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My hon. Friend the Member for Northampton, North will be interested in the fact that this country has been at the forefront in the support of orphans and vulnerable children for a long time. We set a spending target of £150 million for the years 2005-08, but actually spent £180 million. More than 30 countries have developed
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national action plans for orphans and vulnerable children. Considerable donor funding has been committed, including significant funding from the UK and the United States. The challenge now is to integrate the needs of children affected by AIDS within wider national polices and budgets to ensure long-term domestic funding that reaches vulnerable children.

Ms Keeble: I have asked at various times about tracking the £150 million, but an answer has never been forthcoming. Can the Minister give a breakdown of how the £180 million was spent—in which countries and in which years? That would be very helpful, but perhaps he could write to me if the answer is not in his speech.

Mr. Lewis: I am grateful to my hon. Friend for that detailed question. I assure her that the answer will be forthcoming, but it is likely to be in writing. I will ensure that she is provided with some detail following the debate.

We seek to achieve progress through our support for country-led programmes that reach the most vulnerable children, and through our work to ensure a robust evidence base to guide global actions and effective global leadership. At country level, we will ensure that children are reflected in health, education and social protection plans. The strategy commits us to spending £200 million on social protection programmes, and to working in at least eight African countries to develop social protection policies and programmes that provide effective, predictable support for the most vulnerable households.

We are focusing on the most affected countries: Zimbabwe, Kenya, Zambia, Malawi, South Africa, Angola, Botswana, Ghana and Rwanda. There has been a major focus in Parliament on the tragedy in Zimbabwe, but there may now be a glimmer of hope with the new Government. We still want to focus on the need for major reform in that country and progress on the economy and human rights, but there is a glimmer of hope.

Funding must reach the most vulnerable communities and children. For example, in Swaziland, the Department for International Development supports through UNICEF 665 neighbourhood care points, which support more than 35,000 vulnerable children living in the community. In Zimbabwe, we have supported more than 200,000 children through a multi-donor programme of support implemented through more than 100 community-based organisations.

We are ensuring that increased spending is supported by good evidence. We have provided funding to the Joint Learning Initiative on Children and HIV/AIDS, and the Inter-Agency Task Team on Children and AIDS, to inform global actions. This work has informed our response on social protection for AIDS-affected households and children. Social protection, including cash transfers, has been shown to be effective in reaching and strengthening families affected by HIV and AIDS. Social protection can vastly increase the number of AIDS-affected households getting predictable assistance. It helps keep families together and protects both children and their vulnerable carers. That is why, in Malawi, DFID is supporting social protection policy development and the design of a national programme and social protection legal framework. DFID is also strengthening
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the department responsible for poverty and social protection, which is specifically delivering services in that country to vulnerable children.

We need an effective multilateral response and global co-ordination. Our support for UNICEF is crucial in that respect. In 2004, DFID supported the development and implementation of UNICEF’s framework for the protection, care and support of orphans and vulnerable children living in a world with HIV and AIDS, which sets out a global action plan specifically for orphans and vulnerable children. We are providing £5 million to UNICEF’s Unite for Children, Unite Against AIDS campaign. The biennial global partners forum on children affected by AIDS, which was held in Dublin in October last year, presented the most up-to-date evidence available on how best to meet the needs of orphans and vulnerable children. Based on the information presented at that forum, we are convinced that our policies and programmes are strongly supported by current evidence and emerging global best practice. Over the next seven years, we will continue to measure the impact of our programmes and policies on the lives of the most vulnerable children, and to ensure that global policies for children affected by AIDS continue to be informed by lessons and best practice from DFID-funded programmes and elsewhere at country level.

We accept that the situation remains critical. We believe that all the world’s children, wherever they live, deserve access to the services they need, and that we have a moral responsibility to do whatever we can to bring that about. I welcome Parliament’s devoting such a significant chunk of time to this debate today, which will not only enable us to reiterate our collective commitment to the fight against AIDS, but will shine a light on this issue in an effort to ensure that the world does not take its eye off an incredibly important goal for the future of the poorest people in the world.

3.2 pm

Ms Sally Keeble (Northampton, North) (Lab): I am sorry that I have to leave after speaking, as I mentioned in my note to you, Sir Nicholas. I have a long-standing meeting with somebody that I have already had to rearrange once.

I welcome this debate. The United Kingdom Government play an important role in international development. I welcome the fact that the needs of HIV/AIDS orphans have been recognised. However, it is important to be hard-headed in looking at what is happening to the HIV/AIDS orphans on the ground. Since 2004, I have made that the one bit of international development work that I still deal with, so that I can focus some attention on it. I set up a charity to focus specifically on work with HIV/AIDS orphans. I have to say that, although I fully recognise the UK Government’s input, the reality for a lot of orphans is dire and the numbers are increasing. In that sense, the position is getting very much worse.

It is important, when looking at what the solutions might be, to recognise the severity of the problems facing those children. It is also important to recognise that the solutions are not just in the area of health policy or development policy, but are to do with children’s policy. Those children’s needs are as complex and varied as those of children anywhere in the world. If we are
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going to make it possible for those children to take their place in the adult world in future, we have to ensure that we meet all their needs, not just their health needs—and not just through a development prism.

I want to deal specifically with the needs of the HIV orphans in sub-Saharan Africa, because I have looked at that area in particular. The countries that I have looked closely at, although I am familiar with others, are Zimbabwe, Kenya and Tanzania. I am aware of South Africa, but that is obviously in a slightly different category.

We must recognise that there has always been a problem in relation to orphans in Africa. But it is about working out why the pressures of HIV/AIDS make so much difference. The figures for Kenya show that between 1985 and 2008 the total number of orphans increased from 1,251,878 to 1,852,139. Hon. Members might think that, although that is a substantial increase of over 30 per cent., it is not out of control. But I shall break those figures down and just look at the dual-orphaned, not just at maternal or paternal orphans. The number of AIDS orphans has increased from zero in 1985 to just over 326,000 in 2008 and the number of non-AIDS orphans has decreased dramatically, from just over 240,000 to almost 95,000. So there has been a complete cross-over in children’s well-being, in terms of having parents. As we all know from our experience in this country, it is best for a child to have two parents—preferably a mother, I hasten to say, as all colleagues in the Chamber are male. Certainly, the parents are the prime advocates for the child and they are the child’s main defence against all life’s disasters. In normal times, if it had not been for HIV/AIDS, through the falling off of the number of orphans we would have seen real improvements in the well-being of children in Kenya. Instead, there is more vulnerability, because of the impact of HIV/AIDS on the parents.

Parents’ illness is also an issue. The figures for Kenya are just for children who are orphans, but there are, in addition, children who look after sick parents for a long time and, in the process, suffer from poverty and from staying out of school and from all the other things that affect children with a sick parent. I met one little girl in Kenya whose mother, a lone parent, had brought her into an emergency shelter before dying. The little girl, who had been looking after her mother, was stick thin—she was skin and bones—in a country that should at least be able to feed its children. She had not been to school and had no proper clothes. So, although she had a parent and was not a complete orphan until her mother’s death, her chances in life were massively compromised by her mother’s poor health. Ironically, in purely material terms she was probably better off in the emergency centre than she had been while her mother was alive, because at least she got food and medicine and had a secure roof over her head at night.

Looking at the numbers, we have to accept that the position is, perhaps, more complex than the simple headline figures sometimes warrant, scandalous as the overall number of orphans is. Enormous improvements have been made in the treatment of adults. That is visible in sub-Saharan Africa, where the levels of illness and the obvious signs of HIV/AIDS are not as they were some years ago. None the less, the numbers of orphans continue to increase.


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This morning I spoke to a person in Tanzania who runs a big centre for HIV/AIDS care and supports a lot of orphans in the community. It supports a network of children living in foster homes or with parents who are ill. The person I spoke to told me of the dramatic increase that the centre had seen in the number of orphans, which had risen from 5,000 to 7,000 in one year. By this September—just a few months from now—staff expect to be supporting 9,000 orphans. The orphanage is a big organisation, which is run by a British person, but it does not get a penny piece from the UK Government. All its funding comes from the US—it has never been able to access UK funding. There are therefore some real issues about ensuring that people know how, when and where to access UK funding.

We also need to look at the complexity of children’s needs. My hon. Friend the Minister was right to spell out the work that has gone into supporting health systems, and he was right about the need to ensure that money was well spent and sustainable. He also mentioned the very real problems of paediatric formulae, and the hon. Member for Cotswold (Mr. Clifton-Brown) noted the particular problem of requiring a range of such formulae to provide proper care for children. As he said, such things are not always particularly commercially attractive to companies, so we need to give some real thought to how we can tackle the issue. My hon. Friend also noted the problems involved in ensuring that women do not pass the virus on to their children. Baragwanath hospital, in Soweto, has a sophisticated health care system, but things are quite different when women are giving birth in the slums. That is one of the real challenges that we need to tackle.

In addition to such obvious health system issues, a range of other issues affect children, although I will deal with only some of them, because I would be here all afternoon otherwise. One major issue is children’s rights. For example, where both parents die, the children may be left in a hut, and the relatives may come for the hut. In one case that I saw, the hut was starting to break down and there was no repair system in place. In another instance, the husband had died, the mother was nearly dead, the granny was looking after the children and some rustlers came and stole the cattle. There are therefore real issues about children’s property rights.

There is also an issue about children having all their certification. As my hon. Friend will know, cash transfer payments often depend on the children’s having birth certificates. Non-governmental organisations have done some interesting work to ensure that children have the certification that they need to get support and cash transfer payments. Those are all important issues.

Another important issue is children’s psychosocial needs. Compared with setting up hospitals and providing medicines, meeting children’s psychosocial needs may seem like a secondary issue. As we all know from our experience in the UK, however, it is important to equip children for adulthood and to ensure that they can function as adults and do not carry too much excess baggage of grief from their childhood. I saw some interesting work by faith-based organisations in Zimbabwe, which got children to do memory books about their families and to keep pictures of them. As the children passed from being eight or nine-year-olds into adulthood,
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they had something to hold on to from happier days when their parents were around, and they could deal with their grief.

The importance of that was brought home to me most as a result of a meeting that I had with a little girl. I will talk about her a bit more at the end. I had previously met her and her family and I had taken a picture of them all to use in things such as leaflets. The following year, I found out that her mother had died, the baby had died, one daughter had been taken away by relatives, the little boy had gone somewhere else and the little girl, who was very ill, had ended up in a shelter. When I met her, I happened still to have the picture of her with her family so I gave it to her. By the end of the day, I had to get a second copy because she had run around with it and worn it out completely. She had nothing to remember her family by except for that picture. That really brought it home to me that we have to meet the psychosocial needs of orphans—whether in Africa or the UK. It is not about giving a child a pill but about putting proper care provisions in place so that the child can grow and develop.

Obviously, changes have taken place over time, and the biggest change that I have seen relates to food. We could transform the lives of quite a lot of children if, after dealing with the health care system, we found money to feed them. There is not much in the way of food in the store cupboards of many of the projects that support children. There are real issues about who does and does not get access to World Food Programme food and what type of food they get. One of the main things that projects that support orphans do is feed them, but those which feed small babies have no infant formula. There are all kinds of debates about infant formula, but it is not very clever to give a little baby powdered skimmed milk. It should not be beyond the wit of some of us to sort out the provision of something appropriately nutritious for babies whose mothers have died or cannot feed them, perhaps for nutritional reasons. We should be able to do something where babies have no one else to breastfeed them and need better quality food, and it is about the number of calories.

One of the things that most struck me the last time I went to the orphanage outside Nairobi was that food had become chronically expensive. For example, the amount of rice that the children were eating had fallen because it was too expensive, so the variety and quality of their diets had been severely curtailed. Similarly, the amount of meat that they were eating was going down. The orphanage spent about £2.10 a week on food per child, and that met only their basic needs. Again, that is in a country that should have a plentiful supply of food.

There are also issues of governance. I know that my hon. Friend the Minister is very concerned about governance, and the Government are doing a great deal of work on it with developing country Governments. However, there are issues relating to services for children in those countries, just as there are problems with such services in this country. The departments that deal with children tend not to be very important in the bureaucratic hierarchy, so they cannot get much done. Often, those who deal with these issues are in a sub-section of a department that is tucked away somewhere at the bottom of the heap. There is a real need to ensure that departments that provide services for children can deliver.


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Let me give a simple example. DFID has bought a large number of malaria nets, which are supposed to be supplied free to young children in malarial areas. The orphanage that I mentioned earlier is in a malarial area just outside Nairobi. The couriers responsible for delivering our malaria nets took them to the district commissioner’s office. However, no malaria nets reached the orphanage—I was told that they had simply ended up in the local market. It is completely wrong that malaria nets paid for by British taxpayers and intended for orphans should not be delivered to orphanages. If there had been strong advocacy from children’s services departments to make sure that the malaria nets did not go off into the general distribution but went to the identified centres where the children were living, perhaps those children would have got the malaria nets that could save their lives. Big issues arise from that incident, as they do in relation to other areas of children’s services. If the right kind of attention were given to children’s services there would also be more training for social workers. A professor in Nairobi is trying to get that issue raised, and to obtain recognition of the need for more trained social workers to make sure that children’s services are delivered properly. I hope that my hon. Friend the Minister will be sympathetic to the idea of supporting that work.

My hon. Friend did not speak about the cash transfers that were being considered to replace the £150 million that was earmarked over three years. There have been experiments with cash transfers and in some places—largely in South Africa, which has more sophisticated financial systems—they have proved quite successful. However, I hope that if the main financial support for HIV/AIDS orphans is to be given through a system of cash transfers, there will be clarity about who gets the money and what they get it for, and careful follow-up. If cash transfers are to be given to a family to look after orphans it is important that the money should subsidise the family income generally, and preferably should help the orphans, rather than that it should go to perhaps more privileged family members who do not need so much support. It is also important that if the money is supposed to go to the poorest 10 per cent. of people, as I think it is in some areas, there should be clarity about that, so that it goes to those poor people intact and to good effect.

I hope that my hon. Friend will carefully consider the very good role of some UK companies and their corporate and social responsibility policies, which have provided community support for some orphans. Business Action for Africa has done a lot of thinking in this area, and has co-ordinated the work of quite a number of companies.

Finally, perhaps I may give an account of the life of one of the children we are concerned about. It is the little girl whom I met with her mother, who was HIV-positive and a single parent. The little girl—Beatrice—had three siblings; there was an older girl, a brother and a baby called Tabitha. The baby was being spoon fed with powdered skimmed milk made up with water that was given by an NGO; her mother chose not to breastfeed because she thought she might pass on HIV to the baby. The mother was on antiretrovirals, so it was thought that it would be possible to stabilise the family, but unfortunately the mother and baby died. The older girl was of reasonable working age and was quickly taken off by family members up-country to work on a farm. The siblings lost touch with her completely. The little boy, who was thought to be HIV-positive, was put in a children’s home.


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The next time I saw Beatrice she was in an emergency shelter in Nairobi. Apart from being HIV-positive, she had tuberculosis and was very ill. Those caring for her managed to deal with the TB and get her into a reasonable physical state. They fed her up, and once she was a little recovered they got her on to antiretrovirals. The next time I saw her she was in the same children’s home as her brother. They had no bed nets or running water and not much food. She was starting to lose weight. The next time I saw her she had lost a considerable amount of weight. The next time I went there, she had been moved up-country. The organisation that had done all that work for her was virtually out of funds. My hon. Friend the Minister knows which organisation I mean, because I have spoken to him about it before. If we are going to provide support and protection for the children, it is desperately important that we support and safeguard the organisations that feed them. In four or five years of going to and fro, the state of some of those organisations has got significantly worse.

Mr. Lewis: The Secretary of State has asked me to meet my hon. Friend to talk about the work that she is doing at the moment specifically with a Kenyan non-governmental organisation, and at that meeting—in the next couple of weeks, I hope—there will be an opportunity to discuss further some of the detailed issues that she has mentioned affecting the experience of organisations on the ground.

Ms Keeble: I am grateful to my hon. Friend because my perception is that there has been progress in areas such as treatment, and where there has been economic development there have been improvements anyway. However, some of the more vulnerable members of society have been left out of that and, as always, that means children. Everyone says that children are the future and that we must look after them, but children are always at the bottom of the heap when it comes to any form of assistance. The evidence is that if they have parents, and particularly if they have mothers, they have someone to fight for them. A doctor told me that the failure of the mother predicts the failure of the child.

Once the parents have gone, the next line of defence is often the NGOs and community groups, which feed the children and provide them with counselling and personal support, clothe them and advocate for them. It is obviously important to improve the systems and do the cash transfer payments, but we should also make sure that the community-based organisations that provide so much help and support are supported in their turn, so that they can see to it that the next wave of the HIV/AIDS epidemic—that of the orphans—will be resolved, and those children will have a secure future.


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