More Information: Johanna de Beer
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A DRAFT NATIONAL STRATEGIC FRAMEWORK FOR CHILDREN INFECTED AND AFFECTED BY HIV/AIDS |
STATEMENT OF INTENT
The National Strategic Framework (NSF) will be the impetus for the development and implementation of approaches that effectively capacitate and mobilise children, families and communities to combat many of the effects of the HIV/AIDS pandemic. It will ensure that children who are affected by HIV/AIDS have access to integrated services that address their basic needs for food, shelter, education, health care, family or alternative care, and protection from abuse and maltreatment. It is an intersectoral strategy that necessitates a pro-active response from all sectors of South African Society and which focuses most directly on the rights and needs of children affected and infected by HIV/AIDS. This grouping incorporates both those children who have contracted HIV as well as those that live in an environment in which the pandemic’s presence directly impacts on the lives of children. In this document it is clear that orphans are particularly vulnerable and particular emphasis will be placed upon meeting their needs. The NSF will address the immediate and urgent needs of children at the present time and also develop a longer-term strategy that will prepare South Africa adequately for future challenges. The NSF will link with and build upon existing government strategies in order to engender an effective and concerted governmental response to HIV/AIDS.
The HIV/Aids epidemic is the principal challenge/threat facing South Africa and has clearly an enormous impact on children in the coming decade. Appropriate intervention strategies are required urgently to ensure that the rights of children infected and affected by HIV/Aids are protected.
The Inter-Ministerial Committee on HIV/AIDS requested that a National Strategic Framework for Children infected and affected by HIV/AIDS should be developed in collaboration with all sectors. The Minister for Welfare, Population and Development is responsible for the development and implementation of the NSF.
On 9 and 10 November 1999 a consultative workshop was held with stakeholders. Eighty-two representatives from government departments as well as non-Governmental organisations attended the workshop. The Portfolio Committee on Welfare and MINMEC were also consulted. Recommendations from the workshop and other consultations form the main component of the programmes proposed in this document.
South Africa has the second fastest growing epidemic in the world with an estimated 1600 new infections occurring daily. The 1998 annual antenatal HIV sero-prevelence survey estimates that 22,0 percent of South African women were HIV positive. Projections in South Africa are that the epidemic will plateau at an antenatal sero prevalence level of 30 – 38%, at which stage 26% of adults and 18 to 19% of the total population will be HIV positive. It should be realised that although the epidemic will reach a plateau, the social implications of the epidemic will still be felt for many years and provision should be made for the generation after the epidemic.
In most part of the industrialised world, usually no more than one percent of the child population is orphaned. Before the onset of HIV/AIDS, societies in the developing world absorbed orphans into the extended family and communities at a rate of just over 2,5 percent of the child population. Today, as a consequence of AIDS, 11 percent of Ugandan children are orphans,
9 percent in Zambia and 7 percent in Zimbabwe. This scenario is likely to be repeated in South Africa.
At present, it is estimated that 5 percent of the child population in South Africa is affected by HIV/AIDS and it is projected that this figure will increase to 16 percent. A 1997 survey estimated that there are presently one hundred thousand orphans in KwaZulu-Natal. If the current trends persist this could increase to two hundred and fifty thousand within the next few years. If this is extrapolated to include the other provinces, some idea of the scale of this problem becomes clear.
The cumulative effect of these factors is that South Africa is now faced with the reality of:
- Increasing numbers of children in distress associated with the escalating AIDS epidemic
- The inability of traditional models of surrogate support care to accommodate the number of children in distress.
- The inability of poor communities to absorb children in distress into informal care facilities without the introduction of outside support.
- The stigma associated with HIV/AIDS infected and affected families.
- The pressing need to develop intervention strategies to ensure that the rights of children who are affected by and infected with HIV / AIDS are protected.
IMPACT OF HIV/AIDS ON CHILDREN, FAMILIES AND COMMUNITIES
3.1 Children are losing one or both parents as a result of the AIDS epidemic. These are the children who will most probably be forced into child labour, who will not have the opportunity to attend school and who will be most at risk of contracting the HIV-virus.
3.2 Uninfected children born to infected mothers have a 2.4 to 3.6 times increased mortality rate than children born to uninfected mothers.
- The family structures and role changes within families will change due to the AIDS epidemic. Children may have to be fostered or adopted. With the increase of mortality among adults, older people will be pressurised to care for children as well as the sick adult(s). This burden will often fall on the grandparent/gogo The situation will be worsened by the fact that the older person will also experience an economic setback because of the loss of financial support from their children which means that their meagre resources will not cope.
- The demands to care for a sick family member could lead to the neglect of the caregiver’s own needs and of the needs of others in the household. A feeling of insecurity and uncertainty of the future after the mother / father’s death is depressing for the children.
- In the South African context, statistics show that almost all HIV infections in children below 13 are the result of mother – child transmission. It is important to stress that the lack of dis-aggregated data that provides a breakdown of age groups and gender means that information related to the spread of the epidemic amongst the young is not complete. Greater knowledge and understanding of issues related to sexual behaviour and, more importantly, sexual abuse is needed. This reflects the belief that a recent and escalating phenomenon with the potential to worsen the current HIV status of children in South Africa is the increasing sexual exploitation and abuse of children.
- It is clear that children’s psychosocial distress begins with a parent’s illness and they are left emotionally and physically vulnerable after the death of the parent(s).Due to the death of the mother / father or both parents, one will find more and more child -headed households. It is quite often associated with the increase of movement of children onto the streets or into commercial sex work and the increase of child labour. The very young children are also particularly vulnerable to these situations.
- When the parents die, the question arises regarding redistribution of household assets. This could lead to the fact that the children could be prevented from inheriting from their parents due to customary laws. Children could also lose the house they were living in.
- It is also vital to stress the cyclical nature of the relationship between HIV/AIDS and poverty. For a variety of reasons it is the poor that are the most vulnerable and which traditionally bear the brunt of the epidemic. AIDS creates not only orphans, it also kills and disempowers the very people best equipped to raise them, or who contribute to their upbringing. The traditional safety net for orphans, the extended family (which is one of our most reliable support systems), has come under huge strain as a result of the loss of many breadwinners and caregivers.
- Vulnerable families care for vulnerable children and they live in vulnerable communities. One finds that communities with a high prevalence figure of HIV/AIDS are already disadvantaged with a high level of poverty, poor infrastructure and limited access to services. Therefore, one consequence of this loss of income and support is that the affected poor sink even deeper into the mire of poverty and neglect.
- Certain needs of children both infected and affected by HIV/Aids have been identified. These include the following:
- medical care
- alternative care preferably community based
- basic needs such as food, clothing, shelter and general nurture
- education
- life skills and vocational training
- protection from discrimination and an exploitative environment
- their psycho-social needs have to be understood and appropriately addressed
Unless families and communities are strengthened and provision is made for adequate resources and support, the numbers of children orphaned as a result of HIV/AIDS will place an unmanageable strain on extended families and an overwhelming pressure on government and community resources.
The impact of HIV/Aids on existing resources in communities and government is further illustrated in the attached ANNEXURE "A" (problem statement)
- APPROACH
- OBJECTIVES OF THE NATIONAL STRATEGIC FRAMEWORK FOR CHILDREN INFECTED AND AFFECTED BY HIV/AIDS
4.1 Taking the above conditions and predictions into consideration it is therefore critical that in South Africa a two-pronged approach be applied:
4.1.1 The care system is transformed to ensure efficiency, effectiveness and appropriateness
4.1.2 Family and community strengths are identified and built upon to maximise the potential of each community to care for their vulnerable children
Taking the needs of the children and the success of the existing programmes into account the following will be the objectives of the National Strategic Framework for Children infected and affected by HIV/Aids:
- A complete and rapid appraisal on services for children infected and affected is vital to inform the strategy. This is presently being undertaken through a research project, which is funded by Save the Children UK. The research will be completed in February 2000.
- The establishment of community-based programmes to:
- Assist children, families, communities and provinces to identify the most vulnerable, to help prioritise resources and to preserve family life.
- Strengthen families, children and communities in using their own strengths to help themselves through prevention programmes, counselling and support to those who have been traumatised.
- Support families, communities and other stakeholders to identify and implement strategies that promote children’s well being, for example medical care, substitute care, nutritional needs, educational needs, and protection from abuse and exploitation.
- identify external supports for communities and enable communities to build support networks.
- Implementation and further development of effective and affordable community based care and support models and targeted preventative interventions.
- Ensure that the Comprehensive Childcare Legislation being developed by the SA Commission deals effectively with the needs of orphans and this includes the protection of children’s inheritance.
- Establishing and strengthening poverty alleviation / eradication programmes in affected areas.
- Training programmes for professionals community workers, child and youth care workers, community leaders, families, NGOs and CBOs.
- Foster intersectoral collaboration at all levels and establish integrated institutional arrangements at provincial, regional and local levels for implementation and monitoring of the strategy.
- Determine the financial implications of implementing the strategy.
- Services to children infected and affected by HIV/Aids would need to be contextualised within the framework and the process of the transformed child and youth care system, which has been established as a process and procedure.
- The framework is underpinned by a developmental approach which focuses on strengths rather than pathology; understanding and responding appropriately to developmental tasks and needs; and maximising the potential of each individual, family and community to deal appropriately with challenges confronting them.
- The following principles of the child and youth care system shall be taken into account for planning purposes regarding children infected and affected by HIV/AIDS:
Everyone who intervenes with young people and their families should be held accountable for the delivery of an appropriate quality and service.
- Empowerment
The resourcefulness of each young person and their family should be promoted by providing opportunities to use and build their own support networks and to act on their own choices and sense of responsibility.
- Participation
Young people and their families should be actively involved in all the stages of the intervention process.
- Family-centred
Support and guidance should be provided through regular assessments and action planning which enhances the family's development over time.
- Continuum of care
Young people at risk (and their families) should have access to a range of differentiated services on a continuum of care, ensuring access to the most empowering and least restrictive programmes appropriate to their individuals.
- Integration
Services should be inter-sectoral and delivered by a multi-disciplinary team wherever appropriate.
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Continuity of care
The changing social, emotional, physical, cognitive and cultural needs of the young person and their family should be recognised and addressed throughout the intervention process. Links with continuing support and resources, when necessary, should be encourage after disengagement.
Young people and their family should be exposed to normative challenges, activities and opportunities, which promote participation and development.
All actions with young people and their families should be rendered in the most effective and efficient way possible.
Positive developmental experiences should be ensured for young people, both individually and collectively. Appropriate guidance and support should be ensured through regular assessment and action planning which enhances the young person's development over time.
The rights of young people as established in the UN Convention and the SA Constitution shall be protected.
All services to young people and their families should be the most appropriate for the individual, the family and the community.
All services prioritise the need to have young people remain within the family context wherever possible. To this end family capacity building and access to a variety of appropriate resources and supports should be of primary concern.
Every young person should be provided with the opportunity to grow up in their own family, and where this is proved not to be in the best interests of the child or not possible, to have a time-limited plan which works towards life-long relationships in a family or community setting.
6.4 The new system provides for a continuum of intervention levels, as follows:
Level 1: focuses on prevention. By this we mean that children, families and communities are strengthened and provided with the capacity, tools and access to resources which allow them to identify and confront the consequences of the pandemic, thus preventing a further disintegration of the family and community structure. This would amongst other things, also prevent the removal of orphans and other children from their family homes. In doing this, the preventative approach would provide the necessary foundations to ensure that families can in most instances provide for the care, protection and development of their children.
Level 2: focuses on early intervention. This is to provide support, strengthening and capacity to those young people and families who are known to be particularly vulnerable to the impact of HIV/AIDS and who are at risk of possible statutory intervention.
Level 3: focuses on statutory process. This is the effective assessment, care and management of young people and their families at the start of statutory intervention and during their court case and finalisation of placement options.
Level 4: is a continuum of care and development. This is from the least restrictive (such as foster care) to the most restrictive (such as a school of industries). This level is in itself the most restrictive and intrusive level as well as the most expensive.
6.5 The transformation requires that most resources are shifted to level one and two and that the methodology of working with children and families (for example strengthening families, communities and young people themselves) ensures that the maximum number of children and youth (especially orphans) receive care, protection and development within their families and/or communities of origin.
6.6 The policy guidelines and minimum standards for the Child and Youth Care System will be extended to make provision for children and youth who are infected and affected by AIDS.
- COMMUNITY BASED CARE AND SUPPORT MODELS FOR CHILDREN LIVING IN A WORLD WITH HIV/AIDS
- Community based care initiatives and responses to the effects of HIV/Aids have been found to be more effective in other African countries such as Uganda, Zimbabwe and Zambia in the providing services to children who are affected. Therefore programmes which are designed to strengthen the capacity of families and communities to care for their vulnerable children are central to this strategic framework.
- In drafting policy, legislation and programmes there are four key rights that should be applied to children infected and affected by HIV/AIDS, namely survival, protection, development and participation. These rights originate from the founding principles of the CRC and reflect South Africa’s obligation to children as signatories to both the CRC and its complementary convention, the African Charter. These rights are encompassed in the elements listed below.
- The following are essential elements of community based care programmes:
- Strengthening the capacity of families.
- Early identification of families and children in need.
- Special needs of childheaded households should be addressed.
- Ensure that such families have access to food, clothing, shelter, education and health services.
- Link families with poverty alleviation programmes and social grants.
- Provide counselling services to address the psychosocial needs of children and their families.
- Link families with child day care services.
- Provide capacity building in child care, HIV / AIDS, nutrition, and primary health care.
- Strengthening community-based responses.
- Build on existing projects and make them more accessible to the community.
- Establishing family support projects and ensuring NGO funding.
- Review home based programmes / models and disseminate information and experiences with others for adaptation to specific contexts.
- Establish AIDS Action Teams in each hospital to link affected / infected persons to home based programmes.
- Establish / broaden the representivity of intersectoral forums to manage holistic delivery of training, funding, information dissemination, monitoring and evaluation of home based care.
- Mobilise communities for early identification of children and families.
- Establish childcare committees.
- Find foster and adoption placements for children.
- Secure other placements for children such as cluster caring or placement of children with relatives within the community.
- Building the capacity of foster parents, adoptive parents or alternate care givers.
- Support and link foster and adoptive homes with services and resources.
- Link communities with poverty alleviation programmes such as income generating or food production programmes.
- Support NGOs and CBOs.
- Provide capacity building programmes for communities.
- Developing awareness programmes.
- Ensure that Government protects the most vulnerable children through the provision of essential services.
- Information campaigns aimed at increasing access and decreasing corruption disseminated through the media, community forums, government and parastatal institutions and civil society structures (NGOs, Unions, etc.)
- Build in safety nets for people caring for infected / affected people through various options such as:
- Family support assistance for children over seven years
- Foster care grants for foster parents
- Disability grants for the terminally ill parents / care givers
- Community support assistance
- Ensure access to government financial support services such as the child support grant
- Build the capacity of children to support themselves and encourage their participation at all levels.
- Ensure access to education.
- Support informal and alternative education options for older children.
- Empower children through life skills programmes.
- Encourage peer support at school.
- Investigate the possibility of child movements.
- Encourage the participation of children in community events related to HIV / AIDS
- Create an enabling environment for affected children and families
- This involves a policy framework, mechanisms for co-ordination, mechanisms to ensure that resources are used.
- Issues of stigmatisation, disclosure and discrimination are also significant.
- Fundamentally the priority is to create a context for children; families and communities affected to cope.
Refer to the Implementation of the Strategy in section 12 below for more information about proposed programmes to address the above element.
Various programmes are presently being piloted throughout the country. These pilots will be replicated according to the National Strategic Framework for Children infected and affected by HIV/Aids. Details of the replications are in Annexure "B".
8. INTER-SECTORAL COLLABORATION
- A National Strategic Framework for children infected and affected by HIV/Aids seeks to provide an overall guidance to all stakeholders. This framework will be revised from time to time, including revision of the framework as well as new developments.
- An inter-sectoral, integrated and decentralised approach to both HIV/AIDS and specific aspects related to children is critical. South Africa requires a co-ordinated and comprehensive national strategic framework to ensure that sufficient and effective care, protection and development measures are urgently implemented for orphans and vulnerable children. An integrated approach makes provision for the effective and efficient utilisation of resources by various sectors and targets areas or communities which are impacted by HIV/Aids.
- An institutionalised community participation and decision-making has to be established by forging links with provinces, local government, community-based organisations and non-governmental organisations. This approach is used in countries such as Uganda and Rwanda and has proved to be effective in caring and supporting for the affected families and have even reduced the rate of new infections in Uganda.
- MANAGEMENT AND INSTITUTIONAL ARRANGEMENTS:
- Management Committees
Inter-sectoral management committees at national, provincial, and community level will have to be established or strengthen existing ones to ensure that implementation takes place. The committees will play a major role in the identification of vulnerable children, community participation, building and maintaining partnerships, management of programmes and funding, monitoring and evaluation.
The committees will be more active at community level; therefore, the involvement of local government, traditional leaders, community based and religious organisations will be crucial at this level. The utilisation of existing structures at provincial and departmental level will need to be explored to avoid and prevent duplication of child care services.
9.2 National and Provincial Co-ordinators
- The National Plan of Action for Children in South Africa will be responsible for ensuring that the rights of children are protected and for monitoring funding levels, and maintenance of focus at community level.
10. FUNDING
- The implementation of the strategy will have financial implications at all levels. Funds which have been budgeted for by government departments for HIV/AIDS will not be sufficient to initiate implementation.
- A special allocation was approved by Cabinet to set aside funds on the national budget for an effective integrated response to the HIV/Aids pandemic.
- Annexure "C" indicates funds required for the next three years to implement the Strategic Framework.
- CONSULTATIVE PROCESS
This document was workshopped on 9 and 10 November 1999 and the following programmes and implementation business plan were developed. The consultation of the strategic framework will be ongoing in order to incorporate new developments.
The following list includes stakeholders who have been consulted:
- Commission of Gender Equality
- The Ministry in the Office of the Presidency
- Department of Justice
- Department of Finance
- Provincial government departments
- Relevant NGOs and CBOs
- Religious groups
- Traditional healers
- Traditional leaders
- Children and families
- Caregivers
- People living with HIV/AIDS
- National Children’s Rights Committee
- Local government
More Information: Johanna de Beer