Orphans and Vulnerable Children

Lyn's Comment: The world has become increasingly aware of HIV since the early 1980’s. The pandemic has been described as having three waves.

“In the first wave, people are infected with the virus. In the second wave, people become ill. The third wave is made up of the effects of people dying of HIV/AIDS, such as on surviving children and young people.”  (OVC Support)

In faith communities, caring for children orphaned by HIV, or children made vulnerable by the challenges of HIV should always be a priority.

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News about Orphans and Vulnerable Children


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The Coalition for Children Affected by AIDS. 12/2016

Publishedd by CCABA

The Coalition for Children Affected by AIDS believes that children need to be made a higher priority in the international response to HIV and AIDS

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Making the Children of Key Populations a Priority for Equitable Development. 30/11/2016

Published by CCABA

Allow me to introduce you to a young, HIV positive mother—we’ll call her “Sarah”—in South Africa. Sarah is living in extreme poverty. To ensure her child has food and shelter, she is a sex worker, likely how she contracted the disease. Forced with the untenable choice of providing either food or childcare—she cannot afford both—she locks her baby in the house while she works. She is consumed with thoughts of how often the baby cries, and worries what will happen if her home catches fire or someone breaks in while she is gone.

Sarah is not alone. And her baby is far from the only child that is suffering.


Today, on World AIDS Day, we can’t forget that this experience is the reality for many of those whom the global health community has determined to be most vulnerable to HIV and AIDS–not only sex workers like Sarah, but also people who use drugs, transgender people, and men who have sex with men. While the global health community has worked for many years to determine the best way to fight HIV and AIDS among key affected populations, we know very little at all about their children.

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International Children’s Day: Looking after Young People affected by HIV . 31/5/2013

1 June is International Children’s Day. This year we’re reflecting on the 3.4 million children under the age of 15 who live with HIV and AIDS, and the inspiring work of our partners to improve their lives.

Published by CAFOD

The HIV pandemic doesn’t just threaten the physical health and survival of millions of children around the world. It also destroys their families and deprives them of love, care and protection. Many of them are excluded from their communities and schools because of stigma and discrimination.

Blenda’s story

Blenda Uganda HIV support group

Blenda is now secretary of her support group which helps young people living with HIV

12-year-old Blenda lives in Lukaya, a rural area in Uganda. She lost her mum because of AIDS when she was four, and then became sick herself. Blenda’s grandmother pushed for her to be tested at CAFOD’s partner, the Kitovu Mobile clinic for HIV testing.  At first her dad refused, believing antiretroviral drugs had killed his three brothers. But Blenda’s grandmother persisted and Blenda got tested. She was found to be HIV positive.

The Kitovu Mobile AIDS Organisation supported Blenda to attend peer support group workshops for HIV positive children.   “I shared with my dad what I learned from the workshops: that HIV drugs don’t kill people but to help them live positively with HIV. Since then he always encourages me to take the drugs,” she says.

Blenda is now secretary of her support group, where she shares her experiences and ways of reducing the risk of infection. “I want to ask parents and guardians of children living with HIV and AIDS to show them love, educate them, and not to discriminate against them, because we are like any other children”, says Blenda.

The future for young people affected by HIV and AIDS

Our partners around the world have found that young people find it easiest to talk about their condition when it’s to other young people. But we need to make sure they get the right information and have a thorough understanding about HIV, so we train young people to be peer educators.

We also know that stigma and fear often stop young people from getting the medical help they need.  Our partners tell us one barrier is the attitude of the adults in whom they should be able to confide. That’s why we want to step up our work to lobby governments, to make HIV counselling, testing and services more accessible to young people. 

In Peru, one of our partners is developing partnerships between health workers and teachers.  Teachers are often the first port of call for questions from young people but don’t always know the answers.  They can refer the young people to health workers who can offer information, guidance, counselling and friendly care, while trained adolescents and youth leaders answer concerns from young people in the neighbourhood.

I want to ask parents and guardians of children living with HIV and AIDS to show them love. We are like any other children”

– Blenda, Uganda

At CAFOD we’ve always believed our faith calls us to walk alongside those most affected by poverty and injustice.  We’re redoubling efforts to ensure universal access to HIV prevention, treatment, care and support and to eliminate mother to child transmission of HIV.

As well as providing care for people living with HIV, we support people to start up small businesses so that they can provide for their families, plant nutrition gardens to supplement their diets, assist with will-writing to ensure that children have legal rights to inherit their parents’ property, support children to go to school and work with communities and faith leaders to reduce stigma and discrimination.

This International Children’s Day let’s share the vision of a HIV-free generation, and keep working to make a difference to children’s lives.

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OVC Conference 2012 Declaration. 12/11/2012

We, as individual citizens, and many of us as parents; leaders of organisations; policy makers; implementers; activists; and researchers, attending this conference from within South Africa as the hosting nation; and other African states, and inspired by the child within each of us.

Recognise the moral right of the child to:
•    Really be a child;
•    Be surrounded by both parents as the minimal ideal, and any other nurturers of integrity possible;
•    Live in a healthy village, a protective nation and a humane world; and
•    Enjoy appropriate early and further childhood development
We commit, therefore, never to turn a blind eye in our personal spaces first and foremost, and to be advocates for the moral right of the child on every possible platform.

As caring organisations we pledge to collaborate among ourselves, with governments and with our nations in nurturing the child with love, care, protection and support by:
1.    Participating in the development of SA’s White Paper on Family (July 2012)
2.    Working with all government departments relevant to the welfare of the child and specifically (in SA) the Department of Social Development and Department of Women, Children and People with Disabilities, in their respective and central roles in government;
3.    Working together and holding one another accountable.
Signed on behalf of the Orphans and Vulnerable Children Conference (OVC) 2012 Committee by:

Prof Anna Coutsoudis (Chairperson)
Dr Zolile Mlisana (Co-Chair)
Prof Geoff Setswe
Dr Ruth Bland
Dr Tendai Nhenga-Chakarisa

For more information on the OVC conferences please contact:
Dr Zolile Mlisana,
Email: zolile@sirmlis.com

Issued by the Foundation for Professional Development on behalf of the Orphans and Vulnerable Children Conference (OVC) 2012 Steering Committee


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SA Children's Misery. 21/5/12

A damning United Nations report has highlighted horrific conditions under which many of South Africa's children are forced to live.

Times Live

Graeme Hosken
21 May 2012

The Unicef report - yet to be released - offers detailed insight into unnecessary deaths and devastating living conditions of SA's children and demands that government take immediate action.

With 11.5million of the country's 19 million children living in poverty - and 7million living in 20% of the poorest households - the report shows poor children are 17 times more likely to experience hunger and three times less likely to complete school than children from wealthier backgrounds.

The report, titled "A Programme of Cooperation between government and Unicef for 2013 to 2017", shows just how far South Africa needs to travel to ensure the most of services - the homes of 1.4million children rely on streams for drinking water, 1.5million children live in houses with no flushing toilets and 1.7million live in shacks.

South Africa is one of the most unequal countries, said Unicef's South African representative, Aida Girma.

"The government must increase its understanding of inequity and its causes or lose the chid rights battle. The major problem is the government's lack of accountability and priorities.

"Everyone claims to be accountable, but in the end no one is . While the government is open to ideas, it has no clear strategy for the rural or urban poor. Unless there is immediate focus on challenges. it is doubtful that poverty will be eradicated."

Girma called for an urgent focus on children's needs as two-thirds of child deaths were preventable, proper health protocols were not followed.

About 10.3 million children depend on the government's monthly R270 child support grant. One million children who are eligible for grants do not receive them.

Four out of 10 children live in homes where no one is employed. In cases of dire poverty, this figure increases to seven in 10 children.

But the picture becomes even bleaker where the health, education and security of South Africa's young are concerned.

Without "drastic" intervention, South Africa will not achieve its 2015 UN Millennium Development Goals of eradicating child and mother mortality and malnutrition - "all of which [are] preventable".

More than 5million children are HIV-positive, with between 250000 and 300000 babies born to HIV mothers annually.

HIV/Aids is the biggest killer of the country's children, according to Girma.

"Forty percent die from the pandemic annually. There are 4million orphans, with 2million orphaned by Aids. Action is needed now.

"South Africa accounts for 28% of the world's TB-HIV co-infection rate, with 400000 South Africans affected. Children account for nearly 25% of all new tuberculosis cases.

"While the government has good legal frameworks protecting children's rights and has progressed in delivering services to children, its capacity to implement policies are virtually non-existent.

"There are no proper databases, with millions of children falling through the gaps and remaining trapped in poverty. Since 2003, the Health Department has not done a demographic and health survey."

Women, Children and People with Disabilities Ministry spokesman Cornelius Monama, said it was urgently reviewing a national action plan for children .

"The challenges facing our children are immense. We are working on child survival programmes and are implementing health, education, housing and safety monitoring and intervention strategies ensuring the delivery of services and protection of children."

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Addressing the Consequences of HIV/AIDS Affected Households: Psychosocial Support Interventions for the Next Generation of OVC. 15/7/11

Children orphaned by AIDS are 117% more likely to suffer from post-traumatic stress disorder (PTSD) than those whose parents are alive.

OVC Support

By Lucie Cluver and Robyn Cox
15 July 2011

Over 22 million people are infected with HIV in sub-Saharan Africa. In South Africa alone, 850 people die from AIDS every day. Although the last 30 years have seen considerable developments in prevention, treatment, and care for the disease, research is revealing the considerable, and multiple social consequences of AIDS on families, and especially on children. Our four-year Orphan Resilience Study with 1000 girls and boys showed that children orphaned by AIDS are 117% more likely to suffer from post-traumatic stress disorder (PTSD) than those whose parents are alive. Even more tellingly, they are 67% more likely to suffer from PTSD than children orphaned by other causes such as homicide, or cancer.

As part of our National Young Carers Study, we have interviewed 6000 children and 2600 of their caregivers. Preliminary findings suggest that the significant long-term, and major impacts of AIDS on child development and psychological health, also affect children whose caregivers are sick with AIDS. These children are just as likely to suffer from an equally severe psychological disorder such as depression, anxiety, or post-traumatic stress. When comparing these children to those whose caregivers have other chronic illnesses, 50% more children from AIDS-affected households are afflicted with psychological disorders.

The National Young Carers Study has also shown the impact of children’s psychological distress on their education. 43% of children caring for someone sick with AIDS were so worried that they couldn’t concentrate at school. 41% missed school, or dropped out entirely so that they could care for their caregiver. Physical and emotional abuse, and transactional sex are also significantly more likely among children in AIDS-affected families, and tuberculosis infection is 16% among children caring for those with AIDS, compared to 4% for those in healthy families.

The effects of these outcomes are not isolated in childhood. For children affected by AIDS, these disorders worsen as they become young adults, much more so than children from healthy families or other orphans.

So how can we address the devastating consequences of AIDS for future generations? The South African government has been eager to use results from research like the National Young Carers Study to guide their policy-making, such as for the 2009-2012 National Action Plan for Orphans and Other Children. Research has also been used by the South African Department of Social Development to inform programmes that will provide life skills training for affected children and their communities. Non-governmental organisations, such as the Regional Psychosocial Support Initiative, are using research to establish programmes that help to boost their resilience, improve psychological health and lower children’s risk of infection by teaching them how to properly care for sick adults. Major development organisations such as the Swedish International Development Cooperation Agency and UNICEF are also using research in developing interventions that provide AIDS-affected families with basic needs such as food.

This is just the beginning. Antiretroviral rollout needs to be improved - a Kenyan study showed that children were better fed and had better school attendance when their AIDS-sick parents started taking antiretrovirals. Helping children with AIDS-affected caregivers to attend school more often, and to facilitate learning when they cannot attend is vital. A recent DFID review found that cash transfers to vulnerable families improved child outcomes. And importantly, evidence-based psychosocial interventions are desperately needed to combat the psychological distress experienced by children in AIDS-affected families.

Interventions that rely on strong research evidence are vital in addressing some of the biggest challenges facing the next generation. In order to be effective, and accepted, these interventions should be developed through the collaboration of researchers, governments, communities, and affected families, taking into account the multifaceted, complex, and changing face of HIV/AIDS.

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Elimination of Pediatric AIDS High on Rome Agenda. 19/7/11

It is morally wrong that babies are still being born with HIV when we know how to prevent it

19 June 2011

ROME — Eliminating pediatric HIV and AIDS was high on the agenda on the first day of the sixth International AIDS Society (IAS) Conference on HIV Pathogenesis, Treatment, and Prevention in Rome.

Even before delegates had been officially welcomed during the evening’s opening session, my colleagues and I had already attended four satellite sessions focused on the issue of HIV and children.

My organization, the Elizabeth Glaser Pediatric AIDS Foundation, kicked things off with a morning session on the role of community in preventing new HIV infections in infants and children, and keeping their mothers healthy. The Foundation was joined by representatives from CARE, the Regional Psychosocial Support Initiative (REPSSI), the Global Fund and the London School of Health and Tropical Medicine (LSHTM) in a panel discussion.

The goal of the discussion was to bring together researchers and program implementers to find ways to measure the success of community engagement activities. Ultimately, programs like these can substantially increase success rates to prevent mother-to-child transmission of HIV (PMTCT) and to treat HIV/AIDS.

The discussion was moderated by Dr. Anja Giphart, of the Foundation and Linda Richter of the Global Fund and the Human Sciences Research Council in South Africa. The panel highlighted successful approaches, including:

-Using community-based counselors for HIV-positive mothers undergoing PMTCT

-Training traditional birth attendants to help identify infants who have been exposed to HIV

-Integrating community-based psychosocial counseling and support into PMTCT services

-Collaborating with local post offices and community health care workers to identify TB patients who have been lost to follow up

Two representatives from LSHTM presented reviews of the scientific literature and studies on the effectiveness of community-based approaches. They concluded that there is enough evidence to show that community involvement in HIV prevention and treatment is effective, but what’s needed now is implementation science and the processes to put them into practice.

While it’s important to learn from successful examples, they also stressed that these should not be replicated for every situation or country. It’s important to identify challenges to each individual program, and to adapt successful processes to come up with interventions tailored to the situation and local context. There’s no “one-size-fits-all” solution.

An afternoon session looked at the challenges in developing and purchasing new pediatric formulations for antiretroviral drugs. It was sponsored by IAS and its Industry Liaison Forum, UNICEF, WHO, and the Clinton Health Access Initiative (CHAI), and discussed the fact that drugs available for adults are often not suitable for infants and children. The session looked at the challenges to developing child-appropriate formulations, including:

- Developing more pediatric ARVs and making the ones we do have more accessible to children. For example, small children can’t swallow pills, so they need liquids or similarly easy drug formulations to take.

- Overcoming market barriers that prevent the production and purchase of pediatric ARVs. The population of HIV-positive children is much smaller than the adult population, which means there is less opportunity to innovate and less purchasing power to drive down costs.

The panel discussed how to incentivize the production of pediatric drugs for this relatively small patient population, and how to simplify the purchase of drugs for countries that need them.

A third session covered the operation and implementation challenges to scaling up PMTCT, and was also sponsored by IAS’s Industry Liaison Forum. It featured examples of both successes and roadblocks to universal PMTCT access from Zimbabwe and Uganda. Dr. Angela Mushavi, the PMTCT coordinator for Zimbabwe’s ministry of health, spoke about her country’s experience, which has included a longtime partnership with the Foundation.

Dr. Mushavi detailed Zimbabwe’s decade-long history with PMTCT and maternal health in the context of HIV, and discussed what will be necessary to reach its goal – the virtual elimination of new pediatric HIV infections by 2015.

“Do we give up,” Dr. Mushavi asked, acknowledging the remaining challenges. Her answer: “A most emphatic no.” She stressed the need to better understand the challenges, and design country and community-specific innovative and creative solutions.

One of the last sessions of the day focused on measuring the effectiveness of national PMTCT programs to reach the goal of the elimination of pediatric AIDS. This discussion was sponsored by WHO and the U.S. Centers for Disease Control and Prevention (CDC), and included the experiences of Mozambique, Swaziland, Kenya, Rwanda, and South Africa.

Like Zimbabwe, each country has its successes and challenges, some shared and others unique. But all countries are striving for the goal of universal access to PMTCT services. In a national survey in South Africa in June, results showed that the rate of mother-to-child transmission of HIV had been reduced to an average of 3.5 percent, approaching the rate found in high-resourced countries.

While the rate varied within the country, South Africa’s Department of Health wants to reduce it in all regions to far less than 2%, and is working with the various provinces to develop an action framework for eliminating pediatric AIDS.

These new numbers show that the momentum is there, and the goal is achievable.

By the end of the day, I had noticed another example of momentum through numbers.

Even though not everyone had arrived in Rome for the conference, all of these sessions were packed with attendees, with few seats available. This shows that more and more people are aware of the unique issues surrounding pediatric HIV and AIDS, and the need for stepping up the political, financial, and research commitment to create a generation born free of HIV.

“It is morally wrong that babies are still being born with HIV when we know how to prevent it,” Michel Sidibe, executive director of UNAIDS, told IAS delegates at the evening’s welcome and opening session.

We couldn’t agree more.


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UNICEF Pleads for HIV Children. 4/12/10

HIV/AIDS have wreaked havoc on individuals and families for nearly three decades


By Yinka Shokumbi
4 December 2010

"HIV/AIDS have wreaked havoc on individuals and families for nearly three decades with the tragedy of untimely death as well as medical, financial and social burdens.

"The irony however is that although children's concerns have always been present within the great spectrum of need associated with HIV, they have to some extent been overshadowed by the very scale of the epidemic in the adult population".

This was the thought of the Assistant Representative and Chief of B-Field office, Mrs. Sara Beysolow-Nyati as expressed during a meeting last week with media managers in Lagos.

According to Beysolow-Nyati, latest estimates show that more than 1000 children are born daily all around the world with HIV and more than half will never see their second birthday if they are not diagnosed and treated.

Already from the world estimate of 33.3million people living with the virus, 2.5million are children and in sub-Saharan Africa nine per cent of deaths of women in pregnancy are as a result of HIV.

This is because only very few of the women get access to adequate services to prevent the transmission of the virus tot heir babies.

The Chief of B-Field revealed also that while the fifth stock taking report of the 'Unite for Children, Unite Against AIDS' shows that some progress has been made in the care of children with HIV, "more still needs to be done to ensure that the best care, treatment and support for HIV and AIDS is available to all who need it".

She observed that though some children have benefitted from the substantial progress, a lot of others have fallen through the cracks due to inequities rooted in gender, economic status, geographical location, education level and social status of their mothers and guardians.

"And so lifting these barriers is crucial to universal access to knowledge, care, protection and the prevention of mother-to-child transmission (PMTCT) for all women and children", said Beysolow-Nyati.

She pleaded with Nigerian governments at all tiers to scale up efforts in all communities to ensure that every individual living with HIV gets access to treatment and equally scale up prevention services in order to ensure new infections do not occur.

Statistics of children living with HIV in 2009 was grim as about 370,000 contracted the virus during perinatal (childhood) and particularly during breastfeeding period.

Information on best breastfeeding practices for breast feeding women though available in many of the cities' media are largely not reaching women in rural areas because of non-availability of community media in many of the rural communities.

Experts have therefore called on government to liberalise the licence for community-based media to enable broadcast of health preventive messages in the dialect of the people for their benefit.

According to the UNICEF HIV/AIDS programme on PMTCT, an HIV pregnant woman who has successfully received HIV treatment during pregnancy and has delivered an HIV-free baby can practise exclusive breastfeeding with no addition of any form of fluid in the first six months of life with the right support and care.

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The Difference AIDS Makes to Vulnerable Children. 5/11/10

AIDS-affected children struggle with educational and mental health issues

5 November 2010

Johannesburg - New South African research shows that AIDS-affected children struggle with educational and mental health issues more than their peers, who are vulnerable for other reasons.

The research, which authors said was the first to measure the effects of AIDS-related illness among care-givers on children, was conducted by Oxford University and South Africa’s University of the Witwatersrand and presented at the Orphaned and Vulnerable Children (OVC) Conference in Johannesburg on 1 November.

Led by Oxford’s Lucie Cluver, the study followed 730 vulnerable children from three South African provinces – the Western and Eastern Capes as well as Gauteng – over four years.

Researchers found that having a care-giver suffering from an AIDS-related illness almost doubled the chances of a child not being enrolled in school compared with a child whose carer experienced other illnesses. Children whose care-givers were battling opportunistic infections were also more likely to miss school days and have concentration problems.

A July 2010 report by Statistics South Africa (StatsSA), estimated that AIDS-related illnesses accounted for 43 percent of all deaths in the country over the past decade.

According to StatsSA, there are two million children who have lost one or both parents due to AIDS in the country.

Different vulnerabilities

Cluver said the findings may point to a higher demand for care associated with AIDS-related opportunistic infections than with other illnesses.

About a third more children cared for by adults with opportunistic infections reported doing at least three hours of housework daily compared with children whose carers had other ailments.

“We asked children about this increased care work,” Cluver told IRIN/PlusNews. “A lot of it is what we might call intimate healthcare – they’re cleaning wounds, washing people, toileting people, they’re responsible for giving medication ... but a lot of it is also sibling care, housework...”

Big problems, small shoulders

Cluver also said that in a linked study of 850 OVCs, those whose carers had AIDS-related illnesses said they felt responsible for that person's well-being and guilty about leaving them to go to school - creating high levels of anxiety that adversely affected the children’s mental health.

“[AIDS-related] sickness is impacting on concentration both because of the care work they are doing – so the kids are worrying about what they need to do – but also through increased levels of psychological disorder… which would be issues that, in the west, would be seen by a doctor or psychologist.”

Children with a care-giver who suffered from AIDS-related illnesses had heightened levels of anxiety, depression, problems with peers and post-traumatic stress disorder, according to Cluver.

Cluver said that in addition to programmes commonly aimed at OVCs, such as feeding schemes and fee waivers, schools could respond to the needs of children in such households by offering psycho-social support or perhaps introducing flexible time-tables for children with heavy care work burdens.

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Orphans get Raw Deal. Living with AIDS # 455. 4/11/10

Development of children orphaned as a result of AIDS is at greater risk of health and social ills


By Khopotso Bodibe
4 November 2010

The development of children orphaned as a result of AIDS is at greater risk of health and social ills, conference is told.

“My mother loved me. She used to buy for me what I asked her to buy for me. She used to teach me how to read books and to read the Bible. She used to teach me how to fold blankets. When she got sick, my grand-father came to visit her. She did not recognize anyone anymore. After that she stayed for three days, then, she died. My mother had a neck-lace with Mother Mary on it. It was gold. She wore it all the time. But when she went to bath she took it off. She gave it to me. When I wear it, it makes me think that she is always there for me”, says a soft-spoken girl, barely into her teens, about the memory of her mother.

It is children such as this one whose development is under severe threat. Addressing delegates at a conference on Orphans and Vulnerable Children in Africa, in Johannesburg this week, chairperson of the steering committee of the meeting, Dr Ashraf Grimwood, said “the health and development of children who are orphaned by AIDS, was at a far greater risk than that of children orphaned by other causes”.  

“We have to acknowledge the evidence that children orphaned by AIDS suffer more than the loss of their parents. They are at greater risk of poor health, poor education and less protection than children who have lost parents through other causes. They are more likely to be malnourished, sick, subjected to child labour, abuse, neglect or sexual exploitation and are at a greater risk of contracting HIV. They suffer more discrimination, stigma and could be denied access to education, shelter as well as play” Grimwood told the conference.

In his address, he singled out the scale of orphan-hood in east and southern Africa, saying that the “SADC is home to more than 17 million orphans. About 28 million children in east and southern Africa lack one or both parents. And in South Africa, about 44% of children in the lowest quintile do not live with their biological parents”.  

Many orphaned children end up becoming heads of house-holds, often looking after elderly grand-parents and younger siblings, thus, it is crucial that they also have a support network.

 “Carers who are children need to be recognised and supported wherever possible through support that will mitigate the economic responsibility they carry. They need to be supported so they, too, can attend school. They need ongoing information, education, training around how to care for old and young who are also sick as well as themselves. They also need psychological support. These children are often discriminated against, facing social exclusion as they exhaust their financial, social and emotional resources”, said Grimwood.

He added that “central to reducing the number of orphans and the attendant challenges is to improve the outcomes of maternal health programmes, which is number 5 in the United Nations’ Millennium Development Goals”. 

 “No woman should die giving life. Most maternal deaths can be avoided. This MDG 5 has had the least progress and is the most under-funded. Unfortunately, in many countries across Africa the maternal mortality rate is increasing. And we’ve seen this in South Africa - haemorrhage, hypertension, HIV, malaria and heart disease being the main causes. It cannot be ignored and has to be seen as a critical component of prevention of orphans and vulnerable children and youth, and thus, should always be seen as part of a context of preventive strategies we implement” Grimwood said.

He also decried the high rate of teen-age pregnancies in the region of sub-Saharan Africa and emphasised the need for the education of girl children. He said “increased access to family planning interventions could reduce maternal mortality from unwanted pregnancies”.

“Adolescents in our region have a high birth rate with no significant decline over the last 20 years. They are averaging 120 births per 1000 women aged 15 – 19. Young women in the poorest households are three times more likely and more at risk of pregnancy and birth than the richest households – and two times greater if they come from rural areas. Education, obviously, is critical. Girls with secondary education are least likely to become mothers. The unmet need for family planning remains moderate to high in sub-Saharan Africa, where 1 in 4 or 25%, have little access. So, improving access to family planning could result in a 27% drop in maternal mortality rate by reducing unintended pregnancies from 75 million to 22 million”.

Grimwood called on civil society to always be there for orphaned children, urging society to help them live a purposeful existence and to create a better future for them.

“The holistic support of these children – the physical, emotional, spiritual, psycho-social needs all need to be equally addressed. We are not sure how this will play out in the future. But chances are most will cope and most children will be up-standing citizens of the future”, he said.

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Five Ways to Reduce Trauma in HIV Orphans. 10/11/10

Here are some ways to minimize trauma among these children

10 November 2010

Nairobi — When a child loses a parent to HIV/AIDS, grief counselling helps with the trauma of loss, but when the child is both poor and orphaned, the chances of a fulfilling life are significantly diminished.

Studies have found high levels of psychological distress among such orphans, and suggest interventions to improve their mental wellbeing. Here are some ways to minimize trauma among these children:

Keep them in the family

Most African orphans remain with their extended families, being cared for by either the remaining parent, grandparents or other relatives. Studies show that staying with family is best for children; institutional care should only be a temporary solution or last resort.

Keeping brothers and sisters together also enhances their emotional wellbeing; a 1998 Zambian study found increased emotional distress after sibling separation.

In addition, it appears that remaining with closer relatives rather than more distant ones is also better for orphans. A 2003 study in the district of Rakai, central Uganda, found that the more distant the relative, the lower the chances of child survival.

Meet their basic needs

Few African parents leave wills, and property grabbing is common when adults die; in a Ugandan survey, 21 percent of orphans aged 13-18 reported property grabbing. The phenomenon undermines the livelihood of families already weakened by the death of parents.

In addition, families who take in orphaned children are often poor themselves; additional mouths to feed often stretch limited resources to breaking point. These families may need economic support to a larger number of dependents.

A 2008 study suggested that programmes such as school-feeding schemes, sustainable food and gardening projects, employment initiatives and targeted assistance for grant applications could have positive mental health impacts on AIDS-orphaned children.

Provide psycho-social care

Dealing with the loss of a parent is tough enough, but watching a parent die, adjusting to a new family and dealing with stigma and a much worse economic position make counselling all the more important. A 2002 study in Tanzania's commercial capital, Dar es Salaam, found that orphans were significantly more likely than non-orphans to internalize their problems, jeopardizing their long-term mental health.

Grief counselling is important, notably for younger children who do not yet fully grasp the concept of death. Orphans may also need more life-skills training, particularly if they are not living in traditional family set-ups and have little chance of learning, for instance, gender roles and how to make the transition from childhood to adulthood. Peer support groups can be especially helpful in allowing orphans to share their feelings with people who may be going through similar situations.

Keep them in school

School drop-out rates tend to be higher among orphaned children; they often quit school to care for sick parents and never make it back into the education system. A 2004 Princeton University study of 10 sub-Saharan African countries found that orphans were at significant risk for lower school enrolment.

According to Robinah Ssentongo, director of Kitovu Mobile Organization, which cares for thousands of Ugandan orphans, school is crucial to their happiness. Kitovu Mobile runs farm schools for orphaned children.

"When these orphans are not in school something happens, they refuse to think, but once they get back in school they regain focus on their lives," she told IRIN/PlusNews. "The difference between the child on the first day of farm school and one term later is amazing - they begin to look like any other child."

Free primary education has gone some way to improving overall school attendance, but other factors, such as living with a non-relative, continue to hamper orphans' education.

School-based peer support groups have also been shown to reduce psychological distress of orphaned younger children and teenagers.

Caring for the carers

Families taking in orphans face challenges too - a new household structure, additional expenses and the responsibility of caring for psychologically distressed children.

Custodial families may need counselling themselves to adequately respond to the emotional needs of orphans.

Surviving grandparents often step into the role of parent when their children die from AIDS-related causes. A Ugandan study found that custodial grandparents experienced extreme economic deprivation, felt physically challenged with care-giving and emotionally stretched by concerns for the children under their care.

According to a 2009 South African study, families caring for orphans are not receiving the support they need; the authors found a lack of assistance from social support services and family. They recommended that health workers and home-based caregivers be trained to support orphans' caregivers.

Authors of the Ugandan study recommended that grandparents be offered "respite care, child care, parenting support, support groups and skills development and recreational opportunities for the grandchildren".

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Lack of Awareness among Caretakers Leads to Poor Immunisation of HIV Orphans: Study. 27/7/10

The immunization status of children without HIV was better than that of the HIV orphans

Indian Express

By Anuradha Mascarenhas
27 July 2010

A study carried out by the paediatric department of Sassoon General Hospital has revealed that HIV/AIDS related mortality has a negative impact on health and socio-economic life of HIV orphans. There is a high incidence of development delay, repeated hospitalisation, dropping out of schools, severe malnutrition and incomplete immunisation among the HIV positive orphans, the study says.

The department had sent its study in the form of a poster ‘HIV/AIDS Orphans-The silent sufferers’ to the international AIDS conference at Vienna recently. Dr Aarti Kinikar, associate professor and head of the Department of Paediatrics, Sassoon General Hospital, told The Indian Express that there was a need for a comprehensive approach in dealing with HIV/AIDS families. Along with the Society of Friends of Sassoon General Hospital, a support group of caretakers of the HIV orphans has been set up.

The study was conducted among 55 HIV orphans and 55 orphans who did not have HIV. The children were mainly from slum areas of Pune and rural parts of the district who visited Sassoon ‘s paediatric department for treatment.

According to Kinikar, the immunization status of children without HIV was better than that of the HIV orphans. Of the 55 HIV orphans, 11 were staying with relatives, 31 lived with their mothers as the fathers died of AIDS while 13 children lived with their fathers. Twenty six girls below 18 years of age were married and were infected with HIV. There were 16 girls in 18-21 age group and were infected with the virus after marriage. Among the HIV positive fathers, 32 youngsters were between 18 and 21 years of age.

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Solving South Africa's AIDS Orphans Crisis Vital to Child Health. 27/7/10

AIDS orphan crisis cannot be overlooked.

27 July 2010

A new report by a South African university has called attention to the state of child health in South Africa. In this regard, the AIDS orphan crisis cannot be overlooked.

have some of the worst indicators for child health and mortality in the world, says a new report by Cape Town University. The report, entitled “South African Child Gauge for 2009/2010” was released today by the University’s Children’s Institute.


South Africa is one of 12 countries in the world that has not seen its child mortality rate decline at all since the 1990s. Quite the contrary, the number of child deaths have risen from 56 deaths per 1000 live births to 67 deaths per 1000 live births.

While many vertical funding programs targeting a select few particular diseases (malaria, tuberculosis and HIV/AIDS) have come to the forefront of international health programming, it is vital that more general health concerns remain a priority. Hospitals still require trained staff, important medical equipment and ample supplied in order to save lives. “For example,” said Malathi Pillai, UNICEF’s deputy chief for South Africa, “a majority of neonatal deaths in South Africa could be averted by improving the quality of care at district hospitals.”

Yet, South Africa puts a great deal of money into its health care system –8.7% of its GDP to be exact. This is higher than many other developing and emerging economies. So, what is the problem?

Well, one problem is certainly the ratio of sick children to the limited amount of financial resources. But largely, hunger continues to be the pre-eminent barrier to child health. Over 60% of the children who died in South African hospitals between 2005 and 2007 were undernourished. Diarrhoeal diseases and HIV/AIDS also continue to stalk the Rainbow Nation’s children.

In 2007, there were 1.4 million AIDS orphans living in South Africa, representing nearly half of all orphans. Given that these children are extraordinarily vulnerable extreme poverty and hunger with no parents or community to care for them (for often they are stigmatized with the HIV-positive status of their deceased parents), South Africa is unlikely to solve the challenges of child mortality without systematically addressing the orphan crisis. This holds true for southern African countries facing similar problems, such as Swaziland, Lesotho, Botswana and Zimbabwe.

It is not uncommon for children who have lost their mother especially to be handed over to orphanages or other family members by their fathers, who must work and cannot care for them.  Of South African’s AIDS orphans, the great majority (802,000) have watched their mothers die.

South Africa has made great strides in addressing the problem and presents an interesting example to other countries. The country is currently rewriting its national laws in order to give AIDS orphans similar rights to adults. The changes will grant them the right to seek low-cost public housing and special government grants. This pragmatic venture will likely help to mitigate the social marginalization of child-headed households and ensure that AIDS orphans are afforded the same basic rights of childhood as their peers.

Child Health and Food Security in Africa

In all of Africa, 40% of the population under 5 years old are malnourished. One dimension of hunger is chronic malnourishment owing to structural barriers such as poverty and climate-related barriers such as flooding and drought; this is reflective of two long-term problems in the food security dimension to child health:  access to food and food supply.

Transient barriers food security is the other dimension, and it is caused by natural disasters that either destroy crops or infrastructure (thereby preventing food from being delivered) – known as a secondary emergency to such events as hurricanes, cyclones, tsunamis, etc. The 2007-2008 food crisis is another debatable transient barrier to food, for while prices of staple food grains escalated to record highs, they have come down, but remain above average historical levels.

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Child Mortality Falls after Mothers Receive HIV Drugs. 20/7/10

Antiretroviral therapy was found to reduce the risk of child death by 75%.


By Keith Alcorn
20 July 2010

Children born to mothers with HIV in a rural district of KwaZulu Natal were 75% less likely to die before the age of five if their mothers received antiretroviral therapy, researchers from the Africa Centre reported on Monday July 20th at the Eighteenth International AIDS Conference in Vienna.

The impact of HIV spending on other major health problems, particularly the Millenium Development Goals on child (MDG 4) and maternal mortality (MDG 5), has been limited to date, despite the compelling evidence of the impact of HIV on child and maternal mortality, particularly in southern Africa (see International AIDS Society position paper, Making Motherhood and Childhood Safer).

The study presented on Monday, carried out by the Africa Centre in KwaZulu Natal, extends research presented last year at the Fifth International AIDS Society conference in Cape Town and conducted by the same research group in the same district, which showed that antiretroviral therapy for mothers reduced mortality in children under two years of age.

The researchers used a well-established district population HIV surveillance study as the basis for an evaluation of the effect of maternal antiretroviral treatment on child mortality in under-fives.

The study evaluated the change in child mortality after the introduction of antiretroviral therapy in 2004. The researchers identified 300 live births in mothers with HIV between 2000 and 2006, and matched these women to mothers with HIV and mothers without HIV by age. They also assessed survival rates of the infants born to women with unknown and negative status. All women and the infants born to them during the period of interest were followed until the age of five.

Three hundred of 12,052 women who gave birth between 2000 and the end of 2006 initiated ART within five years after delivery.

The incidence of death by five years of age in children of untreated mothers was 9%, compared to 5.7% in children of mothers who received antiretroviral therapy, and – after adjustment for other risk factors – antiretroviral therapy was found to reduce the risk of child death by 75%.

Other studies on the impact of HIV spending on wider health system outcomes were less clear-cut in their findings.

Research in Rwanda, comparing 26 pairs of health centres, one providing HIV care and the other not, found that although centres providing HIV care showed a trend towards better outcomes with regard to a range of indicators including child immunisation, adult and child hospitalisation and curative visits to the health centre, the only indicator on which HIV clinics did significantly better was providing BCG vaccinations to all patients.

In Zambia, another study of health facilities found a significant relationship between the number of people receiving antiretrovirals and an increase in utilisation of family planning services by non-HIV patients (r=0.83, Spearman rank correlation test), between voluntary counselling and testing uptake and family planning service usage (r=0.30), and between uptake of PMTCT services and uptake of antenatal services (r=0.50).

However, researchers presenting study findings on the effects of HIV spending on other health system outcomes agreed that more research was needed, looking in particular at a wider range of settings and services, and taking into account the effects of other recent global health initiatives, notably GAVI, which has been supporting the purchase of vaccines for child immunisation.

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More than 2, 000 Kids Abandoned Annually. 1/7/10

More than 2000 children are abandoned annually in South Africa because of Aids, poverty, drug abuse and teenage pregnancies, Child Welfare South Africa revealed.


By Olebogen  Molatlhwa
1 July 2010

Most of the children are under the age of 10, as it is reportedly “easier” to abandon them in public areas such as parks and hospitals, while older children are left with relatives before the biological parents disappear.

Child Welfare South Africa has also revealed that mothers, particularly economic migrants and asylum seekers from neighbouring countries, were abandoning their children in big numbers at hospitals after birth.

It was also proving difficult to identify and find the mothers because they give false names.

The mothers soon return to their native countries without their babies, with the knowledge that the children will be safe and cared for.

Megan Briede, acting Gauteng coordinator of Child Welfare SA, told Sowetan that between 2000 and 2300 cases of child abandonment and neglect had been recorded over the last three years, an increase of between 8percent and 10percent year on year.

“The problem (of abandoned children) is not levelling off but showing a steady increase,” Briede said.

“Child Welfare SA has recorded approximately 2392 new cases of abandonment (in the past year), with the majority (60percent to 75percent) being African.”

Current statistics put the figures of abandoned children at:

-African: 1500
-Coloured: 700
-Indian: 70 to 80
-White: 30


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Why Family Is Best For Orphans. 30/9/09


NAIROBI, 30 September 2009 (IRIN) - Africa's orphans will experience a richer, more wholesome childhood if they are raised within a family rather than in a childcare institution, according to speakers at a conference on family-based care for children in Nairobi.

"We need to heed the cry of a child's heart for an adult who will care for them and be crazy about them," said Monica Woodhouse, who runs the South African NGO, Give a Child a Family.

According to the UN, there are more than 34 million orphans in sub-Saharan Africa today, 11 million of whom lost parents to the AIDS pandemic.

Traditionally, orphans in Africa are raised by the extended family, and while many families continue to take in orphaned relatives, conventional family structures are buckling under the pressure of caring for additional children; a 2006 study in Korogocho, a Nairobi slum, found that more than half the 436 people surveyed were caring for at least one child orphaned through HIV/AIDS.

Too poor to cope, many families now reject these children, leading to a proliferation of institutional childcare facilities across the continent; in Uganda, for example, government statistics show that the number of children in orphanages nearly doubled between 1998 and 2001.

Separation is hard

"There are plenty of studies which show that raising children in institutions as opposed to families affects their cognitive, social, emotional and even intellectual development," Philista Onyango, regional director of the African Network for the Prevention and Protection against Child Abuse and Neglect (ANPPCAN), told IRIN.

"In Africa, people are not trained to work with these children and often don't know what they are doing, so orphaned children in institutions can wind up being physically or sexually abused," she added. "Many are not even registered and those that are, are not properly regulated."

According to the National Council for Children Services in Kenya, there are 417 charitable children's institutions registered, while another 800 are estimated to be operating unregistered.

"Separation from the family is harmful to children; it doesn't matter if I have grey hair on my head, my mother is still my mother, my family is still my family - children need that sense of belonging," said George Nyakora, regional training director for the SOS Children's Villages, which places children who cannot be connected to their biological families in family environments.

Cost issues

Speakers also said the cost of supporting families to raise orphans was significantly lower than keeping a child in an orphanage; a study from South Africa showed the cost of residential care can be as much as six times that of providing care to children living in poor families.

"All the money donors are pouring into institutions should instead be invested in enabling families to raise these children," Onyango said.

Even HIV-positive children on life-prolonging anti-retroviral medication do better growing up with family, according to Protus Lumiti, chief manager of the Nyumbani Children's Home in Nairobi.

"We run a home with about 110 HIV-positive children, but even we realise this is a last resort," he told IRIN. "We have another facility in Nairobi caring for 3,500 children who are based with their families but come to a centre for drugs and nutritional support - community-based care has worked very well in our experience."

"There are some extreme situations, for instance, where a child's disability is so difficult that it can only be properly managed by professionals in an institution, but there is certainly no need for as many childcare centres as we are seeing on the continent," ANPPCAN's Onyango added.

Protection factors

However, steps - including legislation, screening of families, training of child welfare professionals and setting up monitoring and evaluation mechanisms - are necessary to ensure children are successfully placed with relatives.

"We tend to focus on the moral issue of homeless, orphaned children, but we need to look at the economics of it, and to create minimum standards that families must meet in order to care for children," said Nyakora.

Onyango noted that it was not unheard of for children to be abused within their own families, so mechanisms needed to be in place to ensure families were assessed for suitability and monitored to ensure they were giving children the best possible upbringing.

"Sometimes the relatives are only interested in the deceased's property, and not the child's welfare, when they offer to take in orphans," she said. "Setting up child welfare committees at the community level who can monitor a child's progress would be an excellent idea.

"The people left to care for the children - often their grandparents - also need support beyond ensuring the children are fed, clothed and educated," Onyango said. "They need community support in parenting these children, and structures that will ensure the young children will not wind up looking after their old grandparents instead of living a child's life."

"As long as they have the financial capacity and social support to raise children, a family is the best place for a child," Nyakora said.



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SA ‘Getting Better’ at Protecting its Children from HIV. 27/08/09

CAPE TOWN — SA is making tentative headway in its efforts to protect children from HIV, but much more needs to be done to save lives,a new scorecard from the Catch network shows. The network is an alliance of organisations that work with children and HIV.
“When it comes to children and HIV, we are making some progress, but it is insufficient,” Mark Heywood, deputy chairman of the South African National AIDS Council, said yesterday. “No one can assume that because (former health minister) Manto (Tshabalala-Msimang) and (former president Thabo) Mbeki are gone, we are doing well, because we are not,” he said.
The scorecard measures progress towards the government’s targets for preventing infections and caring for children affected by HIV, which are detailed in its HIV/AIDS National Strategic Plan. It shows SA is on track to meet its 2011 treatment targets for women and children, as well as those for preventing infection among teenage girls and providing drugs to HIV-positive pregnant women to reduce the likelihood of transmitting the virus to their babies. For example, the plan says 93% of teenage girls visiting antenatal clinics in 2011 should be HIV-negative; in 2007 (the most recent year for which data were available) 87% of adolescents tested were HIV- negative, up from 84% in 2005.
The director of the Children’s Rights Centre, Cati Vawda, questioned whether these targets were sufficiently bold, warning that progress towards the goals was no cause for complacency. The figures masked the difficulties still facing many children, she said.
The scorecard also shows SA is below target regarding the number of children under the age of one who are getting the child support grant, and that there are too few social workers to provide the services promised by the Children’s Act. Last year , 38% of children under the age of one were getting the grant, but about 60% of children “would probably have qualified”, says the publication.
Vawda said monitoring SA’s efforts to deal with children and HIV was hamstrung by patchy data. It had proved impossible to determine what proportionof babies born to HIV-positive mothers were free of the virus at three months, and how many children who had been raped were able to get antiretroviral medicines to reduce their risk of getting HIV.
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A Need to Redefine "Orphan". 03/04/09

DURBAN, 3 April (PLUSNEWS) - In the popular imagination, the face of the AIDS epidemic in southern Africa is often an orphan who has lost both parents to the virus and is now fending for him or herself in a household made up solely of other children.

Child-headed households certainly exist in South Africa, but the commonly held wisdom, reinforced by the media, that extended families cannot absorb any more orphans, and the number of child-headed households has been rising steeply in recent years due to the HIV/AIDS epidemic, has never been backed up by solid data.

New research by the Children's Institute of the University of Cape Town has found that the popular perception of both "AIDS orphans" and child-headed households has little basis in reality.

"We need to redefine the word 'orphan'," said Katharine Hall of the Institute, presenting the research at the 4th South African AIDS Conference in Durban on Thursday.

The Institute estimates that AIDS orphans actually only account for 37 percent of the total 18.2 million orphans in South Africa, and that 80 percent of those have a surviving parent.

By analyzing data from 22 national household and labour surveys between 2000 and 2006, Hall and her colleagues found that the proportion of child-headed households in South Africa had not increased in that period, and had remained below one percent.

Orphans who had lost both parents only accounted for 8 percent of child-headed households, and most such households were located in three largely rural provinces: Limpopo, KwaZulu-Natal and Eastern Cape. No child-headed households were recorded in the more urban provinces, such as Gauteng.

Hall argued that the focus on HIV as the main cause of child-headed households has masked other social realities, such as the need for many parents in rural areas to migrate to cities to find work, and had skewed the interventions set up to address the problem.

"The existence of living parents in the majority of cases suggest it's inappropriate to conceive of these households as permanent arrangements requiring intervention or dissolution," she said.

Government support

While it is widely recognized that the most effective interventions for orphaned or abandoned children are those that support family members to care for them, bureaucratic requirements for accessing such support have tended to hinder rather than help this process.

Sonja Giese presented findings from research she conducted on behalf of the Alliance for Children's Entitlement to Social Security (ACESS) into obstacles to obtaining birth registration documents for children. Without them, caregivers are unable to access social grants and other forms of government assistance.

Registering a child's birth requires the presence of the mother, who must present her own identification document. There are no alternatives for children living with other caregivers.

© IRIN. All rights reserved. HIV/AIDS news and analysis: http://www.plusnews.org/


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Millions of Orphans, Vulnerable Children. 26/03/09

New estimates of the orphans and vulnerable children (OVC) in sub-Saharan Africa paint a stark picture of the heavy burden borne by Africa's youngest citizens. The scope of the problem is enormous, with more than 6 million OVC in Tanzania and Uganda, more than 3 million in Cameroon, Kenya and Zimbabwe, slightly less than 3 million in Cote d'Ivoire and Malawi, and a half million in Lesotho, according to a new study.   

In addition to measuring the scope of this crisis, Orphans and Vulnerable Children in High HIV-Prevalence Countries in Sub-Saharan Africa looks closely at the well-being of this vulnerable population.

Compared to children living with both parents, OVC suffer specific disadvantages. They are less likely to attend school than non-OVC when they become adolescents, perhaps because they cannot afford school fees, they need to help with housework, or they must care for sick parents or younger siblings. However, in an encouraging find, they are as or more likely than non-OVC to attend school between the ages of 5 and 14.  

For the first time, this study examines some specific challenges confronting orphans and vulnerable adolescents. Adolescent OVC, especially girls, are less likely to refrain from sexual activity than non-OVC adolescents. Nonetheless, OVC are not necessarily more prone to other risky sexual behaviors or to sexual exploitation.   

The study also finds that orphans are less likely than non-orphans to sleep under a mosquito net, a major method of preventing malaria. 

Few families affected by HIV make plans for the future care and upbringing of their children, according to the study. Not only is such succession planning lacking, but there is also little support for families struggling to care for orphans and vulnerable children.

The study also looked at whether or not children's basic materials needs are met, that is, they have at least one pair of shoes, two sets of clothes, and a blanket or sheet. In two countries with available data, Cote d'Ivoire and Zimbabwe, similar proportions of OVC and non-OVC have their basic material needs met. However, in households with both orphans and non-orphans, orphans are somewhat less likely to have basic material needs met than non-orphans in both countries. 

These findings show pressing needs to strengthen welfare programs for struggling households in sub-Saharan Africa, especially with regards to education, malaria prevention, and adolescent sexual health for OVC.

The data come from eight nationally-representative Demographic and Health Surveys (DHS) and AIDS Indicator Surveys (AIS) conducted between 2003 and 2006 that included HIV testing of adult women and men. Orphans include children who have lost a mother or a father or both parents. The study used a broad, all-encompassing definition of vulnerable children, including children who are fostered, living in a household with a chronically-ill adult or a recent adult death, living in a household with one or more HIV-infected adults, living in a household with no adults, or living in a household with other orphans. The analysis excludes street children and children living in institutions, but this exclusion is unlikely to alter the study's findings due to the small proportions of such children in the total population.

To download a free copy of Orphans and Vulnerable Children in High HIV-Prevalence Countries in Sub-Saharan Africa by Vinod Mishra and Simona Bignami-Van Assche, go to http://www.measuredhs.com/pubs/pub_details.cfm?id=838&srchTp=home

For additional information about the study or MEASURE DHS, please contact Erica Nybro at press@measuredhs.com or 301-572-0425

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Report Exposes Myths that Fuel Epidemic. 08/03/09

By Michelle A. Vu:  Christian Post: Feb. 27 2009

A recent report on HIV/AIDS found that the global response to the epidemic is based on significant misconceptions that have resulted in policies that fail to meet the needs of millions of children and their families.

One of the biggest misconceptions is that only orphans need support and services, the report by the Joint Learning Initiative on Children and HIV/AIDS (JLICA) spotlighted in its first chapter.

The “powerful myth” has led to the belief that the majority of children who lost a parent to AIDS lack family and social networks and need to be cared for in orphanages.

JLICA's research indicates that 88 percent of children designated as orphans in reality have a surviving parent. The report calls on the United Nations to change its definition of an orphan, who are currently defined as “a child who has lost one or both parents,” because most AIDS orphans are still supported by immediate or extended family.

"The overwhelming majority of children who have lost a parent to AIDS can and should remain in the care of their families, provided that those families receive appropriate support," JLICA said in its report.

Instead of placing AIDS orphans in orphanages, the report recommends that African families be strengthened and seen as “the foundation of any long-term response to children affected by AIDS.”

Governments should provide support and services to the families so they can care for HIV/AIDS children in such areas as health care, education and social welfare.

Also, the support should not only be restricted to children who have lost parents, but to all children who are vulnerable.

“We recognize it is critically important to provide assistance to the family as well as the child in order to help stabilize the child's home environment,” commented Amy Metzger, senior health specialist and director of Compassion International’s AIDS Initiative, to The Christian Post.

“Therefore, Compassion's AIDS Initiative not only provides treatment and care for children in Compassion's program that are found to be HIV positive and/or have AIDS, but Compassion also provides care to our beneficiaries' nuclear family - his or her siblings and/or caregivers,” she said.

The report also argues that prevention campaigns that focus on behavioral change overlooks the “harsh realities” that many children and young people live in. It calls on governments to put money into efforts to increase girls’ physical safety in public places such as school, work, public transportation, and recreational sites.

Governments should also help girls stay in school and improve their economic status, the report recommends.

There are an estimated 2 million children living with HIV as of 2007. Meanwhile, some 12 million children in sub-Saharan Africa are estimated to have lost one or both parents to AIDS, representing about 37 percent of parental loss from all causes, according to UNAIDS.

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AIDS Response Fails Children. 11/02/09

By Joe DeCapua Washington D.C 11 February 2009

A new report says the global response to HIV/AIDS has failed to meet the needs of millions of children and their families. It recommends new approaches to simultaneously address HIV/AIDS, poverty, food insecurity and social inequity.

The report is called Home Truths: Facing the Facts on Children, AIDS and Poverty. It's a two-year study done by an independent alliance of researchers, policymakers, activists and others called the Joint Learning Initiative on Children and HIV/AIDS.

A co-chair of the alliance is Jim Yong Kim, director of the FXB Centre for Health and Human Rights at Harvard University.  "This is a global report. But we focused primarily on the countries of sub-Saharan Africa that are confronting a severe AIDS epidemic," he says.

The report finds that families provide the best care for children. Yet despite bearing up to 90 percent of the cost, they receive little or no financial assistance from governments.

It also finds that extreme poverty is a barrier to the increase of AIDS services. And while HIV infection rates are often highest among women and girls, not enough is being done to address the social conditions and norms that make them more vulnerable.

Kim says that while AIDS treatment and prevention have "revolutionized" the approach to health care in developing countries, a new direction is still needed.    "The re-direction of the AIDS response to serve families and communities, especially in those communities that are hardest hit, can be the motive for strengthening health services and social protection for the poorest and most vulnerable, especially the children and their families," he says.

The two-year study looked closely at HIV infection rates among children.

"So, what did we find when we looked at how children are faring in this epidemic? Statistics show that, one, over 90 percent of the more than two million children living with HIV are infected before or during birth. Yet, only one in three pregnant women with HIV in low and middle-income countries gets the treatment they need to help prevent infection of their babies. And still, only a very small proportion of children living with HIV receive the life-saving anti-retroviral treatments," he says.

What's more, fewer than 10 percent of children born to HIV-positive women are tested for the AIDS virus before they're two months old.

The report also finds that most children labelled AIDS orphans in sub-Saharan Africa actually have a surviving parent or other family member willing to care for them. But those potential caregivers often lack the basic resources to give the children what they need.  Kim says, "Resources, though, are currently not reaching the families that need them. And in the most severely affected region families and communities pay 90 percent of the financial cost of caring for children affected by the epidemic with little or no assistance from government."
Extreme poverty is blamed for blocking their access to AIDS-related programs, with over 60 percent of children in sub-Saharan Africa living in poverty.

Kim says, "In countries in which HIV is endemic, the disease impoverishes entire communities. When we make relief too narrowly AIDS specific, we miss a large portion of children impoverished by the epidemic. In fact, only providing benefits for people living with HIV or with family members, who are living with or die from HIV, is probably counterproductive. It can create stigmatization and abuse for those in need of help."
Kim says family care is always preferable to institutional care, such as orphanages.

The Joint Learning Initiative on Children and HIV/AIDS recommends greater financial support for children and their families; a greater focus on children's needs, not their HIV status; ensuring the physical safety of girls and women at school, on public transport and places of recreation; and addressing behavior and attitudes that encourage sexual abuse.

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HIV and Children's Education. 17/6/08

By Miriam Mannak

CAPE TOWN, Jun 12 - Children who live in communities with an HIV prevalence rate of 10 percent or more have half a year of schooling less than children in other communities.

In this way the negative consequences of HIV/AIDS are felt beyond the families that are directly affected.

These facts were presented at a World Bank conference in South Africa by Robert Greener, senior economic adviser at the Joint United Nations Programme on HIV/AIDS (UNAIDS).

Greener was speaking at the Annual Bank Conference on Development Economics (ABCDE), which ended in Cape Town yesterday (Jun 11). The theme for this year was ‘‘People, Politics, and Globalisation’’. The conference was co-hosted by the South African government’s treasury department.

Greener also said that children who lose one or both parents to HIV/AIDS are less likely to remain in school and complete their education than other children. In the long run, this will have negative effects on African economies.

HIV/AIDS hampers ‘‘knowledge and skills transmission from one generation to the next which, over time, results in the loss of human capital. This also has an impact on economic growth. Economies need educated and skilled people’’, Greener told the conference.

The conference also heard that the prospect of a child remaining in and eventually completing school is much more likely in female-headed households.

‘‘In African households, it is usually the father who decides whether a child goes to school or not. However, it is the mother who decides how long the child will enjoy an education," explained Natalia Trofimenko of the Kiel Institute for World Economy, a research institution attached to the University of Kiel in Germany.

‘‘According to our statistics, children growing up in female-headed households are more likely to stay in and finish school compared to their counterparts who live in male-headed households.’’

For Trofimenko the education of women and girls is not only important for improving their life opportunities as individuals. ‘‘When you educate a girl, you increase the chances of her future children to attend and complete school,’’ she said.

Apart from the good news about female-headed households, HIV/AIDS has a worse effect on girls’ than on boys’ education. Aparnaa Somanathan, a World Bank health economist at the World Bank, explained the gendered effect of HIV/AIDS on families.

It is usually the older female sibling that is pulled out of school, especially after the death of the mother. ‘‘Younger siblings, especially boys, will remain in school,’’ according to Somanathan.

Samwel Otieno of Kenya’s agriculture ministry indicated that girls are also more likely to be married off early, which means the end of their school education.

Generally, children who have lost one or both parents as a result of HIV/AIDS are more likely to drop out of or be taken out of school. ‘‘Children that have lost their parents to HIV/AIDS have on average one year less of education then non-orphans,’’ Trofimenko said.

This happens because they either drop out due to the emotional and psychological stress or because they are needed at home.

According to Trofimenko, older children have a greater chance of quitting when one of the parents dies or gets sick. ‘‘Due to their age, these children are more likely to become the designated person to take over the tasks of the missing or sick parent.’’

Another factor causing AIDS orphans to leave school prematurely can be found in the financial constraints that HIV/AIDS causes. ‘‘Due to high medical bills and the costs of funerals the remaining parent is less likely to keep the children in school -- simply because he or she cannot afford it,’’ Trofimenko explained.

Children that have lost both parents to HIV/AIDS and are absorbed in extended families also have a smaller chance of finishing school. ‘‘Foster parents might have a different idea about the necessity of education then the child’s birth parents,’’ argued Trofimenko.

The foster family’s financial situation also plays a big role in whether or not the foster child is kept in school.

Taking these and other factors into consideration, it is crucial to provide HIV-positive adults with anti-retrovirals (ARVs), says Trofimenko. ARVs are medication that is used to prolong the lives of HIV-positive people.

‘‘Postponing the death of parents is crucial,’’ she says. ‘‘When extending the life of the parents, you not only improve the child’s overall quality of life but you also increase his or her chance to complete school. This has a positive impact on a child’s life later on.’’

According to figures by the United Nations, the worldwide number of children who lost their parents to HIV/AIDS has increased from 8.5 million in 2000 to 14 million in 2006. About 80 percent of them live in Africa. These figures exclude the millions of children whose parents are terminally ill due to AIDS-related causes.


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OVC Resources

Tools and resources for dealing with orphans and vulnerable children and youth.

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Child Status Index

Published at OVC Wellbeing
Date and author unknown


The Child Status Index (CSI) provides a framework for identifying the needs of children, creating individualized goal-directed service plans for use in monitoring the well-being of children and households, and program-level monitoring and planning at the local level. As of 2013, the CSI has been used in 17 countries in sub-Saharan Africa, Asia, and Latin America. It has been translated for use in a variety of geographical, linguistic, and cultural contexts.

The last several years of CSI implementation have enabled MEASURE Evaluation and others to learn about how the CSI fits into the overall package of information gathering tools and when, and in which circumstances, the tool is best used. The CSI was developed which describes its primary use as a case management tool and lessons learned about best usage.

All information needed to use the Child Status Index in an organization or agency is available in the CSI Tool Kit. The Tool Kit consists of the Child Status Index Manual,  the CSI Training Manual, a chart displaying the CSI domains, the CSI record form, a pictorial version of the CSI for low-literacy users, and a quick-reference CSI Made Easy Guide for field users of the tool.

Child Status Index Documents

The Child Status Index (CSI)

Provides a framework for identifying the needs of children, creating individualized goal-directed service plans for use in monitoring the well-being of children and households, and program-level monitoring and planning at the local level.

The Child Status Index (CSI) – Training Manual

This manual provides guidance for community care workers and other wardens of orphans and other vulnerable children who intend to use the Child Status Index tool. It provides:

  • an overview of the Child Status Index, its purpose, development, and application;
  • an overview of the recommended approach for training care workers in the use of this tool;
  • Instructions for workshop facilitators on how to offer the most effective and engaging training workshops; and
  • supplemental materials, such as class handouts, frequently asked questions, and a workshop evaluation form.

Child Status Index (CSI) Domains

Chart displaying the CSI domains, the goal for each domain, two factors of each domain, and descriptions of the four levels of well-being for each factor.

Child Status Index (CSI) Record Form

Used to record background information and findings from the child assessment visit.

Child Status Index (CSI) Pictorial Version

Presents the CSI domains, factors, and levels of well-being as pictures.

Child Status Index (CSI) Made Easy

Contains both a pictorial and written form of the CSI and provides basic instructions for how to complete the CSI.

Clarification Regarding Usage of the Child Status Index (CSI)

The Child Status Index (CSI) is a widely used information collection tool among programs for children who are orphaned or made vulnerable by HIV/AIDS. The last several years of CSI implementation have enabled MEASURE Evaluation and others to learn about how the CSI fits into the overall package of M&E tools and when, and in which, circumstances the tool is best used. This document briefly describes the tool, its purposes, and the lessons learned about best usages. 

FAQs re: the Child Status Index (CSI)

Overview of Child Status Index Studies

Provides an overview of two CSI assessments.

Editor’s Note: The information contained on this webpage was reproduced with permission with the MEASURE Evaluation website. For more information about the CSI and MEASURE Evaluation other projects, please click here.

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Prevent and protect: Linking the HIV and child protection response to keep children safe, healthy & resilient. 23/04/2015

PDF icon CP HIV Report FINAL secure.pdf645.11 KB

Subtitle: Promising practices: Building on experience from Nigeria, Zambia and Zimbabwe

Written by World Vision and Unicef

PDF size: 646 KB

Executive Summary

The potential to achieve an AIDS-free generation depends on protecting children from abuse, violence, exploitation and neglect. The reverse is also true: preventing HIV will help protect children from these violations. A review of evidence, commissioned by the Inter-Agency Task Team on Children Affected by HIV and AIDS in 2013,3 concluded that ‘it is the
responsibility of every child protection actor to ensure that no child be needlessly exposed to the risk of acquiring HIV and that no child living with HIV is denied his or her right to HIV testing, treatment, care and the support necessary to live a healthy, independent life. It is the responsibility of every person working on HIV prevention, care and support for children
to prevent abuse, neglect, violence and exploitation and to support child survivors of these protection violations.’4
This report seeks to provide lessons about why making such synergies is important – what difference it makes for children and their families – and how this is being implemented in practice within three African countries. This report builds on the reflections and experiences collected from practitioners and policymakers at country level in order to provide practical
recommendations on how to engage more effectively across the HIV and AIDS, health and child protection sectors.
The consultants undertook this study by first developing guiding questions to assess promising practices, reviewing key evidence that has emerged since February 2013, and then liaising with three countries selected by UNICEF. The consultants then conducted a brief field visit to each country, which included meetings with national stakeholders and visits to selected
projects and services that highlight promising practices. The three countries highlighted in this report are Nigeria, Zambia and Zimbabwe. As the in-country work proceeded, it was obvious that programmes were coming to the realisation of the need to integrate responses but had not explicitly reflected on the process of doing so. Therefore, country visits involved
documentation but also served as an interactive reflection between policymakers and practitioners and the global study team in order to build upon the interest and engagement of national stakeholders.

Key findings

Evidence published since February 2013 provides additional weight to the existing evidence that was highlighted in the original 2013 study. At policy level the children and AIDS community has started to focus on the need to identify and support protection, care and support interventions that contribute primarily to HIV prevention, treatment and mitigation
results. Focusing on these interventions to deliver HIV outcomes remains a challenge, and the report findings reinforce the fact that HIV outcomes cannot be achieved without addressing child protection violations and other social and economic factors that increase HIV vulnerability and risk. The absence of clear reflection of this necessary linkage in HIV and in
child protection guidelines is a significant challenge addressed in this report.

The major lessons learnt from emerging models are as follows:

  1. A comprehensive policy framework to address HIV and child protection outcomes should stimulate multi-sectoral collaboration. Such a framework holds all actors accountable and enables different sectors to report within one framework and work towards mutually supportive objectives.
  2. The interventions that have intentionally brought together service providers and HIV affected communities, especially children and young people living with HIV, have led to positive results.
  3. Case management and referral mechanisms are the ‘glue’ that binds populations affected by HIV and services, including child protection.
  4. Programmes working with children and young people, especially with the adolescent age group, are seeing that understanding and addressing child protection concerns lead to subsequent improvement in HIV treatment outcomes.
  5. Engaging children and young people living with HIV in all phases of programming provides critical understanding and empowerment that can reduce stigma and discrimination, which improve both child protection and HIV outcomes. HIV-related stigma and discrimination are central to HIV-affected children’s experience of abuse, violence, exploitation and neglect, and addressing stigma and discrimination must be a key component of any HIV programme targeting children.
  6. Programmes should invest in improving communication between children and their caregivers from an early age in order to achieve HIV-related outcomes as children enter adolescence.

Key entry points

The 2013 study identified potential entry points where combined HIV and child protection intervention can offer a more preventative, sustained and integrated response:

  1. Ensure that HIV and child protection are explicitly linked in one national policy, for example, using the development of the next national policy framework for children (e.g. the National Children’s Plan, OVC or MVC Plan, Vulnerable Children’s Strategy or Priority Agenda for Children, National AIDS Strategy) as a means to understand the interlinked economic, HIV and child protection vulnerabilities faced by children and families.
  2. Include a focus on understanding and addressing HIV-related stigma and discrimination, as children and adolescents experience them, within HIV and child protection guidelines, standards and operating procedures.
  3. Ensure that children, adolescents and young people, especially those living with HIV, are thoughtfully included throughout the various programming phases.
  4. Involve child protection experts in national and subnational working groups on HIV prevention, treatment, care and support, as well as in OVC (orphans and vulnerable children) or impact-mitigation groups, which could lead to improved HIV prevention and treatment outcomes that have been negatively affected in the past by child abuse,
    violence, exploitation and neglect.
  5. Invest in a strong case management system that links HIV, health care, economic strengthening/social protection and child protection to improve paediatric HIV testing and treatment outcomes and support HIV-affected children and families who are at risk of harm.
  6. Use the development of alternative care or family strengthening strategies and programmes as an opportunity to recognise, and respond to, neglect and abuse of children living with HIV in all forms of family and other alternative care, and to provide access for children living with HIV to appropriate testing, treatment and care.
  7. Include one or more specific indicators on HIV and child protection synergies in national social workforce strengthening strategies.
  8. Build on the global attention to violence against children and gender-based violence to link specialised services on sexuality or sexual abuse and violence with child protection case management and HIV prevention and treatment programmes.
  9. Use the adoption of new PMTCT (prevention of mother-to-child transmission) and paediatric HIV treatment guidelines as an opportunity to include priority child protection information and referral protocols in staff job descriptions and standard operating procedures.
  10. Include positive parenting to encourage communication and disclosure strategies between parents/caregivers and children and adolescents.

The report concludes that practical linkages are still emerging, many of them intuitively, within programmes. Policymakers must generate opportunities strategically and purposefully to establish linkages within policies and strategies. Globally, HIV and child protection actors must build on the evidence available to support the development of more integrated policies,
strategies and guidelines.

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Project Hope’s Parenting Map

Published at OVC Wellbeing.org
Date and author unknown


Project Hope’s Parenting Map innovative concepts and tools such as the Parenting Map, a low-literacy data collection tool intended to provide caregivers with a quick but comprehensive snapshot of each child’s “well-being” in the household. 

Parenting Map Resource Tools

Parenting Map Tool

Training Guide

Score Card

Action Plan

Practice Exercises

Answer Key to Practice Exercises

Ice Breaker

Sample Analysis

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Catholic Relief Services OVC Wellbeing Tool

Published at OVC Wellbeing.org
Date and author unknown


A goal of programs to help orphans and vulnerable children (OVC) is to improve wellbeing. Yet measuring wellbeing has proven to be an elusive concept for many engaged in OVC programming. Catholic Relief Services (CRS) places an agency priority on OVC programming and has aimed to find a way to measure the wellbeing of OVC in a holistic manner. Using a scientific process, CRS developed an OVC Wellbeing Tool (OWT) for use as a self-report measure for OVC aged 13-18. The tool was created by Shannon Senefeld, Susan Strasser and James Campbell, with significant input from Dorothy Brewster-Lee, Kristin Weinhauer, Ruth Kornfield, Linda Lovick, Ana Maria Ferraz, and Rolando Figueroa. For a more complete list, see the Acknowledgments page. The tool was piloted in Haiti, Kenya, Rwanda, Tanzania and Zambia. Data has now been collected on thousands of OVC using the CRS OWT. Advanced statistical analyses suggest that this is a valid and reliable tool for measuring wellbeing among OVC. This resource contains everything you need to use the OWT.

See more at: http://www.crsprogramquality.org/ovcwt/#sthash.qK0Z3Rem.dpuf

CRS Documents

OVC Wellbeing Tool (User’s Guide 2009)Based on the data collected within this pilot, advanced statistical analyses, along with feedback from the pilot countries further served to refine the OWT. Presently, the tool is 36 questions long and takes approximately 20 minutes to administer. Scoring can be done immediately or via a computer program. Results are used to monitor OVC programs over time.

OVC Wellbeing Tool Scoring Guide:

The OWT is a relatively easy tool to score. Each of the ten domain responses are averaged according to the responses on the statements within that domain. Note that there are seven statements in the tool that need to be reverse coded for scoring before averaging the domain scores. Each domain therefore receives an average score within the range of 1 to 3. The ten domain scores are then added together to create the total wellbeing score. The final score can thus range from a low of 10 to a high of 30.

It is important to examine the overall OWT scores according to the local context. In some cases, certain settings will have an overall lower mean score on the OWT than others. This may be due to a number of different factors (recent natural disaster, larger number of double orphans, etc.). In order to fully examine whether the children in that area are improving or not, it is better to calculate the overall mean for that area and then compare the children to that mean. For example, if children in Village A had a mean OWT score of 24 with a standard deviation of 3, the program would want to look carefully at those children that fell more than one standard deviation from the calculated mean. This contextual examination of OWT scores provides the best systematic method of understanding what the data means from one setting to the next.

Scoring and InterpretationDespite possible contextual variations, it is possible to make some general statements regarding wellbeing overall and the OWT scores. Based on the pilot data from OVC in five countries, highly desirable scores are 25 or above. However, it is relatively rare to find baseline scores at this level. Instead, scores often center around 23, which are interpreted to mean that overall wellbeing is average, with room to improve wellbeing in certain domains. Based on research within the pilot, the authors recommend that special attention be paid to programs when the wellbeing nears 22 or below, as this may signify deficits within certain domains. Scores below 15 require immediate action to determine if there was an error in response or if there is a problem affecting the children that needs to be addressed. 


Scoring Syntax

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South Africa's Progress in Realising Children's Rights, 03/2014

South Africa’s 20-year anniversary of the start of democracy is a good moment to take stock of progress in realising children’s rights, and to flag challenges in need of attention. The Children’s Institute, University of Cape Town, in partnership with Save the Children South Africa, therefore conducted a review of South Africa’s laws aimed at realising children’s rights to assess whether these laws have been designed and are being implemented in compliance with international and constitutional law.

Rights examined include children’s rights to birth registration; basic nutrition; social assistance; basic education; special protection when in conflict with the law; protection from violence; and appropriate alternative care when removed from the family environment. Each chapter identifies the main design flaws and implementation challenges that are blocking progress and makes recommendations for reform.

Download the publication.

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A Guide to the Children’s Act for Health Professionals. 1/6/10

Published June 2010 by the Children's Institute

Fourth Edition

Written by Prinslean Mahery, Paula Proudlock and Lucy Jamieson

Guide focuses on the sections of the Act that need to be applied by health professionals. This is a very useful tool for health professionals who work with children as well as for those who work with health professionals.
-Status of the Act
-Laws repealed
-Why did South Africa need to reform the law on consent to health treatment for children?
-Sections in the Act

Download this resource here (PDF, 271.8 KB, 36pg)

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Child Care Workers Casework Management Manual

This manual was produced by Gail Taylor, Technical Advisor to OneLife Project, EveryChild Guyana .
Help & Shelter is pleased to make it available for wide distribution. Credit must be given to the One Life Project and Everychild Guyana/Child Link when the content is used.
September 2009
About the manual
This manual is aimed at a range of individuals who work with vulnerable children in a number of different contexts and organizational settings. Wherever possible, it tries to provide generic information that will be useful across a number of different contexts and roles.
However, this manual is intended as a working document, not as a finished publication. It is organized in such a way that you can add materials which are relevant and specific to your own particular job and to the agency that you work in. You are encouraged to seek out information and documentation from within your own organization and to insert alongside the examples already provided. In that way it will become a valuable reference document for yourself and for others working in your organization.
Some of the material and examples of, for instance, job descriptions, referral procedures, risk assessment procedures, professional values and boundaries, are taken from a Handbook of Good Practice that was developed in 2009 for and with staff from the Childcare and Protection Agency (CPA) of the Ministry of Labour and Human and Social Services.

Download manual here (Zip file, 4.65 MB)

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Say and Play: A Tool for Young Children and Those Who Care for Them. (Published 2009, Added 2012,)

Tool for young orphans and vulnerable children and those who care for them.

Author: Dr Jonathan Brakarsh
Publication Date: January 1, 2009

Published by Project Concern International in Zambia, this interactive tool is designed for orphans and vulnerable children from three to six years old and those who care for them. This includes parents, caregivers, early child development teachers, home-based care teams and all those who take an interest in the welfare of young children. It uses pictures, stories and games to help children talk about their lives and, through these activities, it guides adults to identify and support the emotional and social needs of children. According to the publishers, the activities and pictures in the book prompt community action groups to discuss the challenges facing young children in their communities, allowing them to devise simple, practical strategies to better protect and guide their young children.

This book contains the following topics:

    Topic 1: What do children need to grow?
    Topic 2: Helping young children with their problems
    Topic 3: Children on their own
    Topic 4: When the caregiver is sick
    Topic 5: Talking to children about death
    Topic 6: Our hopes
    Topic 7: Caring for children

Download PDF: Say and Play: A Tool for Young Children and Those Who Care for Them
Publisher: Project Concern International in Zambia
Cost: Free to download
Languages: English
Number of Pages: 52
Contact Information:
Project Concern International in Zambia

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Yekokeb Berhan Child Support Index 09/2012

Published at OVC Wellbeing
Written by Yekokeb Berhan Program/Pact for Highly Vulnerable Children
September 2012


Ethiopia’s Yekokeb Berhan Program for Highly Vulnerable Children is a five-year program funded by the United States Agency for International Development (USAID) that is designed to improve child-wellbeing by ensuring that highly vulnerable children and their families can increase their knowledge, skills, self-reliance and access to appropriate, quality-driven services that will, in turn, lead to healthier, more productive and more fulfilling lives.

The program is implemented by Pact, in partnership with UNICEF, Child Fund, FHI360, 40 local implementing partners and the government of Ethiopia (primarily the Ministry of Women, Children and Youth Affairs) in all nine regional states and two city administrations.  Trained, incentivized volunteers individually assess over 500,000 children annually through application of the program’s Child Support Index. Care plans and interventions follow, all of which are monitored for quality-assurance and documented on the program’s national database.

The Child Support Index in Ethiopia builds on the original Child Status Index and several other adaptations.  It is designed to:

  1. Screen for program eligibility (based on the number of unmet needs) after it is determined that the child meets at least one category of vulnerability, as determined by the Government of Ethiopia’s Standard Service Delivery Guidelines for programs serving orphans and vulnerable children.
  2. Understand and measure the assets and needs of each child and caregiver who is enrolled in the program.
  3. Function as a care-plan for recommended interventions, based on the assessed needs of each child and caregiver.
  4. Determine priority for care for emergency-action when it is determined that a child is severely malnourished, has (possibly been) abused, and/or is HIV+ but not receiving treatment.
  5. Determine whether an enrolled child is eligible for transition out of the program (e.g. graduation) or soon will be.
  6. Help Implementing Partners plan and budget for the interventions needed, for example for school supplies or household repairs, based on the aggregate level of need that the CSI assessment reveals.
  7. Help Implementing Partners provide background information to partner organizations in the community, such as health centers and other NGOs, so that they can plan for the number and type of referrals that they will receive.
  8. Measure change over time.

By contrast to the original Child Status Index and other assessment tools, the Child Support Index of Yekokeb Berhan is unique in several ways:

  • It contains 7 indicators directed to the primary caregiver and 13 for each child, thus making it a truly “family” index.
  • It requests some indicators not contained on the original CSI, e.g. related to disability, HIV-testing, economic strengthening and the coordination of care
  • It is designed so that a combination of pre-selected indicators can serve as a screening tool for specific benefits, e.g. 8 indicators for a Vulnerability Assessment to determine eligibility for Economic Strengthening support; 2 indicators for a referral to the World Food Program, etc.
  • It uses culturally sensitive Ethiopian pictographs and other symbols to make it easier-to-use for low-literate volunteers

The two-page CSI score-sheet also contains a question under each indicator that asks, “Care Action Planned?” which trained volunteers fill out for all low-scores (one dot or two).  There is a separate code sheet that lists the interventions that can be recommended.  The code sheet should also be referenced when monthly reports are completed to record what interventions actually occurred since the last report was submitted.  In this way, change can be measured over time, and new planning undertaken for the future.  The website OVCtools.net contains the CSI tool, training manual and coding sheet.

For more information, contact:

lucy y. steinitz,  ph.d.  senior technical advisoryekokeb berhan program for highly vulnerable childrenpact – p.o box 13180  - addis ababa, ethiopiaphone: +251 911 88 23 17     www.pactworld.org.email: lsteinitz@pactworld.org (w)/ lucy@steinitz.net (h)


Author   Yekokeb Berhan Program/Pact for Highly Vulnerable Children


Source: U.S. Agency for International Development (USAID), Cooperative Agreement Number AID – 663 – A – 11 – 00005.

Date: September 2012

Disclaimer:  The contents are the responsibility of Pact and its Yekokeb Berhan Program for Highly Vulnerable Children (HVC) partners and do not necessarily reflect the views of USAID or the United States Government.


Author   Yekokeb Berhan Program/Pact for Highly Vulnerable Children


Source: U.S. Agency for International Development (USAID), Cooperative Agreement Number AID – 663 – A – 11 – 00005.

Date: September 2012

Disclaimer:  The contents are the responsibility of Pact and its Yekokeb Berhan Program for Highly Vulnerable Children (HVC) partners and do not necessarily reflect the views of USAID or the United States Government.


Author   Yekokeb Berhan Program/Pact for Highly Vulnerable Children


Source: U.S. Agency for International Development (USAID), Cooperative Agreement Number AID – 663 – A – 11 – 00005.

Date: September 2012

Disclaimer:  The contents are the responsibility of Pact and its Yekokeb Berhan Program for Highly Vulnerable Children (HVC) partners and do not necessarily reflect the views of USAID or the United States Government.

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The Essential Package. Brochure. 2012

The development of the Essential Package was spearheaded by CARE, Save the Children and the Consultative Group on Early Childhood Care and Development (CG)

Subtitle: "Holistically Addressing the Needs of Young Vulnerable Children and Their Caregivers Affected by HIV and AIDS"
The development of the Essential Package was spearheaded by CARE, Save the Children and the Consultative Group on Early Childhood Care and Development (CG) in conjunction with a multitude of stakeholders in both the ECD and HIV fields. The EP builds on existing evidence from ECD practice and uses this evidence to ensure that interventions respond to young children’s physical, cognitive, communication and social/emotional developmental needs. It has been adapted for contexts in which families and young children face threats to their development

-Acknowledgements-Definitions-Introduction: The issue-Why an essential package for young vulnerable children and their caregivers affected by HIV and AIDS-What is the essential package?-What are the building blocks of the essential package?-How and where should the essential package be used?
-What are the key outcomes?
-For more information

Download this brochure here (PDF, 1.44 MB, 40 pg)

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Act, Learn and Teach: Theatre, HIV and AIDS Toolkit for Youth in Africa. 2006

UNESCO, Coordinating Committee for International Voluntary Service. This new toolkit provides guidance to youth in Africa on how to use interactive theatre in HIV and AIDS education. The manual provides historical and theoretical background along with key points and tips to design and present an interactive play. A CD-ROM and posters are available. Similar toolkits have been developed for other regions in Arabic, French and Spanish. Download PDF, 5.52 MB

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Because I am a Girl: The State of the World's Girls. 2007

(Plan International). This 98-page publication summarizes issues of inequality and poverty faced by many girls and includes relevant tables and statistics. This is the first of several reports on the topic to come from this group, and it offers an eight-point action plan listing steps through which individuals, organizations, and governments can contribute to improve girls’ lives. Download (PDF, 4.08 MB)

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Building Resilience in Children Affected by HIV/AIDS.

Building Resilience in Children Affected by HIV/AIDS is a 150-page guide to psychosocial support for children. Its eight chapters are designed to help parents, caregivers and teachers understand children who are caring for a sick parent or who have lost a parent. It provides practical advice on supporting children who have experienced loss, and suggests helpful discussions and games. It was written by Sister Silke-Andrea Mallmann at St. Mary's Hospital at Mariannhill in South Africa. Large (162 pages, 5.60MB). Download
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Building Resilience: A rights-based approach to children and HIV/AIDS in Africa.

HIV and AIDS have impacted severely on Africa and its children. The infection rate has risen rapidly and the scale of prevalence is largely unabated. Moreover, the epidemic compounds existing problems that children and families face resulting from decades of exploitation, poverty, civil and regional conflict, and natural disasters. UNAIDS data indicates that Sub-Saharan Africa remains the hardest hit region in the world, with a total of 25 million people living with HIV/AIDS. Responses to the HIV and AIDS crisis should recognise root-causesof the spread and impact of HIV and AIDS, including gender inequality, as a source of vulnerability. A new report published by Save the Children Swedenexamines howa rights-based approach's underlying principles of universality, indivisibility, responsibility, and participation canprovide a firm foundation for framing priorities and responses to children and families. Download PDF (831KB)

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Champions for Children Handbook: How to Build a Caring School Community Pilot Edition. 03/08

Children's Institute & SADTU.  This handbook is a guide to mobilising schools and neighbourhoods around the well-being and needs of children to create caring school communities. It was developed through action research in four school communities in the Western Cape and the Free State. The work was done in partnership with the South African Democratic Teachers' Union, and in collaboration with other organisations, including the Caring Schools Network (CASNET). The handbook is available in hard copy or CD-ROM to communities who would like to participate in the research.  Use online handbook  here.

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Changing Children’s Lives. Experiences from Memory Work in Africa, (Healthlink). 2007

The focus is on learning and analysis in the theory and practice of memory work as well as demonstrating its effectiveness as an HIV response. Download PDF ( 32 p; 8.39 MB).

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Child Rights in Focus. The Official CI Newsletter, Issue 7. 03/08

This issue reports among others on Parliament's passing of the Children's Amendment Bill and related input from the Institute's residential care research; an assessment of readers' perceptions of the South African Child Gauge 2006; a Means to Live workshop to discuss the coherence of poverty alleviation programmes; and the launch of a training programme for health professionals on children's rights. Read also about new Children's Institute publications such as the third edition of the South African Child Gauge 2007/2008, and contributions to a number of academic publications.  Access publication online
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Children's Act - Implications for NGOs

On the 1st of September a group of PRISMA's South Afrcan partners had a workshop around the Children’s Act (Act No. 38 Of 2005) and the Children’s Amendment Act (Act No. 41 Of 2007).

The session was presented by Ms Agnes Muller, Children’s Act Manager, Department of Social Development, and Ms Ruth Mojalefa, also from the department.  They kindly shared their informative presentation

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Children's Property and Inheritance Rights, HIV and Aids, and Social Protection in Southern and Eastern Africa, FAO. 2007

The role of property rights in alleviating poverty and strengthening social protection and self-actualization (personality development) is widely acknowledged. However, property and inheritance rights for young people have always been tenuous, more so in countries where thousands of people of productive age prematurely pass away due to AIDS-related causes. There is a growing realisation that issues of children’s property rights violations should be given attention and urgency because of the impact of HIV and AIDS, which has resulted in an increase in the number of children orphaned by AIDS. Download (PDF, 1.29 MB).

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Children's Rights Centre Publications.


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Helping Children Living with HIV.

A companion book to use with the children’s book, My Living Positively Handbook. For parents, caregivers, social workers,health workers and others Download PDF (16p 1.44MB).

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My Living Positively Handbook.

"This book was made by children, families, doctors, nurses, teachers,and counsellors. Many of us are living with HIV, just like you. We hope that our pictures and words will help you learn a lot about HIV and living positively." Download PDF (42p, 4.08 MB) Also available in IsiXhosa and IsiZulu.

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You and Your Child with HIV - LIVING POSITIVELY.

A booklet for caregivers of children living with HIV and for the children themselves so that they can be partners in their own health care Download PDF ( p, 2.09 MB).

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Commitment to Practice: A Playbook for Practitioners in HIV, Youth and Sport. 2008

Mercy Corps. Within the HIV/AIDS sector, there is growing recognition that sport-for-development (SfD) approaches can achieve significant HIV prevention goals. This paper encourages practitioners to develop “plus sport” programs that have non-sport, HIV/AIDS-related outcomes as their primary objectives. xamples are provided from programs in Liberia and Southern Sudan.  Download PDF, 34 pages, (2.96 MB).

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Economic Strengthening for Vulnerable Children. Principles of Program Design and Technical Recommendations for Effective Field Interventions, USAID. 2008

The report assists practitioners in identifying best practices for economic strengthening and then designing programs that are reflective of these practices while also being adapted to the specifications of vulnerable children. Download (PDF, 2.26MB)

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Educate Girls, Fight AIDS.

The Global Coalition on Women and Aids published Educate Girls, Fight AIDS which provides perspectives on addressing AIDS through empowering and educating girls. Download (109 KB).

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Enhanced Protection for Children Affected by AIDS.

(UNICEF )2007,  A companion paper to The Framework for the Protection, Care and Support of Orphans and Vulnerable Children Living in a World with HIV and AIDS. This publication discusses the protection issues facing children affected by AIDS, outlining the actions needed to reduce their vulnerability. It calls for enhanced social protection, legal protection and justice, and alternative care, underpinned by efforts to address the silence and stigma that allow discrimination, abuse and exploitation of children to continue. Download (PDF, 1.58 MB)
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Family Life Education: A Handbook for Adults Working with Youth from a Christian Perspective. 2008

FHI/Interagency Youth Working Group. 

This handbook is designed to help adults talk to youth about sexuality, reproductive health, and HIV in the context of faith communities. It provides accurate public health information on sensitive issues in the context of faith values and does not promote religion. This handbook was adapted from a 188-page training manual that includes six day-long workshops. 

Download PDF, 41 pages, (1.52 MB).

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Helping My Child Stay Healthy: For Carers of HIV Positive Children

(Family Health International (FHI))

Helping My Child Stay Healthy gives suggestions on how to talk to children about HIV, support them on antiretroviral therapy, and provide support on general health and prevention of opportunistic infections. Finally, the book outlines ways caregivers themselves can stay healthy.Helping My Child Stay Healthy, produced by FHI/Cambodia through the PRASIT program, provides information on the special needs of HIV-positive children and suggests ways to involve them in their own care. In addition to guidance for caregivers, the book also has practical suggestions for health-facility and home-based care teams who work with children (regardless of HIV status).

Download PDF (2.45 MB; 86p)  


- Children and HIV
- Talking about HIV
- HIV transmission
- Accessing healthcare
- Health and hygiene at home
- Food and nutrition
- Antiretrovirals
- Opportunistic infections
- Managing illness
- Caring for yourself
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Home truths: The Phenomenon of Residential Care for Children in a Time of AIDS.

Meintjes H, Moses S, Berry L & Mapane R (2007) Children's Institute & Centre for the Study of AIDS, University of Pretoria.  This research report provides a description and analysis of the complex patterning of residential care for children in South Africa, as well as how it relates to national policy and law and to international child welfare policy. It provides an analysis of basic characteristics of the children resident in the range of settings identified. It examines different aspects of the residential care settings themselves, including the legal status of homes, models of care, staffing, programme provision, funding, relationships to "community", and knowledge and practice around HIV/AIDS. In highlighting the complexity of the phenomenon of residential care in practice, the report raises questions about the dominant policy discourses and the relationship between the State and the residential care sector.
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Identifying Sources of Adolescent Exclusion Due to Violence: Participatory Mapping in South Africa, Population Council. 2008

This report examines the factors that shape adolescents' lives in South Africa. Researchers studied how economic literacy and life skills education affect young men and women who are economically and socially disenfranchised and at high risk of HIV infection. Download PDF (300KB).

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Letting Girls Play: The Mathare Youth Sports Association’s Football Program for Girls. 2002

Population Council, 2002. This publication is designed to assist those developing sports programmes for young people – particularly young women. It demonstrates how sports can be a vehicle for social development and for the transformation of gender norms, breaking down social and gender barriers to personal achievement. The Mathare Youth Sports Association (MYSA) philosophy is helping its members develop life skills on and off the playing fields. Over the years MYSA has increased the scope of its programs as well as the numbers of young people it serves, so that now it operates a far-reaching HIV/AIDS education program, an extensive football program, an educational scholarship program, a photography project, and numerous community service and environmental education activities. Download
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Missing Mothers Meeting the Needs of Children Affected by AIDS.

Save the Children. Until now, support for children affected by AIDS has focused on orphans. This document argues that the more care a mother gets, and the longer she can be supported at home, the better her children’s chances of survival. Download Report PDF (226.17KB)

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Mobility Mapping and Flow Diagrams: Tools for Family Tracing and Social Reintegration Work with Separated Children. 2003

Over the past decade, child welfare practitioners have adapted participatory learning and tools and techniques to address a wide range of issues relevant to children in difficult circumstances. This tool (2003) provides concrete examples and simple step-by-step instructions which can be used by both experienced and novice practitioners who deal with children in difficult circumstances. Part I shows how a mobility map can be used as a special documentation tool for “hard-to-trace” children by providing information about their lives prior to separation. The methods described have been instrumental in the successful tracing of immediate family members or other relatives of separated children. Research findings that support the usefulness of drawing to facilitate recall among younger children are also presented. Part II builds on the first by discussing mobility maps and flow diagrams as family assessment tools for use in reintegrating separated children into households. Methods presented in the second part have facilitated the reintegration of children into households in an impoverished environment. Download PDF (373KB).

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National Action Plan for Orphans and Other Children Made Vulnerable by HIV and AIDS in South Africa. 2006 – 2008

South African Department of Social Development. (2006) This National Action Plan is based on key strategic areas and programmatic interventions in the National Policy Framework for orphans and other children made vulnerable by HIV & AIDS.

The rationale for developing the National Action Plan was to clearly define the unique value-adding role of various stakeholders in addressing the social impact of HIV and AIDS. This is based on the premise that no single sector can successfully address the impact of HIV and AIDS epidemic on individuals, families and communities.

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Our Right to be Protected from Violence. Activities for Learning and Taking Action for Children and Young People. 2006

The Secretariat of the United Nations Secretary-General’s Study on Violence against Children.  Children and young people played a large part in producing these, helped by Save the Children.This is an educational booklet designed to provide children and young people over the age of 12 with information about violence and ideas for actions they can take to prevent violence and respond to it. In addition to the Secretary-General's report to the General Assembly and a book called World Report on Violence against Children, some materials have been prepared specially for children. Children and young people played a large part in producing these, helped by Save the Children.

Download PDF (4,419 KB).

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PLACE in Zimbabwe: Identifying Gaps in HIV Prevention among Orphans and Young People in Hwange District, 2006, MEASURE Evaluation. 2008

The Priorities for Local AIDS Control Efforts (PLACE) method is a tool used to identify areas where HIV transmission is most likely to occur, and, within these areas, to identify gaps in prevention programs. In Zimbabwe, the PLACE method was used to understand what factors are putting adolescent girls (orphans and non-orphans) and young women 18-24 years of age at risk of acquiring HIV. Programmatic recommendations are offered. Download PDF, 152 pages, (1.98 MB)

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Putting Young People into National Poverty Reduction Strategies: A Guide to Statistics on Young People in Poverty, UNFPA. 2008

Many national poverty reduction strategies overlook the needs of young people. Even where national strategies do have a youth focus, the analysis of their situation is limited because little or no reference is made to readily available data. For those advocating on behalf of young people in poverty, considerable scope exists to make use of simple but reputable statistics to mount a strong case for Governments and civil society to allocate more resources for addressing poverty among this major population group.

The purpose of this step-by-step guide is to show how relevant statistics on young people in poverty can be easily sourced for use in developing national poverty reduction strategies. The guide shows how to use accessible databases on the Internet to provide individual countries with sophisticated statistical profile of young people in poverty.

The available data can provide a profile at three levels of young people in poverty. At the broadest level, it is possible to show how significant young people, defined as a specific age group, are in a country's basic demographic structure now and in the future. The second level focuses in on the incidence of young people in poverty, using, for example, national averages based on Millennium Development Goals indicators. A third level of data offers a more differentiated picture of young people in poverty. This involves presenting detailed data, taking into account young people's differences by gender, rural/urban location, where the data is available, household poverty status.  Download PDF (1.73 MB).

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South African Child Gauge 2007/2008. 2008

Children’s Institute. 'Children’s right to social services' is the 2007/2008 theme of this popular annual review of the situation of children in South Arica. The Children’s Act (as amended) is the primary law that is aimed at giving effect to this right. The South African Child Gauge 2007/2008 provides in-depth information on some of the pioneering aspects of the new law and the budgetary and human resource challenges that need attention to enable maximum impact for vulnerable children. It also contains an update on legislative and policy developments pertaining to child rights, and provides updated statistics on the demographics of children in South Africa and their access to a range of socio-economic entitlements. Download full document (PDF, 3,8MB) or in sections here.
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Street Children and HIV & AIDS.

Methodological Guide for Facilitators. This training guide focuses on street children, their risk of contracting HIV/AIDS, and prevention of risk behaviours. Written by field practitioners and experts on guidance and counselling of youth in West Africa, it is structured to be a training tool to assist facilitators in the field. Its format and organisation emphasise portability and functionality and include tools to measure the effectiveness of the facilitators' interventions. Prior to offering the training materials, the guide describes its own conceptualisation and writing. It includes its focus on street children and who they are, the three phases of the project of elaborating a training guide with field-tested methods, and the role of a sub-regional seminar in Niamey for the training of facilitators in 2005. Click here for this resource in PDF format.

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Strengthening systems to support children's healthy development in communities affected by HIV/AIDS : a review [Report]. 2006

RICHTER, Linda. This document is a review of the scientific evidence and practice experience in providing what has come to be called psychosocial programming and support for children infected with and affected by HIV, and their caregivers. A great deal of attention is currently focused on psychosocial support programmes for children living in communities affected by HIV/AIDS. Psychosocial support programmes include a range of interventions such as awareness raising, counseling, group experiences for children, opportunities for recreation, and the like. However, several technical consultations, as well as the available evidence and experience, suggest that it is necessary, in the face of the combined effects of the HIV/AIDS epidemic and poverty, to support the psychosocial well-being of vulnerable children through as many avenues as possible. Efforts to promote the psychosocial well-being of vulnerable children require conditions and assistance that go beyond psychosocial support programmes, and there is now a strong call for integrated services to families and children affected by HIV/AIDS. Download PDF (4751 KB).

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The Children's Act No. 38. 2005

Microsoft Office document icon ProclaimAct.doc25.5 KB

The South African children's sector is governed mainly by the Children's Act. The Children's Act No. 38 of 2005 can be downloaded here.

All sections have not been proclaimed yet. The proclamation for the commencement of certain sections of the Children's Act was been signed by the President to commence on the 1st of July 2007. This proclamation is available below.

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The Children's Institute.

Information on legal and policy issues regarding children can be found from the Children's Institute, which aims to harness the collective academic capability in the University of Cape Town to promote enquiry into the situation of children, to share this capacity through teaching and training programmes, and to present evidence to guide the development of laws, policies and interventions for children. For a large selection of information and resources, particularly on legal matters, visit their website.

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The Memory Work Trainer's Manual.

The memory work trainer's manual guides trainers through a course to support parents, guardians and carers affected by HIV and AIDS, by helping them to:
  • Share information, hopes and fears with their children
  • Strengthen each child's sense of identity and belonging
  • Plan for the future care of their
Download the whole manual (144 pages 716 KB)
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Toolkit for Positive Change: Providing Family-focused, Results-driven and Cost-effective Programming for Orphans and Vulnerable Children.

(Source: Save the Children Federation Inc.,2009)

Codeveloped by USAID and PEPfAR.
This document provides a road map for implementing programs for orphans and vulnerable children (OVC ) and offers evidence-based approaches and tools that could be used to help scale-up services and make them more effective. The donor community can use this toolkit to help make informed decisions about investing their resources. Policy-makers could use it to help determine which interventions and services for OVC would produce the desired outcomes. For practitioners, this document is a practical guide about how to successfully implement a comprehensive package of services and interventions for OVC and their caregivers.

Download PDF 1.64 MB, 96p.


AcknowledgementsList of Acronyms
Glossary of Terms
Chapter 1: Introduction and Context
Key Elements of the OVC Toolkit
Chapter 2: Formative Assessment
Chapter 3: Program Design and Community Mobilization
Chapter 4: The Tierred Approach to Partnerships
Chapter 5: Building Capacity of National and Local Level Partners
Chapter 6: Developing a Coordinated Care Approach to Service Provision
Chapter 7: Coordinated Care Services
Chapter 8: Improving Quality of Services
Chapter 9: Mobilizing Local Resources
Chapter 10: Monitoring and Evaluation
Chapter 11: Documentation of Lessons Learned and Promising Practices
Chapter 12: Sustaining OVC Services
Resources Mentioned in the Toolkit for Positive Change


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Tuko Pamoja: A Guide for Talking with Young People about their Reproductive Health. 2006

Kenya Adolescent Health Project. 2006 The guide is designed for adult health professionals and provides information and tips to improve their communication skills. Download PDF (444 KB)

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Tuko Pamoja: Adolescent Reproductive Health and Life Skills Curriculum. 2006

Kenya Adolescent Health Project 2006. The life skills curriculum includes 30 sessions and is designed for teachers, group leaders, health professionals and others working with youth. Download PDF, (1.17 MB)

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