are met. Poverty remains the main reason for institutionalisation
in the developing world (Tolfrey 1995). This will include developmental
solutions which attack poverty and underdevelopment and responsive
intervention such as family sponsorships or income-generating
projects specifically targeted at those extended families in danger
of breakdown resulting in their AIDS orphans needing institutional
care.
15. Prevention in its broadest sense is
not the prerogative of social welfare departments; but every government
department, as well as NGOs and intergovernmental agencies all
have responsibility for ensuring that children have the best possible
environment for their health and development. Therefore effective
prevention requires intersectoral co-operation and the support
of the DFID, the UN, EU, WORLD BANK and IMF.
16. (a) Programmes to enable AIDS orphans
to have their needs met in their families and communities must
respond to the particular needs of the children, families, and
communities concerned and empirical evidence of why children in
the particular community have needed or may need institutional
care. It is important therefore that they are developed in partnership
with those concerned and this also enable families to retain control
over their lives. It is also beneficial to develop existing community
problem solving structures rather than competing with these. The
most appropriate responsive approaches to prevention are likely
to involve the wider community in exercising responsibility for
supporting AIDS orphans and their families. In Africa, in particular,
this would be utilising and developing age old community support
systems.
(b) The use of methods which are appropriate
and affordable in the particular context are important. Approaches
which rely, for example, on paid trained social workers are unlikely
to be feasible or affordable in developing countries, particularly
where such trained social workers are in short supply and with
the logistical difficulties involved in providing for scattered
rural communities. There is usually a wealth of knowledge concerning
the needs of individual children and potential resourcefulness
in meeting these needs within a local community itself. It is
often better to focus on assisting local organisation structures
to develop such potential and to identify necessary additional
resources needed to ensure an appropriate care plan is implemented
for each orphan and child in serious need in the local community.
It is beneficial to build on peoples' strengths rather than an
exclusive focus on problems or pathology. Where possible it is
better to assist a family in becoming self sufficient such as
by assistance through income-generating projects rather than long-term
material aid. There needs to be more direct targeting of income-generating
and material aid programmes to the families most in need of these
to enable them to continue to care for children in need, particularly
AIDS orphans.
(c) The emotional needs of children devastated
by the deaths of their parents and sibling needs more recognition,
understanding and assistance. Education programmes are needed
concerning children's needs, to dissipate stigma to those associated
with AIDS and to generate more community support for victims and
their orphans. For the many children already admitted to institutions
for reasons of poverty, family tracing and reunification programmes
are urgently needed ensuring an appropriate care plan is implemented
to enable adequate care to be provided by the family. For the
relatively few children, who for some reason cannot be adequately
cared for in the extended family despite necessary assistance
being given, then the alternative of fostering within the child's
immediate community should be considered or in some cases where
appropriate, adoption, rather than institutional care. However
research suggests that the numbers of children needing such alternate
care would be few. In developing countries where children represent
ones future support system, extended family members generally
willingly provide care for children to the best of their ability,
provided they have the financial means to do so.
17. Successful projects which have developed
on a small scale in different countries deserve consideration
for replication on a larger scale elsewhere after suitable modification.
Mozambique has been successful in promoting a national policy
of non institutional care by a combination of promoting inter
departmental co-operation on this, public education concerning
the needs of children for a family, control of admissions to institutions,
development of prevention services such as provision of milk for
orphans, day care centres, family tracing programmes and most
essential the active promotion of community-based support for
children in difficult circumstances.
18. The Chief Charumbira project in Zimbabwe
(see paragraph 34 of of the previous memorandum) has also
been successful in enabling the needs of orphans to be met within
their families by developing services and care plans in partnership
with the communities concerned utilising the traditional roles
and responsibilities of chiefs and village and community leaders.
19. Another successful example is a pilot
child social welfare project in Rakai, Uganda. Tasks allocated
to social workers, and their assistants and ultimately volunteer
child advocates in their community development role in the pilot
child social welfare project were:
(i) raising awareness within communities
of the needs and rights of children, and the importance of extended
family and community care systems in meeting these and dissipating
ignorance and stigma concerning AIDS, its victims and their orphans,
by addressing meetings, liaison with local leaders and other organisations;
(ii) facilitating communities in identifying
problems concerning vulnerable children, providing advice and
arranging assistance were necessary and mediating in disputes
over property of widows and orphans;
(iii) assisting by tracing the families
of children admitted to residential care and facilitating their
resettlement where appropriate;
(iv) supporting and co-ordinating community
initiatives and work of NGOs and government departments concerned
with children and assisting in training of their staff;
(v) recruiting volunteer child advocates,
supporting and supervising them in their role to work at village
level to identify and advocate for vulnerable children and offer
information and advice.
20. By placing responsibility for the care
and protection of children within the community while at the same
time offering support to local initiatives and co-ordination,
the indications are that this project has been successful in avoiding
the unnecessary separation of children from their families and
communities, and in promoting an awareness of their needs and
rights. The use of volunteers has been an essential feature in
developing an approach which is both cost effective and appropriate
to the local situation. This project demonstrates clearly the
extraordinary capacity of local people to respond positively to
the problems of children in need despite the enormous problems
associated with poverty, the long-term effects of civil wars,
and the rapidly growing social and economic effects of HIV/AIDS.
21. The magnitude of the AIDS orphan crisis
is such that only if International Organisations combine to form
a concerted effort to develop culturally appropriate and cost
effective services to support families and communities in the
care of AIDS orphans, is there hope of averting a disaster of
epic proportions. Unless traditional extended family and community
care systems are supported and developed to meet the demands made
on them, they will crumble under the unprecedented burden. The
irreversible destruction of these age-old social support systems
resulting in millions of unsupported children and disabled and
elderly persons, would be a global disaster in human and economic
terms, and cause irreversible damage to the economies concerned.
Francesca Simms, Social Work and Child Care Consultant
The European Children's Trust
May 2000
REFERENCES
Maldavo 1999. Speech for The Third Ministerial
Meeting of The World Trade Organisation, Seattle 1999.
M Rutter & N Madge (1976) "Cycles
of Disadvantage", Heinemann, Great Britain.
F Simms 1985 "Relevance of Children's
Homes to the Basotho Culture", a report for International
Voluntary Service, Lesotho.
F Simms 1988. "An Evaluation of Children's
Institutions in the Kingdom of Lesotho and Recommendation of Alternatives",
a report for the social services department of the Government
of Lesotho.
F Simms 1996 "The Relevance of Children's
Homes to the Basotho Culture", MPhil thesis University
of Lancaster, Great Britain 1996.
D Tolfrey 1995 "Roofs and Roots. The
Care of Separated Children in the Developing World",
Save The Children Fund UK.
UNICEF/WHO 1998 "Epidemiological Fact
Sheet on HIV/AIDS and Sexually Transmitted Diseases"—Malawi,
Zambia, South Africa, Mozambique. Joint United Nations Programme
on HIV/AIDS (UNAIDS) and World Health Organisation (WHO), 1998.
UNICEF/ UNAIDS 1999 "Children Orphaned
by AIDS" United Nations Children Fund (UNICEF) and Joint
United Nations Programme on HIV/AIDS (UNAIDS) 1999.
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