14. Memorandum submitted by Tearfund
EXECUTIVE SUMMARY
Tearfund, with its Southern-based partner organisations,
welcomes this opportunity to submit a statement to the International
Development Committee.
HIV/AIDS is part of everyday life for many millions
of people in the South. HIV/AIDS is having a devastating effect
in many parts of Africa and huge populations in Asia are under
threat. The impact will continue to be felt for decades. Children
are key to a community's economic, social and family structures.
The vast majority of children feel the effects of HIV/AIDS, whether
or not they are from HIV/AIDS-affected families. Children affected
by HIV/AIDS, including those in the increasing number of child-headed
households, must be included in responses to the pandemic.
A long-term commitment from all stakeholders
is needed to provide sustainable and effective responses to HIV/AIDS
to prevent the further spread and to reduce the impact of HIV/AIDS
on children and their communities. Over twenty years of the pandemic
has shown us the need for action on all fronts, mobilising both
government and civil society to address issues of prevention and
care. Based on the experience of Tearfund and its partners, we
believe that significantly improved responses to HIV/AIDS are
possible through increased support for national governments and
local community groups in the South.
Faith-based organisations
The critical role played by faith-based organisations
(FBOs) in response to HIV/AIDS is increasingly recognised by donors.
FBOs have played a critical role among communities affected by
HIV/AIDS, particularly children, through the provision of a combination
of practical, emotional and spiritual support. Through their presence
at the grassroots, with the local experience and ability to mobilise
the church and other community groups, FBOs are critical in any
response to HIV/AIDS. In particular, they may be critical in ensuring
that policy initiatives reflect reality. DFID and other donors
should build on their existing understanding of FBOs and deepen
this in regard to the opportunities and limitations for FBOs.
DFID and other donors should seek to work with others to discern
what the most appropriate roles and processes and engagement with
FBOs might be, and to develop appropriate frameworks for their
support.
Poverty Reduction Strategy Papers
HIV/AIDS and poverty are inextricably linked.
Poor people have an increased vulnerability and suffer an even
greater impact due to the pandemic. In terms of its impact, HIV/AIDS
exacerbates poverty. Therefore no poverty reduction strategy can
ignore HIV/AIDS. Many donors, including the UK government, have
adopted Poverty Reduction Strategy Papers (PRSPs) as the framework
to channel their aid. The Poverty Reduction Strategy thus increasingly
becomes the main channel for international donor funding. It is
vital that PRSPs respond to HIV/AIDS. DFID and other donors should
support the inclusion of responses to HIV/AIDS and its impacts
on children in PRSPs.
RECOMMENDATIONS
1. Specific provisions for orphans and vulnerable
children
In many cases children orphaned and made vulnerable
by HIV/AIDS—Orphans and Vulnerable Children (OVCs) are doubly
vulnerable; a marginalised group that require increased prioritisation
of resources. DFID should make specific provisions for orphans
and vulnerable children and their caregivers in its HIV/AIDS strategy.
2. Implementation of UNGASS commitments
DFID must make time-bound, measurable and resourced
plans for the UK's implementation of its commitments to children
orphaned and made vulnerable by HIV/AIDS, including ensuring that
DFID support for national governments enables them to implement
commitments made at the United Nations General Assembly Special
Session on HIV/AIDS in 2001.
3. Long-term commitment of support to the
grassroots
In the formation and implementation of its new
HIV/AIDS strategy, DFID should work with other donors to ensure
that appropriate support and finance is made available on a long-term
basis to those working effectively at local level. In particular,
DFID and other donors currently increasing the provision of aid
through direct budget support should review the potential impact
of this approach on the vital role played by actors within communities
such as NGOs, FBOs and other local-level agencies in response
to HIV/AIDS. In doing this, DFID should take forward the recommendations
of the Global Strategic Framework for the Protection, Care
and Support of Orphans and Vulnerable Children Living in a World
with HIV/AIDS.
4. Greater understanding of FBOs responding
to HIV/AIDS
DFID and other donors should build on their
existing understanding and deepen this in regard to the opportunities
and limitations for FBOs, and of what the most appropriate roles
and processes for engagement with them might be.
5. The effective integration of HIV/AIDS
strategies into national poverty reduction plans
In the formation and implementation of its new
HIV/AIDS Strategy, DFID need to articulate clearly how their support
for direct budgetary support and PRSPs as the central mechanism
for aid fits with support and funding of response to HIV/AIDS
at the national level and the three ones model; one HIV/AIDS Strategy,
one HIV/AIDS Commission, and one way of measuring and reporting
progress[151]
6. Urgent review of PRSPs in the response
to HIV/AIDS
There should be an urgent analysis of the process
by which PRSPs are formed and their use as an aid mechanism in
the response to HIV/AIDS. This should build upon the work of the
Independent Evaluation Office of the International Monetary Fund
(IMF) and the Operations Evaluation Department of the World Bank
on PRSPs.
7. Leadership in the International Community
DFID should provide leadership in the International
Community to focus global attention and resources on OVC and their
caregivers through focus on HIV/AIDS and Africa in the UK's presidencies
of the G8 and EU in 2005. The increasing need for responses to
children affected by HIV/AIDS in South and Southeast Asia should
also be highlighted.
INTRODUCTION: HIV/AIDS
AS TEARFUND'S
PRIORITY
Tearfund is a Christian relief and development
agency working through local partners to bring help and hope to
communities in need around the world. Tearfund currently works
with more than 450 partner organisations in around 70 countries.
Tearfund has been supporting responses to HIV/AIDS by partner
organisations in Africa and elsewhere for more than 20 years.
More than 120 of Tearfund's partner organisations currently focus
on responding to HIV/AIDS, and more than a third of these have
a specific focus on children. Tearfund supported organisations
are involved in care, prevention and education.
Tearfund has identified HIV/AIDS as its highest
priority and is very encouraged that the UK government is putting
HIV/AIDS at the top of its international agenda—as announced
in the UK's Call to Action on HIV/AIDS. As the UK government sets
out priorities for its presidencies of the G8 and EU in 2005,
Tearfund welcomes the emphasis on both HIV/AIDS and Africa.
TEARFUND EXPERIENCE
OF ORPHANS
AND OTHER
CHILDREN MADE
VULNERABLE BY
HIV/AIDS IN SOUTHERN
AFRICA
— A survey of 453 children orphaned
by AIDS in four districts in Zimbabwe by a Tearfund partner found
that shelter, health, nutrition and education were all key needs
of OVCs. With limited access to every essential service, OVCs
are trapped in a perpetual cycle of poverty.
— Three quarters of children interviewed
were living in households headed by women; grandmothers headed
a third of households.
— Children expressed their felt need
for spiritual support, counselling, love and friendship from peers
and adults. In one district, 30% of the children said they would
appreciate visits, prayer and encouragement not just immediately
but even long after the death of their parents, since "grief
is not an event".
— Increased adult mortality is likely
to lead to loss of assets and skills. If coping strategies rely
on skill, experience and hope for the future, children orphaned
by HIV/AIDS have lost out in each of these area and are less likely
to recover. Access to education is a high priority.
— School meals can be an effective
response to educational, physical and emotional needs of vulnerable
children. A Tearfund partner providing free meals in government
and community schools in Zambia has demonstrated an improvement
in school attendance, enrolment and in both weight and height
of chronically malnourished children.
— Orphans in Zimbabwe consistently
expressed their desire to attend school, seeing it as an opportunity
to improve their circumstances. Children not going to school said
they experienced loneliness.
A CRITICAL ROLE:
FAITH-BASED
ORGANISATIONS IN
RESPONDING TO
CHILDREN AFFECTED
BY HIV/AIDS
— In a recent study across six countries
(Kenya, Malawi, Mozambique, Namibia, Swaziland and Uganda) Foster
(2004) identified the key role played by faith-based organisations
in supporting orphans and other children made vulnerable by HIV/AIDS.
More than 9,000 volunteers working out of 686 FBOs supported more
than 150,000 orphans and vulnerable children. This was mostly
through community-based initiatives combining elements of spiritual,
material, educational and psychosocial support[152].
— One Tearfund supported FBO has trained
1,993 volunteers through 302 churches. These churches are now
supporting over 50,000 orphans in community based care, distributing
food, providing milk for babies whose mothers have died, fostering
individual orphans, identifying cases of abuse and defending the
rights of vulnerable children, setting up a "safe house"
as an emergency shelter, identifying cases of severe malnutrition
and arranging hospital treatment.
— In a recent survey of churches in
Zambia almost half were engaged in youth education activities
and/or orphan care in their community. Church leaders identified
their main needs as training and resources; there is recognition
of the need for training to help them plan effectively to meet
the overwhelming needs they witness every day. Leaders also expressed
concern about difficulties in accessing funding from donors for
the work they are engaged in.
— One urban church community in Zambia
is supporting 20 community schools for 2,500 orphans. The church
provides teachers and free meals at school. In a rural community
of 350 households a group of nine women volunteers are caring
for OVCs, widows and bed-ridden patients. In this community out
of 1,000 school age children, 150 are orphans. Often women have
been caring for orphans for many years without any formal support.
— Evidence from Zambian churches suggests
that among adult patients receiving home-based care an equal number
of members and non-members are being cared for. Care through faith-based
organisations is not limited to membership of a specific group.
Co-ordinated local initiatives are a key response
to HIV/AIDS. A number of major donor agencies and governments
are showing increased interest in the response to HIV/AIDS by
faith-based organisations (FBOs). This is reflected in the recognition
of their importance within the Global Strategic Framework for
the Protection, Care and Support of Orphans and Other Children
Made Vulnerable by HIV/AIDS. This and other recent pronouncements
reflect a widespread acceptance that FBOs play a positive role
in development.
In the international response to HIV/AIDS there
is a clear and, to some extent, acknowledged "disconnect"
between widely accepted policies, principles and frameworks on
the one hand, and action on the other. This is true with regard
to support for FBOs. Major donor agencies and governments have
struggled with how to access and support the response to HIV/AIDS
at local level; they see provision for FBOs as a key means to
fund community-level responses. However, this intent has not always
been followed through in terms of FBOs receiving appropriate support.
In communities that are facing desperate situations
as a result of HIV and AIDS and where most people have some kind
of spiritual belief, the input of FBOs is critical. This has been
found to be especially true of Christian organisations in Africa
and Asia, and Buddhists in parts of Southeast Asia. Households
affected by AIDS-related sickness and bereavement, or with orphans
and vulnerable children, value the combination of practical, emotional
and spiritual support. The activities of an FBO may provide a
means to bring affected people together when otherwise they would
be isolated. Beyond the local level, FBOs play an important role
in coordinating and representing the responses of sub-national
and national faith communities, such as evangelical alliances,
dioceses and the national Anglican Church in a country. Such bodies
may make an invaluable contribution to assessing the efficacy
of policy decisions as they draw upon the realities faced by their
local-level associates.
Foster concluded that: "FBOs are among
the most viable institutions at both local and national levels
and have developed experience in addressing the multi-dimensional
impact of AIDS and its particular impact on children. Yet most
faith-based responses are small scale and remain undocumented.
It is difficult to measure their cumulative impact compared to
the more visible project responses of development agencies. Consequently,
FBO HIV/AIDS activities remain under-supported."[153]
So, FBOs play a critical role in providing support to those affected
by AIDS. However, in reality, the real strength of FBOs—their
connectiveness to local issues—means that they receive little
or no external technical or financial support and of necessity
rely on their own skills and material resources. This is not sustainable.
To maintain and expand this role, and share it for adaptation
elsewhere, they need to be given practical resources and support
for a strengthened organisational capacity. There is a great need
for partnerships between FBOs and other organisations; in order
to ensure that groups operating at local levels receive resources,
maximise the impact of these resources and are effectively supported
in their responses, ideally through national governments. DFID
and other donors should seek to work with other stakeholders,
including Southern governments, to discern what the most appropriate
roles and processes and engagement with FBOs might be, and to
develop appropriate frameworks for their support.
PRSPS AND
THE RESPONSE
TO HIV/AIDS AND
CHILDREN
— DFID's response to the IDC Report
on the Southern Africa Crisis emphasised the importance of channelling
assistance through governments and commitments made in the PRSP.
— HIV/AIDS is identified as a "cross-cutting"
issue in the Malawi PRSP. Of the total amount allocated to all
cross cutting issues (HIV/AIDS, gender, environmental sustainability
and science and technology) in the first six months the government
spent less than 0.1% of what the PRSP considered appropriate.
This suggests HIV/AIDS work in Malawi is under-resourced and under-prioritised
by government.
— The Malawi PRSP identifies faith-based
agencies and NGOs as those who have key responsibility for care
and education messages in a response to HIV/AIDS.
It is vital that Poverty Reduction Strategy
Papers (PRSPs) respond to HIV/AIDS. All PRSPs in countries increasingly
and devastatingly affected by HIV/AIDS need to include the issue
as a cross-cutting theme recognising the impact of HIV/AIDS across
all areas of development. National governments need to be better
supported to enable them to implement the PRSP. For this, donor
funding to countries affected by HIV/AIDS must include capacity
building of the national government and its systems for delivering
services.
The World Bank acknowledges that many PRSPs
at present do not include reference to the impact of HIV/AIDS
and children. In late 2003 UNICEF and the World Bank together
analysed 19 PRSPs developed in Sub Saharan Africa countries for
mention of measures to address the needs of children affected
by HIV/AIDS. From preliminary analysis it appears that response
to orphans and vulnerable children have received the least attention
in terms of budget within PRSPs for responses to HIV/AIDS. Despite
increasing recognition of its negative impact on children and
communities and their development, HIV/AIDS is only one of a number
of problems that countries will seek to address in their PRSPs,
and often the capacity of the government to respond is low. DFID
and others recognise that the rise in HIV infections has also
led to a decline in the ability of governments to deliver basic
services.
Although donors are recognising the value of
FBOs in the response to HIV/AIDS, trends in donor funding may
lead to reduced funding. Increasingly, donors are moving from
sectoral approaches to providing funding through direct budget
support to selected national governments with the sectoral spend
determined by the national Poverty Reduction Strategy Paper (PRSP).
DFID projects that, by 2006, 70% of its development assistance
to Africa will be via this mechanism. This may lead to a reduction
in direct funding to non-governmental agencies. It also means
that unless the PRSP prioritises HIV/AIDS and acknowledges the
role that FBOs play, FBOs may be overlooked in receiving a share
of funds originating from direct budget support.
DFID's approach to engagement with African governments
increasingly through direct budgetary support appears to be problematic
in terms of supporting and funding a national response to HIV/AIDS.
This is because there does not appear to be full integration between
direct budgetary support as a mechanism and funding for HIV/AIDS
responses.
Tearfund partners have expressed the need for
more information about the mechanisms and requirements in order
to access funding from the National Aids Commission, supported
by DFID. While recognising the importance of coherence in funding,
is DFID satisfied that resources being made available through
the National Aids Commission are sufficiently accessible to grass
roots agencies? In addition, DFID's CAP strategy for Malawi states
that DFID will "promote an effective, multi-sectoral approach
to HIV/AIDS in Malawi covering prevention, care and impact mitigation".
It is not clear how and where DFID sees FBOs fittingin to this
multi-sectoral approach.
TEARFUND RESEARCH
PLANS
Tearfund, with its Southern-based partners,
proposes two major pieces of research in 2004 that will reflect
on the current experience and learning of partner organisations
in responding to HIV/AIDS through their projects and programmes.
The first will seek to develop an appropriate framework for how
donors might fund and support FBOs and other community-based organisations
responding to children affected by HIV/AIDS. The second piece
of research will seek to further analyse the response to HIV/AIDS
through PRSPs and associated processes reflecting on the current
experience and learning of partner organisations through their
projects and programmes with children and communities affected
by HIV/AIDS in a number of countries.
March 2004
151 DFID (2003) UK's Call for Action on HIV/AIDS,
December 2003. Back
152
Foster, G (2004) Study of the response by faith-based organisations
to orphans and vulnerable children, UNICEF and World Conference
of Religions for peace, January 2004, page 2. Back
153
Foster, G (2004) Study of the response by faith-based organisations
to orphans and vulnerable children, UNICEF and World Conference
of Religions for peace, January 2004, page 4. Back
| 
