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“Keep me away from wisdom which does not cry, philosophy which does not laugh and greatness which does not bow before children” Kahlil Gibran.

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Presentation on theme: "“Keep me away from wisdom which does not cry, philosophy which does not laugh and greatness which does not bow before children” Kahlil Gibran."— Presentation transcript:

1 “Keep me away from wisdom which does not cry, philosophy which does not laugh and greatness which does not bow before children” Kahlil Gibran

2 AIDS orphans & Vulnerable Children An evidence-led response Dr Michael Elmore-Meegan FRSHTM HIV/AIDS Unit ICROSS Kenya IFCW WORLD FORUM 2003 Cape Town

3 Scale and complexity of AOVC Vulnerability Responses Knowing what works Resources

4 “You do not know what is coming over the mountain, darkness is about to fall on our world – if you do not act we will be lost” Leonidas King of Sparta to the Greek states before leading 300 spartans to hold back the Persian invasion at Thermopylae 480 B.C.

5 “Know before you act everything possible from all intelligence or your plans shall fail if you are unprepared you will be defeated” Julius Caesar 51 BC

6 Scale and complexity of the problem This is a rapidly emerging dynamic (often responded to by assumption not knowledge) Needs to be understood in context of the broader situation. Early child development, nutrition safety, well-being, disease, emotional suffering and poverty

7 Statistics do not capture tears The numbers miss pre-orphaned children whose their parents die difficult deaths The data of ten misses the changes in safety, security, diet, happiness and social failure

8 Statistics and data are essential There is limited evidence of patterns, social dynamics or psychosocial damage to children In 3 meta-analyses, only 214 studies and 7 multi-country studies covering 4.2 million 22 psychosocial studies underway and 7 multi- country studies being planned

9 “By 2010 an estimated 106 million children under 15 years are projected to have lost one or both parents with 25 million of this group due to HIV/AIDS” Children on the brink 2001 UNAIDS & UNICEF

10 There are other orphans, other children who are vulnerable HIV/AIDS strikes in may ways Some countries are more vulnerable than others 12% of all children in sub-Sahara are orphans, 6.5% in Asia, 5% in Latin America

11 Mortality, morbidity trends reversing Crude death rates and life expectancy changing by 2 decades in parts of Africa

12 In Sub-Sahara, by 2010 it is estimated 42million orphans, 20 million from HIV/AIDS In 2001, 12 sub-Saharan countries made up 70% of orphan population (esp Nigeria, Ethiopia & Congo) The mean average age on the continent of Africa is 17 (tables on

13 In AOVC Limited hard evidence yet Lots of material, much of poor Lot of theories and assumptions Short time scales Danger of up-scaling ideas that have not been proven to work But We know some things are working We know what we do not know

14 We have limited resources Where are we going to put our money? How will we choose a project? How will we measure success?

15 Vulnerability “History will judge us by how we cared for our children, how we protected the weak and the powerless. Civilisation is determined by our love” Albert Einstein

16 Dynamics of who is vulnerable Starts in the household Children’s adult-network Children's child-network Family network Community network External support structures above all internal stability

17 Our team has been looking at stress, emotional well-being, trauma and coping Achenbach child behaviour scale Modified triple validated scale State of well-being scale Other important studies and assessment tools on

18 Chronic vulnerability Classically defined as exposure to risk Exposure to stress Lack of ability to cope with exposure symptoms e.g. AnxietyTears NightmaresWithdrawal TerrorFear DepressionOb Compulsive D Panic

19 Important programme distinction between symptoms and causes of vulnerability Responding to SYMPTOMS relief, destitute, impoverished families livelihood failure We need to shift focus to CAUSES

20 Programmes targeting causes E.g. Family planning (demographic curves) Environment (deforestation) Climatic (floods in Asia) Policy-based Good governance Rights Land tenure

21 AOVC causes of vulnerability Include Household security Rights education Community protection of children The multiple dynamic of HIV and AIDS ripple damage to social fabric Kills most productive members of society

22 Sound cultural baselines root projects in peoples values not in donors log frames Stigma fear,denial,silence,religious objection,alienation,rejection

23 Not gender neutral Women and girls more biologically and culturally vulnerable

24 The pandemic has multiple “accelerating” effects on other risk factors (primary indices, disease patterns, economy, mortality, trends, social structures)

25 Responses As HIV impact intensifies the local, national and regional capacity to respond is decreasing

26 “A plan… we need a plan?” Homer Simson (at the controls of the nuclear plant during melt down)

27 What is working Organised Collaborations Networks based on equality of partners Government linked strategies Joint interventions are working better Long-term integrated strategies Multi-disciplinary responses

28 Interventions that work Holistic approaches including MCH, PHC Strengthening local coping systems Community-driven safety networks Helping formal and informal support groups

29 Protection of children’s assets Local psychosocial safety networks Targeting families

30 This is no longer a crisis for charities or donors alone It is a regional emergency requiring dramatic legislation, interventions and new types of alliances

31 Successful programmes have Education, social services and community support with Gov/NGO Community working together.

32 Multi-lateral institutions Bilateral institutions Government policies International organsiation programmes Community-based organisations Faith-based organisations Informal community responses

33 The problem greatly exceeds existing efforts Little evidence of impact Community responses often more practical in the lives of children than larger programmes

34 Less than 10% of all orphaned children are being reached by support initiatives If AOVC are able to go to school they are performing as well as other children

35 Evidence “Walk the path that is lit, hold hands or you will walk into the ditch” Maasai proverb

36 Types of evidence Experience Results Observation Proof

37 Knowing what works (measuring and assessing program input) Quantitative Epidemiological Health statistics Demographics Performance analysis Cost effectiveness Qualitative Psychosocial Sociological Anthropological/cultural Socio-economic

38 Organisations across the world are still trying programmes that never worked and were never cost-effective Need to share Best practices Lessons learnt Design skills Evaluation methods How to use evidence Build through culture

39 Need to understand the difference between counting things and real information We need to plan from well-designed scientifically structured investigation and use information well But We must be cost effective and cost efficient

40 In many programmes baselines, design, methodology or knowing the real starting point are not evident Interventions often fail to understand local context, cultural assumptions, non-negotiable values and community wisdom Success does not depend on money but on the acceptance of the strategy by the community

41 In reviewing 28 articles on AOVC in 2002 19 had fundamental statistical errors 24 had incomplete literature review 16 had insufficient sample single 17 had design errors 11 had no new contribution 8 did not understand controlling variables 12 had no situational analysis context 3 were recommended for publication

42 FBOs Dr Geoff Foster’s findings (686 FBOs in 6 countries – Uganda 193, Kenya 171, Mozambique 105, Namibia 91, Malawi 68 and Swaziland 57) Material support School assistance HIV prevention Visiting children/home support Counseling and psychological support

43 Medical care Income generation and vocational training Day care centres Other education Community schools and child development centres Promotion of foster care

44 Other responses Residential children’s homes Street children centres Community-led FBO responses were Well organised Limited impact

45 Need for partnership Need for flexible support from donors Need to redefine donor policies Need to recognise role of small CBOs and FBOs and work with them

46 Resources “The best things in life are free except me” Mae West There are growing resources available free on the internet with more advice, support and help. AOVC web-based resources have tripled in 2003 to 46 sites.

47 “The three richest people in the World own more than the poorest 32 countries” “The 6 richest people in the world own more than the 600,000,000 poorest” “The 250 richest people in the world own more than the 2.5 billion poorest” World Bank

48 Resources are insufficient Global fund & multi-lateral programmes are expensive and bureaucratic Donors are often not good listeners Need for donors to learn from NGOs and from partner-countries, values, culture and beliefs.

49 Manuals and guides to provide psychological symptoms to children Instruments to assess the psychological well- being of children at But … these require research and interpretation skills

50 Real lessons are being learnt and shared


52 Guiding principles for programming for AOVC are available on

53 “In the end they shall forget their children and in their thousands shall they be lost for they failed to see the light and the tears in their eyes, they saw them not” Nostradamus

54 “It starts and ends in loving” The Dalai Lama

55 “If our tears do not lead us to act then we have lost the reason of our humanity which is compassion” The Dalai Lama

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