From the individual to the system: The coming of age of programmes for orphans and vulnerable childr

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From the individual to the system The coming of
age of programmes for orphans and vulnerable
children

• Douglas Webb, PhD
• UNICEF ESARO,
• JLICA Symposium, 24th September 2007

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Rates of orphaning in sub-Saharan Africa are
highest in central and southern Africa (2005)
Source UNAIDS and UNICEF estimates, 2006
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(No Transcript)
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Orphan effects (vs. non-orphan), controlling for
age and sex (from DHS)
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Perceived Problems related to children, by type
of household Kisesa, Tanzania
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Discrimination in the household is not determined
by wealth Zimbabwe, 2004
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Double orphan non-orphan school attendance ratio
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Fine grained analysis Kisesa Cohort study,
Tanzania

• The major finding is the vulnerable situation of
  the girl who has lost her mother or if the mother
  is absent
• If the girl is 6 to 12 year old, she is by far
  the most likely to move to another households
  when a losing a parent
• If the girl is 6 to 12 years old, the chances are
  doubled that she will be sent away to help
  guardians/grandparents if her mother is away than
  if the father is away
• If the girl is 13 to 17 years old and loses her
  mother, the chances that she will be engaged in
  paid work are three times as big as if she lost
  her father
• If the girl is 7 to 9 years old and has lost her
  mother, the likelihood that she will be going to
  school is 0.80 compared to if she had lost her
  father
• If the girl has lost both her parents, she will
  start school one year later compared to the
  situation where her parents are alive
• If the girl is 13 to 17 years old and has lost
  her mother, she is the one getting on most poorly
  with her caretaker
• If the girl is 13 to 17 years of age, has lost
  her mother or both parents, and has lived in at
  least one other home, she is more likely to have
  experienced mistreatment than any other category
  of child

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From parental status to poverty status

• Orphan targeted support is an anachronism
• (household) Demographic based targeting needs
  exploration
• Poverty based targeting will become dominant
  characteristic of social protection

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Data from Kenya suggest double orphans are being
placed in poorer households as epidemic matures
Distribution of double orphans and non-orphans by
wealth quintile
Double orphans
Non-orphans
Source Kenya DHS, 1998 and 2003
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Orphans (1) and Non-orphans (0) in Lower Two
Wealth Quintiles
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Limits of poverty alleviation approaches

• Material deprivation does not fully explain
  intra-household discrimination
• The connection between material deprivation and
  (high risk sexual) behavioural outcomes is not
  clear
• Psychological factors of parent/care-giver loss
  may be a greater predictor of risk behaviours
• Systemic responses in this regard need to become
  more complex in design

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Percentage of children ages 0-17 who are orphaned
by age group, 2005, Sub-Saharan Africa
Orphans due to all causes
Source UNAIDS and UNICEF estimates, 2006
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In Zimbabwe girls who lost their mother are most
vulnerable to HIV
Percent ()
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Evolution of labels

• 1991 AIDS orphan
• 1995 - Orphan
• 1997- Orphans and (other) vulnerable children
• 2005 (most) vulnerable children
• 2007 Children of the community / children in
  the context of HIV/AIDS / our children
  leaders of tomorrow

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Evolution of labels

• 1991 AIDS orphan
• 1995 - Orphan
• 1997- Orphans and (other) vulnerable children
• 2005 (most) vulnerable children
• 2007 Children of the community / children in
  the context of HIV/AIDS / our children
  leaders of tomorrow

• Individual cases, disease specific
• Individual, psycho-pathological approach
• Encompassing broader determinants of
  vulnerability
• Focus on most vulnerable, independent of cause
• Systemic, universal, poverty reduction as entry
  point

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Three essential elements family, civil society,
and state

• Current response system based on (extended)
  family, with limited but vital support from civil
  society organisations
• Viability has been demonstrated but coverage
  remains limited
• Missing piece is a functional, state driven
  social welfare structure, to take coverage from
  20 90
• Social welfare or protection has been missing
  from international policy debates with regard to
  sub-Saharan Africa

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• Percentage of households that receive some form
  of external support for the care of orphans and
  vulnerable children

Provide Paediatric Treatment of HIV
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2. Children affected by AIDS Programmes are
outside Mainstream Development
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2. Moving towards an Expanded, Integrated
Response for Children affected by AIDS
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Types of Social protection interventions

• Social/Cash transfers (South Africa)
• Food and nutrition transfers
• School bursaries
• Fees waivers education and health services
• Non contributory pensions
• Livelihoods and microcredit
• Agricultural subsidies
• Public works, employment and training
• Insurance

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From the individual to the system

• Child vulnerability related to AIDS will
  increasingly be concentrated in the hyper-endemic
  countries in southern Africa
• Orphan are relevant as a proxy of impact but
  not a valid programming or targeting concept
• Vast majority of orphans have adult
  care/supervision and socialisation but the
  quality of that care is compromised
• Need to focus on systemic support to poor and
  vulnerable families/households through social
  protection mechanisms that supplement community
  based action
• Fine grain variations, that do exist in child
  status, can be captured in community targeting
  within broader systemic approaches
• Move from responses that are AIDS specific to
  those that are AIDS sensitive
• Move from charity driven responses to entitlement
  based access to universal social protection.