2000 NMB: Inception Report: A Situation Analysis of Orphan Children in Namibia
Author: Social Impact Assessment and Policy Analysis Corporation
There is little doubt that HIV/AIDS is deepening poverty in Namibia, particularly because the epidemic is hitting people who are often the breadwinners in extended family systems -- absentee males and females -- who, due to their very migration, are more at risk of infection. Namibia is already severely affected by HIV and AIDS and this is set to worsen; it has taken place within the context of poverty, high levels of inequality, a high proportion of female-headed households, and a high percentage of households with members living long distances from each other. It is within this context of vulnerability that households, many of whom are in rural areas, have to cope with the rapidly increasing population of orphan children. At the national level, there is no agency specifically monitoring the status of orphans in Namibia, nor their numbers and locations.
Purpose / Objective
Financed by UNICEF and conducted by SIAPAC, a local social research firm, the study was intended to measure both the quantitative extent of the orphan situation and to qualitatively establish the situations these orphans faced. The purpose of the situation analysis of orphan children in Namibia was to analyse and provide an understanding of the present situation of orphan children in Namibia. The aim was to feed into a process of intervention identification and consideration of the expansion/redirection of existing interventions to better meet the needs of orphans. As the study proceeded, parallel progress was made in defining vulnerable children more widely in Namibia. Therefore, this study is to be used by the Ministry of Health and Social Services and its partners in development, more broadly for vulnerable children programming.
The quantitative assessment of the number and distribution of AIDS orphans in Namibia was determined using the Spectrum model, which specifically projected the number and geographical distribution of AIDS orphans. The estimate for the number of non-AIDS orphans came from specialist studies that tried to estimate the impacts of AIDS orphans on overall orphan numbers. The qualitative assessment looked in detail at the situations facing orphans, including an investigation of coping strategies (internal to households, extended families and communities, and external to these sources) and the extent to which coping could 'cope'. Equally importantly, the study focused on recommending ways forward, soliciting inputs and insights from the orphans themselves, their caregivers, and the organisations and structures in place, designed to assist.
Key Findings and Conclusions
As of 2001, an estimated 22.3% of all Namibian adults are HIV positive, or some one-quarter million Namibians, and this will continue to climb to a figure just under 25%. According to the health information system, in 1999, some 2,823 people died of diseases associated with AIDS, representing 26% of all reported deaths and 47% of all deaths in the age group 15-49. However, most AIDS-related deaths have not been recorded in the health information system. Indeed, model projections indicate that some 50,000 Namibians have already died of AIDS and, by the year 2021, there will be a cumulative death total of over one-half million. The total population by 2021 is estimated at 2.7 million, compared to an estimate of 3.6 million without AIDS.
There are numerous problems projecting the number of orphans in the population. Specifically, there are no existing estimates of non-AIDS orphans, and AIDS orphans estimates are only as good as the seroprevalence data they are based on. What is of interest is that the population results yielded by the model differ from the provisional results of the 2001 census by only 16,000 people. Findings, therefore, suggest that the model is an accurate reflection of reality, and that the seroprevalence data form a good basis for modelling.
A base year number of orphans was estimated by the consultants at 27,493, including only 10 AIDS orphans at the time. For non-AIDS orphans, assuming that all other variables held constant, the numbers were projected at the 'with AIDS' national population growth rate. Using this approach, as of 2001, there were an estimated 82,671 total orphans, of which over half were AIDS orphans. As the epidemic worsens, AIDS orphans are projected to comprise three-quarters of all orphans from 2006. By the year 2021, there will be an estimated 251,054 orphans, with almost 200,000 of these being AIDS orphans.
Looking at regional variation, some half of the nation's orphans will likely be found in the four north central regions of Omusati, Oshana, Oshikoto and Ohangwena, with many of the remainder found in the two northeastern regions of Kavango and Caprivi, and in Windhoek. However, a number of 'urban orphans' are apparently being moved to rural areas after the death of a parent/parents. Therefore, the four north central regions just mentioned are likely looking after some 60% of the nation's population of orphan children.
It is evident that the majority of households (but not all households) looking after orphan children are suffering financial hardships as a result. In most cases, the caregiving household was not able to rely on financial support from the dying parent(s) because either the family was already in poverty, or because they used their resources treating the dying parent(s). Further, many of the caregiving households are already severely poverty-stricken, and the loss of an income-earner (a common circumstance in the case of AIDS) is devastating.
Few households affected by AIDS appear to be able to make provision for their children. Often, this is due to the poverty of the household, but there are clearly cases where the money is being spent prior to the death of the parent(s) to care for the sick. There were also cases where the late husband's family took possessions away from the widow's household while, more commonly, the husband's extended family is less willing to offer financial support to the wife's family if the latter is taking care of the orphans.
Adjustment and Coping:
Orphan children are generally still living with their siblings. However, the situation is more complex than might have originally been thought, arising from extended family systems that result in siblings often living with other extended family members at varied points in their lives, long before they lost a parent/parents. This means that these children are not necessarily moving from one house to another. Further, for those who are moved, the children who have lived together are moved together, meaning that siblings have long been split, but not in a manner that caregiving households nor the orphans themselves viewed as inappropriate.
There is an emergent disturbing trend where a few child-headed households come about with the loss of the second parent (or the only parent in single-parent households). This appears to be most common when there are older teenage children in the family (e.g., 15-17) who end up becoming household heads for the few years that they are still considered to be children. The ability of support networks to cope with older children appear to be weaker than for younger children, and the ability of households headed by these older children and youth (even those aged 18 and older) is certainly of concern. Therefore, while there may be few child-headed households at this time in Namibia, there are a number of households headed by young people looking after younger siblings as the households lose the parents. If these households lose assets to relatives of the father, their situation would be significantly worsened.
Because of where Namibia is in the AIDS epidemic (still on the up-slope of a steep curve), because Namibian families have been disrupted by a profound colonial legacy, and because of some cultural practices, caregiving structures have often been in place before the death of a parent/parents. This has tended to make adjustment problems for many of the children less difficult than would otherwise be the case. This does not, of course, mean that adjustment problems do not exist; of course they do. The death of a parent or both parents is traumatic -- some respondents noted that the children became more withdrawn and tended to have emotional problems -- but it appears to have tempered these impacts.
While coping systems designed to weather the hardships of the past are, therefore, important in responding to the growing number of orphans, this very colonial legacy has meant that many households are more vulnerable to shocks and are less able to cope with additional stress. While households are doing their best to cope, it is likely that their ability to continue to do so in the face of the AIDS epidemic is probably weaker than the overall findings herein suggest. Indeed, case study findings point to a number of cases where coping is already under severe strain.
Surprisingly, some of the respondents were quite open that their relatives had died of AIDS, and used the term specifically. They also noted that others knew that it was AIDS. Anecdotal evidence over the past few years suggests that there is a growing acceptance that AIDS is widespread and that it is among us. Nevertheless, given that AIDS is spread through sexual intercourse, and given that there remains considerable confusion over how AIDS is not spread -- there is particular concern over the implications of casual contact -- there remains discrimination against those HIV positive. Despite this, the study showed that discrimination against the children of those who die of AIDS is minimal.
The number of orphan children being supported by organisations aside from family members appears to be quite low. Instead, most, if not all, needs are being met by extended family members and close neighbours/friends, with some receiving Government support.
There is wide variation in terms of the level of activity, and the level of commitment, of the various Regional AIDS Committees. Some have clear co-ordination problems that negate their effective functioning; others have been outstanding in their ability to lead regional efforts.
The extent to which households looking after orphan children can rely on the wider community was considerably less than anticipated. Nevertheless, findings suggest that households that cannot rely on extended family members were particularly reliant on their close friends and immediate neighbours, apparently because of a lack of alternatives. Extended family linkages were especially strong in the north, while southern and western households appear to rely more on neighbours and friends.
The recently completed Demographic and Health Survey found that only 9% of all women aged 15-49 were currently using condoms, and only one-quarter of all women aged 15-49 had ever used a condom. While it was higher for those aged 15-24, the usage levels are extremely low in comparison with the number of women sexually active. In neighbouring Botswana, for example, usage rates among sexually active 15-24 year olds are over 80%, and consistency of condom use is over 90% (that is, over 90% of 'sexual events' involved a condom; SIAPAC, 2001).
Orphan children are being kept in school. Indeed, caregiving families are going to great lengths to keep the children in school, and school officials are being flexible in understanding the circumstances facing orphans (as they do with children from poor households). The children also appear to have access to other services in the same way and at the same level as other children in the same household.
Most of the orphans and caregivers interviewed were not receiving support from Government to help care for the orphans, nor were they linked to outside support agencies in most instances. The few who had made application for financial support often spoke of a lack of feedback on the status of the application, or problems in the application process that had brought the application to a standstill. This suggests that more needs to be done to follow-up on existing applications and to keep lines of communication open with caregiving families and orphans. To the extent possible, the application process should be expedited.
One possibility is to consider a means-tested financial support package for households looking after orphans. It can be focused on particular needs (e.g., school fees, uniforms, etc.), or broader needs (e.g., financial support for food purchases). Another alternative is to try and reach all households looking after orphans, without applying a means test (but, nevertheless, having to ensure that the child is indeed an orphan and that the household is the caregiving household). Another alternative would be to help households looking after orphans from incurring certain costs. Waiving of school fees, for example, is one possibility, but this would certainly have costs associated with helping schools overcome financing limitations arising from non-payment of school fees, with associated costs to Government.
Many respondents noted that they were not just having problems meeting school fees and uniform costs and other school-related costs for orphan children, but rather for all of their children. They did not feel that it was wise to specifically identify orphan children for such support, suggesting that a more general support package that would allow the household to manage the money for school fees etc. on behalf of the wider household, would be more acceptable. The fact that they had an orphan would be the reason they would obtain financial support, but they should have the discretion to cover the needs of other children.
Enforcement of pending legislation protecting widows is needed, as is further strengthening of initiatives derived from the cabinet directive regarding inheritance.
It is likely that more attention will need to be given to psycho-social support, in a manner that will be able to reach a wider number of orphans. The Ministry and its partners in development will, therefore, need to plan for an increased need for counseling services, with reliance on broadened community-based counselling likely to be the only viable alternative.
Further, given the rise in the number of orphans, efforts should be made to expedite the formal adoption of orphan children not being looked after by relatives, and to consider channels to expedite adoption by extended family members more generally.
Continued efforts to de-stigmatise HIV/AIDS will be particularly important, within the context of overall information, education, and communications activities. Further, the more members of the public 'go public' with their HIV positive status, the more communities will understand the scope of the problem.
Finally, political will is already apparent for HIV/AIDS prevention activities, but this will clearly need to be stepped-up in the face of the rising epidemic. The model of HIV incidence, for example, suggests that HIV prevalence will level off around 2004/5, yet it is hard to see why this would actually happen. Instead, the Botswana model of continued high HIV prevalence growth rates may continue. In this case, keeping HIV/AIDS on top of the political agenda will be instrumental to HIV prevention.
Full report in PDF
PDF files require Acrobat Reader.