Select Committee on International Development Minutes of Evidence

First supplementary memorandum submitted by Francesca Simms, The European Children's Trust


  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.



  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.


  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).


  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).


  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).



  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).


  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".


  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


  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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