CHILDREN ORPHANED BY AIDS Front-line responses from eastern and southern Africa

Contents

2 Introduction

3 The crisis: Unique for the children left behind

7 Country Responses

8 Botswana

11 Malawi

15 Zambia

21 Zimbabwe

26 Conclusion

27 What can individual countries do to help affected children?

33 What can the global community do?

Front cover: Maritas Shaba, with six of the nine grandchildren she has cared for since they were orphaned by AIDS, in the compound of her household in Malawi.

Back cover: A brother and sister, who were orphaned by AIDS two years previously, in Lusaka,Zambia. 2

he AIDS pandemic is the world’s in societies already weakened by under- T most deadly undeclared war, and development, poverty and the AIDS Africa has so far borne its brunt. epidemic itself. According to projec- In 1998 in Africa, where some tions, by the end of the year 2000, a 200,000 lives were lost as a result cumulative total of 13 million children of conflict and war, AIDS killed will have lost their mother or both 2.2 million people. The disease, now parents to AIDS, and 10.4 million of the leading killer in sub-Saharan them will still be under the age of 15. Africa, has taken the lives of 16.3 And the worst is yet to come, in million people since the epidemic numbers both of deaths and children began. Most, by far, have died left behind. The lives already claimed By the end of the year in Africa. by the epidemic are just a fraction of 2000, a cumulative total of Yet as shocking as these deaths are, those that lie ahead, in sub-Saharan 13 million children – the the impact of HIV/AIDS does not end Africa and many other countries of the majority in Africa – will have with them. Because those dying from world. According to estimates by the lost their mother or both AIDS are mainly people in the prime of joint United Nations Programme on parents to AIDS. A Ugandan their lives who are often parents, a less HIV/AIDS (UNAIDS) and the World boy talks to some of his well-known and calamitous effect of Health Organization (WHO), 12.2 15 cousins, all orphaned AIDS is the vast numbers of children million women and 10.1 million men by AIDS, outside their grand- orphaned by the disease. These children were living with HIV in sub-Saharan parents’ house where endure overwhelming and largely Africa at the end of 1999, with infected they live. unmitigated losses, living as they do women actually outnumbering infect- ed men – a pattern not seen on other continents. Globally, the figure is 33.6 million people, and they are joined each year by millions of the people newly infected. In its human and social ramifica- tions, AIDS constitutes a global emergency: It is a growing threat to stability, exacerbating inequalities within and between countries, under- mining previous gains in development and harming children. As the projects described in this report make clear, stronger commitments and sustain- able efforts are urgently needed by the families, communities and children

UNICEF/96-1494/Pirozzi on the front line of this epic struggle. 3 The crisis: Unique for children left behind

either words nor statistics can An AIDS-weakened infrastructure. Nadequately capture the human The impact of the epidemic is felt tragedy of children grieving for dying throughout communities and societies, or dead parents, stigmatized by as teachers and farmers, trained health society through association with care personnel and workers from all HIV/AIDS, plunged into economic parts of the economy have died and crisis and insecurity by their parents’ continue to die in enormous numbers. death and struggling without services National budgets are strained by the or support systems in impoverished demands: By 2005, the health sector communities. The following costs for treatment, care and support characteristics make their crisis related to HIV/AIDS are expected to especially acute. account for more than a third of all government health-spending in The scale of the problem. More Ethiopia, more than half in Kenya and children have been orphaned by AIDS nearly two thirds in Zimbabwe. Why the crisis is in Africa than anywhere else. The As those dying are usually in their unique for children most productive years, many schools, deep-rooted kinship systems that exist The huge scale of in Africa, extended-family networks hospitals, private industries and civil the problem. of aunts and uncles, cousins and services are short-staffed. In the An AIDS-weakened grandparents, are an age-old social private sector, AIDS-related costs – infrastructure. safety net for such children that has including those connected to absen- long proved itself resilient even to teeism from work, insurance and The vulnerability of major social changes. This is now the recruitment and retraining of orphans. unravelling rapidly under the strain replacement workers – are estimated Grief before death of AIDS and soaring numbers of to consume as much as one fifth of all and the tragedy of orphans in the most affected coun- profits. Economists at the World Bank losing both parents. tries. Whereas before AIDS, approxi- conservatively estimate the impact on The AIDS stigma. mately 2 per cent of children in countries with high HIV rates as a developing countries were orphaned, loss of 1 per cent of gross domestic in 1997 rates in some countries were product growth each year. 7, 9 and even 11 per cent. Capacity The effects also reach deeply into and resources are stretched to the daily lives of families caring for breaking point, and those providing someone with the disease, where the necessary care in many cases are resources quickly evaporate. Studies already impoverished, often elderly in urban households of Côte d’Ivoire, and might themselves have depended for example, show that when a family financially and physically on the member has AIDS, average income support of the very son or daughter falls by 52 to 67 per cent, while expen- who has died. ditures on health care quadruple. 4

Savings are depleted and people often both parents are among the most go into debt to care for their sick. exposed of all. And this is particularly Food consumption has been found true in sub-Saharan Africa, where few to drop by 41 per cent. The drain social support systems exist outside on virtually all segments of com- of families and where basic social munities and nations means that services are largely inadequate. very few resources or services remain Orphans run greater risks of Children orphaned by AIDS and fewer can be produced or being malnourished and stunted than are often the first to be provided to those on the front line children who have parents to look denied education when their of orphan care. after them. They also may be the extended families cannot first to be denied education when afford to educate them. A The vulnerability of orphans. Of the extended families cannot afford to boy reads at a community many vulnerable members of society, educate all the children of the house- school in Zambia. young people who have lost one or hold. A study in Zambia, for example, UNICEF/96-1243/Pirozzi 5

showed that 32 per cent of orphans in farming, and caring for the ill or dying AIDS orphans defined urban areas were not enrolled in parent or parents, bringing on stress UNAIDS, WHO and school, as compared with 25 per cent that would exhaust even adults. UNICEF define AIDS of non-orphaned children. Children In addition, because HIV infection orphans as children who who have been orphaned by AIDS may progresses from initial infection to lose their mother to AIDS also not receive the health care they mild HIV-related illness to the life- before reaching the age of 15 years. Some of need, and sometimes this is because it threatening illnesses called “AIDS,” these children have also is assumed they are infected with HIV children can live with long periods of lost, or will later lose, and their illnesses are untreatable. uncertainty and intermittent crises, their father to AIDS. Thus Increasingly, children whose parents as both parents slowly sicken and die. defined, there will be 13 are dead accumulate ever greater In sub-Saharan Africa, where effective million children orphaned by AIDS by the end of burdens of responsibility as head of relief for pain or other symptoms is 2001. This cumulative household when a grandparent or often unavailable, children who live figure includes orphans other guardian or caregiver dies. through their parent’s pain and illness who have since died, as Orphans enduring the grave social frequently suffer from depression, stress well as those who are isolation that often accompanies AIDS and anxiety. Many children lose every- no longer under age 15. In some assessments, when it strikes a family are at far thing that once offered them comfort, paternal orphans – those greater risk than most of their peers security and hope for the future. who have lost only their of eventually becoming infected with father to AIDS – are HIV. Often emotionally vulnerable The AIDS stigma. The distress and included in estimates of and financially desperate, orphaned social isolation experienced by chil- children orphaned by AIDS. A child whose children are more likely to be sexually dren, both before and after the death father dies typically abused and forced into exploitative of their parent or parents, are strongly experiences serious psy- situations, such as prostitution, as a exacerbated by the shame, fear and chological, emotional, means of survival. rejection that often surrounds people social and economic loss. But because reliable affected by HIV/AIDS. Because of this data on the number of Grieving before death and the tragedy of stigma and the often-irrational fear paternal orphans are not losing both parents. A child whose surrounding AIDS, children may be available in many coun- mother or father has HIV begins to denied access to schooling and health tries, the orphan statistics experience loss, sorrow and suffering care. And once a parent dies, children, used by UNAIDS and UNICEF do not include long before the parent’s death. And particularly in the case of girls, may children who have lost since HIV can spread sexually between also be denied their inheritance and only their fathers.* father and mother, once AIDS has property. Moreover, as the rights of claimed the mother or father, the children are inextricably linked to children are far more apt to lose the those of their surviving parent, laws * Some organizations have made orphan estimates for up to 30 years remaining parent. Children thus find and practices that deny widows their in the future. UNAIDS and UNICEF themselves thrust in the role of mother rights and property have devastating believe the possible margin of error in such long-term estimates to be too or father or both – doing the house- consequences for children after their great to make them worthwhile or hold chores, looking after siblings, father’s death. reliable for planning purposes. 6 Protecting children from AIDS

Few young people receive the accu- because they are biologically, social- rate and appropriate information ly and economically more vulnerable they need about AIDS and its trans- both to infection and to unprotected mission. For instance, a national sur- or coercive sex. Recent studies in vey in Kenya in 1998 found that 36 Africa show that girls aged 15–19 per cent of girls aged 15–19 could are around eight times more likely to not name a single way to protect be HIV-positive than are boys their themselves from HIV infection. And own age. Between the ages of 20 32 per cent of girls did not know that and 24 women are still three times a healthy-looking person could have more likely to be infected than men HIV or AIDS. their age. Men’s infection rates do Yet evidence suggests that young eventually catch up, but this does not people are sexually active, and that happen until they are in their late few of them use condoms. In sub- 20s or early 30s. Saharan Africa, more than half of Studies across a range of cultures young women give birth before age have shown that education about 20. In many places, schools provide reproductive health and AIDS does no reproductive health education not lead to premature sexual activity; that would encourage girls and boys on the contrary, it can lead to delays Few young people to postpone intercourse or adopt in the age of first intercourse. Schools receive the accurate and protection against sexually transmit- are the ideal places for such educa- appropriate information ted diseases. tion. In many countries, though, they need about AIDS The results of this are tragic, but children drop out of formal schooling and how it is transmitted. predictable. In South Africa in 1997, before such classes are offered. a small study showed that 9.5 per However, these young people can still A Zambian primary school cent of pregnant girls under 15 years be reached and taught about AIDS – student sings a song about of age were HIV-infected. through informal methods, by parents AIDS prevention while her Girls, in fact, often become infect- and other elders in their community, classmates look on. ed at a younger age than boys by their peers and through the media. UNICEF/95-1058/Pirozzi 7 Country responses: Botswana, Malawi, Zambia and Zimbabwe

fforts to protect children Uganda’s non-governmental organ- E orphaned by AIDS are nearly as izations (NGOs), community-based old as the epidemic, and many are organizations (CBOs) and religious beginning to show real progress. groups played an important role in Several of these nascent efforts have developing effective responses. taken place in Botswana, Malawi, By the mid-1990s, an emphasis Zambia and Zimbabwe, 4 of the on government decentralization 10 worst-affected countries in the transferred responsibilities for world in terms of HIV prevalence. child protection in local areas, over These efforts, detailed below, provide to local governments. At the same encouragement and concrete examples time, the Ugandan Government to other countries and communities extended education to all children seriously affected by the pandemic. and rebuilt health facilities, leading It is important at the outset to to improved access and services underline that what distinguishes all for children. successful and sustainable efforts to The use of radio, which reaches all combat the HIV/AIDS crisis, including parts of the country, has played a key providing care for orphans, is political role in educating people about how will. One country that has clearly HIV/AIDS is spread and prevented. shown leadership in this area is A public declaration by popular Uganda, where some of the first AIDS musician Philly Lutaaya that he was cases in Africa were identified in 1982 HIV positive provided an important and where the numbers of orphans opportunity to promote public had exploded less than a decade later. discussion about AIDS and new Uganda’s high-level response, and its prevention and care programmes. outspoken acknowledgement of the Young people have always been crisis, remain a model yet to be emu- the prime focus of many of the UNICEF/99-0292/Pirozzi lated in most other hard-hit countries. country’s AIDS programmes. As early as 1986, the Government The experiences to date in provid- Uganda has been at the acknowledged the AIDS crisis and ing care and protection for orphans forefront of initiatives to began mobilizing both domestic and and other affected children need protect children from AIDS international support to combat it. more thorough review and, where through improved basic In the early 1990s, the Uganda AIDS satisfactory, considerable acceleration. social services. A major Commission was established within Nonetheless, the steps described success has been increased the President’s office as were AIDS may offer lessons to other countries enrolment in primary Control Programmes within several struggling to meet the needs of schools. This girl attends a government ministries. their children. community school northeast of Kampala, the capital. 8 Botswana: Mobilizing national resources

The HIV/AIDS epidemic in Botswana Background is the deadliest emergency and the With diamonds as its main source biggest social and economic crisis fac- of revenue, Botswana is among the ing the country today. After three wealthier countries in the region, decades of sustained economic growth, showing strong economic growth. HIV is threatening to wipe out hard- Over the past three decades, against a won gains in social development, backdrop of stable democracy, the including improvements in child country has made enormous strides heath, nutrition and education. By the in the area of socio-economic develop- year 2000, it is projected that AIDS will ment. During the 1970s and 1980s, be responsible for an astounding 64 infant and child mortality and per cent of deaths of children under malnutrition declined sharply, while five years of age in the country. literacy rates and academic achieve- With over 20 per cent of its popu- ment rose steadily. lation between 15 and 49 years of age Furthermore, Botswana has distin- infected with HIV, Botswana grapples guished itself from other countries in with an AIDS epidemic as severe the region by its high level of public as that of its neighbours. And rates spending on basic social services, of HIV infection continue to rise operating relief schemes to assist the sharply, for reasons that are sadly evi- worst off and creating safety nets dent. First, denial about the existence for national emergencies, such as of AIDS is widespread. Second, there droughts. There are still great dispari- has been little change in people’s sex- ties, however, between the rich and ual behaviour. Finally, there is a high poor, and a large proportion of the rate of sexual activity among young population – some 47 per cent – lives people. In Botswana’s major urban in poverty.

UNICEF/94-1217/Andrew areas, more than 30 per cent of all pregnant adolescent women are National policy and review Throughout sub-Saharan infected with HIV. of child laws Africa, the extended family, The impact AIDS has had on the A National Orphan Programme was often the grandparents, are country’s children has been nothing established in April 1999 to respond struggling to care for children short of devastating. The rate at to the immediate needs of orphaned orphaned by AIDS. Two which children have been orphaned children. The Programme is run by brothers, whose parents died in Botswana has quadrupled in just various government departments, of AIDS, play football outside the three years between 1994 and NGOs, CBOs and the private sector, their grandmother’s house 1997. By the end of 1997, around and its objectives are to review and where they live with seven 4 per cent of Botswana’s children develop policies; build and strengthen of their siblings. under 15 had become orphaned institutional capacity; provide because of AIDS. social welfare services; support 9

community-based initiatives; and Services for orphan care in Botswana The Government monitor and evaluate activities. The Government encourages commu- The Programme is responsible for nities to provide care for orphans encourages communi- coordinating the registration of and to rely on institutional care only orphan data through a national as a last resort. Orphans in Botswana, ties to provide care for database; identifying and addressing therefore, are still usually absorbed the needs of foster children and foster by the extended family. Their care- orphans and to rely on parents; training community volun- takers are predominantly women. teers in basic childcare; providing Nationally, 47 per cent of households institutional care only HIV/AIDS counselling; and reviewing are headed by women, most of and developing government and whom are single. And female-headed as a last resort. child protection policies. households make up the majority of A major goal of the Programme all the households living in poverty. is to develop a comprehensive A number of NGOs and CBOs National Orphan Policy, based on have taken the lead to support these the Convention on the Rights of the extended and foster families, including Child. A number of existing laws Childline Botswana, Botswana that address issues of child support, Christian Council, Botswana paternity, custody, financial support Christian AIDS Intervention Program and guardianship are being reviewed and Tirisanyo Catholic Mission. These or amended. organizations provide services in communities throughout the country, Models as a tool for social planning ranging from family counselling and To assist policy makers in their plan- day care for orphans to providing ning, Botswana’s Ministry of Finance for basic needs such as food, clothing has developed a way to model the and education. impact of the epidemic on population growth and structure, social services Contracting out services: and economic activity. Such a model The Bobirwa Orphan Trust will provide the Government with a In the rural subdistrict of Bobirwa, clearer picture of the numbers of district authorities have contracted children requiring care and their out to the Bobirwa Orphan Trust needs. In the long term, the goal is for the delivery of essential government all organizations involved in orphan services to orphans in the area. care to integrate their family and Approximately 58,000 people live community support projects into in the subdistrict, according to larger programmes dealing with 1991–2021 population projections, health, education, agriculture, water and 54 per cent of households are and sanitation. headed by women. 10

There are still many The Trust is made up of commu- A district-based database on nity volunteers and local extension orphans, maintained by the Council obstacles and challenges staff – government-paid employees, of SW&CD Department, is also including social workers, family wel- being piloted. By September 1999, to overcome. First, the fare educators, the Home-Based Care 1,084 orphans had been entered Coordinator and the sub-chief. Under into the database. Orphans are also country’s high-level the pilot initiative, members of the assisted with uniforms and other Trust identify and register orphans in educational needs by UNICEF, the officials have only the subdistrict, through home visits, Bobirwa subdistrict Council and schools and churches; screen orphans the Trust itself. recently begun to using established criteria to identify the type of assistance they need; Botswana’s future obstacles speak about the initiate community-based foster and challenges placement; identify local groups There are still many obstacles and chal- problem and make it a purchasing food, clothing and other lenges to overcome. First, the country’s necessities and distributing them to high-level officials have only recently national priority. orphans; and refer cases needing begun to speak about the problem and special attention to the Council of make it a national priority. Because Social Welfare and Community initial government response to the Development (SW&CD) Department. crisis was slow, AIDS has already done Needy orphans are assisted with food, significant damage to previous clothing, blankets, toiletries, coun- progress in social development. selling, day-care services, toys, bus Second, responsibility for AIDS fares to and from school, school uni- within the Government is not well forms and other educational needs. defined. There are two Ministries The Trust provides preliminary dealing with orphans – the Ministry orphan data to the Council where it of Health (through the National is evaluated to determine whether or AIDS Control Programme) and the not assistance is needed. The Council Social Welfare Division of the Ministry ensures that local orphan identifica- of Local Government, Lands and tion and registration criteria conform Housing. The split jurisdiction for to government criteria as provided in AIDS orphans between these two the National Destitute Policy; defines Ministries has made it difficult to the needs and assistance available; coordinate a national effort and handles referral cases; provides to document lessons learned along training to local extension staff and the way. community volunteers on government Third, there is no strong tradition of child welfare policies and laws as well NGOs and CBOs working in the area as technical support to the project. of childcare and rights. Communities 11 Malawi: Striving for early childhood care

have been very much dependent upon It is estimated that around one in government funding to undertake seven of the population aged 15–49 community-based initiatives. years in Malawi is infected with HIV. Finally, existing child protection Over 25 per cent of women attending laws and policies are fragmented antenatal clinics in the urban centres of and outdated. Blantyre and Lilongwe test positive for Despite the challenges, there are HIV, and girls aged 15–24 are six times hopeful signs that political com- more likely to be sero-positive than mitment has begun to accelerate boys the same age. The incidence of the Government’s response to the tuberculosis has more than tripled HIV/AIDS epidemic. This commit- since the late 1980s, largely due to HIV. By the end of 1997, ment, and the establishment of a The AIDS crisis has had a crippling 6 per cent of children under National Orphan Programme, are impact on the country’s children. the age of 15 in Malawi critical first steps towards halting By the end of 1997, 6 per cent of chil- were orphans. A boy the spread of AIDS and mitigating dren under the age of 15 in Malawi orphaned by AIDS tends a its impact. were orphans. pot cooking on an open fire. UNICEF/94-1207/Andrew 12

It was recognized early Setting priorities early on Ministry of Justice. These laws include It was recognized early on that because the Wills and Inheritance Act, the on that because commu- communities are in the best position to Adoption Act, the Child and Young assess their own needs, they would Persons Act and the Foster Care Act. A nities are in the best play an important role in addressing shortage of lawyers in the Ministry of the AIDS orphan crisis. One of the Justice, however, has significantly position to assess their Government’s main strategies, there- delayed this process. fore, has been to promote and support own needs, they would community-based programmes. Care for the youngest As early as 1991, the Government Researchers have thoroughly docu- play an important role of Malawi established a National mented the importance of the pre- and Orphan Care Task Force. The Task postnatal months and the first three in addressing the AIDS Force – made up of national and dis- years of life in a child’s development. trict representatives from the Ministry Concerned agencies such as UNICEF orphan crisis. One of of Gender, Youth and Community and others are now making what is des- Services; the National AIDS Control ignated as “early childhood care for In the Government’s main Programme (Ministry of Health and survival, growth and development” a Population); NGOs; religious organi- cornerstone of their child programmes. strategies, therefore, has zations and UNICEF – is responsible Malawi has led the way in the for planning, monitoring and revising region on early childcare and develop- been to promote and all programmes on orphan care. ment (ECCD), and its pioneering work One year later, in 1992, National has been adopted by neighbouring support community- Orphan Care Guidelines were estab- countries, including Zambia. ECCD, lished. The guidelines serve as a broad which in Malawi covers children under based programmes. blueprint to encourage and focus sub- eight years of age, has played an espe- national and community efforts. Over cially important role in providing care the years, the guidelines have been for the country’s AIDS orphans. revised and have guided many of the Across the country, community- local and district efforts to support based organizations, working closely orphans. The Government will use the with district social welfare officers, are lessons learned from these initiatives to setting up child-care centres with the develop a National Orphan Care Policy. aim of improving the care of children The Task Force has also established as well as increasing their learning a subcommittee that is reviewing opportunities. At the centres, which existing laws and legal procedures to are for all children in the community, provide greater protection to vulnera- children play, learn, socialize and eat. ble children. Recommendations for Caregivers ensure that orphans in modifying several laws to protect their communities attend the centres orphans have been submitted to the and benefit from their activities. 13 Malawi’s National Orphan Care Guidelines

In 1992, with advisers from the • The National Orphan Care Task In 1992, Malawi’s National Uganda Government and NGOs, Force will continuously plan, Orphan Care Task Force Malawi’s National Orphan Care Task monitor and revise programmes and policies. developed guidelines for the Force developed the subregion’s first care of orphans. A boy guidelines for the care of orphans. The • The Government will encourage orphaned by AIDS in northern main points of these guidelines are: donor support for resources to help orphan programmes. Malawi does his homework on the verandah of his • The first line of approach in • The lead government body on orphan care must be community- orphan issues will be the Ministry grandmother’s home, based programmes. The Govern- of Gender, Youth and Community accompanied by two of ment will coordinate the activities Service. his siblings. of service providers. • Formal foster care will be expand- ed as the second most preferred type of care. • Institutional care should be the last resort, though temporary care may be required for children awaiting placement. • Hospitals should record next of kin, so that relatives can be traced if children are abandoned. • The registration of births and deaths should be improved, to assist the monitoring of orphans. • The Government will protect the property rights of orphans, and these rights should be widely publicized. • Self-help groups should be devel- oped to help affected families with counselling and other needs. • NGOs are encouraged to set up programmes of community-based care, in consultation with the Government. • The needs of all orphans should be considered on an equal basis, regardless of the cause of death of the parent or parents, or their

gender or religion. UNICEF/93-BOUO494/Andrew 14

A village in Malawi and Orphans who need special attention a kitchen for their home. Older its youngest orphans are closely followed up. In some students also look after smaller In a village in rural centres, arrangements are made with children and involve them in recre- Malawi, about 30 small community health workers to moni- ational activities. children sit in rows, recit- tor their growth and health status. Community work in Namwera ing their lesson, singing Collaboration with district authori- has been organized through Malawi’s and clapping their hands. They are assem- ties has significantly improved the Community-based Options for bled in the village’s capacity of the community-based Protection and Empowerment (COPE) child-care centre, where organizations to tend to orphans. project. The project, implemented they are taught and The district team trains caregivers through Save the Children Federation cared for by local volun- on a variety of issues, including Inc., helps villages set up local orphan teers. Some of these children are orphans, childcare, income generation to committees to detect, monitor and cared for by elderly support the centres and providing assist vulnerable families and children. grandparents who are psychological support to orphans Women, children and youth all partici- unable to provide them and their guardians. pate in decision-making on the village with proper meals. committees. The communities have Others are looked after by – or may even them- Strengthening community responses also set up communal gardens to selves be caring for – In rural and urban areas across support at risk families and orphans. mothers who are too Malawi, communities are developing At the same time, UNICEF assists ill to cope with their a variety of ways to cope with the families and guardians with loans to children’s basic needs. growing crisis of AIDS orphans. boost income-generating activities. The centre, which takes children up to Village orphan committees have Many NGOs and community- primary-school age, is been established in many villages based organizations work closely with run as a cooperative to monitor their local situation and government ministries and district and staffed by trained to take collective action to assist those authorities to plan and carry out villagers. The staff are in need. Anti-AIDS clubs have also orphan programmes. Most extension reimbursed for their time by other villagers who been created to educate communities workers from the different ministries may also look after the about HIV/AIDS transmission and are members of the Community staff’s fields and provide prevention, as well as to address the Orphan Care Committees and food for the centre. needs of those infected with the provide support through various The village elders virus. In Namwera village, for exam- activities. For instance, agricultural stress that it is important to have a safe place ple, the local school has formed an extension workers assist communities where these children can anti-AIDS club where pupils carry in establishing gardens for vegetables come during the day to out AIDS-prevention activities as well and crops, as well as in maintaining learn and be fed and as help needy orphans. After children small livestock for the child-care washed. Health care in one family lost their parents to centres. Social welfare workers have a outreach workers also come to the centre to AIDS and their house and living school social work programme that immunize the children conditions rapidly deteriorated, one also looks at ways to support needy and monitor their growth. group of students built the orphans orphans in school. 15 Zambia: Supporting community commitment

Challenges for the future After Uganda, Zambia has the highest Lack of administrative capacity at the proportion of children orphaned by national level coupled with inade- AIDS in the world. By the end of quate resources has made it difficult 1997, some 360,000 children – 9 for the Government to keep up with per cent of children under 15 – were the growing pandemic. At the same orphaned because of AIDS, and the time, research and data collection numbers are increasing rapidly. need to be improved in order to assess But families already worn out by the severity and scope of the problems widespread and extreme poverty are presented by the large number of stretched beyond their capacity. orphans and respond effectively. About 80 per cent of the country’s In Zambia, by the end of The dedication and solidarity of rural population is considered to be 1997, some 360,000 community members across the living below the poverty line, more children – 9% of the children country have been a major factor in than 50 per cent of children are under 15 – were orphaned the progress that has been achieved chronically malnourished and large because of AIDS, and the so far. At the same time, a strong numbers of families are forced to numbers are increasing collaborative effort between the ration food. It has been estimated that rapidly. Two brothers in Government, NGOs, community- 42 per cent of all young Zambian Lusaka, Zambia, wash based organizations and churches, children suffer from stunted growth. clothes outside the house with support from UNICEF, has Families are having difficulty where they have lived with helped strengthen Malawi’s orphan coping in urban areas as well, and a foster family since being programme in recent years. many children have been forced onto orphaned by AIDS. UNICEF/98-1033/Pirozzi 16

the streets. In 1991 in Lusaka, the cap- system is breaking down. In 1992, ital, some 35,000 children were living HIV/AIDS-related illness accounted on the streets. Today that number has for about 30 per cent of hospital beds more than doubled to around 75,000. and 43 per cent of in-patient days, in Many of these children are sexually those hospitals surveyed. exploited; half are orphans. AIDS has made the whole country The crisis is eroding the Govern- poorer. All sectors of the Zambian ment’s ability to provide services, economy have felt the deep ravages of while at the same time increasing the the epidemic. One large company The AIDS crisis is eroding demand for them. Zambia’s primary reported in 1995 that its costs from the Government’s ability to health care system used to be consid- HIV/AIDS illness and death exceeded provide basic services, while ered one of the best administered and its total profits for the year. at the same time increasing most decentralized among all African the demand for them. countries, but now, with increasing NGOs trying to fill the gap A woman very sick with AIDS household poverty, external debt Zambia has several policies that pertain is visited by an NGO health obligations, and demands placed on to children, but no national orphan worker in Lusaka, Zambia. health services by HIV/AIDS, the policy. Although many ministries have included AIDS issues in their planning, the Government has been slow to respond to the AIDS orphan crisis. The Permanent Secretaries from the Ministries of Health, Education, Social Services and Children have formed a task force to look at the problem of orphans and vulnerable children with the goal of establishing a national coordinating body. As in many countries, NGOs, CBOs and religious institutions have tried to fill the gaps. In the last few years, the number of groups dealing with AIDS issues – previously fairly low – has grown. Most of these organ- izations recognize that orphaned children should be cared for by the community rather than by institu- tions and as a result, much of their work focuses on strengthening

UNICEF/96-1246/Pirozzi families and extended families. 17

Some NGOs, CBOs and religious Community schools condense the Zambia does not groups provide direct assistance to seven-year government curriculum orphans and their families in the into four years. In the past, children provide free primary form of food assistance, clothing who entered community schools and school fees. Many more, however, (never having attended a government education to children. develop initiatives designed to school) were older than their counter- encourage independence and self- parts and the four-year curriculum With high national reliance. Frequently, NGOs assist allowed them to finish the equivalent communities to develop community grade seven at an age close to that poverty rates, parents schools as a means to provide educa- of children in government schools. tion. A majority assists communities However, as larger numbers of families and guardians are to develop some sort of financial sus- are unable to afford government tainability through income-generating schools, increasingly younger children finding it increasingly activities, including oil pressing, have begun to attend community raising chickens and gardening. The schools. In recent years, some of these difficult to pay... to money is often designated to pay for community schools have begun to school fees and uniforms for orphans. provide early childhood education, send their children to Too often, however, the returns are catering to the needs of very young minimal in proportion to the efforts orphans without caregivers, or to government school. and resources invested. those whose caregivers are either too old or too young to give them ade- Educating orphaned children: quate care. Volunteer community schools Although the Zambia Community Zambia does not provide free primary Schools Secretariat tries to monitor education to children. With high quality, the growing numbers of com- national poverty rates, parents and munity schools make it difficult to guardians are finding it increasingly monitor them effectively, and quality difficult to pay for the school fees, varies widely. The teachers are often uniforms and books needed to send drawn from members of the commu- their children to a government school. nity: NGOs provide teacher training, A study in urban areas revealed frequently using a manual developed that 32 per cent of orphans are not by the Ministry of Education, NGOs, receiving formal schooling, compared UNICEF, teachers and curriculum with 25 per cent of non-orphans; in specialists. The manual provides rural areas, the figures for children teaching methodology and outlines a not enrolled in school were a syllabus, including tips on teaching staggering 68 per cent of orphans the material. Model lessons are compared with 48 per cent of included as well as techniques for non-orphans. monitoring a student’s progress. 18

The Programme was Chikankata Community-based programmes (Home-based Care, Orphan Support Programme Reproductive Health, Nutrition and designed to strengthen The Community-based Orphan Growth Monitoring) run by the Support Programme (CBOSP) at Salvation Army Hospital. the communities’ Chikankata Salvation Army Mission The Chikankata Community Hospital is a pilot programme, started Health and Development Department capacity to address in two communities in 1995 and Team at the hospital provides technical expanded in 1999 to include an addi- support and training for Care and the growing number tional three communities. Between Prevention Teams (CPTs), made up 2,000 and 5,000 people live in each of community members, including of orphans and to community, most of them farmers. chiefs, farmers, teachers and business- Chikankata has been hit hard by men. The teams are the focal points create awareness about HIV/AIDS, although HIV rates are not for community responses to all available because testing is not routine- HIV/AIDS-related matters. CPTs the problems these ly done at the hospital. In 1999, there identify and care for those who are were some 1,500 orphans registered in infected with HIV; help mobilize children face. the five project communities. A major- resources; coordinate activities with ity of those orphaned have lost both local partners; and train commu- parents and all their inheritance at the nity volunteers. The Health and same time because surviving relatives Development Department Team quickly appropriate property. In most makes regular visits to all commu- cases, however, children are cared for nities to follow up on how they by their grandparents. are progressing. The Programme was designed to In addition to CPTs, local Children strengthen the communities’ capacity in Need (CHIN) committees were to address the growing number of also formed. These committees, estab- orphans and to create awareness lished in the five communities where about the problems these children the programme is being implemented, face. The Programme provides educa- consist of 24 members from different tion and health services; facilitates sectors of the community, including local income-generating projects; con- schoolteachers, community health ducts HIV/AIDS prevention among workers and village headmen. CHIN vulnerable children; and links up local committee members, known locally as communities with agencies working “caregivers,” are trained in community with orphans outside the community. education, advocating for children in situations of child abuse, family Organizational structure education and counselling. The CHIN The Community-based Orphan committees register orphans and Support Programme is one of several vulnerable children; conduct regular, 19

usually weekly, home visits to see namely those who are extremely poor. how orphans are faring and what Communities are now formulating needs they have; and organize their own criteria for vulnerability, income-generating activities. A which differ from one community to CHIN Coordinator, based at the the next. Chikankata communities are Chikankata Salvation Army Hospital, continuously counting orphans to supervises the committees. assist with planning.

Data collection Life skills training The process of registering orphans is The training of orphans in life skills invaluable in helping communities not was introduced this past year. Done only to assess the scale of their orphan mostly through school peer education problem and ensure that benefits groups, or the counselling and psycho- In rural areas of Zambia, reach the correct children, but also in social support offered by the local 64 per cent of orphans are building community awareness and CHIN committee members, the train- not enrolled in formal school, support for initiatives designed to help ing is designed to teach orphans to compared with 48 per cent orphans. Although communities began make informed decisions about their of non-orphans. Children by looking at the needs of orphans, lives. The hospital is currently looking attend an outdoor class at a they soon reformulated their criteria for a partner to train the orphans in community school in Lusaka, to include other vulnerable children, practical skills. the capital. UNICEF/98-1021/Pirozzi 20

Resource-generating activities Although NGOs, CBOs, churches and Resource-generating projects are other volunteer organizations are managed by local CPTs and CHIN making significant contributions in Zambian children attend committees. Most communities are strengthening local communities, they class in a community school running a small shop and a vegetable have a long way to go before making in the village of Mazabuka, garden. The produce from the garden an impact nationally. At present, one of many non-formal benefits the aged, widows and orphans. Zambia’s volunteer bodies, churches education alternatives for and NGOs manage to provide assis- extremely poor children, A long road ahead tance to only around 7 per cent of including those orphaned Communities remain in the front those children requiring it. by AIDS. line of care for orphans in Zambia. A number of factors make it diffi- cult for these institutions to scale up existing interventions. First, their responses are not consistent and there is little coordination between them. Second, government involvement is severely limited at the present time. Third, the funding is totally inade- quate to address the issues on a large scale. Finally, institutions are overwhelmed responding to immediate needs of these children and families. With little funding and relying heavily on volunteers, many are stretched almost to breaking point. They have few resources to analyse what is working and what is replicable, much less to scale up efforts. However, the activities of these organizations mitigate the suffering of orphans. Many of the programmes that exist have a good reputation and community commitment is strong. Supporting these efforts is crucial in the monumental task of assisting families and communities in Zambia to care for the country’s orphans. UNICEF/98-1022/Pirozzi 21 Zimbabwe: Strengthening community responses to orphan care

Zimbabwe has one of the worst AIDS Policy reaffirmed the position that Three phases of epidemics in the world. Currently, orphans should be placed in institu- Zimbabwe’s Community 26 per cent of all adults are infected tions only as a last resort. based Orphan Care with HIV, according to figures from By the mid-1990s, the Department Projects: the National AIDS Coordination of Social Welfare had begun piloting Phase One: Assessing Programme (NACP). The UN three models of Community-based the situation. Population Division has projected Orphan Care: a rural, urban and com- During the first phase of that, in the years 2000–2005, half mercial farm model. Today, 30 com- the project, data is col- of all child deaths in the country munities are at various stages of lected to determine not will be due to AIDS. implementing one of the three models. only the number of AIDS orphans and other chil- As in Zambia, by the end of 1997, dren in need of special there were some 360,000 children The Chief Charumbira Community- protection living in the orphaned by AIDS – 7 per cent of based Orphan Care Programme in district, but also who is all children under 15 – and the Masvingo Province caring for these children likelihood is that many more children The rural model of Community- and how they are living. will share this fate. based Orphan Care was launched in Phase Two: Increasing Masvingo District in Masvingo awareness of the Early recognition of the problem Province in 1994. This district of problems affecting AIDS The orphan crisis in Zimbabwe first 165,879 people is divided into three orphans and children in need of special drew national attention in July 1992, areas and 94 villages and governed by protection. when the Government of Zimbabwe’s traditional leaders: Chief Charumbira, The data and research Department of Social Welfare coor- sub-chiefs and village leaders. The collected during the first dinated a national conference on Orphan Care Programme was phase is used to raise orphans, with support from UNICEF. structured to utilize the traditional awareness of the plight At that time, it was recognized that a roles and responsibilities of these of orphans through- out the community. small number of NGOs and CBOs leaders, who have the authority to Communities are had already begun to strengthen their mobilize their people and resources encouraged to discuss own responses to the increasing num- in times of crisis and emergency. their problems and ber of orphans. It also became clear Chief Area Committees, composed share their experiences that compared to institutionalization, of the area sub-chief, advisors and vil- in order to develop community-based care was cost- lage leaders, were established in each possible solutions. effective and, because it kept children of the three areas. These Committees Phase Three: in a familiar social, cultural and ethnic address policy and planning issues Strengthening environment, reduced their distress. and also unify and guide village activi- communities. In 1995, the Government of ties. Local activities are carried out Communal projects and activities in this phase Zimbabwe developed a National by Village Committees, made up of aim to improve the Policy on the Care and Protection of village leaders and five members of the capacity of caregivers Orphans, which was finally approved community. Most of their work is to provide economically by the Cabinet in May 1999. The done through community volunteers. for the children under their care. 22

The Village Committees report Assessing the problem to the Chief Area Committees who The Area and Village Committees are report to the District Development responsible for counting orphans. They Committee (DDC) through its Social are trained by members of the Child Services subcommittee. Through Welfare Forum, already established in the DDC, the community-based their districts and provinces, to identify structures for orphan care are linked all orphans and other children needing Jean, 3, a Rwandan boy to the formal government. This refer- protection and to record them in their who lost both parents to ral system enables the Government to registry. The registration process is AIDS, nestles against his understand better the needs of the ongoing and all orphans are registered grandmother, who cares for community and gives communities irrespective of whether or not they need the boy and his two sisters. the ability to influence state policy. assistance. Information recorded on each child includes name, date of birth, address and nearest school, names of deceased parents, names of caregivers, as well as any particular problems the child is having. Committee members are also trained to refer children to appropriate agencies when their needs cannot be met by the Committees. If a request is beyond the capabilities of the Area Committee, the case is referred to the State through the Social Services subcommittee of the DDC. Both the Village and Area Committees keep records for follow-up and accounting purposes. It became clear during the first phase of the Programme that extended families were playing a crucial role in caring for orphans. Of 11,514 orphans and children needing protection counted in the Masvingo and Mwenezi Districts, over 11,000 of them were being cared for by relatives living in the community. The majority of caregivers were women, widowed and over 50 years

UNICEF/97-1031/Pirozzi old. Often, they were the children’s 23

grandparents (frequently their grand- UN agencies and other donors to Zimbabwe’s orphan mothers). Most of the caregivers had develop their income-generating policy not inherited anything, pointing out activities. For example, some com- Zimbabwe’s policy on there was nothing to inherit. Perennial munities received funding to sink care and protection of drought worsened their situation. boreholes in their gardens to ensure orphans was drafted in a supply of water. In April 1998, an 1995, but Cabinet approval was delayed Organizing the community electric dehuller grinding mill was due to the financial Once the data were collected, meetings donated by the National AIDS implications of the policy with local chiefs and village headmen, Coordination Programme. Other on the national budget. church leaders, party leaders, govern- assistance has come from Africa The Cabinet finally ment officials and other interested Groups of Sweden who trained approved the policy in May 1999. Its main parties helped to raise awareness of the volunteers in home-based care for tenets include: problems associated with the large the terminally ill. • Care of orphans in number of orphans. institutions should be Village Committees organized initia- Challenges for the future only a last resort and tives using community volunteers as The three models for Community- should be temporary. their driving force. Villagers now ensure Based Orphan Care – rural, urban • All children, including that orphans are properly fed, clothed and commercial farm – depend upon orphans, should and housed. Where possible, they see strong leadership and an unflagging receive education, that school-aged orphans attend and commitment from the community. and there should be remain in school. Volunteers have even But as the projects in Masvingo laws and guidelines to enforce this right. taken on a child’s household chores and Mwenezi Districts demonstrate, to enable the child to attend school. communities are willing to absorb • The property rights of To help families pay for school fees, in and care for their orphaned children. orphans should be safeguarded by 1995, the Village Committees asked The Committee structure ensures that legislation. community members to donate Z$1.00 the chiefs and leaders share power (US$ .03) per household. The Z$2,000 and responsibility equally, thus • The care and protec- tion of orphans that was raised paid fees for 18 primary minimizing conflicts. Furthermore, must comply with the school children. The next year, during the Committees are effectively linked Convention on the the drought, households donated to official state machinery, ensuring Rights of the Child and Z$2.00, raising Z$3,000. Villagers also that communities are provided with the African Charter on pool their labour and monetary the technical support they need in a the Rights and Welfare of the Child. resources to develop communal gardens timely manner. and woodlots to help generate income. But communities cannot shoulder Implementation of the the burden without support. Many of national policy at the local level is the External support the volunteers are poor themselves responsibility of local In some cases, Village Committees and most income-generating projects government, communi- have sought additional support from are very rudimentary and do not ties and NGOs working local NGOs, international NGOs, generate sufficient income. There is a in partnership. 24

Zimbabwe has one strong need to build and strengthen presence in the district. At the business acumen among community moment, however, the Department of the worst AIDS members. has a small staff and limited Additional resources are needed resources and doesn’t have the epidemics in the for community-based care to be capacity to assume this role in replicated on a national scale. To go all districts. Furthermore, the world... by the end to scale, the Department of Social Government has not yet allocated Welfare, the coordinating agency, the resources to replicate this of 1997, there were must have a committed and stable programme nationally. some 360,000 children The Farm Orphan Support Trust (FOST) of Zimbabwe orphaned by AIDS – 7 Farm workers in Zimbabwe are caregivers, establish monitoring per cent of all children multi-ethnic. Many are immigrants procedures and raise community or the children of immigrants, and awareness. All the farms register under 15 . many more are Zimbabweans orphans individually and send who have moved from their native biographic information to a central villages. Families are therefore often computerized data bank. This isolated from their extended family procedure helps in tracing relatives. networks and no longer have any FOST promotes five levels of regular contact with their families orphan care. Its most preferred is back home, leaving children with within the extended family. If that no one to take care of them if their is not possible, orphans are to be parents should die. placed within substitute families. In 1986, the Farm Orphan After that, small groups of orphans Support Trust (FOST) of Zimbabwe will live together on a farm, looked was set up as a community response after by a carefully chosen caregiver to the situation of orphans in com- employed by the farm for the mercial farming areas. On FOST’s purpose. The next most preferred executive committee there are type of care is an adolescent child- representatives of the farms – both headed household with siblings employees and employers – from remaining together, preferably in the Government, academic institutions, family home. Here they are cared for churches and NGOs. FOST aims by the eldest child with the regular above all to keep sibling orphans supervision and support of the farm’s together, within a family of the Child Care Committee, the communi- same culture and in a familiar ty and the local field officer. Finally, environment. It operates foster FOST will arrange for temporary schemes on farms, using farm care in an orphanage, until a better development committees to train solution can be found. Children at a centre in Nairobi, which provides a temporary home for HIV-positive children and those orphaned by AIDS. UNICEF/98-1123/Pirozzi 26 Conclusion

The AIDS epidemic esponses to the crisis of orphans heightens the opprobrium meted Rin eastern and southern Africa, out to those suspected of having the will not diminish such as those initiatives described in disease. As a result, many infected the previous section, are still nascent people are too ashamed and fright- until discrimination, and in no way commensurate with the ened to admit their illness. When enormity of the problem. Human, they courageously break the silence, including persistent financial and organizational resources they may pay dearly, enduring are needed on a massive scale if affect- beatings, being thrown out of their gender bias and ed countries are to prevent this crisis homes, deprived of their children from completely overwhelming health, and even murdered. inequity, is eliminated. education and other basic services and The AIDS epidemic will not from breaking down millions more diminish until discrimination, includ- Throughout the world, families and social support systems. ing persistent gender bias and For countries in the region, already inequity, is eliminated. Throughout but particularly in characterized by underinvestment in the world, but particularly in sub- social services, the impact of AIDS on Saharan Africa, the ratio of female to sub-Saharan Africa, the social services has been catastrophic. male AIDS cases is rising. Teenage The obstacles remain formidable. girls are especially vulnerable. The ratio of female to male Poverty, conflict and the very rapid protection of the rights of girls and spread of HIV infection itself have all women is critical in the context of AIDS cases is rising. severely limited the range of options AIDS, especially their right to set the for action. In addition, many govern- terms of their own sexual activity, ment leaders and policy makers have including its safety, and to refuse sex been reluctant to face up to the full altogether. And the responsibilities of extent and urgency of the HIV/AIDS boys and men to respect these rights pandemic and to communicate these need strong emphasis. to the public. As a result, denial Also incommensurate with the persists throughout societies, made enormity of the AIDS problem are worse by the general unavailability the resources to deal with it. Against a of voluntary and confidential HIV backdrop of poverty aggravated by counselling and testing facilities. global trends, debt and miscued budg- UNAIDS estimates conservatively that et priorities, AIDS programmes are nine tenths of those infected in east- simply starved of resources. A recent ern and southern Africa do not know UNAIDS-funded study concluded that they have HIV. the epidemic is expanding three times In such a climate, discrimination faster than the resources to combat also thrives. Lack of knowledge breeds it. Total spending on AIDS in Africa, unfounded fears that the virus can which goes largely to prevention, is spread through casual contact and some $150 million a year – no more 27

than the annual budget of a small to act in the best interests of children hospital in Western Europe. Barely a when allocating the resources avail- tenth of that sum comes from national able in the society, no matter how budgets in the region. And even more small the total amounts. The State resources will be required if small ini- must also demonstrate good faith tiatives are to be taken to larger scale. by being able to show that actions Under the Convention on the have been taken to give children the Rights of the Child, States have a duty priority they deserve. Government commitment to I. What can individual countries do to help affected children? AIDS education and preven- tion efforts for young people There are no quick fixes to any of the A forthright commitment at the is crucial. Here, a Burundian challenges brought on by AIDS, and highest political level is a first and girl in a Bujumbura primary problems associated with the large vital step in dealing effectively with school holds up a t-shirt that numbers of orphans are no exception. the AIDS crisis. Uganda set an exam- reads “We are taught and First and foremost, national govern- ple of this commitment in the 1980s we teach AIDS prevention.” ments have a responsibility to create an environment where children can realize their rights, including those to survival and development, to the highest attainable standards of health, to education and to protection from abuse and neglect. There are a num- ber of measures that governments can take to protect the rights of children and women in the AIDS crisis:

1. Mobilize political will and reallocate national resources

Strategic action should: • Invest in poor communities. • Allocate resources more fairly. • Increase investment in basic social services, especially education. • Involve all sectors. • Coordinate action centrally. UNICEF/95-0251/Davies 28

Only by investing in and throughout the 1990s, and more be coordinated among the actors. recently countries such as South Establishing a central and high-level poor communities can Africa and Botswana have followed coordinator for national policies – suit. Visible and influential leadership preferably from a powerful office such the AIDS challenge is essential to help societies overcome as the Office of the President or the the fear and stigma associated with Ministry of Finance – is an important be met, as AIDS HIV infection. step to ensure accountability and This strong leadership must be follow-through on commitments. disproportionately backed with resources. Only by invest- ing in poor communities can the 2. Bolster the capacity of families affects the most poor AIDS challenge be met, as AIDS and communities to care for and disproportionately affects the most support orphans and disadvantaged in poor and disadvantaged in developing countries. Governments need to Strategic action should: developing countries. spend more on these communities • Ensure access to basic services. but they can go a long way towards • Provide assistance through meeting the fundamental needs of specially targeted programmes their people by allocating existing – child-care services resources more fairly. This can be – income generation done by channelling a higher percent- – credit/loans age of available resources into basic – food production – psychosocial support. social services such as basic education, primary health care, nutrition and low-cost water and sanitation. Studies Families provide the best environment have shown that investing in these for bringing up children and if services benefits the poor more direct- adequately supported they will be best ly than investing in high-end social able to provide the care that children services such as secondary education orphaned by AIDS require. This or advanced health care. support must encompass improved Since AIDS has wide-ranging access to basic services, including effects on a country’s education and health care, safe water and sanitation, social welfare systems, religious and education, as well as assistance institutions, agricultural production, with childcare. Policies need to be private businesses and community designed to prevent families with groups, coping with its impact orphans from sinking into deep requires the cooperation of many poverty. These may entail support for sectors. It is essential that policies, income-generating activities, small technical support, information cam- business cooperatives, vocational paigns and health and social services training and micro-credit schemes. 29

Keeping orphans in school is especially learned that orphanages are not the crucial in breaking the poverty cycle. answer. Expensive to build and main- Also key for families is receiving tain, orphanages remove children the emotional support and encour- from their communities and extended agement that will help them deal with families. These and other institutions current problems and plan for the set up to care for children can have future. This psychosocial support can catastrophic consequences on chil- be provided by other family members, dren’s emotional lives and develop- friends, community members or ment. And when institutions are no organizations and is an essential longer able to absorb growing num- part of home-based care. bers of orphans who have no other A group of quarry workers in Countries that have relied on insti- support systems, some children end up Malawi watch a video on tutions to care for their orphans have homeless and hungry on the street. AIDS prevention. UNICEF/93-1223/Andrew 30

NGOs, churches and 3. Stimulate and strengthen supported and magnified. First, some community-based responses of the less experienced organizations community-based should receive training, policy guid- Strategic action should: ance and management and financial organizations are often • Support NGOs and community- support, essential to help communi- based partners with ties assess and analyse problems, the first to respond – technical assistance formulate appropriate actions and – policy and planning guidance determine what resources are neces- training to the needs of sary. As was demonstrated in Malawi – resources. and Botswana, governments at the communities affected • Identify and strengthen local and district as well as national community-based care and levels can provide such support. support to by AIDS. – substitute or foster care Second, NGOs and CBOs under- families taking small or pilot projects can be – child-headed households helped to identify the best practices – orphanages, which play and implement them on a larger scale. a transitional role. UNICEF and other UN agencies may • Make use of the formal be particularly well placed to help welfare system. organizations identify and replicate • Promote exchanges of infor- success stories and to analyse lessons mation about experiences. learned. Donors and international • Bring small initiatives to NGOs also play an important role larger scale. in this regard and in supporting community-based initiatives with technical and financial support. When NGOs, churches and community- attempts are made to replicate experi- based organizations are often the ences in other settings, affected com- first to respond to the needs of munities should identify how best to communities affected by AIDS. They adapt them to their own situation. are best placed to identify not only Community-based responses to vulnerable children and families but children orphaned by AIDS include: also the best ways to provide them with long-term support. • Substitute or foster care families who These organizations have strong can care for children when family motivation and commitment, and members are not available on an their projects, though often small in informal or formal basis. scale, can have enormous impact. There are two ways in which the good • Family-type groups comprising work of these organizations can be orphaned children living together in 31

a family unit and cared for by a 4. Ensure that governments protect carefully selected, paid caregiver. the most vulnerable children

• Support to child-headed households Strategic action should: consisting of children ‘parented’ by • Obtain political commitment. an elder sibling. • Promote and protect children’s human and legal rights. • Orphanages, which are the least desirable option for reasons • Review and reform laws and policies dealing with children. stated above. • Monitor the impact of AIDS on children. As shown in Zimbabwe, such community-based interventions can be strengthened when integrated into a country’s formal social welfare sys- Concerted efforts are essential for Children orphaned by AIDS tem. Such integration helps ensure children orphaned by AIDS, who are more vulnerable than that community groups receive timely are more vulnerable than children children orphaned for other technical expertise and support and orphaned for other reasons, largely reasons, largely because also have a voice at higher levels that because of the stigmatization and dis- of the stigmatization and might not otherwise be heard. crimination they suffer. It is important discrimination they suffer. UNICEF/96-1424/Pirozzi 32

to ensure that the rights of such chil- to protect children and women, but dren are respected, that their these sometimes marginalized mem- living situations are secure and that bers of society may be unaware of health and education services are the laws or have no channel to take available to them. advantage of them, making strong Governments have an obligation to advocacy in this area essential. review and reform laws and policies Governments also need to monitor dealing with children and women, the impact of HIV/AIDS on children Governments should take especially the most vulnerable. This and families, to plan interventions strategic action to develop is crucial in the case of AIDS, where and determine their effectiveness. alternative education deaths in the family commonly Accurate information on the numbers programmes. Children drink leave orphans and widows at risk of of children orphaned, where they are, water from a handpump losing their inheritance and property the circumstances of their lives and in a non-formal community rights – often their major sources of the nature of their needs is vital. As an school in Zambia. income and food. Laws may exist advocacy tool, such information can also help raise awareness about the social impact of AIDS and promote realization of children’s rights.

5. Build the capacity of children to realize their rights and fulfil their needs

Strategic action should: • Support psychosocial and family counselling. • Enable children to obtain education and training through – sponsorship programmes developing non-formal and alternative education programmes – empowering children through life skills programmes.

It is essential to address the emotional needs of children devastated by their parents’ deaths from AIDS. Commonly,

UNICEF/96-1223/Pirozzi children orphaned by AIDS not only 33

watch their parents die but often nurse Assistance to families prior to parents’ Strategic global them through a long period of wasting death should also encompass practical action should: disease, which may include inconti- help for the household in such areas as • Increase needed nence, depression and dementia. A nursing care, food production and resources to the child’s grief and depression are often preparation, and upkeep of the home. most-affected hidden and remain unrecognized. This psychosocial support needs regions. Where possible, emotional support to be accompanied by assistance for • Support sustain- through individual and family coun- education and training in income- able develop- selling should be given to children as generating skills, both of which foster ment. well as to their families before the self-reliance. Such assistance may • Support and parents’ death. Parents with HIV or go directly to families and children promote the AIDS must also be helped to come or to non-formal or alternative Convention on the Rights of to terms with their approaching death education programmes benefiting the Child, includ- and to plan for their children’s welfare. part-time students. ing children’s right to be protected from II. What can the global community do? discrimination. • Financially sup- Improved access to quality education • How and where to ask for support port local projects and information about sexual and and obtain access to youth-friendly and interventions reproductive health should be a health services. helping children priority. Life skills, such as those orphaned by • How to negotiate for safer sex, taught in Zambia’s Chikankata pro- AIDS. including protected sex. gramme, are a particularly important • Highlight the AIDS part of this effort. Children, especially • How to obtain information, advice crisis, including those orphaned by AIDS, need and assistance regarding human orphans, in sector-wide skills that will help them avoid being rights, including legal rights such programmes. exploited sexually or legally. Such as inheritance. skills, which should be culturally • How to care for people with AIDS sensitive and appropriate to the chil- in the family and community. dren’s age and maturity, include: • How to make sound decisions about A global response to AIDS needs relationships and sexual intercourse. to reinforce the entire spectrum of children’s rights and help change • How to resist pressure for unwanted the underlying conditions of under- sex or drugs. development, poverty and rural/urban • How to recognize and avoid or inequities that so severely limit the abil- leave a situation that might turn ity of people and nations to cope with risky or violent. problems and develop their potential. 34

One tangible and important meas- If the world renewed commitment ure would be for the donor communi- to increasing this assistance – in ty to halt and reverse the plunge in 1970 countries had agreed to an official development assistance (ODA). aid target of .7 per cent of donor AIDS is a global emergency. In 1997, levels plumbed new depths, GNP – sustainable development could As the visors worn by these falling to the lowest average ever, of .22 be accelerated and poverty reduced. Kenyan children proclaim, per cent of donor GNP, at a time when These enhanced levels of ODA could “Anybody can get AIDS”. global wealth was growing rapidly. go towards strengthening basic social UNICEF/96-0601/Wahihia 35

services, especially education, as well other actors can count on. These Debt relief provides one as HIV prevention and support for resources can go a long way, as there orphans, through such measures as is a vast well of experience to guide avenue for the 20/20 Initiative. actions in sub-Saharan Africa, from Among the steps the global the community level on up. These such large-scale community can take are: actions should aim to improve access to services and promote other resource mobilization, 1. Declare a global emergency measures to strengthen families The AIDS pandemic has turned sub- and communities in the struggle particularly since Saharan Africa into a killing field, against HIV/AIDS. creating an orphan crisis of epic pro- sub-Saharan African portions requiring nothing less than an 4. Make AIDS a priority in poverty emergency response. Political leaders, reduction through debt relief countries are dispropor- international agencies and national While increased ODA to Africa is and international NGOs need to crucial, it is clear that addressing the tionately burdened by increase awareness of the scale and crisis of HIV/AIDS and orphans urgency of the AIDS orphan situation. will require greater resources than debt. With AIDS- bolstered ODA could offer. 2. Exchange information Debt relief provides one avenue exacerbated poverty, Exchanging information about for such large-scale resource mobiliza- successful experiences and projects tion, particularly since sub-Saharan debt is a major can spark and guide action among African countries are disproportion- neighbouring countries. International ately burdened by debt. With AIDS- stumbling block to and governmental development exacerbated poverty, debt is a major agencies, as well as NGOs, can play stumbling block to improving basic improving basic an important role in facilitating such services. A 1998 UNICEF-UNDP cooperation and exchange. study of 12 countries in sub-Saharan services. Africa showed that 7 of them spent 3. Keep Africa high on the more than 30 per cent of their nation- development assistance agenda al budgets on debt-servicing but only Official development assistance to between 4 and 20 per cent of their Africa, in decline for a number of budgets on basic social services. years, needs to be increased along Through the HIPC Initiative, with support from private founda- initiated by the World Bank and tions and other sources. Resources are International Monetary Fund in needed of a magnitude that can help 1996, a few countries in Africa have bring successful actions to national obtained debt relief, but the relief is scale. And they must be allocated with too little and too late. To improve the a regularity that governments and Initiative, the major industrialized 36

African governments and countries advocated for accelerated The UN system, including UNICEF, their development partners debt relief, particularly for Africa, at UNAIDS and key partners, must work are increasingly allocating their June 1999 summit in Cologne, with governments to ensure that resources to social sectors. and there is clear agreement amongst the poverty-reduction plans linked Here Ethiopian children enjoy all creditors and most debtor govern- to debt relief include significant a puppet show on health edu- ments that debt relief should be contributions to the struggle against cation and AIDS prevention. strongly linked to poverty reduction. HIV/AIDS, including service provision for orphans and other children affected by the pandemic.

5. Make HIV/AIDS a priority in sector-wide approaches to development African governments and their devel- opment partners are increasingly allocating resources to social sectors, especially education, health and water and sanitation, through the mechanism of sector-wide approaches (SWAPs) or sectoral investment plans (SIPs). In these schemes, governments, in consul- tation with partners, define objectives and strategies for sectoral support, and all parties apply their resources to this common plan or strategy rather than carrying out independent projects. World Bank sectoral lending is an important part of this sector-wide approach in many African countries. It is essential that social service needs associated with HIV/AIDS, including those of greatest relevance to orphans, be accorded high priority in sector- wide approaches. This prioritization of HIV/AIDS should be the focus of advocacy and policy development efforts of UNICEF and other UNAIDS co-sponsoring agencies partaking in

UNICEF/96-0560/Pirozzi sector-wide discussions and planning.