Transcript An Overview: Linda Richter Global Partners Forum, Dublin, 2 October 2008

An Overview: Linda Richter
Global Partners Forum, Dublin, 2 October 2008
What is JLICA?
• Diverse, independent,
multidisciplinary, time-limited
• 4 Learning Groups (Framework)
• 40+ authoritative research outputs
– all externally reviewed
• Thousands of inputs
• Providing solid evidence for bold
action
Presentation
The global response to date:
• Accepting our failures
• Reframing the response
• New directions for policy and action
Accepting Failures - 2007
• 17% of new infections – failures of
vertical prevention
• 2.1m children living with HIV globally –
90% in SSA
• <10% of eligible children receive
• early diagnosis of HIV at 6 weeks
• co-trimoxasole or ARV treatment
• Increasing parental deaths 
• Only 15% children/families
receive external help 
Children living with HIV globally
1990-2007
2,500,000
Global
SSA
1,500,000
1,000,000
500,000
Asia
Eastern Europe & Central Asia
LAC
Sub-Saharan Africa
Global
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
0
1990
Number of Children
2,000,000
Orphaned children in SSA
14,000,000
Number of Orphans
12,000,000
10,000,000
8,000,000
6,000,000
4,000,000
2,000,000
0
1990
1995
2000
2002
2003
2004
2005
2006
2007
Orphan misunderstandings
• AIDS orphans ±37% of orphaning –
18.2m orphans!
• 80% of “AIDS orphans” have a
surviving parent
• “Orphan” - confusing, miscommunicated, distorting the response
• Orphans are not the only or
necessarily the most needy 
Problems with data
• Lack of data – gaps (5-14 years)
• Not consolidated - age
inconsistencies, across agencies
• Poor data – 71% of 273 studies
don’t define orphan
• Proliferation of non peer-reviewed
grey literature
• Available good data not well used or
disseminated 
Child-headed households
• <1% in 40 SSA surveys
• Very small, if any, in DSS sites in
SSA
• 0% in Karonga (Malawi) and Kisesa
(Tanzania)
• <2% in Africa Centre (SA)
• Only data errors in Agincourt (SA)
• <1% across 5 cross-sectional HH
surveys (1995-2005) (SA) 
Percentage of children living in
different household types in
South Africa (1995-2005)
October
Household
Survey 1995 (%)
October
Household
Survey 1997 (%)
Note: Source: Own calculations based on Stats SA data.
No child in
household
No adult - only
0.11
0.34
children
Skip-generation
1.69
2.44
October
Household
Survey 1999 (%)
General
Household
Survey 2002 (%)
General
Household
Survey 2005 (%)
-
-
-
0.45
0.67
0.66
2.23
2.3
2.29
Young adult (1825) with children
1.22
1.86
1.71
1.88
2.27
Single adult with
children
Other
Total
7.31
9.28
9.39
9.71
11.27
89.68
100
86.09
100
86.22
100
85.44
100
83.52
100
Source: Richter and Desmond 2008
Roots of our failure
1. It is not only orphaned children
who are affected
2. Critical gaps in essential services
3. Families, many in extreme
poverty, support children without
assistance
4. Family poverty & gender
inequality undermine children’s
outcomes
1. It is not only “AIDS orphans” …
• Parental mortality in general
• JLICA reviewed 383 “orphan” studies
•
•
•
•
75 empirical
Consistent detrimental effects
Neither poverty nor HIV controlled
Effects adversity and/or ill-health?
• Education is a vulnerable area, but gap
narrowing (data 15 countries)
• Stigmatising effects of targeting
2. Implementation failures and gaps
• PMTCT, infant testing, prophylaxis,
treatment
• Children much less likely to receive
treatment than adults in the same
settings
• Integration of HIV/AIDS services
• Universal primary health care
• Universal primary education
3. Families support children
• HIV and AIDS cluster in families
• >95% of affected children live in
families
• Only 15% receive external help
• Families absorb ±90% of cost of
impact on children
• Families are a critical network to
expand prevention, treatment &
care
4. Undermining child outcomes
• Family poverty
• + 60% of children in SSA live in poverty
• By very low poverty lines
• Kagera survey RIATT: $3.5/month
average family of 3
• HIV/AIDS impoverish families – 25%pm
• Consumption drops – food, education,
care
• Child labour increases
• May limit expansion of prevention and
treatment
• Gender inequalities
• Drive infections
Reframing the response
Five key lines of action:
1. Support children through families
2. Build social protection to protect the
weak and vulnerable
3. Expand income transfers to poor
families
4. Implement comprehensive &
integrated family-centred services
5. Address powerlessness of women &
girls
1. Support children through families
Optimal care arrangement for children
Most children are in family care
Families have responded – at cost
Preferable to orphanage/ group
residential care 
• Families are a critical entry point for
prevention, treatment & care
• Strengthen the capacity of families
•
•
•
•
Strong arguments against orphanages
• Cater overwhelmingly for poor rather
than orphaned children
• Well-established negative effects on
brain, language, cognitive,
emotional & social behaviour
• Cost up to 10 times family care
• Opportunity cost of not investing in
families
• De-institutionalisation is very costly to
children & society
Strengthen families
• Family-centered PMTCT & other
HIV/AIDS interventions
• Keep families intact through
treatment
• Support extended family fostering
• Provide home health visiting & ECD
• Support community organizations
that backstop families
• Build social protection 
2. Build social protection
• Individual, family & social
impoverishment makes it harder to
prevent HIV & mitigate AIDS
• Responds to children’s needs – cut
consumption, schooling, care and
increase labour & mobility
• On developmental agenda & responds
to popular concerns
• HIV/AIDS adds impetus to human
rights arguments
3. Expand income transfers
• Provide relief, avert borrowing, sale
•
•
•
•
•
•
of assets
Demonstrated effectiveness in poor
countries
Can take variable forms
Affordable eg Mozambique, Lesotho
Reduces intermediaries, overheads
Enables uptake of essential services
The entry point for improved social
protection
Transfers increase spending on
children’s basic needs
Use of Cash Transfer by Program
80%
70%
60%
50%
40%
30%
20%
10%
0%
Food
Education
South Africa OAP
Kenya Cash Transfer for OVC
Namibia Old-Age Pension (urban)
Malawi FACT
Source: Adato and Bassett, 2008 JLICA
Health
Other
Zambia SCTS
Mozambique INAS (urban)
Malawi DECT
Savings &
Investment
4. Integrated family-centred services
Income transfers increase use of services.
JLICA review of successful programmes:
• Partnerships under government leadership
• Community-based care system linking
medical & social support services
• HIV/AIDS services integrated with poverty
reduction (income transfers, job creation)
• Community health workers
• Funding commitments (least 5 years)
4. Structural changes for girls
• Empower women through increased
social protection & income transfers
• Keep girls in school – secondary
education
• Increase physical safety of girls
• Address men’s values, roles and
prospects – work
Directions – way forward
• National social protection, starting
with income transfers, is critical to
improve children’s outcomes
• Target programmes based on need,
not HIV or orphan status
• Adopt family-centered models in
social policy & service delivery
• Prioritize structural prevention
measures to address gender
inequalities
The Joint Learning Initiative
on Children and HIV/AIDS
www.jlica.org