AIDS Orphans in Africa: SOS Framework for Action (2003)
We are continually updating and innovating our framework for action (see AIDS Africa best practice from a recent workshop) but this is the most recent formal document on how we approach the issue of HIV/AIDS in Africa.
Introduction
By the end of 2001, more than 60 million people worldwide had been infected with HIV and more than 20 million had since died due to AIDS. In sub-Saharan Africa alone, an estimated 6,000 people are dying every day due to AIDS, which is more than ten times the number of people dying from wars in Africa. As a result of HIV/AIDS, the number of orphans is actually increasing year-by-year in sub-Saharan Africa, undoing previously hard won gains in maternal and child health and survival. While at the end of 2001 more than 16 million of sub-Saharan Africa’s children had lost their mother or both parents, this figure is expected to rise above 21 million by 2010. Undoubtedly, the orphan crisis brought about by HIV/AIDS represents an enormous challenge to our organisation. This document provides a clear frame for putting our priorities into action. The resulting programmes shall provide good practices that can then be shared and used to develop the most effective responses to the orphan crisis. While the main challenge presently lies in sub-Saharan Africa, which has so far been the hardest hit part of the world, it is essential that experience gained and lessons learnt within Africa are shared worldwide. This crisis challenges us to build on our wealth of experience in orphan care and to reach beyond our conventional thinking, for the sake of making a meaningful difference in the lives of those children and young people who are being affected by HIV/AIDS.
SOS Children, as the world's largest orphan charity, sets its priorities as follows.
There are six key priorities for our HIV/AIDS-related work, which are:
1. Awareness and prevention to be carried out through all SOS locations, including schools and training centres. By fighting the spread of HIV/AIDS, SOS Children strives to prevent children from losing their parents to AIDS in the first place. We advocate for de-stigmatisation and non-discrimination.
2. Voluntary counselling and testing (VCT) to be offered through our SOS medical and social centres. For those parents who are living with HIV/AIDS, VCT opens the possibility to early interventions that can prolong and improve the quality of their life.
3. Prevention of mother-to-child transmission of AIDS to be promoted by our medical and social centres, through medical treatment and/or advice on safe infant feeding practices. Through this, the number of children living with HIV/AIDS can be minimised.
4. Support for orphan households and households where children are living with terminally-ill parents. Families are supported to improve their ability to protect and care for their children. In this way, we enable orphans and vulnerable children to stay within a caring family environment and their community of origin.
5. Provision of anti-retroviral (ARV) treatment to parents who have children living with them. Where parents receive such medical treatment, they are likely to live longer and have a higher quality of life. This means that their children are also likely to have a better quality of life and to grow-up in a family without becoming an orphan.
6. Long-term family-based care is provided through our SOS children’s villages and other long-term family-based care programmes for those children who have already lost the care of their family and who require such long-term care.
Putting our priorities into action
1. Prevention of child abandonment: social & educational programmes. The first five of our key priorities fall under the umbrella of the prevention of child abandonment strategic initiative. As such, they are to be implemented through our social and educational programmes, including our social centres, medical centres, kindergartens, schools, vocational training centres, and emergency relief programmes.
While a target has been set to reach 100,000 more children world-wide through these programmes by 2008, it has been decided that we should reach 40,000 more orphans and vulnerable children within Africa and Middle East by 2006. The key to success for these programmes is to find effective ways of supporting families (and communities) to improve their ability to protect and care for their children. Ultimately, the main indicator of success shall be shown by how many families are able to become self-reliant and take on the full responsibility of care for their children.
The frame for these programmes is as follows:
a) Target group: As an organisation that specialises in providing care and support to orphans and vulnerable children (OVC), we keep our focus on those children who have lost the care of their parents and those who face a significant risk of this happening to them. It should be noted that while AIDS is increasingly the major cause of children losing their parents, we do not exclusively focus on AIDS orphans, as this is often practically difficult and carries the risk of stigma and discrimination. As such, our target group is made up of children who:
- are living with a terminally-ill parent (can be AIDS or another terminal illness)
- have already lost one or both parents (due to AIDS or any other cause)
- are living in an orphan household (i.e. a household sheltering one or more orphans)
As we aim to prevent these children from losing the care of their families, this means that we work primarily with orphan households and households where children are living with terminally-ill parents. In particular, we give attention to those children within this group who are living in the most vulnerable circumstances, such as those within child-headed and grandparent-headed households.
b) Cost per child: Each programme shall provide care and support to children at an average cost per child per month of no more than US$20. Spending is flexible within this overall financial frame, with the cost of support being higher for some children than for others and the costs for each child being likely to fluctuate over time, according to individual needs at a particular time.
c) Resources: We strive to make the best use of the organisation’s existing facilities and infrastructure (e.g. buildings, vehicles and equipment), and shall develop these over time according to their needs and priorities. We aim to reach more children primarily by investing in and working through people - whether they are co-workers or our partners in the community - rather than through additional buildings and equipment.
d) Anti-retrovirals: In countries where the provision of ARVs is legally and practically possible, we facilitate the beneficiaries of our programmes (OVC and their care-givers) to have access to such treatment. Once started, such treatment needs to be sustained. This is done primarily through working with partners who have the required expertise and capacity, e.g. public health services and/or health-related NGOs. This may be achieved by making referrals; providing financial and material support; and/or capacity-building. We should only provide ARVs directly where we have existing medical centres with the capacity to professionally administer them. This should be within the overall financial frame of US$20 per child per month.
In countries where government authorities are not open to the provision of ARVs, we support lobbying and advocacy efforts, with a view to securing provision through public health services.
It should be noted we take an holistic approach to the care and support of people living with HIV/AIDS, including counselling, support groups, wellness management and positive-living programmes, as well as ARVs.
e) Social programmes: We shall develop community-based prevention programmes, through social centres and medical centres. These shall focus on supporting families within the community to care for their orphans and vulnerable children, and/or serve as a focal point for essential services required by HIV/AIDS-affected families. In developing these programmes, we may work together with other organisations or institutions that have a particular area of expertise, such as provision of medical services or home-based care. Examples of the kinds of programmes that could be developed are:
Home-based care & support programmes: Community volunteers make regular visits to targeted households, with a view to (i) assisting with the care of the sick, childcare and household chores; (ii) offering material support according to needs, e.g. food, fuel, clothing and school fees; (iii) supporting the family to become self-reliant in caring for their children, e.g. promoting income-generating activities.
Immediate action required in sub-Saharan Africa (agreed at Oct 2003 Continental Meeting)
As a minimum, a home-based care & support programme shall be established at each location where we have an SOS Children’s Village. Each such programme should reach at least 25 orphan households and/or households where children are living with terminally-ill parents. This is not to be done by SOS families, but rather added in the form of new programmes by end-2004. These programmes can even be carried out through partnerships with community-based organisations. This may mean building their capacity to offer effective home-based care & support to OVC. As a result, an average of 125 more OVC would be supported in each of the 88 locations where SOS has facilities (a total of +11,000 children in 2,200 families).
Regional directors approve these programmes and submit a simple funding request for each programme. This includes the name of the location, the target group, a short description (with clear indication of how the most vulnerable households are identified and how families shall be supported towards self-reliance in caring for their children) and the budget request. The finance department will provide clear financial guidelines.
Primary health care services: Counselling, support groups and medical treatment for people living with HIV/AIDS. Adolescent-friendly services, that address their health needs and are accessible to them. Awareness and prevention programmes geared towards effective behaviour change among high risk groups. Support groups for young mothers.
‘Drop-in’ centres: A place where HIV/AIDS-affected children and families can find (i) HIV/AIDS-related information and education; (ii) counselling and support groups, (iii) guidance on future planning and positive-living for people living with HIV/AIDS; (iv) parenting skills training; (v) referrals for social security benefits; (vi) legal advice; (vii) day care for young children and homework support for older children.
f) Educational programmes: We will ensure that our kindergartens, schools and vocational training centres play an effective role in addressing the situation of orphans and vulnerable children. Examples of how this may be achieved include:
-Educational scholarship programmes: Spaces made available for orphans and vulnerable children; subsidised school fees; may also support with clothing, transport and other school expenses. As a minimum requirement, at least 30% of the children attending our educational facilities should be from our target group. This is in addition to children from SOS families.
-Support services: Learning support, counselling services and nutritional support available for all children attending our educational facilities.
-Awareness and prevention activities: Sexuality and reproductive health integrated into school curricula; behaviour establishment programmes to equip young people with sexual communication and negotiation skills. Children’s participation in health promotion activities within the community may be encouraged, e.g. through anti-AIDS clubs or use of child-to-child approaches.
-Educare programmes: Supporting day care and educational facilities within the community to improve their ability to provide quality services to children attending them, e.g. capacity-building for community-based crèches in disadvantaged communities.
-Out-of-school education programmes: Basic literacy programmes for orphans and vulnerable children who have fallen out of the formal schooling system.
g) Partnerships: We form partnerships with individuals, groups, organisations and institutions, wherever this enables us to more effectively put our priorities into action. In particular, we work together with partners to build a comprehensive safety net for HIV/AIDS-affected children and families, to ensure that they have access to essential services.
2. Leading the way: SOS children’s villages
The sixth priority of providing long-term family-based care shall primarily be achieved through our children’s villages. The following steps are taken within our villages:
a) Use of facilities: Continuous efforts are made to ensure that our children’s villages are used to their full capacity. Where children’s villages have less than 15 SOS family houses, additional houses can be built.
b) Testing of children: Children living within sub-Saharan African children’s villages can be tested for HIV after they have joined their SOS family. This pro-active step is taken in the best interests of the children, to make it possible for early interventions that prolong the life and improve the quality of life of those children who test positive. The frequency of testing is determined within the national association, taking practicalities and legal aspects into consideration.
It should be noted that HIV tests are not taken before admission into a children’s village and HIV status (if already known) is not considered in the admission decision.
Voluntary counselling and testing (VCT) for youth staying within SOS families and youth accommodation is encouraged.
c) Children living with HIV/AIDS: Medical treatment is provided to children within SOS families who are living with HIV/AIDS, subject to the best medical advice available.
3. Co-workers
The following policies apply to all of our co-workers:
a) Pre-employment testing: We do not test prospective employees for HIV before employment.
b) Voluntary counselling and testing: We facilitate access to voluntary counselling and testing for all of our co-workers.
c) Care and support of co-workers living with HIV/AIDS: We facilitate access to the required care and support for those co-workers who are living with HIV/AIDS. This includes support groups, wellness management and positive-living programmes, as well as medical treatment for the co-workers, their spouses and dependant children. This covers government-employed teachers who are working in SOS Schools and any other staff employed by another party, unless such treatment is already provided for by their employer.
d) Counselling for HIV-affected co-workers: We facilitate access to counselling services for co-workers that have family members or colleagues living with HIV/AIDS.
e) Termination of employment: We do not terminate the employment of any co-worker on the basis of their HIV status.