Childhood under threat, warns UNICEF

The HIV/AIDS pandemic has already created millions of orphans throughout sub-Saharan Africa, but the worst is yet to come, warned Per Engebak, UN Children's Fund (UNICEF) regional director for Eastern and Southern Africa. Marking the release of UNICEF's report 'State of the World's Children 2005: Childhood Under Threat', Engebak told IRIN that sub-Saharan Africa already has 15 million orphans and vulnerable children (OVC) and this figure is likely grow to 25 million by 2010. The report identified HIV/AIDS as "one of the greatest threats to childhood in the world today", and noted that sub-Saharan Africa is the "the epicentre of the HIV/AIDS pandemic" and the only region where orphan numbers are increasing. "In sub-Saharan Africa, most children who have lost one or both parents have been cared for within the extended family, an intricate and resilient system that has traditionally been quick to respond, and still takes responsibility for around 90 percent of orphans in the region," the report said. "But the tidal wave of loss that the HIV/AIDS pandemic has occasioned has severely stretched this safety net, particularly in the most affected countries: Botswana, Lesotho, Swaziland and Zimbabwe. Households that have taken in orphans - whether these children are relatives or not - are likely to become poorer as a result, because the household income will have to sustain more dependents." Largely due to HIV/AIDS, between 1990 and 2003 life expectancy decreased by more than 15 years in Lesotho, Swaziland, Botswana, Zimbabwe and Zambia, and by six to 15 years in South Africa, Namibia and Malawi. The death of adults often results in child-headed households, and the role of primary caregiver is mostly taken on by a female relative. "The United Nations Secretary-General's Task Force on Women, Girls and HIV/AIDS in Southern Africa recognised in its 2004 report the particular burden placed upon older female caregivers. It recommends that governments and their development partners provide social grants or other financial support to these women whenever possible," UNICEF said. "To this end, Swaziland submitted a proposal to the Global Fund to Fight Aids, Tuberculosis and Malaria to provide stipends to women caring for orphans and vulnerable children. Additionally, securing assets and property rights for women and girls is key to addressing the economic hardships they face because of HIV/AIDS." UNICEF called on governments and development partners to: "strengthen the protective environment for children at every level, from the family right through to the level of national and international legislation; dedicate the funds needed to support programmes for orphans and vulnerable children, which currently receive only a small proportion of the overall HIV/AIDS funding; scale up projects for OVC; keep adults alive by increasing access to antiretroviral therapy and raising awareness of HIV/AIDS; prevent new infections among children by applying and scaling up proven techniques and interventions; eliminate school fees and other barriers to education; and combat poverty and conflict, which interact with HIV/AIDS to magnify the negative impact on childhood." HIV/AIDS THE GREATEST THREAT Engebak told IRIN that "issues related to HIV/AIDS are the single greatest threat to children in Southern Africa, both from the perspective of right to survival and protection, as well as development needs". "The situation is particularly critical in Southern Africa, where, at the moment, we have at least four countries with an orphan population that is [verging] on or exceeding 20 percent of the total child population," Engebak commented. "The sad thing is that the worst is yet to come - we are estimating that the orphan population in sub-Saharan Africa is likely to be around 25 million by 2010, and we do not see - even under the best of circumstances ... that the increase is likely to taper off before 2015 and 2020. UNICEF estimates that a third of the child population will be orphans in Swaziland, Botswana, Zimbabwe and Lesotho. Obviously, it's a very critical situation," he added. He spent two days in Swaziland this week, and described the situation of OVC as traumatic. "A large number of these kids are now dropping out of the school system - their families and or community cannot sustain school fees. These children are subject to violations of sexual abuse and other forms of abuse; they are largely traumatised and we are basically seeing an inadequate care system to provide for these children," Engebak said. "It's a similar pattern to what we are seeing in most of the Southern African countries - that's why we've been insisting on the need for [governments to have] national action plans for orphans. These plans are now in place in all Southern African countries except Botswana, but we believe Botswana will have one by mid-2005." Fifteen countries in sub-Saharan Africa, along with UNICEF and other development partners, have conducted national rapid assessment and analysis of the situation of children, in order to develop national action plans. "These action plans are a step in the right direction but, clearly, we need an immediate scale-up in response if we are to ensure that these kids are not going to fall off the cliff, in terms of their survival, protection, care and support," Engebak added. Poverty is an aggravating factor for many OVC. "Many of these children are obviously coming from poverty-stricken families. That situation is further exacerbated by the fact that either one or two or both parents are ill or dying from AIDS and, of course, the most traumatised children are those who are double orphans, who have lost both parents," Engebak noted. "We see that there's an enormous need for a support structure, and many countries are gearing up neighbourhood care systems, where there's a good collaborative effort between national authorities and civil society organisations, faith-based organisations and others in providing support services, in terms of access to food, basic services, trauma counselling - to have a shoulder to cry on is particularly important for these children." He added that another important intervention with a direct impact on child vulnerability "is keeping parents alive". "The rollout plan of antiretrovirals, and prevention of mother-to-child transmission (PMTCT) services are particularly important. Part of the PMTCT services obviously must include testing for HIV, so that mothers will know their status. Also, to ensure that the high-risk groups are being properly tested and, if indeed positive, that proper measures are taken to minimise the risk of mother-to-child transmission. These measures are built into national action plans, and the challenge now is to resource these plans so we can scale them up," Engebak stressed. In Swaziland at least 30 percent of the country's 120,000 orphans are being reached through neighbourhood care systems. "The elimination of school fees will be another critical factor. It's going to be very, very important and, unfortunately, there's no agreement on that yet. I met with the minister of education [on Wednesday] and there's a commitment to work towards a solution to ensure elimination of school fees for orphans in Swaziland," Engebak added. UNICEF has identified three strategic areas of focus in the region. "Firstly, the need for a social safety net for orphans, and that has been rolled out in different countries - South Africa, for example, has 2.2 million children on social grants. They have a social cushion for most of their orphans - even if it does not reach all, it does reach a great number of orphans. South Africa also has a good system that has been promoting foster care. Other countries have also tried social grants - Botswana and Namibia - but it has been limited in scope and reaches few orphans," Engebak said. "Some countries are trying school feeding, through which orphans will also get take-home rations for other siblings in the home - that has proven to be quite effective and well targeted. Some, like Zambia, contemplated a bursary system, essentially a scholarship programme that applies to secondary pupils; some countries have eliminated school fees and that's quite effective. So there's a large number of safety net programmes, and we're hoping countries will be expanding on well-targeted programmes," he added. Secondly, programmes aimed at protection, care and support, such as neighbourhood care points, are now being considered in a large number of countries. "Again, it's proven quite effective, but it also takes longer to scale up to benefit the majority of orphans, and that is still a challenge," Engebak noted. "Finally, a large number of older children, from 14 to 18 years of age, basically have the need for livelihood training - training that enables them to sustain themselves - and here we need to take into account that in most Southern African countries, agricultural practices are traditionally passed from one family member to another - planting techniques etc., are passed from one generation to another. "But many of these young people simply do not have the skills and competency. With FAO [UN Food and Agriculture Organisation] we are rolling out a junior farmer initiative to target young orphans, and give them the skills and competency for livelihoods. It's also important to target young girls, and young people in urban areas, so they have access to vocational training, so they can insert themselves gradually into the labour market," Engebak explained. RESOURCES NEEDED With regard to these plans, Engebak said, "the commitments are there, but the resources are largely lacking". "Most of the strategic elements have been identified; most of these elements have already been proven effective - we simply have been lacking the resources to scale them up. What we firmly believe is that the PRSPs [Poverty Reduction Strategy Papers, drawn up by countries in consultation with the World Bank] need to be targeting the most vulnerable sectors of the population: OVC. [Government] sector programmes also need to be targeted at orphans, and that [international] funds being made available, whether through the Global Fund or others, also need to have provisions that specifically address the needs of orphans," Engebak suggested. He noted that a lot of the gains made in infant and under-five mortality in the region have been reversed. "The progress made for children in the 80s and 90s, we are now seeing, is being terribly undermined and eroded, particularly in infant and under-five mortality rates. We see it in Zimbabwe, Botswana, etc. - countries that had made tremendous progress. It is an area that needs urgent [attention], as the worst is yet to come," Engebak warned.