Tearfund Good Practice Guidelines
Focus Area Two
Impact mitigation through support services for widows and children
1.
DEFINITION AND DESCRIPTION
HIV and AIDS have the greatest impact on poor households headed by women with a high number of
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dependents . Women, and older female children, tend to have the burden of care for ill family
members and younger children, often coping at the same time with their own ill health. Grandparents
are often needed for the nurture of their grandchildren Once household members fall ill, there is
both loss of household income and an increase in expenses, particularly relating to medical care and
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funeral expenses. HIV has a major impact on household food security, incomes and livelihoods . In
rural areas illness and death lead to decreased agricultural production; in urban areas they lead to
reduced employment and earning capacity. Malnutrition often follows. The need for food can lead to
sale of assets, including land and livestock, affecting long term food security. Coping strategies may
include migration for work and selling sex. Children fail t attend school regularly. The lack of social
workers means that vulnerable children are often unidentified and responses/resources are
inadequate.
Impact mitigation means working to decrease the negative impact of HIV on vulnerable people as
much as possible.
Children are impacted by HIV and AIDS in some of the following ways¹;
• Being infected themselves with HIV through mother-to-child transmission or through increased
vulnerability as teenagers
• Living with a chronically ill parent or parents and being forced to take on household and care
giving duties. As a result their education may be put delayed or they may be absent from school
frequently.
• Living in a household with greater poverty because of HIV and AIDS
• Being subjected to stigma and discrimination due to an association with someone with HIV or
AIDS
• Becoming orphaned because of an AIDS-related illness
In recent years there has been considerable valuable work on defining the needs of Orphans and
Vulnerable Children (OVC) and suitable programmes for their support – the website for the Joint
Initiative on Children Affected by AIDS (JLICA) – www.jlica.org is a major resource as is the Coalition
on Children Affected by AIDS – www.aidsalliance.org and the World Conference of Religions of Peace
– www.coreinitiative.org. The Training Manual on Channels of Hope by World Vision is very
comprehensive. The new Training Manual from Tearfund – Guardians of our Children’s Health,
provides new approaches towards greater community and church action.
Some governments – even in poor Sub-Saharan countries are introducing conditional cash transfer – a
monthly sum of money given to mothers provided their children attend school regularly and attend
for regular health checks. There is now much greater emphasis on Social Protection.
Tearfund is committed to an integrated approach to impact mitigation. This includes promoting
access to treatment for opportunistic infections and anti-retroviral therapy (focus area 3); ending
stigma and discrimination (focus area 4); prevention of mother-to-child transmission (focus area 1);
and behaviour change among children and young people (focus area 5).
2.
NGO CODE OF GOOD PRACTICE IN HIV²
The NGO Code, subscribed to by Tearfund, calls for HIV and AIDS to be brought into the ‘mainstream’
of development and humanitarian programmes. The goals of these programmes, which include
increasing household income, food security and literacy, address both the causes of vulnerability to
HIV infection and the consequences of HIV and AIDS. The Code supports the ‘Convention on the
Rights of the Child’ and ‘HIV and AIDS and Human Rights: International Guidelines’. The Code states
that NGOs will:
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2.1 Design or adapt development programmes to reduce vulnerability to HIV infection and meet the
needs of people living with HIV and AIDS (PLHA) and affected communities.
• Ensure that development programmes reach households where employment options are limited,
where food supplies are insecure or income-generating capacity is affected by HIV and AIDS, and
where there is reduced productivity due to increased burden of care or changes in family
composition such as grandparent, female and child-headed households.
• Agricultural programmes have a vital role in reducing vulnerability to HIV and AIDS and NGOs
should adopt appropriate local strategies to support PLHA and maximise productivity.
• Micro-finance or credit schemes should be made available to meet the needs of PLHA
• Unsafe water and sanitation affect poor and marginalised populations, particularly women, girls
and PLHA; water and sanitation programmes should be designed taking into account the
vulnerabilities of women and girls to HIV, and the needs of people living with HIV.
• Programmes for OVC affected by HIV and AIDS should be child-centred, family- and community
focused and rights based.
2.2 Provide a range of support including food, clothing, legal assistance and economic support;
support, respite and training for carers of PLHA, as well as information about household hygiene
procedures.
Underpinning all of these issues is the importance of the participation of people living with HIV and
AIDS (PLHA), under the movement of ‘Greater Involvement PLHA’ (GIPA) in all aspects of
programming (planning, policy and implementation).
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GUIDELINES FOR PRACTICE
3.1 What would this mean for someone who is living with HIV¹
• Infants and young children would be less vulnerable to disease, death and delayed development
if their parent(s) die of an AIDS-related illness.
• Children whose growth and development is affected by intrauterine exposure to HIV, even
though they do not acquire the virus, will develop normally
• Children and adolescents who are orphaned would have a protected environment with access to
education.
• Vulnerable households, such as those headed by women with HIV and AIDS, grandparents or
children, would be supported in their efforts to continue to provide good physical and psychosocial care, adequate diet and have children who attend school, regardless of their poverty.
• Households who have taken in orphans would be mentored, supported and assisted to enable
them to provide love, support, guidance, nurture and reassurance to orphans without the
pressures of economic scarcity and household rationing.
3.2 What should Tearfund-supported projects implemented by partners cover?
The choice of activities entered into, and the extent to which they are carried out, will depend on the
resources of the partner and the capacity for sustainability. Not all of the following are expensive or
require long-term financial input. There are 12 different domains of child “well-being”:- Growth,
micronutrient status, health, intelligence, fitness, knowledge, skills, relationships, emotional
resilience, personal peace, spirituality and hope. It is often helpful to assess the aims, activities and
impact of programmes along each of these lines to ensure that holistic child development is
supported. Not every programme should aim at doing everything but every programme should ensure
that they link with others so that all domains of child development are covered.
Some of the activities below have considerable impact on different aspects of child well-being:3.2.1 Short-term support – at the time of immediate crisis of illness or death of spouse or parent
• Emergency aid - food and shelter
• Link families with medical care: especially to assess HIV in children of parents who die from
HIV/AIDS - by facilitating Voluntary Counselling and Testing (VCT), access to
treatment/prophylaxis of opportunistic infections and Antiretroviral Treatment (ARV). Help
families to plan for the future, including consideration of land inheritance rights for widows or
children.
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Registration of births and marriages.
Bereavement support for children.
Ensure that children go to school regularly
3.2.2. Long-term support – to continue for a variable length of time after the emergency situation
• Economic and advisory support with micro-credit or ‘start-up’ grants, with business or
agricultural advice which will promote long term food security.
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• Economic support by planned regular grants of cash (cash transfer ) or food as part of a strategy
to promote long-term food security.
• Training for women and men in strategies to deal with violence and sexual abuse
• Education support, which may include assistance with school fees and provision of uniforms,
books, school meals, extra tuition or specific skills training.
• Context-specific support for agriculture, water and sanitation.
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3.2.3
Mobilise and support community-based responses
• Assist church and other community leaders to identify, mentor and support vulnerable families
needing extra food or other emergency assistance.
• Provide training and other assistance for church and wider communities, including school and
healthcare workers, to monitor children in informal or formal care arrangements, and provide
information about human rights groups for violations relating to child-trafficking, worst forms of
child labour and of sexual abuse². Care should be taken to include women in training programmes
in order to address the vulnerability of girls².
• Discussions with church communities, including PLHA who are willing to disclose their status, in
order to reduce stigma and discrimination.
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• Practical and psycho-social support e.g. day care, youth camps, help with seasonal labour .
• Provide support to HIV infected adolescents who have acquired HIV in utero, especially as they
face up to their future and sexual activity
3.2.4
Influencing government policy for protection of children and provision of resources
• All partner organisations should be members of the appropriate national consortia: these may
include interdenominational, denominational or NGO networks or specific HIV and AIDS related
organisations. This enables contribution to a collective voice for lobbying and advocacy.
• Partner organisations should encourage the Christian church leadership to become more
informed and take an active advocacy role.
• As size, influence and the political environment permit, partner organisations can be part of an
individual or collective voice for the rights of women and children.
3.3 How can people living with HIV be involved?
• PLHA-led support groups can be encouraged to share the skills they have acquired, such as
economic independence, coping with grief and parenting skills for vulnerable children.
• HIV positive women are in a unique position to note the vulnerability of other PLHA and to
monitor the well-being of orphans and other vulnerable children.
• PLHA should be encouraged to lead discussion with church and community groups to reduce
stigma and discrimination.
Greater Involvement of PLHA (GIPA) should be encouraged at all levels of the organisation and
programmes, with the aim being to obtain representation in each of the following categories: target
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audience; contributors; speakers; implementers; experts and decision makers . Women need to be
actively encouraged and supported to participate.
3.4 Understanding the gender dimensions within the area
The gender inequalities relating to HIV start with an increased risk to women of acquiring the virus
and end with them bearing the worst of the family and social consequences.
• Fear of violence may stop a woman seeking diagnosis or treatment.
• The bulk of caring for infected family members and young children falls on women, especially
older women.
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NGO Code: p.25. Pyramid of Involvement by PLHA
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There may be a legislated lack of right for women to inherit property.
Where girls are less valued than boys, there is an increased risk of sexual exploitation and less
chance of education.
Child marriage may be more likely, either for the ‘protection’ of the girl, or financial gain of
relatives organising the marriage. Early and forced marriage for children and young women
increases school drop-out rates and the chance of acquiring HIV.
Girls are likely to be used for domestic work, which is often associated with physical,
psychological and sexual abuse and lack of education
Sexual abuse of boys living on the street is high in some countries.
3.5 Relationship to homecare
Community home based care givers are well placed to:
• Assist in the early detection of families affected by HIV. The earlier that diagnosis can be made,
the less likely it is that the household will be further impoverished and affected by ill health.
• Monitor child welfare and intervene where this is lacking.
• Support the care of ill family members, therefore increasing the likelihood that girls can continue
to attend school.
• Encourage support from a community network of neighbours and family
• Encourage PLHA in adequate nutrition, domestic hygiene and in continuing with regular smallscale income-generating activities, in order to prevent increased poverty and despair.
• The number of children that a carer can care for is limited by the emotional resilience and
support they receive and the physical resources available. Unpaid volunteers cannot provide all
that is necessary for the development of OVC. The fine balance between “payment” and
“honoraria” needs to be struck if sustainable support is to be achieved.
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SOME KEY INDICATORS
Baseline measurement of indicators is part of project planning and should be included in the initial
proposal submitted to Tearfund. This may be carried out by the partner organisation or rely on
information gathered by other agencies within the target community.Some examples include:• Ratio of boys/girls attending school, the % of children who attend for less than 80% of the
term among orphans compared with non-orphans.
• % of households with orphans who receive any financial, nutritional, emotional/spiritual
support from: the government, an NGO, the church, a community group, neighbours.
•
% of households with widows who receive any financial, nutritional, emotional/spiritual
support from: the government, an NGO, the church, a community group, neighbours.
• % of child headed households who receive any financial, nutritional, emotional/spiritual
support from: the government, an NGO, the church, a community group, neighbours.
• % of Out-of-School Youth who gain access to skills training or regular safe employment
• Widows and families with HIV having a regular source of income
o Rural families staying on the land and continuing to farm
o Urban families continuing with the previous form of income-generation or acquiring a
new way of generating income.
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REFERENCE LIST
1. Africa’s orphaned and vulnerable generation: children affected by AIDS (AOVG). The United
Nations Children Fund (UNICEF) July 2006. www.unicef.org
2. Renewing our voice: Code of good practice for NGOs responding to HIV/AIDS 2004.
Mainstreaming HIV/AIDS pp76-84. Julia Cabassi, David Wilson. Distributed by Oxfam GB.
www.oxfam.org.uk/publications
3. Making cash count: lessons from cash transfer schemes in east and southern Africa for supporting
the most vulnerable children and households. Save the Children UK, HelpAge International;
Institute of Development Studies. 2005 www.savethechildren.org.uk
4. UNGASS Indicators from: Core Indicators Manuel[1].2005_En.pdf downloaded from UNAIDS
Website
5. Joint Learning Initiative on Children Affected by HIV/AIDS www.jlica.org
6. International HIV/AIDS Alliance www.aidsalliance.org
7. Orphan Support www.ovcsupport.net
8. Channels of Hope – by World Vision
9. Guardians of our Children’s Health – to be launched by Tearfund
10. Social Protection – Overseas Development Institute (ODI) – www.odi.org.uk
11. Social Protection and DFID www.dfid.gove.uk
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