Barriers and Incentives to Orphan Care in a Time of AIDS and Economic Crisis A Survey of Caregivers

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Barriers and Incentivesto Orphan Care in a
Timeof AIDS and Economic CrisisA Survey of
Caregiversin Rural Zimbabwe

• Brian H. Howard1, Carl V. Phillips2, Nelia
  Matinhure3, Karen J. Goodman2,
  
• Sheryl A. McCurdy1, Cary Alan Johnson4
• 1 University of Texas-Houston School of Public
  Health, Houston, USA
  
• 2 Department of Public Health Sciences,
  University of Alberta, Edmonton, Canada
  
• 3 Department of Sociology, University of
  Zimbabwe, Harare, Zimbabwe
  
• 4 Africare Zimbabwe, Harare, Zimbabwe
• Corresponding author brianhoward58_at_hotmail.com

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Abstract

• Background In Zimbabwe, where 1/4 of adults are
  HIV and 1/5 of children are orphans, AIDS and
  economic decline are straining societys ability
  to care for orphans.
• Methods A cross-sectional quantitative survey of
  371 caregivers, including 212 caring for double
  orphans, to explore barriers and incentives to
  orphan care in rural Zimbabwe.
• Findings 1) Foster caregivers are
  disproportionately female, older, poor, and
  without a spouse 2) 98 of non-fosterers are
  willing to foster orphans 3) poverty is the
  primary barrier to fostering 4) financial need
  may be greatest in single-orphan households and
  5) families lack external support.
• Conclusions Incentives should focus on financial
  assistance, starting with free schooling, and
  development of community mechanisms to identify
  and support children in need, to evaluate and
  strengthen families capacity to provide orphan
  care, and to initiate placement outside the
  family when necessary.

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Orphan-care crisis in Zimbabwe

• 22 of adults HIV life expectancy 39 yrs (63
  yrs in 1994).
  
• Epidemic exacerbated by economic crash, political
  isolation.
  
• 19 of children have lost one parent (single
  orphans) or both parents (double orphans), 80
  due to AIDS (2003).
  
• Almost ¼ of rural households foster orphans.
  Number of street children and child-headed
  households growing.
  
• Preferred, most cost-effective form of orphan
  care the extended family is straining.
  Diminished or non-existent forms of external
  support (WHO).
• Limits of familys capacity and obligation are
  unstudied.
  
• Caregivers views of barriers and incentives to
  orphan care can inform policies and programs to
  avert an impending calamity (USAID) that
  millions of children will grow up without the
  nutrition, education, and social nurturing
  necessary to sustain a healthy society.

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Methods

• Cross-sectional survey (2003) for Africare in
  rural East.
  
• 371 caregivers of students at 34 prim./sec.
  schools
  
• 2/3 randomly selected from among future
  beneficiaries of Africare AIDS project (school
  fees, psychosocial support, and income generation
  for households identified by school/community as
  most severely affected by AIDS).
• 1/3 caregivers of classmates, matched by grade
  level and gender.
  
• 62 closed-ended questions. In Shona at
  caregivers homes. Written consent. No
  incentives. Response rate 92.3.
  
• Analysis by group
• Group A (foster caregivers) 212 fostering
  double orphans
  
• Group B (Africare parents) 85 Africare project
  participants, 2/3 widowed with single orphans
  
• Group C (control parents) 74 not caring for
  orphans, not selected for AIDS project most
  promising pool of potential fosterers.

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Who is fostering?

• Female 53 grandmothers, 22 aunts (14
  siblings)
  
• Older (or very young) 34 age 60 (vs. 4 of
  non-fosterers) 15 in their 70s or 80s
  
• 5 in their teens (vs. 0 non-fosterers) 3 yrs
  
• Single 48 (most widowed), vs. 21 of controls
• Limited education only 22 had primary school
• Poor
• 54 subsistence farming
• 20 of households contained skilled or general
  wage employee, vs. 38 of controls
  
• 20 had no regular income, vs. 12 of controls

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Physical and emotional well-being

• All 3 groups struggling 1/3 reported hunger in
  household once a week.
  
• Priorities for assistance were financial school
  fees (84), food (70).

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Attitudes toward fostering

• 98 of 357 respondents said they were willing to
  foster a child, even if already fostering.

8
Fostering beyond the family

• Group C control parents were most likely to
  have a spouse and a wage-earner in the household
  and to be in good health. Their responses
  reflected attitudes that may limit motivation to
  step forward for fostering, especially from
  outside the family.

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Discussion and conclusions

• Overwhelming willingness to foster orphans,
  motivated by family obligation and compassion and
  constrained by poverty, is a strong foundation
  for a system of orphan support ensuring a home
  for every child.
• Kinship obligation is most important motivation
  to foster. But 2/3 said other factors most
  often financial capacity mattered more.
  
• Greatest barriers to fostering are lack of money
  and organization.
  
• Fostering stipend, including free schooling.
• Early intervention for single orphans in
  AIDS-impoverished homes.
  
• Support building community mechanisms to
  routinely respond to families in need, to
  identify and intervene early in support of
  households severely affected by AIDS, to evaluate
  and strengthen families capacity to provide good
  orphan care, and to initiate placement outside
  the family when necessary.
• Serve all orphans, regardless of cause.
• Above all, avoid damaging extended familys sense
  of responsibility for and control over decisions
  regarding care of their young.

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Discussion and conclusions

• AIDS fear/stigma not cited as major factors in a
  fostering decision but may inhibit initiative to
  foster AIDS orphan, esp. from outside the
  family.
• No reservoir of financially secure households
  that must simply be persuaded to take in orphans.
  Based on their reservations about fostering,
  non-fostering parents may be target for outreach
  emphasizing AIDS-stigma reduction, rewards of
  fostering (plus guaranteed school fees).
• Affordable, accessible ART In orphan care, too,
  nothing beats prevention.
  
• Limitations Small convenience sample,
  cross-sectional survey design, lack of
  qualitative depth. Excludes households without
  children and households too poor, sick, or
  disarrayed to send their children to school.
  Zimbabwes unique combination of economic crisis,
  AIDS dispersal, and political isolation limits
  generalizability.
• In decisive ways for Zimbabwe, orphans are the
  foreseeable future and strengthened families
  their best hope. How communities, the country,
  and the world move to help the too-old and
  too-poor nurture the too-young through the double
  disaster of AIDS and poverty will shape the
  nations health and prospects for generations to
  come.

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