Regional Perspectives Successes and Challenges - Africa

Orphans and vulnerable children: Communities in need of support.

The Regional Psychosocial Support Initiative for Children Affected by HIV/AIDS (REPSSI) provided the regional perspective for East and Southern Africa during the Technical Consultation on Children and HIV/AIDS in London, 7-8 February, 2006. The initiative is a psychosocial support (PSS) network for children affected by HIV and AIDS. REPSSI operates in 13 countries and has a partner base of nearly 60 organisations in the region working to mainstream PSS into their activities and policies. Ms Noreen M Huni, speaking for the region, told participants that the family system has not collapsed, but is very overstretched. Communities are committed to caring for and supporting the children themselves; extended families, communities, faith-based and non-governmental organisations (NGO) provide the majority of care and support for orphans and vulnerable children (OVC) in the HIV/AIDS context.

In this region, OVC programming has recognised that cultural systems, practices and beliefs are a valuable entry point for successful and sustainable interventions. For example, Malawian initiation ceremonies have included HIV/AIDS prevention messages in their curriculum. The elderly are increasingly taking up this responsibility, yet their own material, physical, social, spiritual and emotional needs remain unmet. The overall capacity to responding is extremely inadequate. Knowledge, skills and resources are far from sufficient. Communities need resources and technical capacity enhancement to manage these resources.
The comprehensive care and support packages provided so far are physical, spiritual and material in nature, ignoring the psychosocial well-being of the children. Thus, there is a huge gap requiring unique interventions to strengthen the existing responses. Access to essential services has been agreed upon but tremendous barriers hinder access to these basics. Access to antiretroviral (ARV) drugs remains limited due to issues of affordability, accessibility and treatment literacy. Children are still not accessing ARVs, which as a priority are given to adults. Appropriate dosages and formulations for children are unavailable.

National Plans of Action are in place and most governments are attempting to address OVC needs with the necessary policies, for example the 'Free Education for All' campaign, although other barriers continue to hinder children from attending school. But there is no legislative review to support the Convention on the Rights of the Child; these rights remain inaccessible to most OVCs. Many OVC have no legal existence at national level due to lack of birth registration - therefore no resources are allocated for OVC. Most countries have no national social policy on OVC - leaving NGOs and faith-based organisations (FBOs) to take the lead in responding.

Government officials have begun to include the plight of orphans in their campaign and advocacy strategies. Schools are becoming centres of care and support. Hospitals are also being used as meeting places for support groups, counselling centres and provide information on the well-being of orphans. Certain print and broadcast media are taking a positive responsibility to educate and create awareness of issues pertaining to children within an HIV/AIDS context. There has also been a major increase in the number of NGOs focusing on OVC issues. But challenges remain - there are too many soldiers and no generals in this fight. It is not clear which ministries are mandated for OVC and what status these ministries have. The OVC challenge has a very low profile among the national governments. Noting that children constitute 50% of the population in most countries, isn't it time to create a special ministry for them?

International funding partners, UN agencies, regional and national political structures have all emphasised the seriousness of the problem. But the funding duration is usually less than 5 years, which ignores the fundamentals of child rights programming. Donors often arrive with pre-planned interventions, rather than supporting existing multi-sectoral responses - searching for 'quick results'. Some interventions are unrealistic, and do not take into account succession plans, such as exit strategies. A lack of coordinated donor activities is reported in most African countries and information-sharing is limited between funding partners and recipients. FBOs and CBOs often do not have the technical capacity to access available funds. An additional problem is that regional political structures (i.e. Pan African Parliamentarians, AU, SADC and NEPAD) have failed to mainstream OVC in regional HIV/AIDS, poverty reduction and budgeting and planning frameworks.

UNICEF in collaboration with REPSSI and some African universities have started working on a 'Children at Risk' certificate level programme for child care and support service providers in response to the knowledge and skills gap. Children, families, communities, non-governmental and faith-based organisations are providing the majority of OVC with care and support. But there is an urgent need to make these interventions more visible and respected by the communities themselves, before trying out 'new' interventions. The programme for orphans and vulnerable children should be high on the international, regional and national agendas. The nature and duration of interventions should ensure there is no additional trauma by placing the child and family at the centre of the programmes.

Ishdeep Kohli-CNS