The same study estimates that by 2010 in the 34 countries most affected by the HIV/AIDS disease, there will be 44 million children who will have lost one or both parents.
These are the same countries with the least-developed physical or social infrastructure, greatest poverty and the most limited resources. Clearly there is great urgency to address this rapidly growing problem within Malawi and the poorest countries of the world. The increase in orphan numbers lags behind HIV infection levels by about seven to ten years, thus it will be imperative that strategies to address the problem be sustainable until at least 2020. At the same time, effective programs must be taken to scale nationally to increase coverage equitably. Family and community-based initiatives will be the most important in this expansion. Resources will need to be increased and accurately targeted, based on reliable information, in order to better meet the need. Resource effectiveness can also be enhanced through appropriate integration with basic health and education services and improved collaboration across sectors and at all levels.
In 1992, national guidelines were developed in Malawi for the care of orphans. These guidelines are in the process of being revised and a structure for networking orphan care providers has been developed.
HIV/AIDS presents the most formidable challenge yet to a healthy, stable and productive future. The challenges faced must be met with new and improved strategies, adequately addressing the highlighted issues mentioned above. The review of orphan care programs in Malawi was a first step in understanding the problem, examining some of the experiences to date, and recommending ways in which the Presbyterian Church (U.S.A.) can appropriately respond.
Models of Orphan Care
CBOC (Community-based orphan care) - Outreach and Development Model
This is one of the most common models of orphan care in Malawi and is the model promoted by the National Task Force on Orphans (NTFO). The orphan children are integrated into the families of relatives or conscientious guardians. Aid for the orphans and their families is usually a combination of community contributions and involvement, with help from outside organizations. At the core of this approach are self-help activities for income generation and community development.
The strength of this program is that it can cover the needs of a large number of orphans and vulnerable children for relatively low cost in a culturally appropriate way. It is based on sound development principles targeted for the needs of families in crisis. When it is done well, it uses strong community participation to identify the needs of the orphans and to develop long-term solutions to their problems. Generally it is flexible enough for each orphan family to choose what activity is most appropriate for them to address their needs. Examples of this might include: increasing agricultural production, establishing an income generating activity or covering education expenses for an older child. The principal objective of this model is to empower the family unit to function effectively. In times of extreme hardship, such as when crops fail, the community structure of these programs provides a safety net for relief assistance to be distributed more equitably.
Another strength of this type of program is that it is the most culturally appropriate. The children are raised as a family and are more likely to receive love and affection when kept with siblings and relatives than those who are institutionalized or separated. This security is critical to the development of life skills that are needed to support themselves and to enter into marriage and future family relations.
Sometimes these programs are not comprehensive or well thought out enough to meet the overwhelming needs of orphan households. Programs that focus on only one or two activities leave the family vulnerable. For example, if every family is facilitated in starting the same income generating activity, the market quickly becomes saturated. Also, it is difficult to get accurate information about the impact of these programs. Without this information much time and energy is wasted on activities that are not of much use to the orphans.
Even though the advantages of this type of program are evident to those involved in orphan care, most organizations were having trouble raising funds for CBOC. Because the best programs are decentralized and have low capital investment, donors do not “see” the impact of their donation.
If the program is not linked or networked with other orphan programs, it can leave gaps in the necessary care for orphans. One place where this is particularly evident is when an infant orphan is extremely malnourished or sick. These children often need intensive care such as tube feeding which is impractical in a village setting. In such cases, multiple interventions may be required.
- Strong community participation
- Clear and simple management structure that includes the guardians in decision making
- A transparent accounting structure and good, regular reporting
- A strong, multi-dimensional program for income generation
- Clear, measurable, goals
- Interlinked and networked with complementary activities and organizations
CBOC - Child Care Model
This model is similar to the outreach approach in that it keeps children in the families of relatives or conscientious guardians. The chief difference is the feature of a day care center where children receive supplemental care. There is a wide range of approaches to this model. Some are low-cost, community based and supported, while others are costly, centralized, donor resourced programs.
The strength of this model is that it gives daily attention to the nutritional, developmental and spiritual needs of the orphan. Most of the programs feed the children once or twice a day. Those children who are malnourished receive special attention. The games and learning activities with other children of the community improve the social and mental development of the children. The centers help to reduce the stigma of being an orphaned child since most are open to all children of the village. Many of the programs were staffed by youth and committed members of the local church. In some cases members of the women’s guild assisted in food preparation while church youth act as mentors to the young children. Many of the volunteers viewed this as an opportunity to put their faith into practice and evangelize the children.
The fact that there is a building (or pavilion) for activities opens up many opportunities. Most programs used the building as a community center where adult literacy is taught and social events are held. Activities such as weddings actually help the programs achieve some self-financing. The buildings also help to make the programs visible, facilitating fundraising from donors.
This model works best when it is part of a strong CBOC development program. When the center (i.e. building rather than activities) is the major focus of the program, it draws attention and money away from the long term needs of the households at greatest risk and the older orphans. There is also a temptation to make these centers so deluxe that they are no longer appropriate for integrating the orphans into society. In general, running a daycare center increases the cost of an orphan program and makes it more dependent on outside funding.
- High level of support from volunteers
- Nutritional and general health monitoring and intervention
- Interlinked and networked with complementary, community-level activities and organizations
- Social, physical, spiritual and mental skills development
Child Village Model
This model tries to emulate a normal family environment for the orphans by grouping them as family units under the care of a paid guardian. These family units are clustered in a village-like setting. A large amount of inputs is needed from the outside for building of homes, food, schooling and career training.
This model provides a fairly normal home environment for orphans that have no relatives capable of raising them. The children that are raised in this model will usually have all of their needs covered by the project. They will have health care, schooling, job training, social activities and food security. These villages often contribute to the general community development through efforts such as the provision of clean water, health services, or education. In spite of the cost of this model, it is generally easy to publicize and raise funds for.
The disadvantage with this model is that it can only be provided for a few because of the cost and it does not substitute for a true family environment. It requires at least four times as much external funding to provide for one orphan with this model as compared with a CBOC model. And, when the child becomes an adult, he or she will probably be less prepared for re-integration into society.
- Efficient and effective administration
- Regular communication with donors and communities
Orphanage Model
This is the traditional institutional model of orphan care. The children live in dormitories and eat in cafeteria style. A very large amount of inputs is needed from the outside for buildings, food, and schooling.
Orphanages provide for the needs of orphans with no other options. It is a controlled environment in which all of their physical needs can be met. Because they are sometimes well funded, they can even give an elite upbringing for the few orphans that they can accommodate. In situations like the abandoned child they can provide a needed transitional home until the child can be integrated into a home.
The institutional environment of an orphanage can make children raised there feel like orphans their whole lives. Generally these facilities do not accept non-orphaned children, thus social integration is difficult and stigmatism is maintained. It is also the most expensive model of orphan care.
- Strong fund-raising
- Clear and efficient accounting and reporting mechanisms
Conclusion:
The study team agreed that the community-based models of care for orphaned and vulnerable children are the most appropriate in Malawi. We also felt that there are certain occasions when the community-based models alone will be insufficient to cater for the wide range of child and family needs. In such cases it will be necessary for crisis, transitional support from various interventions. These might include: a crisis nursery for infants or an urban transitional care center for abandoned or street children. In such cases there should be close communication with social welfare authorities at each stage so as to ensure appropriate and timely re-integration of the children into family care.
The team proposes a combination of community-based activities with built-in social safety nets. Appropriate interventions would include the following:
- Nutritional and educational assistance to all children (especially the orphaned and vulnerable)
- Repair of deteriorating houses to assist families in crisis
- Home care and regular visits to households of orphans and HIV/AIDS patients
- Technical skills training and apprenticeships for adolescents
- Appropriate agricultural projects to increase food production expansion of grain banks
- Savings and credit schemes within the community
- Burial societies or co-operatives (to allay catastrophic expenses)
- Mobilizing community responses, skills development and community problem solving
Community response will require effective leadership and committed participation. If too many households within the community fall into destitution, the community safety net will not hold. This is the case in an increasing number of communities in Malawi. Such communities require broader area village support and increased external donor assistance. The Church is appropriately positioned to lead the response to the situation of orphan and vulnerable child support. The response must be sustained in partnership with churches and individuals from around the world. The church has an opportunity and responsibility to lead a rights-based approach to orphan and child care, to continue to advocate for policies and public programs that address the underlying causes of the crisis, to coordinate community-level efforts, and to communicate the message of the children to the world. In order to achieve this, national churches in Malawi and throughout the region must build their capacity to play an effective, leading role.
Simultaneous with the expansion of community-based efforts is an urgent need for establishing crisis nurseries in the central and northern regions of Malawi. Such centers, as mentioned above, should provide transitional care to infants and children under two years of age who are at the greatest risk following the death of their mother. Clear protocols should be established to ensure that they provide temporary, critical, and clinical care. Close collaboration with the Department of Social Welfare and strong community interest and commitment to the centers will be essential pre-requisites. The most appropriate role of the church might be that of catalyst and coordination as opposed to builder/manager.
Another role for churches and Christian, child-care networks is to conduct periodic, action-oriented research which focuses on findings that can guide and refine program development and implementation.
Documentation of field experiences from the sub-Saharan region is scarce. Information on child care programs and best practices would be very useful to churches, other care providers, and donors. Standardizing a monitoring and information system for providers would be very useful in re-evaluating priorities and planning further interventions.
In order to channel funding for support of multiple orphan care initiatives, there should be a centralized trust fund established. In the case of the Presbyterian Church, this might be an Extra Commitment Opportunity Account for the support of orphans and families in crisis throughout the region. The fund should have criteria for reviewing project proposals from CBOC and Church-based child welfare initiatives throughout the region. |
