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Government's social development response to children made vulnerable by HIV/AIDS:
Identifying gaps in policy and budgeting

Judith Streak1


9 September 2005

SARPN acknowledges the IDASA website as the source of this document -
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Sizwe looks after his dying mother and two sisters in a mud-block house north of Durban. He left school last year when his mother was sent home from hospital to die because her bed was needed by someone who might recover. He can’t go back to school because there is no money to buy food or to pay for school fees. Sizwe sends his sisters off to beg for mealie meal from a neighbor who sometimes helps out. He leaves his mother sleeping while he makes his third trip of the day to fetch water from the standpipe. When he returns his sisters are waiting with a packet containing a cupful of mielie meal. Sizwe makes a fire while the older girl rocks the toddler to stop her crying. The mother sleeps between bouts of coughing. It is nearly time. Tomorrow he will visit the lady from the burial society to see if he can get help preparing for the funeral. Sizwe is a ten year old boy living in one of the richest countries in Africa, under one of the finest constitutions in the world, but he has no rights.2

South Africa is one of the countries in the world most affected by HIV/AIDS. (Richter, 2005:1). According to figures released by the Department of Health in 2005, an estimated 6.29-6.57 million people were HIV positive in 2004. (BBC report). This is out of population of about 41 million. The gender imbalance in HIV infections is striking, with many more women infected then men. (Children’s Institute, 2003:2). There is no sign as yet that the epidemic is abating. (Richter, 2005:1).

South Africa is home to approximately 17.7 million children. (Budlender et al 2005). Even without HIV/AIDS, the interplay of factors such as the high level of poverty, unemployment, neglect, abuse, violence and drug dependence ensure that a large proportion of South Africa’s children live in difficult circumstances, can be classified as vulnerable and are in need of support.

There are gaps in understanding of the impact of HIV/AIDS on children in South Africa3. However, no one disputes that HIV/AIDS has had (and will continue to have) the effect of increasing the number of vulnerable children and of compounding the difficulties experienced by those who are already in need of assistance. The generally accepted definition of a child in South Africa is that in the Constitution - a person between the age of 0 and 18 years. This is the definition used here.

How HIV/AIDS is affecting vulnerability among children

HIV/AIDS produces and compounds different forms of vulnerability among children. First, children are being made directly vulnerable by infection (mostly caused by mother to child transmission) and related ill-health4. The number and proportion of infections due to child abuse is increasing. (Van Niekerk, personal correspondence 2005).

Secondly, HIV/AIDS is causing vulnerability among children by leaving them orphaned. Based on calculations of the Actuarial Society of South Africa (ASSA), there are roughly 1 million children in South Africa who have lost a mother (maternal orphans) and around 2.13 million who have lost a father. (Giese, 2004:2-3). It is estimated that about half of all orphaned children have lost parents due to AIDSrelated mortality. (Richter, 2005:1). Projections derived from the ASSA models predict that by 2015, in the absence of any major treatment or behaviour change, roughly 3.05 million children under 18 will be maternally orphaned and 4.51 million paternally orphaned the majority of deaths being AIDS related. (Giese, 2004:4). The vulnerability associated orphan-hood and the child’s need for care and support services – including socio-economic and psycho-social – begins long before the death of a parent(s)5.

Some of the children orphaned due to HIV/ADS find themselves living completely without family support, on the streets or in institutions. Others live – at least for a period – in child-headed households. Their biggest challenge is persistent hunger, followed by a range of other poverty-related concerns, including: the struggle to pay school-fees; lack of school uniforms and other clothing; lack of money for transport and health care; inadequate housing; and insufficient warmth. (Sloth-Nielsen 2004: 23). A large proportion of children in child-headed households do not attend school. (ibid). While the number of children living in these circumstances is large and growing, as a percentage of the total number of orphaned children, it is very small. The majority of orphans are absorbed into families in their communities. Most are living in kinship care and have been informally fostered. For example, Rosetta Heunis, project manager of God’s Goldern Acre in KwaZulu Natal (2005 in personal correspondence) relates that “grandmothers are taking care of up to 15 children (with only an old-age pension as an income)”. Other children have been formally placed in the care of foster parents by the Children’s Court. The extent and depth of poverty in South Africa is such that most of the children absorbed into families and communities are being taken care of by primary caregiver(s) who, even if they have access to a child support grant (CSG) for some of the children in their care and pension do not have access to sufficient resources to meet the household’s basic needs. In many of these households the twin impact of HIV/AIDS and poverty have created a situation that is so desperate that strategies such as getting into debt, depending on neighbours for food and sending children out to work have to be employed simply to try and put food on the table. Hunger and malnutrition are constant threats and attendance at school is often a luxury. (Meintjes et al 2003, Giese et al 2003, Giese 2004, Heunis 2005 & Giese 2005). In the words of Giese (2004:3):
    “Contrary to popular perception, the majority of children who have been orphaned in South Africa are not without adult care, support, supervision or socialisation. They…are being cared for by relatives, many of whom live in impoverished households within poor communities”.
Whether orphaned children struggle any more than other children in the household in such circumstances of poverty and therefore have a need for special measures of assistance is a critical question from a policy perspective and one that is at present the focus of much debate.6

The state’s duty to assist all vulnerable children

Both the law and morality demand that all vulnerable children in South Africa – including the growing number of children experiencing vulnerability due to HIV/AIDS – gain access to care and support services that ensure their development is not compromised by their harsh environment. There is a legal obligation on the state, imposed via the comprehensive cluster of child specific rights afforded children in Section 28 of the Constitution and the broader child rights framework in South Africa to take measures to ensure assistance for vulnerable children. Children made vulnerable by HIV/AIDS have since 1998 been given a great deal of attention, relative to other categories of vulnerable children, in the donor and domestic development debate. Whilst the attention to developing measures to assist this category of vulnerable children is commendable, the response developed to provide for their rights must not diminish action to assist other categories of vulnerable children. These include: children living on the streets; children of refugees; children who are trafficked; children who due to deep poverty at the household level are without access to basic goods and services (such as early childhood development and health care); children who suffer abuse and neglect; child offenders; children living in institutions; and children dependent on substances.

Purpose, structure and scope of paper

This paper analyses the policy and budget action of one government department – social development – in relation to assistance for children made vulnerable by HIV/AIDS. It describes the policy and budgetary measures of the department as well and identifies gaps in them. It also makes some recommendations about actions for addressing the gaps. The policy and budget analysis is presented within the context of the child rights and domestic legal framework governing social development service delivery to vulnerable children in South Africa.

While action targeting children made vulnerable by HIV/AIDS is a special interest throughout the paper, a lot of the description of social development policy and budget action relates to measures to assistance vulnerable children in general. Moreover, the gaps identified in the policy and budget action for children made vulnerable by HIV/AIDS for the most part apply to measures to assist all vulnerable children. This is because the social development department approach has been, quite rightly for the most part, to mainstream measures to assist the category of vulnerable children made vulnerable by HIV/AIDS within the broader set catering for all vulnerable children.

The paper comprises four sections, followed by a conclusion. Section one explains the service delivery role of the social development department in relation to caring for children made vulnerable by HIV/AIDS. Section two sketches the child rights and legal context underpinning social development service delivery to vulnerable children. Section three provides an overview of the policy framework developed to coordinate and guide social development service delivery to children made vulnerable by HIV/AIDS and identifies its shortcomings. It covers three broad programme categories – social assistance, social welfare services and action to facilitate more coordinated and effective service delivery for children orphaned or otherwise made vulnerable by HIV/AIDS. Section four focuses on budgeting for service delivery to children made vulnerable by HIV/AIDS. It explains how the public budgets allocated for social development interventions to assist children made vulnerable by HIV/AIDS are determined, highlights the funding crisis that has built up over the years, raises the problem of pinpointing funds allocated to and spent on services for children made vulnerable by HIV/AIDS, provides an overview of trends in relevant programme budgets over the period 2004/05-2007/08 and raises concerns about the trends that have emerged. The conclusion contains some recommendations about the type of action social development departments need to undertake in order to build social development policy and budgets that are more capable of ensuring adequate care for the millions of children who are living in desperate circumstances and are in dire need of seeing their rights realised.

  1. It was whilst working on research for this paper that Lerato Kgamphe passed away unexpectedly in Johannesburg on 13 December 2004. The paper was developed out of Lerato’s research and I want to say a big thank you to Lerato. We miss you. Thank you also to Shaamela Cassiem, Teresa Guthri, Sonja Giese and Julia Sloth-Nielson for commenting on the paper and to Deborah Ewing for editing. The ideas in this paper have also been influenced by and benefited from a consultative workshop jointly convened by ACESS, Idasa CBU and SANAC in Cape Town on 30 August 2005 on government’s policy framework, budget and coordination efforts for children made vulnerable by HIV/AIDS.

  2. Adjusted from Ewing, 2000 cited in Giese, 2002:60-6.

  3. See Bray, 2004 for an overview of the challenges regarding research on the impact of HIV/AIDS on childhood vulnerability and development.

  4. In 2002 it was estimated that 91 271 babies became infected with HIV through mother to child transmission (Giese, 2004:2). It is not as yet known how this number is being reduced with the implementation of government’s anti-retroviral programme aimed at preventing mother to child transmission.

  5. Research repeatedly demonstrates the vulnerability of children living with terminally ill adults and siblings and the way in which the illness in the household impacts on children’s access to services, child responsibilities for household chores, care giving and income earnings (Giese, 2004:3). It is estimated that the number of children living with a parent or parents that are sick with AIDS is around 500 000 (ibid).

  6. Meintjes et al (2003) argue that there is no rational argument for offering orphans living in families in affected by poverty income support that is of a higher value to that given to children with their biological parents in the household. Ardington and Case (2004 and Mail & Gaurdian 2005) have produced research which suggests that there may be reason to design special measures for such children. This is because their research flags discrimination in access to resources within the household. It also shows that in such households it is less likely for orphans to be enrolled in school and when in school they lag behind children of the same age. With the spotlight so much on social assistance and other poverty related interventions for vulnerable children (including those made vulnerable by HIV/AIDS), little attention has been given to the question of what special psycho-social interventions are required for orphans and other children made vulnerable (OVC) by HIV/AIDS. Heunis (2005) also suggests that the situation and practice within many families is such that orphans are worse off than most vulnerable children. In her words: “Orphans taken in by extended families are some times used as slaves, do not have the benefit of education and are the last to eat”.

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