Lifting the burden - and the standard - of care

Raising Africa's Children was the title of a conference focused on mobilising resources for orphans and vulnerable children, hosted by Children First in Durban from 26-28 September. The objectives of the conference, funded by the Ford Foundation, were to:.

• identify best practice models of orphan care for Southern African children;
• develop recommendations and action plans on capacity building for community based projects who provide services to, and care for, children affected by the HIV/AIDS pandemic;
• develop recommendations regarding how funds and resources can reach the children.

According to the latest available figures from UNAIDS, 370 000 children under 18 years of age were orphaned (that is, either their mother or their father died) in South Africa in 2003. A total of 2.2 million children in South Africa had been orphaned by 2003 (that is, 13% of all children had lost either a mother or father).
About 1 million of those children are estimated to have lost parents due to AIDS. The total number of orphans is expected to increase to 3.1 million (18% of all children) by 2010 unless something is done to prevent their parents from dying.

Opening the conference, Children First Chairperson Gladys Ryan stressed that the fact there are vast numbers of orphaned children does not give anyone the right to set lower standards for caring for them than for other children.

Fiona Napier, of Save the Children UK, noted in her presentation on resource allocation to community-based care of orphaned children in southern Africa that the challenge was not just tackling the scale of the problem but channelling resources. 'Global resources will be in the region of US$10 Billion - this should be about US$10 000 per orphan - however the money is not reaching children on the ground.'

Noreen Ramsden gave the opening address on behalf of Children First (see page #), on the theme 'Pay now or pay later'. She said that if society invested in meeting all the basic needs of children now, we would have 'a generation of children with good physical and mental health who will have the capacity to participate in society and make a contribution. If we do not pay now - we will pay later'.

The conference was attended by around 200 representatives of NGOs, CBOs, welfare agencies, government departments, donors and business. There was consensus that the burden of care for orphaned and vulnerable children was falling heavily on the shoulders of impoverished caregivers and small community-based organisations. It was generally accepted that the best place for children to be cared for if their own parents were not present or not able to look after them was in a family in their own community. However, any family taking on the responsibility for additional children needed adequate financial, moral and practical support to do so. The challenge was to ensure that the lessons from successful models of care and the resources to implement them reached household level.

Linda Richter of the HSRC noted in her presentation, on scaling up households and schools as nodes of care for orphaned and vulnerable children, that 96% of assistance to children and families in need in South Africa comes from kin and community. 'The greatest impact is made at local level by the people with the least resources. The greatest capacity lies with those furthest from the families in need.'

The conference sessions covered updates on the situation and difficulties of orphaned and vulnerable children, legislation and policy affecting those children, allocation of resources to support them, capacity building for those trying to assist children and networking around some positive community care models.
Heidi Loening Voysey, of Unicef, gave a regional overview of the orphanhood crisis and challenges of community based responses to the crisis. She recalled having visited projects reflecting a range of different models of care, which had been costed by HEARD (the Health Economics and AIDS Research Division) in Durban. 'The least expensive model was the one in which I felt most warmly accepted. The children there had an enormous sense of sharing and mutuality and belonging - they had a consistent caregiver and were rooted in their culture.

She pointed out that the number of orphans was decreasing in all parts of the world except in sub Saharan Africa. There were negative impacts for the children and for those who took over caring for them. Orphaned children are:
more likely to suffer food insecurity
more likely to be stunted
more likely to commit suicide
more likely to be behind in school
Malnourishment is high for orphans. Orphans are also at risk of property grabbing (7% of widowed men suffer property grabbing compared to 20% of orphans and 29% of widows) and understanding of how to protect property rights of orphans is important (see page #).
Unicef had found that orphaned children were more likely to be exploited - in respect of domestic work - more likely to be involved in prostitution and more likely to be living on the street.

A study of the impact of parental death on the education of children, conducted by the Africa Centre, in northern KwaZulu-Natal, showed that the age group of parents of school children were particularly hard hit by parental death. Cally Arlington, reporting on the research, said that comparing orphans to non-orphans of the same age and sex, children who were maternal orphans were more educationally disadvantaged than paternal orphans. Maternal and double orphans were about 30% behind educationally. Paternal orphans were only slightly behind - and this appeared related to poverty. Controversially, the study found that female orphans were not at greater risk than male orphans.
Maternal orphanhood had a negative impact on schooling even when compared to non-orphaned children in the same household. Arlington said it was not yet clear whether the mother's death caused the child to fall behind at school or whether it was an associated factor along with other factors. However, the research showed there was a cumulative impact - the longer mother had been deceased, the further the child fell behind. The educational lack of progress could not be explained by poverty alone as orphaned children were at a significant disadvantage to non-orphaned children with whom they lived.
Arlington identified several policy challenges. These included:

• The need for special assistance for orphans;
• Problems with targeted cash transfers - screening devices appeared to screen out the very people they should support (due to problems with documentation and the application process). A universal grant may be the best solution.
• The need for in-kind transfers, whereby school fees would be waived; however there would need to be a central fund to make up essential income to the school.

Dr Connie Kganakga, of the HIV/AIDS Directorate in the Department of Social Development, spoke on government legislation and policy on community-based care, as well as policy and practice on resource allocation for community-based care.

She outlined the policy framework, action plan and costing for a programme to link social grants to programmes for sustainable livelihoods. She noted there were already 10 million recipients of social grants and a growing backlog of applications. On one hand the issue was how the government was going to be able to keep on increasing the social grants; on the other, mechanisms needed to be put in place to lift the socio-economic status of families, alongside the social grant. 'Otherwise those families never move out of poverty. We are working closely to ensure that the families that are receiving grants will be able to be part of sustainable programmes.'

Kganakga said the action plan would start to be felt on the ground by 2006. 'We are busy with a curriculum to train the care givers while we are looking to get back social workers - and also train social workers in HIV/AIDS and the issue of orphaning in the home…In the next 2 months we should have finalized that curriculum.'
The department was also trying to set up a database for orphans and vulnerable children, with a view to helping them to access services.

Pat Moodley, of the National Child Protection Committee in the Department of Justice outlined changes in child law impacting on orphaned and vulnerable children. She noted that access to the law should be equal for every child but the circumstances of many children and the way the system functions mean this is not the case.
The crisis of the backlog of foster child grants and how this is being dealt with was of particular concern to conference delegates. Moodley said that the Commissioners of Child Welfare had committed themselves to dealing with this crisis - final figures were being collected from the provinces. The plan was to address the problems at a provincial level.
It was pointed out that one of the main blockages in processing grants was getting Home Affairs to issue documents. Shirin Motala reported that ACESS has had to serve papers on Home Affairs after three years of unsuccessful attempts to secure improvements in the processing system. Kganakga said that Home Affairs was part of the problem-solving team in terms of the action plan that had been developed.

Serious concerns were expressed by delegates about the lack of capacity and resources to deal with grant backlogs and to make the social benefits system more responsive to children's needs and more equitable. The appropriateness of the foster child grant, given the scale of need and the levels of poverty was questioned. Joan van Niekerk feared that the provinces where most of the 100 000 grant applications were outstanding would never cope with the backlog but Kganakga said additional social workers had been employed - 150 in EC and 100 in KZN - and a national oversight committee would supervise the process.

The critical shortage of social workers across a spectrum of service areas was discussed in the context of the numbers of children experiencing poverty, neglect and abuse. The Department of Education has recognised the importance of schools as nodes of support for vulnerable children and was providing for social support within schools across the country. Molly Kemp, of Psychological Services, KZN, said the Department had made available funds to employ social workers but again delegates questioned how the gap between need and resources could ever be filled. Carol Bower, of RAPCAN, said that in the Western Cape, there were two social workers dealing with 180 schools.
Some delegates complained about lack of consistency in the criteria that child commissioners/magistrates used for placement applications. Moodley urged civil society organisations to challenge decisions they saw as problematic but said that the Department of Justice was also doing context training for judicial officers to address such problems.
Fiona Napier, of Save the Children UK, presented highlights from that agency's new report Bottlenecks and Drip-feeds - Channelling resources to communities responding to orphans and vulnerable children in southern Africa.

Napier reiterated that while communities want to care for their children, do most of the caregiving work, are best at providing holistic support to children, can be more effective and quicker in responding and can more easily build on existing support, they do become fatigued. Despite the internationally high profile of HIV/AIDS and its impact on children, and the priority given at a policy level to orphaned and vulnerable children, Napier said that less than 10% of HIV/AIDS support came from donors NGO's and government.
Communities were providing support through:

• food money clothes labour
• friends and neighbours
• HIV/AIDS support groups
• loans
• cooperatives.

However, destitute families may never recover from the death of one economically active member of the household and the increased resources available for HIV/AIDS and OVC in particular were simply not reaching communities.

Where funds were, in theory, available to CBOs (defined as organisations with fewer than ten staff, largely dependent on volunteers and working directly in communities) there were many obstacles to accessing them - including locating funding sources, meeting funding requirements and getting feedback on applications.

SCF had found that there was little coordination among donors about donations and spending. Neither national governments nor international NGOs were set up to get funding to where it was needed. 'If this was a business model one would strip out the middle levels to ensure that money gets to the bottom layer', said Napier.
However, there were several obstacles to donors and intermediary NGOs not providing more resources directly to community groups:

• concern about financial accountability;
  
• difficulty making small grants;
  
• fear of producing dependency;
  
• lack of appropriate grantmaking skills;
  
• lack of awareness of the need to fund community groups;
  
• no requirement for money to be spent at community level

Greater investment was needed to increase financial capabilities and to work with communities to develop appropriate and practical monitoring systems.
Some of these themes were taken up in the presentation by the Nelson Mandela Children's Fund (NMCF) on a 'national foundation as a funding conduit: current practices, successes and challenges'

Archie Tsoku, of the NMCF, said it was clear to delegates that 'the rules of the [funding] game are not benefiting the children'. NMCF was established as an indigenous effort - the bulk of its donations coming from within the country. It was committed to supporting indigenous responses to children's needs and was promoting an African model of nurturing orphaned and vulnerable children (Goelama). However, as a funder, it also faced several obstacles to getting resources where they were most needed. Tsoku said that rural areas were underfunded, partly because there were so few CBOs operating (more than half the Fund's expenditure in 2004 was in Gauteng, KwaZulu-Natal and the Western Cape).
He said NMCF was addressing a range of challenges to deal with this. These included the need to move away from reactive to proactive development proposals, looking at the community context for funding projects, compared to the target group approach, costing community inputs, linkages with government, increasing capacity of CBOs/NGO, supporting FBOs.

One of the grantmaking strategies NMCF was using was calling for concept papers - looking more at objectives - rather than full funding proposals. The Fund would then jointly develop proposals from them and make a 5-10% allocation for capacity building, M&E, board development etc. 'The question is, whose core business is it to develop the 20,000 some odd CBOs out there?'

Discussion of this question arose throughout the conference. Some delegates argued that NGOs acted as gatekeepers, blocking the flow of resources to community level. Others cited the valuable role of NGOs as intermediaries, mentoring small organisations, helping to access funding and taking on the administration of small grants. A delegate from Telkom said corporates often found it difficult to understand the role of the intermediate NGOs. 'There are too many NGOs whose objectives are not clear. Many corporates are becoming very scared of intermediaries.' It was noted, however, that intermediaries 'come in different shapes and sizes' and that there were models for transparent, accountable and responsible relationships between NGOs and CBOs. For example, where a larger organisation contracted with a CBO to do work it could help it to develop gradually. By progressing from contracting to giving a small budget, an NGO could help a CBO to build up to the two years of audited statements required to qualify for donor funding independently.

Yugi Nair, of the HIV/AIDS Network, HIVAN, addressed the issue of NGOs supporting capacity building and skills transfer to CBOs. She outlined strategies HIVAN was using to equip community structures to drive effective HIV/AIDS management in southern Africa. HIVAN had an on-going collaboration with residents of the remote rural community of Entabeni, where 43% of pregnant women were HIV positive. HIVAN's role was that of external change agent, working with a project community to develop capacities, resources and partnerships in an isolated area where people had little or no access to formal health or welfare support, and where HIV/AIDS was heavily stigmatised.

Nair said that the challenge had been not in building the partnerships at community level but in getting the Department of Health on board:' We have had four partnership meetings but the DOH has never attended. The Department of Social Development finally attended the last meeting. Our task is to change mindsets in government - not in the community.' A Ministry of Health delegate to the conference expressed great enthusiasm for the model HIVAN presented.

Zeni Thumbadoo, of the National Asosciation of Child and Youth Care Workers (NACCW) showed a video of the NACCW-supported Isibindi project, which provides community based care for vulnerable children, within a children's rights model. Child and youth care workers use daily tasks to build children and the project draws in families, communities, funders, and the department of social development. The project was praised as a replicable multi-sectoral approach to providing quality care outside of the previous residential model.

The role of partnerships and networks of civil society organisations in ensuring more effective support for orphaned and vulnerable children was highlighted by Berenice Meintjies of the Children in Distress Initiative (CINDI). The network brings together more than 100 organisations supporting children affected by HIV/AIDS. One of its roles is as a funding conduit. It operates on a CBO mentorship model - only supporting NGOs that are supporting and capacitating CBOs. It looks for genuine long-term partnerships between NGOs and CBOs with the long-term aim of CBO independence.

CINDI was established on the principles of taking strategic, coordinated action, adopting a multi-faceted and collective approach while maintaining the independence and autonomy of its members. Meintjies said: 'Our difficult decision was how much we wanted fundraising to be member driven versus CINDI driven'.

The network supports member applications for funding and puts forward some joint funding proposals, agreeing on strategic objectives, tailoring proposals according to the needs of the community and the focus of the donor, and negotiating donor terms.

The focus of discussion on the second day was very much on developing local capacity to respond effectively to the problems faced by orphaned and vulnerable children. In this context, Judith Streak, of Idasa's Child Budget Unit, highlighted some of the concerns around current social development policy and budgeting for children made vulnerable by HIV/AIDS.

Streak said that the financial contribution of the non-profit sector to social welfare service delivery, as a percentage of total social welfare service budgets, varied between provinces from less than 30% to more than 70%. For example, in the Eastern Cape, one of the poorest provinces, NPOs contributed 64% of social service provision fro the year 2004/5.
The figures highlighted how government relies heavily on non-profits to deliver social services but does not fully subsidise them, so that ironically the state draws away staff from the non-profit sector with higher salaries - and then loses them, to other countries or other professions that offer even better conditions.

Streak's presentation highlighted the gap between the constitutional obligations of the state to support vulnerable children and the prospects of current policy and budgeting programmes to deliver. She said that according to constitutional law experts, government had to fulfill a direct obligation to children living without adult parents (most vulnerable) through direct service delivery, an obligation to prioritise and fast-track programmes offering services to vulnerable children, to integrate child rights by mainstreaming children's needs into its general anti-poverty programmes, and to engage actively with the challenge of defining standards in relation to the rights. The law governing social welfare services was inadequate to this task and the Children's Bill was still in development.

Streak dealt with the particular policy concerns around the foster child grant (FCG). Foster child grant beneficiaries grew by 198.3% between April 2001 and April 2005, from 85 910 to 256 325 .

The policy - at least in law - was that the FCG was not a grant to assist children affected by poverty but for those defined `in need of care' and placed by the Children's Court due to abuse and neglect. The growing practice of primary caregivers looking after orphans in households struggling due to poverty and claiming and receiving the FCG was problematic for several reasons: it was a complex and costly administrative procedure; it was unfair to other children affected by poverty (whose caregivers could claim a smaller child support grant for a limited number of children up to the age of 14 only); there was no increase in social worker capacity proportional to the huge increase in applications, which was undermining child protection services, and reliance on the FCG was hiding the real policy problem - insufficient income support for caregivers in the context of extensive structural unemployment.
Concerns around the other grants targeted at vulnerable children included:

• The criteria for the Care Dependency Grant do not integrate needs of children's suffering chronic illness due to HIV/AIDS infection and impacts;
  
• There is no support to provide for extra income needs of children suffering chronic illnesses.
  
• The means test for the Child Support Grant (CSG) fails to take into account number of children being supported by caregiver.
• The CSG discriminates against children in larger households.
  
• The exclusion of children aged 14-18 from CSG access ignored both the desperate need and the entitlement of many children to this grant.

With regard to home and community-based care (HCBC) policy, Idasa highlighted:

• Insufficient emphasis on income generation measures to support for care givers - leads to in-adequate care;
  
• Paying stipends to HCBC workers is commendable but screening mechanism could be disincentive to volunteers;
  
• Inadequate monitoring mechanisms;
  
• Insufficient acknowledgement of role of residential care.

Shortcomings in the financing policy for social benefits included that there was no plan for costing resource gaps and how to fill them in relation to different services; it was left to government officials to determine allocations to NPOs (even for statutory services); and the different salary scales of social workers in NPOs and the government sector were still not addressed.

Streak said that the plethora of policy documents and structures did not talk to one another sufficiently and the resulting lack of clarity undermined services on the ground. The Policy Framework for Orphans and Other Children Made Vulnerable by HIV and AIDS in South Africa, developed in 2004, did not go far enough in coordinating service delivery or responding to research and experience in addressing children's needs.

Despite the growing need, there was declining real growth trend in public funding of coordinated action and HCBC for 2006/07 and 2007/08. 'SWS allocations (2005/06-2007/08) remain a tiny proportion of total provincial budgets (in the face of known excess demand for services and NPO financial difficulties)'.
Streak added there was no indication that government was planning to set aside more funds to pay for the extension of the CSG to children aged 14-18, despite the relatively small cost implication of R3.4 billion a year.

The recommendations to address all these concerns resonated with calls throughout the conference for a combination of cash transfer and sustainable livelihood approaches to household poverty, setting of norms and standards for a 'basket' of welfare services for vulnerable children, a holistic monitoring framework, the extension of the CSG (without a means test) to all children, revision of other grant criteria and a policy to address the shortfall in funding for NPO sector service delivery. Particular concern was raised about the delay in scaling up training for early childhood development and a DSD representative said although there was an integrated ECD plan, providing for an expanded cadre of ECD workers through the Expanded Public Works Plan, the department was three years behind in its ECD processes.

Linda Richter, of the Child Youth and Family Programme of the Human Sciences Research Council (HSRC), outlined a strategy for scaling up households and schools as nodes of support for orphaned and vulnerable children. Richter likened the current project-based approach to assisting children to a few shining stars in a dark landscape - even if the number of projects increased, people living in between the stars would still be in darkness. She said while the stars were important, we needed the sun to shine on everyone! One way of achieving this was to move away from a special focus on the proportion of children who were extremely vulnerable and rather improve the status of all children. This was easier to do and more cost-effective.

HSRC is running a demonstration project aimed at improving social security access, social security and family support, and social security and school support. It will operate in 30 schools, over two to three years, reaching 3000 learners aged seven to nine years. The overall goal of the HSRC intervention is to reduce the negative impact of poverty and HIV/AIDS on rural school communities by creating an environment that is: safe, gender-sensitive, healthy, inclusive, conducive to learning and rights-based. Richter said that keeping children in schools had the potential to be the most effective support to those who were most vulnerable. However, schools would need a lot of support to provide all the services needed. She said HIV/AIDS responses were comparatively well-resourced but "We should not have responses to HIV/AIDS that do not contribute to the overall socio-economic development of the country.'

The approach is a multi-sectoral one - involving other departments, religious leaders, NGOs and CBOs in establishing clusters of self-reliant schools that could care for orphaned and vulnerable children but provided a more supportive environment for all children.

Molly Kemp reported on a Department of Education initiative that was also piloting schools as centres of care and support. The KZN Education department covers 6000 schools with seven million learners. The initiative, being developed with the Media in Education Trust (MiET), is also based on a cluster approach. The idea is for education centres within districts to provide resources to schools on the basis of eight schools (primary and secondary) per cluster, coordinated by a support team. One of the objectives was to remove barriers to accessing education.

There were inevitable questions about training, the demands on teachers and lack of resources but great enthusiasm for the commitment to coordinated and holistic responses to supporting vulnerable children.

There is not space to cover the practical aspects of the strategies and models presented at the conference but all the presentations will be available on line and further details may be requested from the authors. A list of the papers and contact details appears below. - Ed