Select Committee on International Development Minutes of Evidence Memorandum submitted by Francesca Simms, The European Children's Trust
A BRIEF INTRODUCTION TO THIS MEMORANDUM
The European Children's Trust (formerly The Romanian Orphanage Trust) is an international non-governmental organisation based in London. It was formed in 1990—in the post Ceausescu era with the aim of alleviating the plight of children in Romania. Ceausescu's regime had left a legacy of many children abandoned by their parents to inadequate orphanages often referred to as "dying rooms".
Since 1990 The Romanian Orphanage Trust has evolved into The European Children's Trust working in countries of eastern Europe and Central Asia to help build child welfare systems to supersede the former institutionalised systems of childcare. The aim is for the new services to be adopted by the local authorities in order to become truly local services. The Trust has experienced at first hand the circumstances of children with HIV/AIDS with inadequate care systems and how the onset of HIV/AIDS impacts on the economic viability of families and consequently the economic viability of a country.
The Trust's core competence is in preventing the break-up of vulnerable families in situations of dire poverty and extreme social hardship. Its experience is that state orphanages, which are home for children affected by HIV/AIDS are:
While The Trust's work has been solely in eastern Europe, the former Soviet Union and Central Asia, and while it does not possess an in-depth knowledge of the issues in southern Africa, it feels that it can offer the Committee points for discussion specifically regarding the institutionalisation of children in Africa as a reaction to the problems caused by HIV/AIDS and the long-term economic effects of this institutionalisation. There is potential for long-term micro- and macro-economic disruption in southern Africa, if this emerging problem is not dealt with now. While the social backdrop in Africa is very different from that in eastern Europe, there are many analogies between the issues that The European Children's Trust's faces in eastern Europe and the issues in southern Africa.
Francesca Simms is unique in that she has worked with The European Children's Trust and has also worked in and written extensively on Africa. The European Children's Trust would like the members of The International Development Committee to benefit both from The Trust's experience and from Francesca's knowledge and hands-on experience of the issues faced in the countries concerned.
The mission of The European Children's Trust is:
"to promote reformed child care systems in central and eastern Europe to meet the need of every child to grow up in a family." Its operating principles are:
As Francesca demonstrates in this report, these principles may well be vital for the continued development of the countries the Committee is due to visit.
The Trust recommends these principles as the basis for work of a far more wide-ranging nature, which impact on the issues that the International Development Committee is now studying in Africa in order to ensure the future stability in these countries.
Daniel A Casson, Strategy Development Manager
The European Children's Trust
THE NEED FOR CULTURALLY APPROPRIATE SYSTEMS TO ASSIST ORPHANS OF AIDS VICTIMS IN AFRICA
EXECUTIVE SUMMARY
1. It is estimated that 16.3 million people have died of AIDS since the beginning of the epidemic and the vast majority have been in Africa where it is said to have "killed 40 years of hard won social progress" (Maldavo 1999). The AIDS pandemic amounts to a global emergency, particularly in sub-Saharan Africa, where it has created an orphan crisis of epic proportions requiring nothing less than an emergency response. The turn of the millennium has seen 11.2 million children orphaned by AIDS, 95 per cent of them in sub-Saharan Africa. Furthermore the numbers are increasing fast and are predicted to reach more than 13 million by the end of 2000 (UNICEF/UNAIDS 99). These children are the neediest of the needy: not only do they struggle with their own grief, but often face severe poverty, as well as stigma and discrimination. It was estimated that in 1997 there were 360,000 living AIDS orphans under the age of 15 in Zambia. 180,000 in South Africa, 150,000 in Mozambique and 270,000 in Malawi (UNAIDS/WHO 1998). For any country to meet the needs of such an unprecedented number of children in need of care requires careful planning and the proactive development of culturally appropriate and cost effective strategies and services.
2. Traditional African extended family and community care systems provide economic incentives to excellence in child care and cost effective solutions to the care of children in need and elderly persons, but are in need of support and further development. The magnitude of the numbers of orphans of HIV/AIDS victims puts immense strain on already stretched systems. Due to a lack of support, there is a real danger that the traditional extended family system of care will break down altogether under the unprecedented burden—resulting in a social humanitarian and economic crisis.
3. In the absence of adequate support to traditional systems, institutions to care for children in need continue to be built. These are cost ineffective, concentrating scarce resources on the few who have access to them; they are psychologically damaging and alienate children from extended family support systems, creating the future dependency of both the children and the elderly relatives for whom they would have been responsible. Furthermore it is argued that by competing with traditional systems, there is a danger that these will be destroyed.
4. It is recommended that proactive support and development of traditional extended family and community care systems, in partnership with traditional leaders, local communities, families and children, is urgently required to enable the development of appropriate community-based resources as well as beneficial, cost effective and culturally appropriate individual care plans for AIDS orphans. Formulation of National Policy for orphans is recommended and a coalition to work towards these aims. Education programmes are required to promote prevention of AIDS, dissipate stigma and raise awareness of needs. To enable family-based care and protect the rights of AIDS orphans requires prevention of social differentiation and poverty and reallocation of resources to meet the fundamental needs of children. This will require individual care plans enabling access to income generating projects, employment or material aid, psychosocial and systemic support, education, community-based resources, and resources to trace families of lost or abandoned children. Such action is urgently required to prevent the destruction of traditional social care systems resulting in millions of destitute children and elderly persons requiring care at a cost quite out of the question for a developing country.
AFRICAN CHILD REARING AND SOCIAL SUPPORT SYSTEMS
5. Although there are variations in different cultures and countries within southern Africa, the extended family system of care predominates and has been observed by a number of researchers to appear to minimise destitution amongst all members of society and ensure that children are cared for within the extended family (Gay 1980, Murray 1981, Barker 1973, Poulter 1976).
6. For example, in the child care system of the Basotho of South Africa and Lesotho, it is fundamental to the system that children are not the property and responsibility of their parents, but belong to the whole extended family of one lineage and are the responsibility of the whole extended family of both lineage's (Poulter 1976, Gay 1980). The extended family's responsibility is stressed in Sesotho ethical code (Matsela 1979) and is obligatory according to Sesotho Customary Law, as are children's reciprocal obligations to any relative who has contributed in any way towards his care or education (Poulter 1976). The reciprocal obligations of children in terms of a corresponding share of future wage support, care or the bride wealth paid on a girl's marriage to those who have reared her, are sufficiently valuable and essential to survival in old age, that all family members frequently compete to have a share in the care and education of a child. It is very rare for a child to lack willing care givers in Basotho society.
Furthermore it is in the interest of all relatives that each child has the best possible care, education and ethical rearing so that they develop into wise, caring, employable and marriageable adults, well able to fulfil their reciprocal obligations and to care for their relatives in return. The system therefore provides economic incentives to excellence in child rearing as family members cooperate to provide the best possible care and education for each child. Babies grow up with a close relationship with their primary care giver, usually their mother, who carries the baby on her back and sleeps with him/her at night. This enables the child to have centred care and breast feeding on demand until weaning—traditionally at about two and a half years of age. During this time and later, the child develops other close relationships and receives attention from "bome" (many mothers) within the extended family.
7. The child's attachment needs therefore are well catered for by shared care in traditional Basotho society. Fostering of children within the extended family is very common, and merely represents a shift of primary care giver within the extended family care. Thus shared care provides continuity of relationships in situations of hardship when the mother may not be present. Grandmothers frequently foster children to enable their parents to earn to support both the children and their grandparents. Traditional child rearing practice is child-centred and all family members generally participate in the indigenous education of each child providing by example, projects, and encouragement a thorough education in essential living and income-generating skills, child rearing, agriculture, care of animals, ethics, philosophy, poetry, music, pottery and art and generally also a trade. Principles of contribution and caring for other members of the family and wider community are strongly stressed in traditional education and religion. Delinquency or mental health problems amongst youth were reported to be rare before western influences exerted pressures on these systems (Matsela 1979). Transfer of bride wealth cattle (bohali) to a girl's family on her marriage also acts as an "insurance policy" for the girl and her children, since in times of hardship they are entitled to support from her relatives and the bohali cattle are means to provide this. It has been observed by a number of researchers that now, as throughout recorded history, marriage without "bohali" is unthinkable for most Basotho women, although payments are now sometimes in cash (Ashton 1967, Poulter 1976, Gay 1980).
8. Thus by a system of responsibilities and reciprocities which have developed over the centuries "The extended family provides a marvellous security for those for whom otherwise there is no security at all. The extended family is a net wide enough to gather the child who falls from the feeble control of neglectful parents, it receives the widow, tolerates the batty, gives status to grannies" (Barker 1973).
9. The village chief has the ultimate responsibility for orphans, who are normally automatically fostered in the extended family, often by the grandmother (Gay 1980, Simms 1996). For children in need the chief generally fulfils his role by calling an extended family or community group conference to formulate an appropriate care plan for the child within the extended family.
RECENT STRESSES ON EXTENDED FAMILY CARE SYSTEMS
10. However, in many African Countries, the extended family and community care system persists under enormous strain. The influence of more individualistic philosophies from the West, socio-economic pressures, increased geographic mobility and urbanisation, lack of confidence in the strengths of traditional systems and values and the introduction of western systems of law, land allocation, religion, education and the institutional care of children all challenge and erode the traditional systems of care which appear to have been so successful in preventing destitution and emotional need considering the resources available. They are systems which, if destroyed, cannot be easily reconstructed and the likely result is an increasing cycle of destitution, unnecessary suffering and expense. It is frequently stated that extended family systems of care are breaking down, and the extent of this breakdown differs from area to area. Although the equitable distribution of wealth in traditional Basotho society has been disrupted by western influences creating a class of "new poor" without the means to provide for the subsistence needs of their children, further analysis of recent pressures on the Basotho child rearing and social support system prior to the HIV/AIDS crisis suggests that, the extended family system of care continues in most cases to provide care givers for all children. The inability of some to finance the care of their children needs to be distinguished from the inability to provide actual care for them (Murray 1981).
11. This was supported by analysis of case studies of Basotho children admitted to children's homes for abused, needy or disabled children from which is was revealed that nearly all were in fact admitted for financial reasons, either because the family were unable to meet their subsistence needs or (in situations of poverty) for financial advantage. In either case the children's needs could have been more appropriately met at far less expense whilst they benefited from living with their own families. None lacked care givers willing and able to provide care for them (Simms 1985, 1988). Admissions to institutional care which could have been prevented by the provision of material aid to the family have long been considered unethical (Short 1956).
12. Children's homes which often provide comparatively advantaged material conditions of care and free education, without corresponding claims on a share of the reciprocal obligations of the child, were found to have been misunderstood by some families, who sought admission for their children for perceived advantages. The psychological disadvantages of the institutions which had inadequate staffing ratios to enable substitute parenting and normal psychological development were less visible. Traditional extended family child rearing has evolved over the centuries to generally provide good child centred rearing and provision for children's attachment needs. However, unaware of research in child care methods, they do not always recognise the merits of their own child rearing systems, nor the damaging psychological effects of other more materially-advantaged care. Many of the children in institutions lost all contact with their extended family-their only future "social security system" nor did they learn adequate skills to survive as adults outside the institution. Psychologically damaged they were not able to benefit much from their education either and were likely to be permanently dependent on the institution. Although some families requested that their children were returned to them, this was sometimes not allowed by the staff of the institutions and once admitted the children were permanently institutionalised. This also resulted in the poorest families losing their future source of care and wage support (Simms 1985, 1988, 1996).
13. The care of children in large institutions is an outdated western model dating from before research by the World Health Organisation in the mid-twentieth century into attachment theory and the psychological needs of children (Bowlby 1956). Although some of the findings have been modified, the central argument that "the care of children in large groups does not meet their needs for normal psychological development"—still holds today. "Institutional care is an insufficient and damaging form of care that should not be imposed on developing countries" (M Mead 1962). The introduction of such children's homes to Africa is particularly inappropriate because they compete with and threaten to destroy traditional extended family systems of care, the destruction of which could result in millions of children and elderly people requiring such care in the future.
14. However, the most persuasive argument against the use of children's homes as a solution to children's needs in the developing world is one of cost. The cost of keeping one child in even a very damaging institution in Africa has been estimated to be as much as providing total and comprehensive support for an average family of 5.2 persons, or assisting the families of over 1,000 children with income generating projects (Simms 1985, 1988, 1996). The cost of a children's home providing adequate ratios of staff to children to minimise the disadvantages of this form of care is even more expensive. In UK such homes cost approximately £41,600 per child per year.
THE NEED FOR SUPPORT TO EXTENDED FAMILIES AND COMMUNITIES TO ENABLE THEM TO CONTINUE TO CARE FOR CHILDREN IN DIFFICULT CIRCUMSTANCES
15. However, without the urgent provision of substantial alternative help to support extended families and communities in the care of their children, particularly in view of the magnitude of the AIDS orphan crisis, there are likely to be soon millions of children requiring care in institutions or living destitute on the streets. It is estimated that in Malawi there are already 75,000 children living on the streets of Lusaka alone and many of these are sexually exploited (UNICEF/UNAIDS 1999). Thus, although it is generally accepted in principle that institutional care of children is not appropriate in Africa (UNICEF/UNAIDS 1999), unless proactive, planned alternative support to the extended family is vastly increased, children's homes are likely to continue to be built as a quick-fix solution to the problem, thereby storing up problems in the long-term.
Case studies of children admitted to children's homes from Basotho families prior to the AIDS epidemic found that resources needed to prevent such admissions were the following: income generating possibilities-employment or material aid for families-support and assistance in enabling the development of appropriate care plans for children within the family-community-based rehabilitation and education facilities for disabled children-police to trace families of lost or abandoned children-temporary foster care for children until families were traced—education of the community in needs of disabled children—support for the community and extended family system of care (Simms 1985, 1988, 1996).
NEEDS OF AIDS ORPHANS
16. The HIV/AIDS crisis brings new needs of huge proportions. Neither words nor statistics can adequately capture the human tragedy of children grieving for dying or dead parents, stigmatised by society through association with HIV/AIDS, plunged into economic crisis and insecurity by their parents death and struggling without services and support systems in impoverished communities. Haworth (studying the effects of AIDS on 116 Zambian families) highlights the process that children often go through before being orphaned. They have often had to care for one or both parents whilst their illness progressed and often with inadequate pain relief, knowing that they suffered from a "shameful" disease. This resulted in trauma and stigmatisation at school. The process can last five years as first father, then mother, then younger siblings die, during which time they may receive little guidance or support as the family is preoccupied with death. They may experience a second round of losses as they move to the care of an aunt or uncle who also become ill and die. Sudden poverty means they cannot attend school so they are deprived of status as well as parents. Often adolescent girls become unpaid servants and there is added danger of sexual harassment. Children often find themselves taking on the role of mother or father or both as their parents die—doing household chores, looking after siblings, farming and caring for dying or ill parents. Children who live through their parent's pain and illness frequently suffer from depression, stress and anxiety. Many children lose everything that once offered them comfort, security and hope for the future.
17. There is considerable evidence that children separated from their parents are placed at increased risk (Pringle et al 1966, Rutter and Madge 1976, Wolkinde and Rutter 1985) and that unresolved childhood bereavement results in higher incidence of mental ill health (Simms 1983). Children who have suffered multiple losses are more vulnerable. Some African cultures have well developed informal customs to provide support in bereavement (Simms 1986). However, stigma may prevent AIDS orphans from benefiting from such support. Orphans run greater risks of being malnourished and stunted than children who have parents to look after them. They also may be the first to be denied education when extended families cannot afford to educate all the children of the household. A study in Zambia showed 32 per cent of orphans in urban areas were not enrolled for school as compared to 25 per cent of non orphans. Increasingly children whose parents are dead accumulate ever greater burdens of responsibility as heads of households when a grandparent or other care giver dies. They suffer social isolation due to stigma and irrational fear—they are often denied access to school or health services as well as inheritance and property. Often emotionally vulnerable and financially desperate orphaned children are more likely to be sexually abused and forced into exploitive situations such as prostitution as a means of survival. As a result they are at risk of being infected with HIV themselves.
POSITIVE CLIMATES FOR AIDS ORPHANS TO FACILITATE COPING
18. Gabarino et al (1992) found that a child's resilience is better after about 11 and children under three are most vulnerable. The following factors can create an environment conducive to coping:
a consistent supportive positive relationship with a primary care giver, and as well as a primary care giver, additional care givers within the extended family. These care givers should model resilience by reassurance and encouragement and helping children to process stress. Community social networks are important and ideology such as a religious belief contributes to resilience as does a supportive educational environment.
EFFECTS OF AIDS ON FAMILIES, COMMUNITIES AND THE ECONOMY
19. The families and communities who provide these needed supports are also devastated by the magnitude of deaths from AIDS. The extended family networks of aunts, uncles, cousins, and grandparents, are an age old safety net for children in need that has long proved itself resilient to even major social changes. This is unravelling rapidly with soaring numbers of orphans in affected areas. Capacity and resources are stretched to breaking point, and those providing care already are impoverished, often elderly, and might themselves have depended financially and physically on the support of the very son or daughter that has died.
20. AIDS also weakens the infrastructures. As those dying are usually in their most productive years, many schools, hospitals, private industries and civil services are short staffed due to HIV/AIDS. National Budgets are stretched. By 2005 health sector costs for treatment and care of HIV/AIDS victims are likely to be one third of total Government Health spending costs. In the private sector AIDS-related costs are expected to amount to one fifth of profits and the World Bank estimated the losses one per cent gross domestic product growth a year. For families caring for someone with the disease resources quickly evaporate. Studies on the Ivory Coast, for example, show that when a family member has AIDS, average income falls by 52 to 67 per cent whilst expenditures on health care quadruple, (UNICEF/UNAIDS 1999). Such families urgently require assistance to create funds necessary for them to continue to provide the care that orphans need.
RECOMMENDATIONS FOR DEVELOPMENTS REQUIRED TO MEET THE CHALLENGE OF THE ORPHANS CRISIS
Government Strategies to Protect AIDS Orphans
Policies to Protect Rights of AIDS Orphans
21. AIDS orphans are the most vulnerable of children because of the stigma they suffer in addition to all their other disadvantages. Governments need to actively pursue policies which ensure that the rights of such children are protected. This involves transferring resources, and developing services and systems for AIDS programmes and to support extended families in caring for orphans, enabling the rights of women and children to be fulfilled and ensuring that every child in need, and particularly every AIDS orphan has an appropriate care plan to address these needs.
Political Will
22. Most important in addressing the AIDS crisis and the crisis of caring for AIDS orphans is political will. Uganda's high level response and outspoken acknowledgement of the crisis, remains a model to be emulated in most other hard hit countries.
Education programmes to Promote Prevention, Dissipate Stigma, and Raise Awareness of Needs of Victims and Orphans of AIDS
23. Most essential are education programmes concerning prevention, to dissipate stigma and to increase awareness of the needs of AIDS orphans and their families. Unfortunately some governments have been reluctant to face up to the seriousness of the problem and communicate this to the Public. Few young people receive the information they need about AIDS and its transmission. In many places schools provide no reproductive health education. A study in Kenya found that 36 per cent knew of no way they could try to protect themselves against AIDS and 32 per cent did not know that a healthy looking person could have HIV or AIDS. In sub-Saharan Africa more than half of women give birth before they are 20. In South Africa a study showed that 9.5 per cent of pregnant girls under the age of 15 were HIV infected.
24. In this climate denial persists and with few testing facilities UNAIDS estimates that nine tenths of those with HIV are not aware of this. Ignorance breeds unfounded fears and discrimination so that infected people are too ashamed to admit this. Those who do sometimes suffer beating, being thrown out of their homes or being deprived of their children (UNICEF/UNAIDS 1999).
25. Use of the radio, which reaches all parts of the country, has played a key role in educating the public about AIDS in Uganda and young people have always been a prime focus of many of the countries' AIDS programmes. Teaching school children more understanding and humane attitudes to victims and orphans is beneficial.
Attention to Emotional Needs of AIDS Orphans
26. It is essential to address the emotional needs of children devastated by their parents' death and sometimes also by the death of younger siblings. They need support and often individual as well as systemic family counselling. If they do not live with their extended family to benefit from the broad education provided in the family unit, then alternative education programmes are needed to empower them through learning life skills.
Developments to Protect the Rights of Woman and Children in the HIV/AIDS Crisis
Prevention of Social Differentiation and Poverty and the Reallocation of Resources to Meet the Fundamental Needs and Rights of Women and Children
27. AIDS disproportionately effects the poorest and most disadvantaged in developing countries. Governments could go a long way to meeting fundamental needs of their people by shifting resources into basic social services such as primary health care, nutrition, low cost water and sanitation and basic education instead of secondary education and advanced health care. In many African countries social differentiation is increasing and many families are not financially able to meet even the most basic needs of their children. For example in Zambia 80 per cent of the country's rural population is considered to be living below the poverty line, more than 50 per cent of children are chronically malnourished and large numbers of families are forced to ration food. It has been estimated the 42 per cent of all young Zambian children have stunted growth. (UNICEF/UNAIDS 1999).
28. The front line on the war on poverty and underdevelopment must be the struggle for economic justice and growth. The fundamental issues of woman's rights, land reform, disarmament, income distribution, job creation, fairer aid and trade policies and more equitable international order remain the fundamental detriments to children's survival, health and well being. However, whilst that war is being waged there is a need for a second front—giving parents in poor communities the knowledge and financial support to protect their children against the worst effects of poverty in their most vulnerable and vital years of growth—so breaking the self-perpetuating cycle of poor growth, and lowered potential by which poverty of one generation casts its shadow on the next. Many industrialised countries have a minimum material "safety net" in the form of a social security system. This is not possible for most developing countries, but a more elementary safety net in the form of minimum food entitlements, primary health care, elementary education, safe sanitation and clean water could be put in place now. However, the UNICEF report recommends an even more basic and immediate goal to provide basic protection for the world's most vulnerable children, the cost of which is politically and financially minimal in relation to the benefits such protection would bring. In addition to an immunisation programme, education of children's parents about child nutrition, breast feeding, and oral rehydration therapy, the report recommends that children's growth is monitored and parent's given, where necessary, the means to prevent the malnutrition of their children. It is calculated that this would improve child health so dramatically as to halve rates of death, disability and malnourishment (Grant 1985).
29. Governments, nationally and internationally must encourage a more equitable distribution of wealth and aim to create an environment where children can realise their rights. This includes rights to survival and development, to the highest possible standard of health, to education and to protection from abuse and neglect. This requires the generation of the political will to achieve this and reallocation of resources. This would benefit AIDS orphans as well as other children in need.
Reformation of Law
30. Many orphans are cared for by widows (often their grandmother). Some laws are in need of reform such as inheritance laws, which in some cases prevent widows from inheriting their land, which may be their only source of income. Advocacy is required for women and children who may not be aware of the legal rights that they do have.
Resources on a Large Scale
31. Human, financial and organisational resources are needed on a massive scale if affected countries are to prevent the AIDS orphan crisis from overwhelming services and breaking down millions more families and social support systems.
Support for the Extended Family System of Care
32. Developments should aim to support and develop the traditional extended family and community care systems. There have been many encouraging initiatives that have developed in a number of African counties, but these are still in their early stages and are small in comparison to the enormity of the problem.
Care Plans for Orphans Developed in Partnership with Children, and Families
33. Africa has a concerning history of the development of culturally inappropriate western systems which undermine traditional social support systems (Murray 1976, Gay 1980, Simms 1996). To ensure that the services developed are appropriate it is important that they are developed in partnership with the countries, communities, families and children concerned. Traditionally problems such as the care of a particular child were solved by family or community group conferences overseen by the village chief. It is suggested that this may well be a model that could beneficially be developed further. Family group conference methods (recently introduced to UK from New Zealand) involve first the identification of the needs of the child concerned and any resources that may be available. Then the extended family and other relevant people chosen by the child and family meet to formulate a care plan to meet these needs, identifying which of available resources are needed to implement the plan. The child chooses an advocate to help represent his/her wishes and support the child during the meeting. Provided that the plan adequately addresses the identified needs it is then accepted for implementation. A plan formulated by the family is more likely to be adhered to and succeed. Such a model ensures partnership and may be relevant in many cases for identifying appropriate care plans for AIDS orphans.
Community-Based Resources and Services Developed in Partnership with Children, Families and Communities and Traditional Leaders
34. It is also beneficial if community-based resources, services and policies can be developed by or in partnership with the communities concerned and if they utilise traditional roles and responsibilities of chiefs and village or community leaders. The Social Welfare Department of the Government of Zimbabwe piloted such a model of community-based orphan care in Masvingo Province in 1994. This district of 165,879 people is divided into three areas and 94 villages and governed by traditional leaders: Chief Charumbira, sub-chiefs and village leaders. The orphan care programme was structured to utilise the traditional roles and responsibilities of these leaders, who have the authority to mobilise their people and resources in times of crises and emergency. Chief area committees composed of the area sub-chiefs, advisors and village leaders were established in each of the three areas. These committees address policy and planning issues and guide village activities. Local activities are carried out by village committees made up of village leaders and community members. Most of the work is done through community volunteers. Villagers now ensure that orphans are properly fed, clothed and housed. Volunteers even take over children's household chores so that they can attend school. Every villager was asked to donate a small amount of money to pay primary school fees and for food in the drought period. Villagers also pool labour and monetary resources to develop communal gardens and wood lots to generate income. The committees were trained by the Child Welfare Forum and are responsible for identifying orphans, recording information about them including needs and ensuring that care plans are made to meet these needs where possible, referring to appropriate agencies where necessary and, if beyond the capabilities of the area committees to the state social services. 11,000 of the 11,514 orphans were cared for by a relative, usually a woman, widowed and often the grandmother.
35. Zimbabwe has developed different pilot schemes for urban areas and on commercial farms—where there are many immigrants and extended families have been replaced by a new structure of community. Here, if the preferred placement of a child in the extended family is not possible, children are placed in their sibling group with foster parents in the children's immediate community.
36. Malawi has also been successful in recognising early on that because communities are in the best position to identify their own needs, they would play an important role in addressing the AIDS crisis. One of the Government's main strategies therefore has been to promote and support community-based programmes.
37. In the development by community organisations (eg NGOs and churches) of community-based resources to support the particular needs of children and families in the area, where possible this should utilise existing traditional systems such as those of the village chiefs as in the pilot scheme in Zimbabwe.
38. Community organisations can be assisted in developing needed community-based resources by:
Formulation of a National Policy for Orphans
39. An important step in addressing the crisis is the formulation of a National Policy for AIDS orphans and a coalition of relevant people and organisations to progress work towards these aims. This policy needs also to be formed in partnership with traditional leaders, communities, families and children involved. In Zambia community members have been largely responsible for initiatives, but also a strong collaborative effort between the Government, NGOs, community-based organisations and churches with support from UNICEF has helped strengthen the orphan programme. Malawi has a National Orphan Care Task Force since 1991 which established The National Orphan guidelines in 1992. These have served as a blueprint to encourage and focus community efforts to support orphans. From lessons learnt from these the Government will develop a National Orphan Care Policy.
Support of Extended Families and Communities in the Care of Orphans
40. Extended families and communities need to be facilitated in making an appropriate care plan for every orphan or child in need to enable them to live in their own family by the provision of the necessary resources and support to make this possible.
Resources to trace families of lost and abandoned children and temporary foster care whilst this is achieved.
41. For some children, such as those who are lost or have been abandoned, first their families need to be traced and then it can be investigated whether there is a relative who could care for the child if given appropriate support. Recording next of kin by hospitals so that families of orphans can be found is important. Also needed are resources to trace families of any children who are abandoned, lost, or who are living on the streets, so that rehabilitation with their families can be attempted. Short term foster placements are needed for children whilst this is done. Cases have been noted in Africa where healthy babies who were cared for in hospitals after being abandoned, have become malnourished (Simms 1985). Even in temporary alternative care, babies, in particular, need to bond to a foster carer to minimise psychological damage. (Bowlby 1952, Pringle 1980).
A Care Plan for Every Orphan
42. A care plan for each orphan is needed to identify a care giver in the extended family and a support system. The needs of the orphan and those who try to care for him/her need to be assessed and an appropriate plan made to provide help required to meet their needs. Each child should have a named person who is responsible for the social work tasks of ensuring an appropriate care plan is made, carried out and regularly reviewed to ensure that the child's needs are met. The care plan may involve the provision of:
43. If these measures still do not enable a suitable placement for an orphan in the extended family then locally based foster care in the child's own community, keeping siblings groups together for mutual support, would be the next best alternative. Other measures that have been used include paying a care giver to look after a family of orphans in the family home, giving support to child-headed households and small "family group homes"—about seven children cared for by paid care givers in the children's immediate community. These solutions are not ideal, but certainly preferable to care of children in large institutions. However research suggests that when an extended family is not able to care for children, in reality the problem is usually the money to finance this care, not lack of an available care giver (Murray 1980, Simms 1985, 1988, 1996). In cultures where caring for children is the means to ensuring one's future survival and social security, it seems unlikely that any extended family member would not willingly care for a child, if they were provided with the financial means to do so and other necessary support. Employment is generally difficult to find in impoverished areas and particularly if the alternative care considered involves paying someone else to care for the child, paying a relative a wage instead to do this task might well enable family based care. However, even the provision of more limited resources to enable the family to meet the child's needs would normally suffice. Case studies of children who have been provided with alternative care from their extended families in Africa prior to the HIV/AIDS crisis, suggest that this could in every case have been prevented had sufficient resources been made available to the family. If this is still the case then this is more cost effective as well as usually much more beneficial for the child (Simms 1985, 1988, 1996).
CONCLUSION
44. The AIDS orphan crisis needs to be recognised as a global emergency and responded to as such. Resources are urgently needed to support extended families in caring for AIDS orphans and other children in need and to reinforce children's rights by changing the underlying conditions of underdevelopment and inequalities which perpetuate poverty from one generation to the next.
45. The consequences of not developing culturally appropriate services to support the extended family and community care systems in caring for these children are too serious to contemplate as the social structure of Africa crumbles resulting in enormous suffering and destitution. This will potentially have an irreversible impact on the development of these African economies and will halt their continuing development.
Francesca Simms, Social Work and Child Care Consultant
The European Children's Trust
January 2000
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