Health%20and%20social%20services%20to%20address%20the%20needs%20of%20orphans%20and%20other%20vulnerable%20children%20in%20the%20context%20of%20HIV/AIDS

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Health and social services to address the needs
of orphans and other vulnerable children in the
context of HIV/AIDS Research report and
recommendationsPresented at PHRC 29 May
2003 By Sonja Giese Childrens
Institute University of Cape Town
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Background

• 6.5 million people in SA infected with HIV (2002)
• 3.2 million women between ages of 15-49 (2002)
• 70 HIV-infected population in stages 1 and 2
• Estimated 150 000 children lost mother to AIDS in
  2002
• South Africa currently has close to 1 million
  children who have lost a mother
• Experts1 predict that this figure will double by
  2010 and peak in 2015
• 1 Centre for Actuarial Research, UCT

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Aim of the research

• To develop a set of recommendations to support
  and inform an appropriate health, social services
  and education response to the needs of orphans
  and other vulnerable children in the context of
  HIV/AIDS, which promote the realisation of their
  basic rights to survival, protection, development
  and participation, and do not compound their
  vulnerability.

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Objectives

• To develop an understanding of the health and
  social needs and living contexts of orphans,
  children at risk of becoming orphans, and of
  their caregivers, with specific emphasis on
  issues related to accessing health, social
  development and education services.
• To review the extent to which these services were
  meeting the needs of OVC in contexts of HIV/AIDS
• To integrate literature and research into the
  drafting of the research report and
  recommendations

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Methodology

• Multi-site (6) qualitative research project
• 5 of South Africas 9 Provinces
• Participants
• Children (who had been orphaned or who were
  living with a sick/dying caregiver)
• Caregivers of these children
• Service providers
• Other informants
• Sought to understand the life experiences of
  children and their caregivers and the factors
  that impact positively or negatively on support
  seeking behaviour, service access and service
  delivery

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Tzaneen
Ingwavuma
Phuthaditjhaba
Cato Crest
Gugulethu
Umzimkulu
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Lived with their grandmother since their father
died and their mother remarried
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Key health-related issues

• Hunger / Malnutrition major concern of children,
  caregivers and service providers
• Children as carers for the sick (paucity of HBC
  and palliative care services)
• Childrens exposure to opportunistic infections
  through living in HIV-affected household
• Health workers unclear on what to do about
  unaccompanied children attending health facilities

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Health-related issues cont.

• Access to preventative services problematic for
  young children in the care of elderly eg. EPI
• HIV-infected children - not seen as a major
  problem, or adequately dealt with at 1o level,
  major concern at 3o
• Paucity of VCT services for children
• Mental health needs of children experiencing
  death and dying largely ignored ongoing support
  needed as with adult support groups

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We are not trained at all to counsel children
and would find it very difficult. We are really
not sure how to do it. We are also so concerned
that if we counsel an 11 year old, for example,
there would be no support for that young person
when they go home VCT counselor
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Health-related issues cont.

• Free health care for children issues related to
  health user fees (particularly where hospital is
  nearest facility)
• Relationship between health workers and home-and
  community-based carers strengthen health
  outreach services and ensure continuity of care
• Opportunities for the identification and referral
  of vulnerable children through health care
  facilities
• Commitment of health workers and need for support

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Key social development issues

• Lack of capacity of social workers striking not
  reaching most vulnerable
• Emphasis of their work on processing foster care
  placements with very little time / capacity for
  addressing other areas of need
• Insufficient poverty alleviation mechanisms with
  reliance on foster care grant to address poverty
  problematic
• Number of grant related issues which need to be
  addressed

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Social development cont.

• Residential care as a knee-jerk response to
  orphans, extended use of existing facilities
• Relationship between social workers and home-and
  community-based carers / health workers not
  able to provide professional support required

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Key education-related issues

• OVC experience similar problems to other children
  in terms of accessing education eg. school fees
  and uniforms, hunger
• Some additional issues include
• Increased responsibilities for care of younger
  siblings / sick adults and for income earning
• Psychosocial impact on children affected school
  attendance and performance
• Increased mobility
• Stigma and discrimination etc..

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Education cont

• Teachers often fail to recognise or respond
  appropriately to the vulnerabilities of children
  experiencing orphanhood
• Examples of good practice show potential for the
  positive role of schools in identifying and
  supporting vulnerable children eg. extended
  school based feeding schemes, collaborative
  efforts schools as nodes of care and support
• Universal precautions not widely available in
  schools eg. gloves, first aid kits

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Some key recommendations

• Putting children first ensure presence on
  agendas
• Recognising process of orphanhood
• Addressing orphanhood within the context of other
  childhood vulnerabilities (poverty)
• Adopting needs-based versus category- based
  response non targeted (implications of
  targeting)

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Key recommendations cont

• Supporting care arrangements in order to ensure
  the sustainability of social safety net through
  course of pandemic (poor caring for poor is
  unsustainable)
• Maximise opportunities within existing service
  infrastructure eg. HBC and schools
• Increased financial and human resources in social
  sector

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Key recommendations cont

• Facilitate and support collaboration common
  denominator in successful initiatives across
  research sites eg. social workers in school
  clusters, school nurses, HBC teams.
• Reduce burden of orphans on services through
  provision of treatment, care and support to adult
  caregivers
• The opportunity that HIV/AIDS presents for
  strengthening service delivery.

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• Full research report and recommendations
  available
• Thank you.