Supporting aid effective responses to children affected by AIDS: Lessons learnt on channelling resources to community based organisations

Supporting aid effective responses to children affected by AIDS

In response to growing numbers of orphans and vulnerable children affected by HIV and AIDS in the last two decades, many communities have formed organisations to provide material and other support to these children. Likewise, international donors and intermediary agencies have increased their funding levels and capacity building efforts to Community Based Organisations (CBOs). Considerable effort has been spent on looking at how to get financial and technical resources to CBOs quickly and efficiently.

This study seeks to improve our understanding of successful initiatives that can create a more predictable and long-term funding environment for CBOs, managing to both address the trade-off between reducing fiduciary risk of monies being misspent yet also avoid disproportionate and onerous levels of accounting and reporting for relatively small sums of money. The study is the result of field research in Uganda, Burkina Faso and Malawi undertaken between April and July 2010, in collaboration with CARE Uganda, SAT Malawi, and IPC in Burkina Faso whose support is gratefully acknowledged.

This study was commissioned and funded by UNICEF-HQ and World Vision UK (WV), as members of the Communities and Resources Working Group (C&RWG) of the Inter-Agency Task Team on Children and HIV and AIDS (IATT), in collaboration with the Regional Inter-Agency Task Teams on Children & AIDS (RIATT) for Eastern and Southern Africa and for West and Central Africa.1 It sought to identify examples of financial mechanisms that provide financial and technical resources to CBOs who themselves provide care and protection to children affected by HIV and AIDS.

Burkina Faso, Malawi and Uganda have successfully established financial mechanisms that attract funding from multiple donors, which improves alignment and harmonisation of donor funding to Civil Society Organisations (CSOs).2 These mechanisms also provide an opportunity for funding to be more strategically allocated against nationally developed strategic plans of action on OVC. However, the degree of input from community level into the setting up or resource allocation was limited. Of the over 50 CBOs interviewed during this study, none had any knowledge or understanding of the macro-environment that had such a significant impact on their access to money. In all three countries, the message was clear – money talks, and with the donor and government at the table, the voice of CBOs was usually not considered, or CBOs were considered too ‘weak’ and poorly informed to have a valid point of view.

Using the five key principles of the Paris Declaration (ownership, alignment, harmonisation, managing for results and mutual accountability) as a guide, examples of good practice and areas for further improvements were identified.

SADC business plan on orphans and other vulnerable children and youth 2009-2015

SADC business plan on orphans and other vulnerable children and youth 2009-2015

Poverty and under development remain daunting challenges for the SADC region. The combined impact of these factors is evident in the increasingly high numbers of orphans and other vulnerable children and youth (OVCY) and the often acute violation of human and child rights. The SADC business plan links with other strategic frrameworks to provide a roadmap of the SADC approach to the care and support for OVCY. 

About two thirds of the population in the region live below the international poverty line of US1$ per day. Poverty in SADC is exacerbated by several factors among which are: (a) high levels of diseases in particular HIV and AIDS, Malaria and Tuberculosis.

These have resulted in unprecedented levels of morbidity and mortality among the people of productive and reproductive age; (b) social conflict and in some cases war; (c) natural disasters such as recurrent droughts and floods associated with climate change which impact negatively on food security; (d) unemployment; (e) and low industrial growth and productivity which is reinforced by high levels of migration of skilled labour from the region.

The recent global economic turmoil is compounding on the already dire situation in the region. Health, social and economic forecasts suggest that household poverty and orphaning will remain high in the foreseeable future. Vulnerable and poor households such as those headed by children, women, older people, people living with disabilities and HIV and AIDS and the unemployed bear the brunt of these numerous challenges, with often little or no options to cope. 

In view of these challenges, SADC developed specific interventions focusing on OVCY, elaborated through the Strategic Framework and Programme of Action for OVC, 2008 -2015 that was approved by SADC Ministers of Health and HIV and AIDS in November 2008 -2015. The Framework and this Business Plan, mark the first deliberate effort to mount a regional response on OVCY in SADC.

The premise of the SADC approach to the care and support for OVCY is the recognition that people in particular children and young people who comprise the demographic majority, are the real wealth of SADC Member States (MS). Thus, the fundamental purpose of development should be directed at enlarging their human freedoms and capabilities by expanding the choices that they have, to live full productive and creative lives, contributing to sustainable development in SADC.

Regional workshop on supporting effective aid responses to children affected by AIDS: Draft workshop report

Regional workshop on supporting effective aid responses to children affected by AIDS: Draft workshop report

The regional workshop on supporting effective aid responses to children affected by AIDS was aimed at stakeholders involved in channelling resources to vulnerable children and their carers, affected by HIV and AIDS in Southern and Eastern Africa to discuss the results of three regional studies undertaken in 2010.  The goal was to discuss the lessons from these studies to both improve their practises at country level and to provide an advocacy agenda of how to work collectively to improve aid effectiveness to children affected by AIDS.

The practice and activities of psychosocial support by communities and families for children and adolescents living with HIV

The Southern African AIDS Trust (SAT) has launched a new resource on the requirements for Psychosocial Support for Children and Adolescents.

Organisations need to support caregivers, families and communities to create conditions that allow children and adolescents to experience being cared for and loved as part of their day-to-day experiences in their families and communities. Young children affected by HIV and AIDS, and other major disruptions in their lives, have critical psychosocial needs that are best addressed when embedded in their everyday lives – through responsive parental care, a return to normalcy (such as routines and opportunities to play), and social participation (such as returning to school and in other community activities).

Psychosocial care, support and rehabilitation are all best provided by families and communities, sometimes with assistance. When families are supported to be able to provide care, few children need specialised psychological or social programmes.

Programmes that can effectively meet the needs of children in the context of HIV and AIDS and poverty are those that acknowledge, support and strengthen the commitment and care of families and households. These responses must be supported by constructive national policies and the mobilisation of resources. Within the mix of required responses, activities to protect, support and promote the psychosocial wellbeing of children and families are urgently needed.

Other resources recently published by SAT include:

Counselling Guidelines for Voluntary Medical male circumcision (VMMC) - a booklet that specifically addresses counselling on Voluntary Medical Male Circumcision (VMMC) as an additional HIV prevention method.

Mainstreaming Gender in the Response to HIV and AIDS in Southern Africa - a guide for the integration of gender issues into HIV and AIDS response.

20 years of strengthening community HIV and AIDS competence: Lessons for the future - a reflection on the South-South learning over the past 20 years as experienced by SAT partners.  

These resources are available through the SAT website: www.satregional.org,  through any of their country offices in Botswana, Malawi, Mozambique, Tanzania, Zambia and Zimbabwe, or by writing to info@satregional.org.

Legal frameworks and policies for orphans and vulnerable children

Legal frameworks and policies for orphans and vulnerable children

A list of legal frameworks and policies for orphans and vulnerable children in SADC countries.

Don't let children fall off the map: Children in Eastern and Southern Africa affected by AIDS

Don't let children fall off the map.pdf

Whilst some progress has been made towards these goals, the reality is that most affected countries, including those in Eastern and Southern Africa still have a long way to go in terms of fulfilling the many commitments and goals. In Eastern and Southern Africa children, their families and their communities continue to live with the harsh impacts of HIV and AIDS.

Community responses for children affected by AIDS: Challenges for the future! RIATT-ESA satellite – ICASA 2011

Community responses for children affected by AIDS: Challenges for the future! RIATT-ESA satellite – ICASA 2011.pps

The RIATT-ESA held a very successful satellite session at ICASA 2011. Focusing on Strengthening families, Increasing effectiveness of resources, and Child participation, The key note address was presented by Dr. Chewe Luo, and looked at future challenges in the community response for children affected by AIDS. 

Dr. Luo is a Paediatrician and Tropical Child Health specialist from Zambia, currently working as Technical team leader for Country programme scale-up and Senior programme Advisor for HIV at UNICEF, New York. She has over 15 years of experience in HIV/AIDS and child health as a clinician and researcher at the University Teaching Hospital in Zambia; as a clinician in the UK, and working with UNICEF at country, regional and headquarter levels. She has a Masters of Medicine in Paediatrics from the University of Zambia and a Masters in tropical Paediatrics and a PhD from Liverpool School of Tropical Medicine in the UK

Children and AIDS: Fifth stocktaking report, 2010

Children and AIDS: Fifth stocktaking report, 2010.pdf

For nearly three decades, HIV and AIDS have been devastating individuals and families with the tragedy of untimely death and medical, financial and social burdens.  Although children’s concerns have always been present within the great spectrum of need associated with HIV, they have to some extent been overshadowed by the very scale of the epidemic in the adult population. Thanks to improved evidence and accelerated action, however, the story of how the AIDS epidemic is affecting children is being rewritten.

No longer a sidebar crowded out by the broader compelling narrative of HIV and AIDS, children are now central to strategies and actions to avert and address the consequences of the epidemic. It is estimated that more than 1,000 babies continue to be born with HIV every day, many of them destined to die before age two if they do not receive medication. Mothers are still dying. Adolescents are still becoming infected with HIV because they have neither the knowledge nor the access to services to protect themselves, and those infected at birth are struggling to reconcile their emerging adulthood with their HIV-positive status.
But advocacy and investment on behalf of children have had an impact, and the goal of virtual elimination of mother-tochild transmission by 2015 appears within reach. In 2005, for example, only 15 per cent of HIV-positive pregnant women in low- and middle-income countries received antiretrovirals for the prevention of mother-to-child transmission (PMTCT) of HIV; in 2009, 53 per cent of women in need received antiretrovirals for PMTCT.

In 2005, only 75,000 children under 15 in need received antiretroviral treatment. Today, that figure is approximately 356,400, around 28 per cent of those in need.

In 2005, 5.2 million young people aged 15–24 were living with HIV; today, an estimated 5.0 million are.4 Before 2005 in many sub-Saharan African countries, children who had lost both parents to AIDS were much less likely to be in school than children whose parents were alive; today, in most places they are almost
equally likely to be in school.

Child protection and children affected by AIDS: A companion paper to the framework for protection, care and support of orphans and vulnerable children living in a world HIV and AIDS. August 2006

The past six years have seen increasing engagement by the international community on HIV, AIDS and children. One of the eight Millennium Development Goals set by governments in 2000 relates directly to HIV and AIDS. In 2001, at the United Nations General Assembly Special Session on HIV/AIDS, governments pledged to protect children affected by the disease. Global commitment to combat the impact of HIV and AIDS on children was again outlined in 2002 in ‘A World Fit for Children’, the outcome document of the UN General Assembly Special Session on Children. More recently, in June 2006, the UN General Assembly adopted the Political Declaration on HIV/AIDS, which reiterated government commitment to “addressing as a priority the vulnerabilities faced by children affected by and living with HIV; providing support and rehabilitation to these children and their families, women and the elderly, particularly in their role as caregivers; promoting child-oriented HIV/AIDS policies and programmes and increased protection for children orphaned and affected by HIV/AIDS…and building, where needed, and supporting the social security systems that protect them.” Many international and non-governmental organizations have endorsed The Framework for the Protection, Care and Support of Orphans and Vulnerable Children Living in a World with HIV and AIDS (The Framework), which outlines key strategies and actions. In October 2005, the Unite for Children. Unite against AIDS global campaign was launched. Among the central goals of the campaign is the protection, care and support of children affected by AIDS. Many countries heavily affected by the pandemic have responded by developing their own plans of action for orphans and vulnerable children, creating a mechanism for coordination and oversight for governments to work closely with civil society. This companion paper to The Framework provides additional information and outlines recommended actions for protecting affected children from increased vulnerability, and for reducing the higher risks they face of abuse, exploitation and neglect. While this paper discusses the protection issues facing children globally, its actions speak directly to the findings of the publication, Africa’s Orphaned and Vulnerable Generations: Children affected by AIDS, which incorporates new research on the vulnerability of orphans in the region hit hardest by the pandemic. All children have a right to protection. A child whose family is wealthy can still be raped or beaten. A girl in a loving family may still be married against her will when this is the social norm. Nevertheless, the risks for children increase when they or their families are poor, lack access to basic services, or are stigmatized within their communities. Parents are children’s first line of protection; risks increase when parents are absent due to illness, death or abandonment.

Children affected by AIDS are particularly vulnerable to protection violations because these problems are more likely to cluster in their lives. Reaching this group of children can be difficult because they may be hidden from view due to the stigma around HIV and AIDS. Children affected by AIDS share many vulnerabilities with children who have disabilities, children who are discriminated against due to the colour of their skin or children who have lost their parents as a result of armed conflict.

Protecting children affected by AIDS requires strengthening national and community-level responses for all vulnerable children. Governments, civil society and their partners can make real progress towards this goal by enhancing social protection, legal protection and justice and alternative care. This work must be underpinned by efforts to address the silence and stigma that allow both HIV- and AIDS-related discrimination, abuse and exploitation of children to continue. It also requires strengthening government authorities that hold the bulk of responsibility for protection, to more effectively provide oversight and coordination. This responsibility often falls to government social welfare agencies, but may also include health, education and other agencies. Priority actions needed in each of these areas are detailed in this document and are summarized in the matrix on the following page.