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“The only thing necessary for these diseases to the triumph is for good people and governments to do nothing.”


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Geoff Foster

Published in Monograph No 109, December 2004A Generation at Risk?
HIV/AIDS, Vulnerable Children and Security in Southern Africa

Edited by




The devastating consequences of HIV/AIDS on African societies, and its particular impact on children, is requiring every organisation involved in fighting the epidemic to find new strategies to address adequately both the scale of the problem and its duration. The crisis of children left behind by AIDS is a humanitarian, development and human rights challenge of unprecedented proportions.
Although there have been substantial gains in improving overall child survival, these gains are being eroded in African countries hardest hit by the epidemic. The scale of the epidemic on this continent makes its repercussions qualitatively different from those in other parts of the world. The economic and social effects of HIV infection and AIDS on children include malnutrition, migration, homelessness and reduced access to education and health care. Psychological effects include depression, guilt and fear, possibly leading to long-term mental health problems. The combination of these effects on children increases their vulnerability to a range of consequences, including HIV infection, illiteracy, poverty, child labour, exploitation and the prospect of unemployment.
The first line of support for vulnerable children is their family, including the extended family and distant relatives, while households that struggle to meet the needs of vulnerable children may be assisted by members of their community. These informal safety net mechanisms are responsible for the care and support of the majority of vulnerable children in Southern Africa. Formal mechanisms, such as those provided by government and civil society, also provide services, especially for children living in situations of extreme vulnerability. This paper considers the interplay between informal mechanisms provided by the family and the community, and formal support mechanisms provided by the state and NGO sectors. It concludes with a set of recommendations for ways in which statutory agencies can strengthen family and community safety nets to cope with orphans and other children made vulnerable by HIV/AIDS.

Children and AIDS: The scale of the problem


It is estimated that in 41 African countries, the number of children who are orphaned, for any reason, will nearly double between 1990 and 2010,1 when almost three-quarters of double orphans in the world will be from Africa. In seven countries in Southern Africa, the most severely affected region, the number of orphaned children to have lost both parents is projected to increase by a staggering 1,100%, from 250,000 to 2.9 million (see Figure 6).



On their current trajectory, HIV and AIDS are set to leave millions of children orphaned and millions more in situations of vulnerability. Many children are first affected during the terminal illnesses of their parents, when they shoulder new responsibilities such as additional domestic chores, taking care of sick parents, income-generating activities and childcare duties for younger siblings. Indeed, it is now recognised that educational, social, economic and psychological problems may be more severe before, as opposed to after, children become orphans.2 In addition, AIDS increasingly affects almost everyone in severely affected communities, even households without HIV-infected members. Children may thus be affected when families provide money to support sick relatives and mothers leave home to provide care for AIDS-affected relatives, or when their children’s standard of living deteriorates when cousins move in after the deaths of aunts and uncles.

Traditional extended family caring


The extended family safety net is still by far the most effective response to economic and social crises throughout sub-Saharan Africa. Members of extended families assist each other socially, economically, psychologically and emotionally. Financially, such assistance most often takes the form of regular urban–rural, inter-household income transfers. When crops fail, family members in town purchase food and bring cash to needy relatives in rural areas. When a relative in town loses a job, they are sent food from the rural areas or are received back into their rural homestead. Households experiencing income stress due to AIDS may send their children to live with relatives who become responsible for feeding the children in their care.
Coping mechanisms regarding orphans are, however, complex and vary according to social setting. In most African communities, the concept of ‘adoption’ does not exist in the Western sense. Even in the absence of parental death, children are often fostered; a practice whereby natal parents allow their children to be reared by adults other than themselves (see Table 3, over page). Child fostering is a reciprocal arrangement that contributes to mutually recognised benefits for both natal and fostering families and fostering by non-relatives remains uncommon. It has also been said that, traditionally, there is no such thing as an orphan in Africa,3 as relatives such as aunts and uncles have almost always taken on the parenting of orphaned children. The concept of a ‘social orphan’ is thus a new phenomenon in most African societies.


Table 3: Percentage of children (5-14) fostered in the developing world
(Demographic Health Survey (DHS), 1990-96)
Near East
Côte d'Ivoire
Cent. African Rep.
Latin America
Dominican Rep.
Burkina Faso
Source: M Ayad et al, cited in S Hunter, 2000.


In the past, the sense of duty and responsibility of extended families towards other members was almost without limits. Even though a family did not have sufficient resources to care for existing members, orphans were taken in. Today, many families still cope with deaths by ensuring that relatives provide care for orphaned children. This may involve a member of the extended family moving into the orphan household to care for children, or orphans moving into the household of one or more relatives.

Weakening of the extended family


Cases of abuse, mistreatment or exploitation of fostered children have been reported. Girls in particular may be taken in by relatives because of their economic value in carrying out domestic chores or obtaining bride price. Judging by reports from child rape centres, cases of sexual abuse of orphans also appear to be increasing. However, though several studies have demonstrated that orphans are disadvantaged compared to non-orphans in other families, few studies have demonstrated significant differences in the ways relatives treat their own biological children compared to fostered children. Though such cases undoubtedly occur, for the most part, relatives go to considerable lengths to keep orphans in school, including borrowing money through informal networks and selling their own assets.4


Yet the extended family, which has proved so effective in the past, is becoming stressed as a result of both a dramatic increase in the number of maternal and double orphans and a reduction in the number of prime-age caregivers, such as aunts and uncles. If present rates of death among prime-age adults continue, it is projected that this will result in distortion of the population structure of affected countries. Although not entirely undisputed, it is argued that a new type of demographic structure, termed the ‘population chimney’, will replace the more familiar pyramid that characterises developing countries. Distortion of the pyramid will occur ten to 15 years after the age at which people become sexually active, when those infected with HIV early in their sexual lives begin to die. The population of women beyond their early 20s and men beyond their early 30s will shrink in heavily affected countries, leading to fewer middle-aged people—the so called ‘chimney’ effect. Due to the fact that more women become infected with HIV, do so at younger ages and die earlier, the epidemic is also expected to take a greater toll on women. The net product of both these trends will be a greater disparity between the number of children in need of care and the number of adults able to provide such care in the future.
Even prior to the HIV/AIDS epidemic, the role of extended families and communities in coping with orphans was in a state of flux. Table 4 outlines some of the changes that have taken place which have weakened kinship systems. The extent of such changes varies from place to place: where traditional values are maintained, such as in rural communities, the extended family safety net is better preserved. Where countries are more urbanised, extended family safety nets are weaker.


Table 4: Changes leading to weakening of kinship systems in recent years
How this has weakened extended families
Labour migration, urbanisation and the cash economy
·  Reduction in the frequency of contact with relatives.
·  Social and economic dependence; possessions are perceived as personal property and no longer belong to the extended family.
Increased life expectancy and family size
·  Impossible for an extended family of three or four generations to reside together.
·  Diminishing availability of land makes it difficult for large families to be economically independent through subsistence agriculture.
Formal education
·  Education about social values occurs through schools and interactions of children with their peers, rather than through traditional mechanisms, lessening the ability of older people to exert social control over children.


As the traditional practice of orphan inheritance by uncles and aunts has lessened, it has been replaced by alternative safety nets, with care provided by grandparents or other relatives. Grandparents are, however, often a last resort and agree to take in orphans because other relatives refuse. It goes without saying that although this provides short-term respite, the ability of many elderly grandparents to protect and provide for children in the long term is limited.

Children who live in situations of extreme vulnerability


The extended family is thus not a social sponge with infinite capacity to soak up orphans. Some children do slip through the extended family safety net and end up in a variety of extremely vulnerable situations. These include living and working on the streets, working for other people in low-paid domestic or agricultural settings, or living by themselves with their brothers and sisters in child-headed households.
It is difficult to obtain accurate estimates of the numbers of children living in extremely vulnerable situations. Estimates for children in these categories vary because of the lack of community-based surveys, standardised definitions (since not all children in these situations are equally vulnerable) and because some agencies inflate numbers for promotional purposes.5
Given these caveats, however, the total proportion of unsupported or exploited children living in extremely vulnerable situations probably represents less than 2% to 3% of all orphans, even in the most severely affected countries (see Table 5).6


Table 5: Estimates of vulnerable children in selected countries
No. of children 0-17, years 20048
No. of orphans 0-17, 20048
Child-headed households
Street children
Economically active children 10-14
4 million
660 000
20 5009
2 million
230 000
3 00211
5 million
810 000
45 00012
South Africa
17 million
2 200 000
0.6 million
100 000
2 500 000
18 million
2 000 000
6 million
1 100 000
75 00017
7 million
1 300 000
1 00019
50 00020

Child-headed households


As a result of the impact of AIDS on communities, changes are taking place in care-giving arrangements for affected children. An increasing proportion of orphans are now in the care of either the elderly or teenage boys or girls. The increase in the number of double orphans has led to the establishment of households headed by children, mostly in their teens, but with some headed by children as young as ten to 12 years old. This was previously unknown in sub-Saharan Africa.21
The number of child-headed households throughout Africa is, however, unknown. What we do know is that there are more child-headed households in urbanised countries such as Zimbabwe and Zambia than in predominantly rural societies like Tanzania, where safety nets are better preserved.22 In countries with severe HIV/AIDS epidemics, it may be anticipated that the number of child-headed households will increase significantly in the future.

Methods of establishment


In some cases grandparents, usually grandmothers, take in orphaned children. As these grandparents’ age or experience deteriorating health, the situation in which the elderly provide childcare is reversed and grandchildren end up caring for increasingly frail grandparents.
When grandmothers die or move in with other relatives because of illness, children are sometimes left to live by themselves. Relatives may take in younger children, leaving older brothers and sisters living together. In other cases, child-headed households are formed when brothers and sisters insist on staying together and refuse to move away from their deceased parents’ homestead.


Child-headed households are usually temporary arrangements. In many instances, it simply takes time for families to organise coping strategies in response to unaccompanied children, and it is accepted that such children will eventually become part of adult-headed households. In other cases, child-headed households disintegrate as a result of various catastrophes, following which children are taken into relatives’ households. Often, it is only after crises that relatives who were previously equivocal about not providing care become amenable to taking in vulnerable children.

Problems faced by child-headed households


The situation of children living in child-headed households is often perilous. ‘Child adults’ often drop out of school for lack of school fees, money to buy books and uniforms and, sometimes, stigma. Many must work hard to feed and educate their younger siblings, while younger children may be forced to labour in domestic or agricultural chores once carried out by adults. Girls may feel their family’s situation might improve if they were married, which may result in teenage motherhood and being forced to choose between their family and their husband if he rejects their younger siblings. Children living in child-headed households thus face problems that are common to other vulnerable children living in destitute households, such as:
·  food insecurity;
·  problems of access to education and skills training;
·  the struggle to meet material needs;
·  the absence of psychosocial support;
·  poor life skills and knowledge;
·  abuse and exploitation;
·  absence of an extended family network;
·  poor housing conditions and insecurity of tenure; and
·  poor access to health care.
What is unique is that these problems are extreme and unrelenting and must be faced without adult assistance.

Child-headed households as a coping strategy


The appearance of child-headed households does not necessarily mean that extended families have abandoned their responsibility to care for relatives’ orphaned children. Not all child-headed households are equally vulnerable, and some child-headed households live in close proximity to nearby relatives who visit regularly and provide them with material support.23 Indeed, some cases can be viewed as a new mechanism to cope with the impact of AIDS. The high prevalence of child-headed households in Swaziland, for example, is a consequence of traditional extended family living arrangements in that country, which enable child-headed households to live in supported situations. Many child-headed households are, however, left to fend for themselves and receive little support from their relatives who are already struggling to feed, clothe and educate their own children. Unsupported child-headed households are particularly vulnerable to exploitation as a result of destitution and a lack of adult supervision.

Street children


In Africa, it is thought that around one million children live and work on urban streets, with the highest rates in post-conflict countries where poverty and family disintegration as a result of war are common.24 Most street children are engaged in trying to earn money, whether by begging, car guarding, buying and selling or crime. An important distinction to make, however, is between children on the street and children of the street.
Where children live on the street, the family support base has generally become weakened and so children share the responsibility for family survival by working on city streets. For these children, the home ceases to be the centre of play, culture and daily life. Nevertheless, while the street becomes their daytime location, the majority return home most nights. Despite potentially deteriorating family relationships, familial ties are still in place and the children continue to view life from the perspective of their families.
Children of the street constitute a smaller number of children who live, work and sleep on the street and struggle daily for survival, alone and without support. Though many people believe that street children have been abandoned by their relatives, in many cases it is more accurate to view such children as having abandoned their families—often as a result of insecurity, rejection and violence. Their ties with home have been broken and they are without families.


Many street children are orphans. In Zambia, for example, 65% of ‘child prostitutes’ and 56% of children living on the street were orphans.25 Similarly, in a survey of 81 male and 15 female street children in Mutare, Zimbabwe, 67% were orphans, compared to an estimate of approximately 20% for the child population as a whole.26 Two-thirds of these children were on the street, mostly staying with a relative; one-third were of the street and had no other dwelling place. It is impossible to say how many such children have been orphaned by AIDS, but given the growing contribution of AIDS to levels of orphaning in the region, it is likely that the epidemic is leading to increasing numbers of street children in Africa.

Problems identified by street children


Table 6 lists the main problems identified by the 96 street children in Zimbabwe.27 Significantly, glue-sniffing—which is associated with social, medical and psychological consequences—was not mentioned, probably because it is viewed by street children as a solution to their predicament rather than a problem.


Table 6: Problems facing street children in Zimbabwe
Bullying by older boys
No food/clothing
Sexual harassment
No blankets
No shelter
No money
Harassment/humiliation by society
Lack of treatment for diseases
Harassment by police
Nowhere to bathe
No problems
Source: FACT, 2000.


Since the majority of street children live with or maintain ties with their families, strategies to respond to their situation should focus on strengthening the capacity of families to care for and protect their children.

Working children


In all societies, children are involved in work, whether for their own families or for money outside the home. Not all labour is necessarily damaging to children, and it is often difficult to draw a line between children’s work that is a normal part of childhood development, such as assisting with family activities, and child labour that is exploitative and harmful. In families, parents or guardians assign work and responsibility compatible with a child’s age, gender and developmental level. Families do not normally and intentionally exploit children.
Africa has a higher proportion of child labour than any other region, with 41% of children below the age of 14 in the labour force. This equates to over 80 million children, almost twice the Asian rate. This more often reflects the adverse economic situation facing families in Africa than regional approaches to child rearing. The most extensive market for child labour in sub-Saharan Africa is for domestic services, such as cleaning, washing, cooking and child minding for girls and gardening, farming, animal husbandry or herding for boys. Other common child labour practices include contract labour on commercial farms and estates, vending, hawking and selling, mining, touting customers for transport, brothels and shabeens and commercial sex work. In some West African countries, the demand for domestic services by children is so high that it may lead to child trafficking.28

Children’s work and the impact of HIV/AIDS


The economic consequences of the HIV/AIDS epidemic are impacting on children, both within and outside the family home.29 Children affected by HIV/AIDS are increasingly taking on adult roles at a young age, including providing care for a sick parent and taking on extra household responsibilities. Some children, especially girls, also have to give up school in order to generate an income.
Orphanhood, in particular, is associated with increased child labour.30 Most child heads of households engage in income generation to support their young families. Adolescents may also leave orphan households to seek work, while some girls become involved in commercial sex or enter into marriage as girl brides to provide for the needs of the young or the elderly in their household. In Tanzania, for example, more than half of those children working full time in the country’s mines were orphans.31 In Addis Ababa, Ethiopia, more than 75% of child domestic workers were orphans.32
Orphans seem more likely to be child labourers as a result of their poorer living conditions, as opposed to discrimination against them by their caregivers. These inappropriate responsibilities can create long-term emotional problems, contribute to lost opportunities in education and development and lead to sexual exploitation. Child labour is illegal in many countries, but law-enforcement will have little effect unless families are supported in order to find adequate alternatives to child labour. The state and the community thus have a responsibility to ensure that children affected by HIV/AIDS are not denied their childhood.

Community safety nets


Seeking relief from family, friends and neighbours is a common response to economic crises. Even the poorest and most vulnerable people have set up resilient and ingenious coping mechanisms. Most communities throughout Africa have a tradition of voluntary associations or solidarity groups that provide essential support to households affected by misfortune. This type of community ‘safety net’---the provision of short-term relief and assistance by individuals and organisations within the community—is a common response to an array of disasters, both natural and man-made.33 In Tanzania, for example, there is a long tradition of social support groups. Members assist one another in routine ways by helping to cultivate one another’s fields and by contributing labour, money or food to one another at times of special need such as sickness and funerals, or on occasions such as marriage ceremonies.34 Voluntary associations provide a wide range of support that includes loans, food, funeral assistance, labour and cash through mechanisms such as:
·  burial associations;
·  grain loan schemes;
·  self-help groups;
·  labour-sharing schemes;
·  savings clubs; and
·  revolving credit-and-loan schemes.
Voluntary associations are poor people’s insurance policies. Relatives, friends and neighbours provide both moral and material support to the sick and vulnerable on the assumption of future reciprocation, and supportive actions are part of a clearly understood system of solidarity, which ensures that all contributing individuals receive support in times of adversity. Culture reinforces such arrangements through oral tradition, as illustrated by the Shona proverb: “What has befallen me today will befall you tomorrow.”

Weakened community safety nets


The amount of assistance that voluntary associations can provide is, however, generally limited and short-term in nature. In the case of death, for example, the duration of support is usually limited to the period of mourning. In addition, community safety nets are being weakened as a result of the steadily growing impact of the HIV/AIDS epidemic.
Better-off families, in particular, are increasingly finding their economic reserves depleted due to the continual demands placed on them by relatives affected by AIDS. Families in these circumstances become less able to contribute in cash, kind or by the provision of work to families in need. As AIDS causes the number of families falling from poverty into destitution to increase, the amount of relief that can be provided per destitute family is likely to decline.

Community initiatives in response to orphans


Without outside influence, community groups in Africa do not generally provide substitute parental care and few have established community foster homes or institutions in response to increasing numbers of orphans. However, starting in the 1990s, communities throughout Africa have begun to add additional layers to their community safety nets by providing material, educational, emotional and psychosocial support to children affected by HIV/AIDS. These community-based support initiatives have been established largely in the absence of significant external facilitation or financial support and are growing in scope and number. Recent research in East and Southern Africa has documented the high prevalence of community responses initiated by churches, mosques, other religious groups, women’s groups and community-based organisations (CBOs).35 In this study, interviews conducted with 690 faith-based organisations found that over 9,000 volunteers were supporting in excess of 156,000 orphans and vulnerable children. Table 7 summarises different support activities carried out by community groups.


Table 7: Community-based support activities provided by 505 faith-based organisations (FBOs)
Type of response
Description of response
Religious education and spiritual support
Spiritual support to families and children through scripture reading, religious instruction, prayers, singing and encouragement to attend worship.
School assistance
School fees, levies, uniforms, equipment, books, boarding
fees, etc.
Material support
Essential material support such as food and clothing to
individual children from destitute households.
HIV prevention
Visiting/home care
Increase awareness of HIV and moral guidance for children.
Volunteers identify needy households in their neighbourhood, regularly visit and provide parenting, advice, household supervision, meal preparation, dwelling maintenance and assistance in household agriculture or income generation.
Specifically provide counselling to children while others incorporate psychosocial support group activities.
Medical care
Enable children to access essential medical support through the provision of medical fees or medicines.
Income generation/
vocational training
Initiatives seek to raise money or provide experience in managing projects such as nutrition gardens, husbandry
projects, manufacturing co-operatives and buying-andselling
initiatives or skills in carpentry, dressmaking, etc.
Day care centres
Care during the day and food for pre-school children, often while caregivers are working.
Community schools
Fostering promotion.
Non-formal education facilities for out-of-school children.
Encourage fostering and adoption by non-relatives of
Source: G Foster, 2003.


Such community initiatives support vulnerable children by enabling families to continue to provide care for orphans. Though most community responses to date are small scale and localised, the cumulative impact of large numbers of local initiatives is proving increasingly significant, and such community initiatives will be an essential element in caring for growing numbers of orphans and vulnerable children in coming years. Yet in order for them to continue to function and expand to address the multiple dimensions of care and protection required by vulnerable children, they require financial and technical support. The nature of the orphan crisis is such that small amounts of long-term funding will be needed to supplement community support mechanisms over the course of several decades. Unfortunately, most donors make large, short-term grants to a small number of contractors and few provide long-term, low-level support directly to community groups. Many grants also involve complicated and expensive application procedures and stringent reporting requirements that make them inaccessible to most CBOs.

This approach is generally incompatible with the situation in affected countries, where thousands of community groups are struggling to sustain social structures in the face of an epidemic with long-term and cumulative repercussions. There is thus an urgent need for the creation of innovative mechanisms to channel resources to community groups. This could be done through intermediary institutions, such as locally administered trust funds, local and regional networks, multi-layered committees and capacity-building NGOs.36

State social security interventions


Where family and community networks fail, become overburdened or require supplementing, the state is often the final port of call. In this regard, there are many mechanisms by which governments can improve the situation of children made vulnerable by HIV/AIDS. These include employment creation, supporting families through the provision of access to basic services such as free basic education, good health care and community development programmes, as well as direct support initiatives such as feeding schemes and the provision of grants. With the exception of countries such as South Africa, Botswana and Namibia, however, state mechanisms in the region are relatively weak.
South Africa has one of the most well-developed statutory social support schemes in Africa. Family and child benefits in South Africa currently include the following:
·  Child Support Grant (CSG), which currently targets children under the age of 11, and will by the end of 2005 target children under the age of 14. The grant is means tested37 and caregivers are eligible for a grant of R170 (approximately US$28)38 a month.
·  Foster Child Grant (FCG) for children placed in foster care. This grant is for the sum of R530 (approximately US$88) a month and only children placed in foster care by a court of law are eligible to receive it.
·  The Care Dependency Grant (CDG) for children with severe mental or physical disabilities who require permanent home care. The grant is means tested and amounts to a sum of R740 a month (approximately US$123). There is no specific provision for children with chronic illnesses such as HIV/AIDS and relatively few children in the terminal stages of the virus have managed to access this grant.39
In addition to these grants, the South African government has put in place Social Relief of Distress measures, which take the form of temporary assistance—in cash or food—for people in need of immediate help to survive. The monetary amount or equivalent of such relief is less than the monthly value of the grants received by the household and will only be given to households for up to three months.
However, while such mechanisms are an important source of support for a range of children living in vulnerable circumstances, problems exist that cast doubt on the ability of the system to meet the needs of children affected by HIV/AIDS.
It is evident that, irrespective of the epidemic, only a minority of the poorest families receive child support grants from the state. It was estimated in 2003 that just over three-and-a-half million (3,622,479) children were registered to receive the CSG.40 Take-up rates have increased in recent years but it clear that many of the poorest children still do not have access to the grants, with a recent report suggesting that between 28% and 39% of poor children under the age of nine do not access the CSG (see Table 8).41


Table 8: Percentage of poor children aged seven and eight receiving the Child Support Grant per province (2003)
Total 7-8 year olds
Provincial poverty shares
Approximate no. of children 7-8 in poverty
Children 7-8 receiving grants
Percentage of poor 7-8 year olds receiving grants by province
Eastern Cape
325 193
244 220
74 214
Free State
108 642
66 489
43 686
262 302
100 462
73 795
444 452
283 560
103 422
289 615
198 097
112 961
146 232
86 862
49 154
Northern Cape
33 117
16 823
8 357
North West
149 796
90 477
38 014
Western Cape
162 308
41 064
29 671
1 921 657
Average: 59%
1 128 054
533 274
Average: 47.3%
Source: Leatt, 2003.


Many eligible children and households do not receive grants either because they are unaware of their entitlement or lack the documentation,42 time and resources necessary to access the social support system. Administrative delays in processing grant applications, as well as the poor attitude of some administrative personnel, also often deny families the grants to which they are entitled under South African law.43 With the number of children to have lost one or both of their parents to AIDS alone expected to peak at 5.6 million by 2015,44 it is unlikely that this situation will improve in the absence of fundamental change to the system.45 Indeed, recent estimates produced by the Children’s Institute in South Africa suggest that less than half of all children under 18 will receive support by 2017.46
This is likely to be compounded by the orientation of the system towards children in adult care, which results in large numbers of the most vulnerable children being hidden from the state’s view. These include street children, child labourers, children of illegal immigrants, children living in child-headed households and children over the qualifying age. Where such children are minors, they are not entitled to receive child support grants on their own behalf and receive little, if any, assistance through current statutory child support systems.
Children affected by HIV/AIDS may also face particular problems in accessing state support. As already mentioned, movement is a survival strategy adopted by many poor households and often increases substantially in response to adult illness or death, as children are sent away to live with relatives who can better provide for them, household members leave in search of work or relatives join the household in order to provide care. Children affected by HIV/AIDS are particularly mobile, often moving several times both before and after their parents’ death.
Given that it may take several months or even years for a grant application to be processed, and that children are required to remain resident with the guardian stipulated in the application, such movement is likely to hamper efforts to obtain grants on these children’s behalf. The death of parents, and the subsequent movement of children, may also result in the loss of documents such as birth certificates, or complicate efforts to obtain such documentation.
Turning to problems associated with the specific structuring of the grants, the CSG is only payable in respect of a maximum of six children per household if they are not the biological children of the applicant. Given that single households often take in several children in addition to their own, the grant does not offer much assistance to the many families caring for large numbers of children.47 This may act as a disincentive for relatives to take orphaned children into their families.
There are also a number of weaknesses associated with the FCG. Despite growing international recognition of the need to keep orphaned children in their families and communities, a disproportionate amount of the child welfare budget is being spent on supporting caregivers who are usually unrelated to the child.48 Under the current system, foster care placements are also required by law to be reviewed every two years. This not only makes the grant expensive49 and labour intensive to administer, it also adds enormously to the workload of already over-stretched and under-resourced social workers—resulting in administrative delays, non-adherence to legal reporting requirements50 and, ultimately, the capacity to absorb only a limited number of children into the system. The disparity between the CSG and the FCG also encourages caregivers, who would anyway be providing care, to have children formally placed in their care by the court.
As Meintjies et al argue, this ties orphaned children and caregivers ‘in need of cash’ to a labour intensive, surveillant and costly child protection system aimed at providing care and protection to children who are without support, or who suffer abuse or neglect.51 In so doing, such a system not only inappropriately targets scarce resources, it fails to address the predominantly material needs of families and children affected by HIV/AIDS.

Choice of care provision for orphans


When parents die there is no ideal placement for the children, just better or worse options. Enabling siblings to remain together in the care of family members they already know and are prepared to accept as new, permanent caregivers is the best option and maintaining orphans in families should be our highest priority.
Providing support to families under stress is the best way to achieve this and programmes such as those described earlier have the advantage of being less costly, both financially and in terms of the emotional cost to the child.

Adoption or fostering


If it is impossible for children to be maintained in their family of origin, the next best option is care within another family, through fostering or adoption by a non-relative. In Western societies, a clear distinction is usually made between adoption and fostering. The former is a type of family placement in which the rights and responsibilities of one set of parents are legally and permanently transferred to another set of caregivers.
Fostering is a less permanent form of substitute care which does not involve the transfer of parental rights and responsibilities. In practice, this distinction can become quite blurred, especially in African countries where legal adoption is often neither available nor accessible. In this context, new and innovative approaches to community foster care are being developed (see Box 1). These need to be assessed and, if found effective, replicated.


Box 1: Community family care

This model of care was pioneered by the Durban Child Welfare Society in South Africa. The aim is to provide relatively affordable, family-type care for up to six children in their communities of origin, or a similar social context. Under this model the community selects, assesses and trains an appropriate community member who becomes full-time ‘mother’ to the group of children. Sibling groups are accommodated and new ‘families’ are created for children who have no contactable relatives.

In contrast to regular foster care, where the house belongs to the foster family, either the state or an NGO provides the accommodation. Wherever possible, a small allowance is paid to the community-mother and she is assisted in accessing the available foster care grants. The created family is linked to all available community support systems and is monitored in the same way as a traditional foster care placement.

The model has proven appropriate in an urban context where abandonment of children is a serious concern.

Source: UNICEF/Child Protection Society, Zimbabwe, 1999.

Institutional care


Institutional responses to the crisis, such as orphanages, will never be able to address the scale of the orphan problem. They are also much more expensive to maintain than assisting families to care for children. Research by the World Bank in Tanzania, for example, found that institutional care was about six times more expensive than foster care, while cost comparisons in Uganda showed the ratio of operating costs for an orphanage to be 14 times higher than those for community care. Other studies have found a ratio of 1:20 or even 1:100.52 Orphanages also run counter to local traditions and fail to meet children’s social, cultural and psychological needs.
Children need more than good physical care. They need the affection, attention, security and social connections that families and communities can provide. Countries with long-term experience with institutional care for children have seen a number of problems emerge as children raised in institutions grow into adulthood and have difficulty reintegrating into society. In Ethiopia, Rwanda and Uganda, for example, evaluation of the effects of long-term residence in orphanages have led these governments to adopt policies of de-institutionalisation and support for family-based care.


Should institutional care be deemed necessary, it should be short term and provided only when other levels of care are unavailable. Care in smaller, family-type community foster homes is preferable to larger institutions. Orphanages that provide dormitory-style accommodation for children of similar ages—for example, those with separate units for babies and pre-schoolers and dormitories for primary school-aged children and teenagers—are particularly damaging to children’s self-esteem and development, since they fail to recreate the family-type environment children require. Efforts should also be made to improve the conditions of children already placed in residential institutions.

Overcoming problems with alternative care strategies53


While community care strategies are the most appropriate means of strengthening the ability of extended families to cope with orphans, few states have yet established mechanisms to strengthen extended family and community safety nets through the provision of financial and technical support. Individual and community initiatives also receive little if any formal recognition by statutory bodies. Whereas children living in institutions or placed in formal fostering are recognised in law, and their situation is regulated and supervised by social welfare agencies, there seldom exist such statutory provisions for supervision and engagement with community care initiatives. However, both children and caregivers in informal foster situations need to be recognised and protected by law. Without such legal status, informal caregivers are often unable to access the government support that does exist, act as the child’s guardian, grant permission for medical procedures, represent the child in judicial acts or administer his or her affairs.
In principle, informal foster care is encouraged by social welfare authorities. Yet in practice, the majority of financial and human resources within child welfare service provision for vulnerable children is spent on alternative care strategies for the minority who have slipped through extended family and community safety nets. Relatively small amounts of money are spent on strengthening informal support mechanisms, and most social service providers are involved in case-oriented approaches and have little experience in community mobilisation or strengthening safety nets. Individual child support and foster care grants do little to strengthen community support systems and may inadvertently undermine them by promoting concepts of paid foster care (see Table 9, over page).


Table 9: Interventions for foster families and children in vulnerable circumstances
·  Family members are most likely to act in child’s best interest.
·  Family integration promotes psychological and intellectual