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 KENYA
Liaison to Ethiopia

Kenya lies astride the equator on the eastern coast of Africa. Kenya is bordered in the north by Sudan and Ethiopia, in the east by Somalia, on the southeast by the Indian Ocean, on the southwest by Tanzania and to the west by Lake Victoria and Uganda.
 

Meet Our Liaison to Kenya

 


Kasuku Taiya

This 13 year old young girl has undergone the cut (Female genital mutilation) and if you look at the picture she has a bead headband that means that she now has successfully undergone the initiation and is ready to be married off, some one translated her fears to me and as you can see she is sad and afraid .
 

Her hope is to be rescued.  She really wants to go to school.  She will need to go to a boarding school far away from her community where other girl s like her are taken care of and her annual educational, and other budget needs, including school uniform, tuition fees, and boarding charges will about $700.

 

I hope God can prepare someone to sponsor her so that she can achieve her dream of going to school.

 
 
Regards Grace Kingatua, Director - AAVIA Kenya
Facts and Figures

Official Name Republic of Kenya.

Capital City Nairobi.

Languages English (official), Kiswahili (official), numerous indigenous languages.

Official Currency Kenyan shilling (KES).

Ethnic Groups Kikuyu 22%, Luhya 14%, Luo 13%, Kalenjin 12%, Kamba 11%, Kisii 6%, Meru 6%, other African 15%, non-African (Asian, European, and Arab) 1%.

Religions Protestant 45%, Roman Catholic 33%, indigenous beliefs 10%, Muslim 10%, other 2%. Note: a large majority of Kenyans are Christian, but estimates for the percentage of the population that adheres to Islam or indigenous beliefs vary widely.

Population 31,138,735. Note: estimates for this country explicitly take into account the effects of excess mortality due to AIDS; this can result in lower life expectancy, higher infant mortality and death rates, lower population and growth rates, and changes in the distribution of population by age and sex than would otherwise be expected (July 2002 est.).

Land Area  566,970 sq km (218,907 sq miles).

 

History

Founding president and liberation struggle icon Jomo KENYATTA led Kenya from independence until his death in 1978, when President Daniel Toroitich arap MOI took power in a constitutional succession. The country was a de facto one-party state from 1969 until 1982 when the ruling Kenya African National Union (KANU) made itself the sole legal party in Kenya. MOI acceded to internal and external pressure for political liberalization in late 1991. The ethnically fractured opposition failed to dislodge KANU from power in elections in 1992 and 1997, which were marred by violence and fraud, but are viewed as having generally reflected the will of the Kenyan people.   President MOI stepped down in December of 2002 following fair and peaceful elections. Mwai KIBAKI, running as the candidate of the multiethnic, united opposition group, the National Rainbow Coalition, defeated KANU candidate Uhuru KENYATTA and assumed the presidency following a campaign centered on an anticorruption platform.


 


AIDS Orphans in Kenya between the ages of 13-18years

AIDS Orphans in Kenya

PowerPoint Presentation

 By: Maureen Waithaka

PHS 508- Colloqium

College of public Service  Jackson State University

Jackson, Mississippi

United States

 Summer 2007

Definitions:

 

AIDS

Acquired Immene Dificiency Syndrome

 

A child

Any human being under the age of 18 years

 

An orphan

A child who has lost one or both parents (as a result of death)

 

Maternal orphan

A child who has lost his or her natural mother (as a result of death)

 

Paternal orphan

A child who has lost his or her natural father (as a result of death)

 

Double orphan

A child who has lost both natural parents (as a result of death)

 

A child orphaned by HIV/AIDS

 

A child whose mother, father, or both parents have died of HIV/AIDS

Vulnerability

A heightened or increased exposure to risk as a result of one’s circumstances

 

Duty bearer

Any person or institution, including the State, with responsibility for the welfare of a child

 

Care giver

A parent or guardian who is charged with responsibility for a child’s welfare – including comfort, upbringing, guidance, provision of basic rights and realizing human rights

 

Service provider

An individual employed or attached to a formal institution that provides professional care or services, such as teachers in school, nurses and doctors in health care facilities

 

Gender

A set of characteristics, roles and behavior patterns that distinguish women from men – socially and culturally

 

Stigma

The holding of derogatory social attitudes or cognitive beliefs, the expression of negative effect, or display of hostile or discriminatory behavior towards members of a group, on account of their membership of that group

 

Discrimination

An action based on a pre-existing stigma; a display of hostile or discriminatory behavior towards members of a group, on account of their membership of that group

 

Succession planning

Mechanisms for parents to give instructions on economic, legal, emotional and practical matters that affect the lives of their children

 

  

Abbreviations and Acronyms:

 

HIV

Human Immuno-deficiency Virus

AIDS

Acquired Immune Deficiency Syndrome

UNAIDS

Joint United Nations Program in HIV/AIDS

KANCO

Kenya AIDS NGOs Consortium

KICOSHEP

Kibera Community Self-Help Program

UNDP

United Nations Development Program

UNICEF

United Nations Children’s Fund

KNASP

Kenya National HIV/AIDS Strategic Plan

NACC

National AIDS Control Council

KAWI

Kenya AIDS Watch Institute

ARVs

Antiretorviral

NGOs

Non-Governmental Organizations

CBOs

Community Based Organizations

GoK

Government of Kenya

FBOs

Faith Based Organizations

KDHS

Kenya Demographic Health Survey

MoH

Ministry of Health

VCT

Voluntary Testing Center

MTCT

Mother –To-Child -Transmission

OVC

Orphans and Vulnerable Children

ERS

Economic Recovery Strategy

CORPs

Community- Owned Resource Persons

 CHEWs

Community Health Extension Workers

  

             I.      Introduction.

HIV/AIDS in Sub-Saharan  Africa.

Although HIV (Human Immune-deficiency Virus) has reached nearly every part of the world, Sub-Saharan Africa has been hit the hardest. Sub-Saharan Africa is home to approximately 2/3 rd of the world’s people living with AIDS. According to the statistics compiled by UNAIDS office in Kenya, looking at  Fig 1, at the HIV prevalence trends in Africa from 1985 to 2005, the overall number of people living with HIV is  24.5million or 64% of the population  in Sub-Saharan Africa,  where 54% of this population are women and 9% are children (below 15 years of age).

Prevalence rates are seen to be levelling out but the number of new infections (incident rates) is seen to be increasing with population growth, as a result of the introduction of  antiretroviral drugs (ARVs) into the health care sectors, where they are distributed to the general population through government hospitals and community clinics and priced reasonably to allow every person the capability to be able to afford the drugs , thus having access to the drugs. AIDS is a leading cause of death among adults between the ages of 15-59 years ( UNAIDS estimates, 2006).

 

Fig 1.

 

 

Source : UNAIDS estimates, 2006

 

Sub- Saharan Africa is home to approximately over 48 million orphans, where 12 million of these orphans are as a result of the AIDS epidemic i.e. children between the ages of 0-17 years have lost one or both parents to AIDS ( UNAIDS estimates, 2006). 

 

          II.      World Wide View of HIV/AIDS.

The total number of orphans between the ages of 0-17 years from all causes in Asia, Latin America and the Caribbean has decreased since 1990 and projected to 2010, yet the number of orphans between the ages of 0-17 years from all causes in Sub-Saharan Africa has risen by approximately 50 per cent from 1990-2010 i.e. 1990 there were approximately 35 million orphans, in 1995 there were approximately 30 million orphans, in 2000 there were approximately 40 million orphans,  and in 2005 there were approximately  50 million orphans. It has been projected that by 2010 there will be approximately 56 million orphans (UNAIDS and UNICEF estimates for 2006).

 

Fig 2.   Number of orphans between the ages of 0-17 years by region, 1990-2010.

  

 

?/font>      It is important to note that there are wide variations across the Sub-Saharan African region in proportion of orphaned children, in HIV prevalence and in the role AIDS is playing in overall orphaning levels.

Fig 3.   Percentage of Children in Sub-Saharan Africa between the ages of 0-17 years, orphaned by any cause, 1995 and 2005

 

 

?/font>      In Kenya in 1995 the percentage of orphans was between 0-9 percent, a number that has gradually increased to 10-14 percent over the last 10 years i.e. in 2005

( UNAIDS and UNICEF estimates, 2006). 

       III.      Situational Analysis  of HIV/AIDS in  Kenya.

The first case of AIDS was observed in mid 1980s. The first recorded case of HIV /AIDS was in 1984 (KICOSHEP Training Manual, 2004). HIV/AIDS was declared a national disaster by the former President of the Republic of Kenya, Daniel Arap Moi on 25 November 1999.  Estimates indicate that 2.2 million people were infected with HIV/AIDS by the year 2003 and 1.5 million people have already died from AIDS related illness leaving behind 800,000 orphans. The prevalence rate of AIDS is 13 per cent and approximately 700 people die each day from AIDS related illness ( KICOSHEP Training Manual, 2004).           

  1. HIV/AIDS in Children in Kenya.

?/font>        20 per cent of the Kenyan population is < 6 years and younger

?/font>        48 percent of the population is < 15years of ages.

?/font>        Over 53 per cent of Kenyans live in absolute poverty. This means that many children – 8.6 million – live below the poverty line

( Central Bureau of Statistic, Demographic and Health Survey, 2003).

        IV.      Definitions

An Orphan:

An orphan is a child under 18 years of age whose mother, father or both parents have died from any cause. 

There are 4 types of orphans from all causes:

1.      Single orphan- a child who has lost one parent

2.      Double orphan- a child who has lost both parents

3.      Maternal orphan- a child whose mother has died (includes double orphans)

4.      Paternal orphan – a child whose father has died (includes double orphans)

(African Orphaned and Vulnerable Generations, 2006).      

 

An AIDS Orphan:

This is a child under the age of 18years, whose mother, father or both parents have died from AIDS (AIDS related illness)

 

           V.      How HIV/AIDS infects Kenyan  Children.

Children born to HIV infected mothers risk infection during pregnancy, labor, vaginal  delivery and breastfeeding. In 2002, 300 children were born infected with HIV. Older children are also vulnerable to HIV infection i.e. 18 percent of young women are infected with HIV within 2 years of becoming sexually active ( National AIDS Control Council (NACC) report, 2002).   

  1. Mother-To –Child- Transmission (MTCT)

Out of the 900,000 children orphaned by HIV/AIDS in Kenya, approximately 78,000 from  0 to 14 years of age were as a result of are mother- to- child transmission (MTCT) i.e. it occurs when a woman infected with HIV  passes the virus to her baby during pregnancy - prenatal transmission- when a child is born to a HIV positive woman, the child will test positive for HIV antibodies whether on or the child is actually infected because of the presence of the woman’s antibodies in the baby’s blood); during  labor and vaginal delivery (though surgical delivery (caesarean section) significantly reduces the risk of MTCT, but is technically and financially intensive and not always realistic in resource for the poor settings) and during breastfeeding- though a recent study in South Africa found that babies who were exclusively breast fed for exactly 6 months were less likely to become infected with the HIV virus within the first 3 months  than those who had mixed feeding – breast milk and formulae feeding. Thus exclusive breast-feeding appears to protect the baby when compared to mix feeding ( National Policy on Orphans and Vulnerable Children, 2005) .

Other factors to consider in relation to breastfeeding, is the duration of breastfeeding. Research has found that the longer a baby is breast fed by a HIV positive mother i.e. less than 6months, the higher the risk of HIV transmission from breastmilk. Also oral lesions in the baby’s mouth or lesions on the mother’s breast will increase the risk of transmission due to the increased port of entry for the virus and exposure to blood;  gastrointestinal illness prevalent in the baby- a weakened gut, will increase the portals of entry for the virus found in breast milk in a baby who is breastfeeding. 

  1. MTCT Statistics in Kenya.

The risk of HIV transmission is:

?/font>        approximately 5 to 10 per cent during pregnancy.

?/font>        approximately 10 to 20 per cent during labor and  vaginal delivery.

?/font>        approximately 10 to 20 per cent during breastfeeding.

?/font>        When no preventive measures are taken, the overall risk for MTCT among women who are HIV positive is approximately 15 to 35 per cent.

?/font>        It has been estimated that 30 to 40 per cent of babies born to HIV infected mothers will be infected.

?/font>         In 2004, approximately 100, 000 children under the age of 5 years were infected

( National Policy on Orphans and Vulnerable Children, 2005)  

        VI.      How HIV/AIDS Affects Children in Kenya.

Children are vulnerable long before their parents die. Children are profoundly affected as their parents fall sick and die from HIV and AIDS related illnesses. Kenyan Children are affected by HIV and AIDS both directly and indirectly  because they suffer psychological stress and trauma. In 2003 there were approximately 1.78 million orphans of which approximately 50 per cent of the orphans was due to HIV/AIDS.  This number is expected to increase to 2.3 million by 2010 ( National estimates of HIV/AIDS in Kenya, 2003-2004). 

In addition, parental illness and death may rob children of their inheritance and above all of parental love, care and protection. Girls, in particular, assume caring responsibilities for ailing parents and parenting responsibilities for their siblings 

  1. Direct  affection of children by HIV/AIDS.

Factors include:

1.      Child living in high risk of HIV infection areas- in poverty stricken areas

2.      Higher dependency ratios

3.      Property Dispossession of orphaned Children.

4.      Stigmatization, discrimination and isolation

5.      Psychological Distress

6.      Educational Status of Children In Kenya.

7.      Malnutrition and Illness. 

  1. Child living in high risk of HIV infection areas- in poverty stricken areas.

This is in households where there is a lack of economic power i.e. money,  to buy the basic needs and necessities. In such homes economic hardships are experienced. With the family’s source of economic support threatened and savings spent on care, the household’s capacity to provide for children’s basic needs decline. Most of these households are forced to rely on the extended family or community for support. But support from family, neighbors and community members may not be sustainable thus are forced to look for alternative methods to make ends i.e. prostitution- where both men and women enter into sex work or form temporary relationships to barter sex for economic survival; drug use and abuse areas drugs are used for recreational purposes, and children are forced to take on the responsibility of supporting the family.

A child living with chronically ill parents or caregivers are worse off in regard to possession of basic material goods (a blanket, shoes and an extra set of clothes) than other children ( Chatterrji, Minki, et al, 2005. In most situation like these the children  are required to work or put their education on hold as they take on household and care giving responsibilities; by diminishing household wealth- living in households that experience greater poverty because of the disease.     Recent studies in Malawi, Mozambique and Swaziland have documented the declining wealth of households as a result of AIDS. As a household member becomes ill, medical care and other expenses increase- ARVs (Anti-Retro Viral drugs) and funeral arrangements and services, while both the ability to work and the capacity to generate income are likely to decrease. This means that more money is spent caring for the sick member leaving fewer resources for the children in the household. Even after death, funeral expenses reduce the financial resources available to the household (Seaman, et al, 2005). 

What is being done in order to deal with poverty in Kenya?

a)      By the Government of Kenya (GoK).

Under the Kenya National HIV/AIDS Strategic Plan (KNASP) 2005/6- 2009/10, poverty reduction and driven economic growth are the two main objective of   Kenya’s Economic Recovery Strategy (ERS) In Kenya, it has been widely accepted that HIV/AIDS has major economic and social impact on individuals, families, communities and on society as a whole. AIDS threatens personal and national well-being of the population by affecting health, lifespan, productive capacity and its transfer between generations. It is the most serious impediment to economic growth and development ( Bell, et al, 2006).

The impact of HIV/AIDS on economic growth and development coupled with the direct impact of increased mortality and morbidity on the lives of the poor makes HIVAIDS a threat to poverty reduction efforts. 

b)      Poverty Reduction Efforts include:

?/font>        The productivity of the agricultural sector, upon which majority of the population rely on for their livelihoods. It suffers from negative impacts on the supply of labor, crop production, agricultural extension services, loss of knowledge and skills, and personal trauma in the form of death. Commercial agriculture is a major source of employment and foreign earnings but us currently being affected by increasing health costs, morbidity and mortality of its workers as a result of HIV/AIDS. Consequences include reduced household and community food security and decline in nutritional and health status of small-scale farmers and families.  

A study in 4 provinces in South Africa found that households with an AIDS related death in the past year spent an average of 1/3 rd of their annual income on a funeral ( Bell, et al, 2006).

Findings from these studies have reconfirmed the complex interrelatedness of HIV, poverty and economic influences.The National Policy on Orphans and Vulnerable Children  covers all children defined as orphaned  and vulnerable, thus under its policy objectives, it ensures that orphans and vulnerable children have basic survival needs, an din doing so protects all children under this policy. This policy advocates for a child’s right to food. ( National Policy on Orphans  and Vulnerable Children, 2005).

 

  1. Higher dependency ratios.

It occurs in households with orphans in grandparent headed households. The dependency ratio is the number of children between the ages of 0-17 years plus adults over the age of 60 years divided by the number of adults aged 18-59 years. The ratio indicates the number of people in the household who must rely on each adult for food security and livelihood.

Fig 4.   Average dependency ratios among households with and without orphans.

  

 

Calculation f the dependency ratio:

The dependency ratio is defined as the number of individuals ages 0-17years or 60 years and older, divided by the number of individuals ages 18-59 i.e.    

# Of people in the household 0-17 years old or >60 years old

                                    __________________________________________________

           

                                    # Of people in the household between 18-59 years old

 

Results from the graph:

Looking at Fig 4 , for all African regions, the dependency ratio of households with orphans compared to the household without orphans is higher i.e. for the Eastern Africa region, The dependency ratio for orphans is approximately 1.6. This means that for each productive adult, there are 1.6 people who must be supported, where are the dependency ratio for non-orphan household is 1.5. This means that for each productive adult, there are 1.5 people who must be supported.

Fig 5.    Average dependency ratios in female-and –male-headed households with double orphans.   

 

Calculation f the dependency ratio:

The dependency ratio is defined as the number of individuals ages 0-17years or 60 years and older, divided by the number of individuals ages 18-59 i.e.    

# of people in the household 0-17 years old or >60 years old

                                    __________________________________________________

                                    # Of people in the household between 18-59 years old

Results from graph:

Looking at Fig 5, the average dependency ratios for male headed household and female headed household  in every country depicted here, female headed household tend to have more orphans in their care than male- headed households, This is  because women are more likely to take care of their own children and are also more likely to take care of orphans because of the nurturing and caring aspect that comes from a woman and not normally displayed by men because of cultural beliefs and norms. In Kenya in 2003 the average dependency ratios in female-male headed household for double orphans was 2.6 Vs 2.0 respectively (Demographic and Health Surveys (DHS) for Kenya, 2003). 

  1. Property Dispossession of orphaned Children.

Fewer people in poorer communities in Kenya make official wills. This increases the risk that a deceased person’s property will simply be taken by family members or by other members of the community. It is in these ways that orphans are often deprived of money or property that is rightfully theirs. Studies have documented the problems orphans face with dispossession.  

a)      What is being done in order to address property rights and children?

The National Policy on Orphans and Vulnerable Children is intended to promote and protect the rights of all children, with special emphasis on those who are orphaned and/or vulnerable.

?/font>        Within the Kenyan Health sector, the Public Health Act, Cap 242, places an obligation on parents to ensure that their children are immunised and allows schools to refuse entry to children who have not had the proper immunisations.  There are also a number of health programmes that specifically ensure access to health services and make provision for children’s well being (National Policy on Orphans and Vulnerable Children.2005)

?/font>        In terms of succession, the Law of Succession Act, Cap 160, governs matters of inheritance, succession and the administration of the estates of deceased persons.  It secures the inheritance rights of orphans and vulnerable children (OVC) by providing that property left behind for double orphans (where there is more than one) devolves to them in equal shares; regardless of the sex of the orphans.  It further provides that where there are surviving children, the estate cannot be administered by only one person.  This checks possible wastage of the estate (National Policy on Orphans and Vulnerable Children.2005)  

a.      Limitations to Law of Succession Act, Cap 160

Although the country’s legislative inheritance rights for adults is very progressive, the inheritance rights for children is still in the formulation stage and has yet to be fully implemented through the enactment of the Children Act, 2001, “ An ACT of Parliament to make provision for parental responsibility, fostering, adoption, and protection of children; to make provision for the administration of children’s institutions; to give effect to the principles of the Convention on the Rights of the Child and the African Charter on the Rights and Welfare of the Child and for connected purposes”. 

  1. Stigmatization, discrimination and isolation

AIDS Orphan are disposed because of their association with a person living with HIV and /or by becoming orphans when they lose one or both parents to AIDS related illness. There is evidence that orphans may experience discrimination within a household i.e. children orphaned by AIDS are more likely to be rejected by extended family members than those orphaned due to other causes - It documented that  51 % of a study in Mozambique showed discrimination against children within poor households in the allocation of resources, especially if the children were not direct biological descendants of the household head ( Nhate, Virgulino, etal, 2006).

In a qualitative research conducted in Malawi and Lesotho, they found that children who had migrated to another household and had also experienced the death and sickness of a parent reported to being given different food from other children in the household, being beaten and overworked and having received inadequate clothing, especially when resources were scarce( Ansell, Nicola, et al, 2006).  Orphans are often moved form their original home to unfamiliar environments. 

a)      What is being done on order to curtail stigmatization, discrimination and isolation?

?/font>        Protection of human rights is an important part of improving the quality of life of the population infected and affected by HIVAIDS.  KNASP aims to promote the protection of the rights of people living with HIV/AIDS through a variety of initiatives i.e. Stigma reduction programs; strengthening the legal, policy and administrative framework for protecting the rights of the infected and affected by HIV/AIDS; advocating for the rights of people living with HIV/AIDS into the national human rights agenda and the programs of human rights organizations active in Kenya; building the capacity of people living with HIV/AIDS to advocate and protect their rights ; and  encouraging people living with HIV/AIDS whose rights have been violated to seek legal representation  through the legal system.(  Kenya National HIV/AIDS Strategic Plan (KNASP), 2005/6- 2009/10)

?/font>        Within the Judiciary a Strategic Plan serves as a blueprint for the improvement of the Judiciary’s efficacy in the performance of its mandate of the due administration of justice in the country.  One of the objectives of the plan is to ensure that Kenyans, including children, have access to justice and that there is timely resolution of disputes with equality, fairness and integrity (National Policy of Orphans and Vulnerable Children, 2005)  

a.      Limitations to the Judiciary

?/font>        Information, education and communication materials are not locally adapted to the local language and situation.

?/font>        People living with HIV/AIDS are still stigmatized.

?/font>        Negative cultural, socioeconomic and religious ideologies and practices.

?/font>        Inadequate child-friendly support groups. 

         5.        Psychological Distress

The illness and death of a parent from AIDS is a traumatic experience for each child left behind. These children experience anxiety, depression, lose out on education (illiteracy), at a greater risk of HIV and other infections from exploitation and abuse. The full impact of a parent’s death is largely determined by each child’s circumstance i.e. the wealth of the household and community; the child’s relationship to caregivers and the age of the child during their parent’s illness and death. 

 6.  Lack of Love, Attention and Affection

The loss of a parent often means that an orphan (single or double) is deprived of interpersonal and environmental stimulation and individualized affection and comfort. They are left without a consistent responsive care.

a)      The impact of children living with chronically ill parents.

AIDS affects children long before parents die. The effects often begin with the onset of the parent (s) illness i.e. impoverishment; emotional suffering; neglect; increased burden of responsibility associated with a parent’s illness; and the stigma, discrimination and ostracization associated with HIV that isolates and demeans a child. 

   7. Educational Status of Children In Kenya.

Less1 million children have been enrolled for school, since the introduction of free primary education (FPE) in January 2003 – there are 7.2 million children in primary school. Of these, 1.2 million children (17 per cent) of currently enrolled children are orphans; drop out rates in primary school are 5.4 per cent And, of all children, 92 per cent of children with both parents alive are in school, whereas 88 per cent of children who have lost both parents are in school (National estimate of HIV/AIDS in Kenya in 2003- 2004)  

           8.         Withdrawal From School.

Economic pressure and the responsibilities of caring for their parents and siblings can lead to children to withdraw from school, even while their parents are still alive.

An analysis based on 19 Demographic and Health Surveys in 10 Sub- Saharan countries, found evidence of intra- household discrimination against orphans- it manifested itself through the investment of the caregivers in education. Orphans had the lower enrolment rates than non-orphans in the same household (Case, Anne , et at; 2006). An important concern in Kenya is that orphans will acquire less education because the amount of education available to the child is directly determined and influenced by the wealth of the household and community and the child’s relationship to caregivers. As a result, orphans experience different types of missed opportunities in education- lack of enrolment, interrupted schooling (missed school days and poor performance while in school).

             a)      What is being done in order to keep children in school?

The Kenya National HIV/AIDS Strategic Plan (KNASP) 2005/6- 2009/10, is to ensure that orphans have access to social services such as education.

Education is a fundamental right and keeping children in school has been shown to reduce the risk of acquiring HIV infection as well as of early marriage, early sexual involvement and female genital mutilation.

Child development involves a holistic approach, taking into consideration the physical, emotional, intellectual, spiritual and social aspects of child development.

a.      How NPOVC keep Children in School:

?/font>         Using schools, other learning institutions and education personnel to identify and support OVC.

?/font>         Ensuring that OVC are enrolled in and complete basic education.

?/font>         Strengthening alternative learning opportunities such as special schools.

?/font>         Establishing non-formal education options, especially an for working child, which does not compromise education standards and quality; and strengthening extra-curricula activities, in partnership with relevant Ministries, such as cultural activities.

?/font>         Initiating flexible schooling options and reviewing school attendance requirements, like uniforms.

?/font>         Strengthening support programs for OVC, including school feeding, health, bursaries, and sponsorship, shelter, care and protection.

?/font>         Extending the provision of bursaries for OVC to attend secondary schools even at constituency level, with due regard being given to gender.

?/font>         Providing textbooks, uniforms and essential female products as a way of removing barriers to access to schooling for OVC.

?/font>         Strengthening and supporting initiatives to achieve gender parity in education.

?/font>         Supporting HIV/AIDS mainstreaming into the school curriculum.

?/font>         Improving HIV/AIDS information access to OVC.

?/font>         Improving institutional capacity of existing schools in order to accommodate OVC.

?/font>         Strengthening education-related partnerships and redefining roles, such as those of the DCS in respect of bursary allocations (National Policy on Orphaned and Vulnerable Children, 2005).             

               Sectoral laws, policies and programs further define rights and access to specific services for children and OVC.  Within the Education sector, the Education Act, Cap 211, provides for the running of the education system and is currently in review to be in line with the policy of free primary education (FPE), which provides for access to primary education for all.  It also addresses the need to target hard-to-reach and marginalized children.  Other policies include the policy on re-entry to school of girl mothers, the secondary school bursary scheme and the policy on mainstreaming gender in non-formal education, together with special needs education. (National Policy on Orphaned and Vulnerable Children, 2005).

               Under Cultural norms and religious laws The Children Act, Cap 586, it safeguards the child from harmful cultural rites such as female genital mutilation and early marriage and the Law of Succession, Cap 160, contains a number of provisions that can be used to secure the inheritance rights of OVC (National Policy on Orphaned and Vulnerable Children, 2005) . 

9. Early Childhood Development (ECD) and education

         Access remains low with 65 per cent of children aged 3-6 years currently not accessing ECD services.  An estimated 62 per cent of children have birth registration documents (86% in urban areas; 56.1 per cent in rural areas) (National Policy on Orphaned and Vulnerable Children, 2005).

According to United Nations Educational Scientific and Cultural Organization’s (UNESCO) Senior Education Advisor, Dr. Susan N’Kinyangi, enrolment rates of orphans in school differ (disparities exist) compared to non-orphans and the situation is made complex by differences in enrolment between children from wealthier households and those from poor households, where children are under enrolled. Reasons for under enrolment of children are financially and gender-related- where in some households boys are still enrolled before the girls because of practice of cultural and traditional beliefs in relation to the role of a boy and girl in household as they are getting prepared for adulthood, where eventually a boy will automatically inherit the breadwinner role of the household and the girl will assume the housekeeper role of the household, a practice that is passed generationally from woman to girl in an informal setting and practice that does not require one to have to attend formal education.

It is important to note that missed opportunities for education begins prior to death of a parent and even before the onset 

a)      What is being done in relation to Early Childhood Development (ECD) in AIDS orphans?

As education should begin at an early age, strategies to increase access to ECD, particularly at public ECD centers, will be undertaken, such as: 

?/font>         Reducing the cost of ECD, with the ultimate aim of ensuring that ECD becomes a component of free education.

?/font>         Establishing mobile ECD centers (such as at watering points for pastoral communities) and prison-based and hospital-based ECD centers.

?/font>         Establishing ECD centers for children living or working on the streets and OVC-friendly ECD programs.

?/font>         Integrating ECD into religious and cultural systems.

   (National Policy on Orphaned and Vulnerable Children, 2005).

10.       Malnutrition and Illness.

Child Health status.

According to National estimate of HIV/AIDS in Kenya in 2003- 2004, 30 per cent of children <5 years old are stunted, and 6 percent suffer from wasting away of muscles and tissue. Infant mortality is 77 per 1 000 live births and under-5 mortality is 115 per 1 000 live births. 55 percent of children aged between 12 and 23 months are fully vaccinated  and malaria kills 26,000 children every year (National Policy on Orphaned and Vulnerable Children, 2005).Harmful traditional practices persist – 32% of girls and women are circumcised.

According to UNAIDS Workplace Coordinator, Mr. George Wainaina, the impact of AIDS in children is directly associated to the vicious cycle of poverty i.e. poverty affects a child’s ability to go to school and to attend classes on a daily basis. Poverty affects a child’s ability to acquire skill training that is compromised every time a child misses a school day. Poverty affects a child’s ability to have access to healthy nutrition that ward of growth retardation and malnutrition that in turn affects a child’s health status and life expectancy. 

a)      What is being done in order to meet the nutritional needs of orphans?

         Under the National Policy of Orphans and Vulnerable Children, 2005, The National Policy on Food Security, has been implemented to provide for improved agricultural inputs, strategies to improve nutrition and the establishment of safety nets that are essential for food security (National Policy on Orphaned and Vulnerable Children, 2005). 

11.       Child Labor

According to National estimate of HIV/AIDS in Kenya in 2003- 2004, Nationally 1.3 million children (aged 5 to 17) were engaged in child labor in 1998/9; most in commercial and subsistence agriculture, fishing and domestic services.  The majority of working children are aged 10-14 years; with the highest proportions found in the Coast, Eastern and Rift Valley Provinces (19-19.8 per cent).

Orphans are vulnerable to children- without parents to educate and protect them, and face increased risk of abuse and HIV infection because many of them are forced into harmful child labor and /or sexually exploited for money or to obtain protection-shelter and food. Up to 6 million Kenyan children require special care and protection – 40 per cent of the country’s total child population.

Under the Labour sector, the Employment Act, Cap 226, it acknowledges the issues of child labour and sets out rules in respect of the employment of children, such as in industrial undertakings, and prohibits the employment of children in certain places (National Policy on Orphans and Vulnerable Children, 2005).

  1. What is currently being conducted in order to address physical, sexual and emotional exploitation and abuse among orphans?

Under The Children Act, Cap 586, it provides extensive protections for children through the following areas: 

?/font>         Government and the family are responsible for the survival and development of the child (505).

?/font>         Child participation and non-discrimination are entrenched (506).

?/font>         A child has the right to live with and be cared for by his/her parents.

?/font>         There is a provision for parental responsibilities.

?/font>         Children are entitled to a basic education – which is free and compulsory.

?/font>         The right to health and medical care is secured.

?/font>         Protection from economic exploitation, hazardous work or work that interferes with education and armed conflict is provided.

?/font>         There is provision for alternative parentage – guardianship, foster care placement and adoption.

?/font>         Protection from physical and psychological abuse, neglect and other forms of exploitation is explicitly stated, as is protection from harmful cultural practices and rites.

?/font>         A child’s right to privacy (subject to parental guidance) is guaranteed.

?/font>         Ways of dealing with child offenders within the juvenile justice system are provided for.

?/font>         Finally, the duties and responsibilities of the child are detailed

(National Policy on Orphaned and Vulnerable Children, 2005). 

  1. Indirect affection of children by HIV/AIDS.

Indirect affection occurs when the communities and services these communities provide are strained by consequences of the AIDS epidemic i.e. doctors and nurses may become infected with HIV and thus suffer from AIDS related illnesses. This threatens healthcare and health services by reducing staff productivity and resources. The healthcare system may also be overwhelmed with new patients from new incidences of HIV infection among the population, thus disrupting services that would have been delivered to the children i.e. teachers becoming ill will eventually disrupt the education process within the community. 

     VII.      Kenyan Family Structures.

The family structure in Kenya is such that 58 per cent of children < 15 years of age live with both their parents, 25 per cent live with their mothers (and not their fathers), 3 per cent live with their fathers (and not their mothers), and 11 per cent do not live with either of their parents (and are considered as “fostered”)( National estimate of HIV/AIDS in Kenya in 2003- 2004). 

  1. Grandparents in Kenya.

In Kenya, extended families – mostly grandparents have assumed responsibility of the AIDS orphans with little public support.  In Kenya 51 percent of double orphans and single orphans not living with the surviving parent are being raised by their grandparents (Evans and Amiel, 2005).

 

Fig 6.   Living situations of orphans and non-orphans. 

 

  

Fig 7.   Percentage of double orphans and single orphans (not living with surviving parent) between the ages of 0-14 years cared for by their grandparents.

  

?/font>      It illustrates the change in the proportion of orphans looked after by grandparents in 5 countries

 

B.        Female headed households in Kenya.

In Kenya up to 2/3 rds of paternal orphans stay with their mother, however a ?or fewer of maternal orphans live with the surviving father.  In Kenya, the percentage of orphans who have lost their mothers and are living in female- headed households has increased since the early 1990s ( UNICEF,2003). 

 

Fig 8.   Percentage of maternal orphans between the ages of 0-14 years living in female-headed household.

 

 

 

C.        Separation of Siblings.

Orphan siblings may be placed in different homes as a way of distributing the burden of care; however data on sibling separation is scarce.

 

D.        Child headed Households.

They are less than 1 per cent of in the countries listed here are headed by children under the age of 18 years ( Monasch, Roeland and Boerman).

This is due to the response of extended families. However that child- headed households that do exist can be expected to have greater needs and vulnerabilities than households headed buy an adult. Children in this situation may be less able to earn sufficient money, protect themselves, deal with the legal system or make good food decisions.

Fig 9.   Percentage of double Orphans and single orphans (not living with surviving parent) between the ages of 0-14 years, by relation to head of the household. 

 

 

E.         Extended Families.

These will continue to be the central social welfare mechanism in Kenya. Extended families will continue to face much pressure from a series of cataclysmic events that directly affect the ability to care for AIDS orphans i.e. they will experience an increase in burden of taking care of the orphans as more and more adults die and the number of orphans and vulnerable children increases. They will also experience a scarcity of resources to meet the needs of the orphans because as the number of orphans due to AIDS increases, the capacity of families, household and communities to take care of the orphans will be stretched and even to the breaking point. This situation is made more complex with the association of chronic poverty and adult HIV prevalence- extended over a long period of time. 

F.         Alternative Care.

Alternate care is in the form of aunts; uncles and grand parents acting as parental care givers and providers of the benefits and protection of the orphaned children.

When a single or both parents die, the child is denied love, nurturing, protection that is important in early child life developmental stages. Thus orphaned experience changes in environment - children are uprooted and moved to new homes or make multiple moves as a result of mistreatment and abuse and changes in the caretaker’s financial circumstances.

It is important to note that the relationship between a new caregiver and the child, strongly influence the outcome of the child. Studies have shown that the closer children remain to their biological family, the more likely they are to be cared for i.e. fostering arrangements are more likely to be more stable and satisfactory if the parent and foster caregiver had s close relationship prior to the onset of   fostering (Verhoef and Heidi, 2005). 

a)      What programs are in place in order to provide alternate care to orphans?

In Kenya, an example of a program that addresses this issue and currently being conducted is the interventional program initiated by Kenya AIDS Non-governmental Consortium (KANCO- is a premier national membership network consisting of over 870 members from non-governmental organizations, community –based organizations and faith-based organizations that have interest in HIV/AIDS activities in Kenya) called Memory Work- a community-based program intended to communicate about HIV/AIDS in the family. Under the direction of the Program Officer, Ms. Joyce Wangechi, the program is created to promote and improve communication between parents infected with HIV virus and their children- to improve understanding of child development and exploring children’s needs at different stages; to educate parent on parenting skills and promoting an understanding of positive relationships between parents and their children; to explore issues of disclosing HIV status and other important information - parents to actively be involved in the  preparation of their  children for the future;  to help parents prepare their children for the impact of separation and loss; to help parents and guardians prepare and plan for their children’s future with children participating in the process, and to explore aspects of new family relationships-for parents to select , prepare and introduce future caregivers to the children. 

b)      What is being conducted in order to address family structures and AIDS orphans?

Providing direct and indirect assistance can be a critical component of effective support to OVC.  Programs include:  

?/font>         Provide specific and appropriate support to child-headed households.

?/font>         Address caregiver issues – resources, skills, and support – especially if elderly.

?/font>         Support the integration of community-based care and support services, such as IGAs, feeding schemes, adult literacy, etc and utilize community members in the selection of beneficiaries (National Policy on Orphaned and Vulnerable Children, 2005).

 

VIII.    Dynamics of Orphaning in Kenya.

2 types of orphaning i.e. single orphan- a child who has lost one parent. (Maternal or paternal) and double orphan- a child who has lost both parents.

?/font>        Single orphans.

Presently, more single orphans have lost their fathers than their mothers because most men in Kenya have children when they are older (approximately > 35 years) thus are more likely to die before their children are grown.

?/font>        Double orphans.

The probability that if one parent is infected with HIV the other parent will also become infected is very high. This puts children at a high risk of losing both parents within a relatively short time( Africa’s Orphaned and Vulnerable Generations, 2006).

 It is important to note that because HIV can also be transmitted sexually and the prevalence of AIDS in women in increasing, these 2 factors increase the probability that both parents will be infected, thus causing the pattern of orphaning to shift and the number of double orphans to increase i.e. in 2005, in Sub-Saharan Africa there were 9.1 million double orphans. It has been projected that in 2010 the number of double orphans will be greater than 10 million. (Africa’s Orphaned and Vulnerable Generations, 2006). 

Fig 10.             The Number of Children in Sub-Saharan Africa, 0-17 years of age experiencing the death of a parent during the year.

 

?/font>      Given the lag time between the infection and death, the number of orphans may continue to increase as prevalence rates continue to remain high for years, even when the incident rates will have been stabilized.  

 

Fig 11.             The Number of double orphans in Sub-Saharan Africa between the ages of 0-17 years, AIDS Vs all other causes, 1990-2010.

 

Results from the graph:

Looking at Fig 11, AIDS epidemic has been gradually increasing over the years i.e. In 1990 was approximately 200,000 double orphans from AIDS, in 1995 approximately 750,000 double orphans from AIDS, in 2000 approximately 2.7 million double orphans, in 2005 approximately 5.2 million double orphan from AIDS and in 2010 it has been projected that there will be over 6.2 million double orphans from AIDS

 

Fig 12.             Number of children in Sub-Saharan Africa between the ages of 0-17 years orphaned due to AIDS, in 1990-2010.

 

  

Results for the graph:

Looking at Fig 12, it demonstrates a gradual increase in the number of children orphaned by the AIDS epidemic over the years

 

In Kenya, double orphans were found more often in the poorest households in 2003 than in 1998 ( UNAIDS and UNICEF estimates, 2006)

 

Fig 13.  Distribution of double orphans and non-orphans by household wealth, in Kenya, for 1998 and 2003.

  

IX.       Age of Orphans and Orphaning in Sub-Saharan Africa.

Four longitudinal research sites ( Kisesa, Tanzania;  Ifakara, Tanzania; Kilifi, Kenya; Hiabisa, South Africa) in 2005 provided information on the age of a child at the time of parental loss i.e. 40 per cent of children experienced death of a parent between the ages of 10 and 14 years; approximately 25 per cent of the 40 per cent experienced a parent’s death before they reached the age of 5 years ( Floyd, Skin, et al; 2005).  

Fig 14. Percentage of children by age at the time of parent’s death, in 4 districts in eastern and southern Africa.

 


 

 

 

 

 

 

 

It is important to note that because HIV is a sexually transmitted disease and the prevalence of AIDS in women is increasing, these 2 factors increase the probability that both parents will be infected, thus the pattern of orphaning is shifting and the number of double orphans is increasing.

It is also important to note that when planning a response that will effectively and efficiently meet the needs of orphaned children (orphaned from any cause), it is very important to take into consideration the age of orphans and the age at which the children are orphaned because it is only through the age factor that you will be able to determine their varied developmental stages – older orphans have a greater need to stay in school. Older orphans are at a higher risk of losing out on an education, thus are at a risk of being subjected to exploitative labor, being exposed to HIV and other sexually transmitted infections thorough physical and sexual exploitation. Younger orphans have a greater need for physical, psychological, emotional and social care and nurturing and are least resilient to exploitative behavior. 

X.        Orphans and their Environment.

In Kenya, the distribution of orphans within the country has been influenced by the following factors: In the past and present years, sickness and death from AIDS or other causes has prompted a migration of children and their families from rural to urban areas and vice versa. In 2003, the distribution of orphans in the country was fairly even i.e. 12 percent in urban versus 12 per cent in rural areas (Multiple Indicator Cluster Survey (MICS) and Demographic and Health Survey (DHS), 1999-2004) .

According to UNAIDS workplace coordinator, Mr. George Wanaina, a migration from urban to rural results from circumstances such as terminally ill parents going home to the village to die and when caring for orphans is seen as being much easier in the rural areas especially when the extended family members are resent there. A migration from rural to urban results from the economic pull of cities and the desire to escape stigma following AIDS death.  

XI.       Women’s Vulnerability and Risk in Kenya.

HIV rates by age and gender for 2001-2005 indicate that there is gender difference of HIV prevalence among males and females. The number of women dying from AIDS is higher. The number of women living with HIV/ AIDS has increased steadily. It is now one of the leading causes of death for women between the ages of 20 -40 years (NASCOP, AIDS in Kenya statistics, 2005).

According to UNAIDS Project Coordinator, Mr. George Wainaina, factors that govern the gender differences in AIDS prevalence in the country include social factors, biological factors, economic factors and political factors. These factors affect AIDS prevalence in women. These factors include:

?/font>        Social factors include gender inequality- this is where a woman is often expected (by cultural norms and normative beliefs) to remain monogamous, yet being married often places them at a much higher risk of infection because men are not expected to be monogamous and in some cases are encouraged to have multiple partners. Also a woman’s lack of power within sexual relationships makes it difficult for the woman to negotiate safe sex with her partner (s) thus has little control over her body because of the little decision making power she has. Cultural traditions such as female genital cutting expose and increase the risk of infection from HIV if the cutting instruments have not been properly sterilized. Cultural norms often deny women knowledge of their own sexual health. Female to male ratio in Kenya is 1.9:1 thus polygamous relationships are greatly encouraged within some communities in adherence to traditional and cultural beliefs, values and practices.

?/font>        Biological factors include the age of women. Young women between the ages of 12-24 years are at high risk of HIV infection because their immature cervical tissues may be readily permeated or damaged during sexual intercourse and thus act as sponges for the absorption of the HIV virus. Older men between the ages of 15-50 years are having sex with younger women between the ages of 12-25 years (UNAIDS estimates, 2006)

?/font>        Economic factors include gender inequality coupled with lack of economic power forces a woman to enter sex work or to form temporary relationships to barter sex for economic survival.

?/font>        Political factors include lack of decision-making power for women in Kenya. 

In Sub- Saharan Africa, there are 3 women living with HIV for every 2 infected men. This discrepancy is much wider among the young people between the ages of 15-24 years- at the start of their reproductive years, where there are 3 women are living with HIV for every 1 infected man. ( NACC, 2005).

XII.     A Look at Addressing the Whole Child 

Government Initiatives

orphaned and made What is the Government of Kenya (GoK) currently doing  in relation to  AIDS orphans?

Responding to the needs of children vulnerable by AIDS requires an understanding of a wide range of possible impacts and variables. Thus no single government or agency can effectively respond to the myriad of problems created by this epidemic, but by using together in a creative coordinated way- with one agenda, the country, the continent, the world can take giant steps into the right direction.

Thus the national response was formed -in 1995 by  the Government of Kenya (GoK) declared HIV/AIDS , when it declared  HIV/AIDS in the country as a national disaster and established the National AIDS Control Council (NACC) to facilitate and coordinate the development of the Kenya National HIV/AIDS Strategic Plan (KNASP) for 2000-2005. This plan set out the multi-sectoral response to the epidemic, jointly agreed upon by stakeholders within the government, civil society, the private sector and development partners.  Thus Kenya adopted the multi-sectoral approach in 1999 under the KNASP and the National AIDS Control Council was created to coordinate it.

 

  1. About Kenya National HIV/AIDS Strategic Plan  (KNASP) 2005/06-2009/10

Purpose.

For the successful implementation of multi-sectoral response to HIV/AIDS 

  1. KNASP is in response to:

?/font>        Increase in incident rates of HIV infection.

?/font>        Young girls being vulnerable to HIV infection.

?/font>        Individuals in HIV discordant relationships

?/font>        Rising cumulative deaths from AIDS

?/font>        Impact of AIDS in orphans, vulnerable children, widows and elderly.

?/font>        High levels of poverty.

?/font>        Commercial sex workers and their clients

?/font>        Migrant workers.

?/font>        Injecting drug users 

C.        Intention of KNASP

?/font>        To ensure effective engagement and participation of all stakeholders in the design, implementation and monitoring of strategic interventions.

?/font>        To ensure that vulnerable and underrepresented groups –such as people living with HIV/AIDS, women, children, people with disability, nomadic and paternalistic groups are empowered to make effective and constructive contribution 

 D.       Challenges that  KNASP  will face:

?/font>        currently being experienced in the implementation of one national strategic plan:

?/font>      At the conceptual level: The national strategic plan is jointly owned by all stakeholders in the national response, thus because of this broad ownership, it is difficulty to establish an authority that is equitable in respect to all stakeholders.

?/font>      At the practical level: attempting to develop an implementation plan for all intervention under KNASP is very complex, time consuming and would duplicate planning processes already in place within many implementing agencies already engaged in the national response. 

E.         Challenges in implementation of KNASP 2000-2005

In order for them to protect the child, there is a need for clear national guidelines on breastfeeding, vaccinations, treatment of pregnant women who are HIV positive and care and support for HIV/AIDS orphans from an early age. 

Non -Government Initiatives:

A.   What are Non- Governmental Organizations  (NGOs) in Kenya currently doing  in relation to AIDS orphans?

They have:

?/font>        Set up initiatives that have been at the front of the campaign against HIV/AIDS in women and children. Funding for these organizations is mainly from donors. NGOs have made significant contributions towards the fight against AIDS pandemic i.e. a membership of over 600 NGOs

?/font>      NGOs in Kenya operate under the Kenya AIDS NGOs Consortium Organization (KANCO), implementing agency for the UNDP/AIDS and development of projects. 

B.   What are Faith Based Organizations (FBOs)  in Kenya currently doing  in relation to AIDS orphans?

They are the churches. Churches in Kenya are currently being challenged by the increasing incidence in HIV/AIDS.

They are:

?/font>        Currently reexamining their traditions, their way of thinking and their communication skills to the people. Currently in the churches, discussion about sexuality has not been common, neither has it been common practice in the homes. But the traditional ways of preparing the adolescents for adulthood are gradually disappearing with urbanization and cultural change. The churches have now been faced with abandoning its traditional approach to discussing sexuality to addressing the issue directly. 

C.   What are Community Based Organizations (CBOs)  in Kenya currently doing  in relation to AIDS orphans?

They are smaller than NGOs.

They have:

?/font>        Formed partnerships with Gok, NGOs, FBOs  and Civil societies  to address the needs of the communities in which they are based in i.e. in. They are mainly formed to address a particular problem rather than a wide range of problems. 

XIII.    Evaluation of current Programs in Kenya.

A review of reports prepared by civil society groups (NGOs, CBOs and FBOs) showed that a number of obstacles and constraints have been implicated for the current Kenya National HIV/AIDS Strategic Plan:

In the Following 7 areas:

1.      In Prevention and Advocacy.

2.      In Treatment, Continuum of care and Support

3.      In Institutional arrangements, managements and coordination

4.      In Mitigation of Socio-economic impact.

5.      Community Empowerment

6.      Human Resource and Development.

7.      Evidence-based Interventions 

  1. In Prevention and Advocacy.

Limitations.

?/font>        Information, education and communication is not locally adapted to local language and situation- dilutes that purpose of desensitization on HIV and AIDS among the various ethnic groups that form the Kenyan population, thus reducing stigmatization, discrimination and isolation experienced by HIV positive people and children, friend and relatives associated with HIV positive persons.

?/font>        Female condoms not available in rural areas and vulnerable groups do not have access to condoms especially in rural area - this will not help in reducing the incident rates of HIV infection that is currently increasing among women in Kenya. It does not help to prevent and protect women for becoming pregnant and also transmitting the HIV virus to their unborn child.

?/font>        Inadequate Voluntary Testing Centers (VCT) sites.

Lack of fully equipped testing centers due to mismanagement of resources, abuse of funds and reduction of resources without replenishing on-time has lead to lack of knowledge about one’s status before engaging in sexual contact with other partners. This has contributed towards the increased incidence of HIV infection among Kenyans, especially within the population in its reproductive years- i.e. 21-35 years. 

  1. Treatment, Continuum of care and Support

Limitations

?/font>        Appropriate drugs for opportunistic infections not available in kits administered to children at the health facilities and at the orphanages

?/font>        Stocks out of blood for transfusion in hospitals due to donor reluctance.

?/font>        ARVs not available or accessible for the children

?/font>        Lack of Test kits for HIV/AIDS in children health facilities and orphanages.

?/font>        Lack of community involvement in the care and support of people and children living with HIV/AIDS.

?/font>        Poor referral networks to hospitals for AIDS sick children 

3.         Institutional arrangements, managements and coordination

Limitations

?/font>        Inadequate financial resources, infrastructure and institutional capacity – within orphanages.

?/font>        Duplication of activities and wastage of resources.

?/font>        Political interference in program activities at the constituency level- corruption and bribery ensues in order to get services carried out at the orphanages.

?/font>        Poor procurement system for supplies- reagents to test for HIV, medication, cleaning supplies and toiletries at orphanages

?/font>        Poor coordination of program activities at the community level – including poor financial tracking system.

?/font>        Large NGOs not willing to share resources with small CBOs and civil society organizations- Orphanages suffer the most in this area, and mostly are forced to depend on funds from donors and well wishers.

?/font>        Transportation Sector not adequately involved in HIV/AIDS activities- there are no designated vans or buses to transport people to and from the health facility, a contract that need to be drawn up between the health sector and transportation sector or a privately owned transportation company that contracts with various health institutions to offer services to its patients and clientele at a standard fee.

?/font>        Mistrust, competition, suspicion and unwillingness to share information among different groups at all levels.

?/font>        Poor geographical coverage of interventions due to vastness of some regions. 

4.         Mitigation of Socio-economic impact.

Limitations

?/font>        High poverty levels and unemployment.

?/font>        No programs targeting orphans in rural areas

?/font>        Church groups over burdened by the responsibility of caring for orphans. 

Community Empowerment

Limitations

?/font>        Negative cultural, socio-economic and religious ideologies and practices – in relation to AIDS orphans. They are seen as being cursed.

?/font>        Target groups not involved in program planning and implementation- most people are starting up homes to take care of orphans but have not conducted a needs assessment so as to ascertain what each orphan that will be coming to live in that home will need, or how the most successful of orphanage in Kenya conduct its practice and try to emulate their home to provide care and services similar to that one.

?/font>        People living with AIDS (and it include children) are still stigmatized.?/font>         

5.         Human Resource and Development.

Limitations

?/font>        Shortage of trained personnel- caretakers, health workers –doctors, nurses, social workers (non-existent), homeowners for AIDS orphans.

?/font>        Health workers not trained in pregnant mother to Child Transmission in majority of the districts.

?/font>        Limited capacity of child advocates influencing and mainstreaming HIV? AIDS activities within sectoral policies in the ministries.

?/font>        Health staff has poor attitudes and are unhelpful while serving people and children living with HIV/AIDS 

6.         Evidence-based Interventions

Limitations

?/font>        The effectiveness of VCT services is unknown- Lack of efficient and effective management practices and data collection and analysis methods for statistical representation of demographic population.

?/font>        Pregnant Mother to Child Transmission activities is confined to big hospitals in urban areas. 

A.        What is currently being done in order to address the needs of the community?

KNASP empowers community organizations and local government institutions to utilize and strengthen existing systems coping with the impact of HIV/AIDS, with particular reference to caring and providing access to education for orphans.

Limitations.

?/span>         Lack of community involvement in contributing resources to support HIV/AIDS activities.

?/span>         Target groups are not involved in program planning and implementation.

?/span>         Inadequate financial resources, infrastructure and institutional capacity of implementing agencies.

?/span>         Duplication of activities and wastage of resources.

?/span>         Political interference in program activities at constituency level.

?/span>         Poor coordination of program activities at the community level including poor financial tracking system

?/span>         Transport sector not adequately involved in HIV/AIDS activities.

?/span>         Mistrust, competition, suspicion and unwillingness to share information among different groups at all levels.

?/span>         Poor geographical overage of interventions due to vastness of some regions. 

XIV.    My recommendation in order to address the AIDS orphans in Kenya.

A.        Recommendation I.

After a review of publications called Norms and Standards for Health Service Delivery, 2006 and Taking the Kenya Essential Package for Health (KEPH) to the Community, 2006, published by the Ministry of Health in June 2006, I would recommend the following:

1)      A community-based Approach of level 1.

This means that all activities will be focused on ensuring that individuals, households and communities carry out appropriate healthy behaviors and recognize signs and symptoms of conditions that need to be managed at other levels of the system- in this case, HIV/AIDS. Each level unit is to take care of 5,000 persons.                                                         

2)      Why community –based approach?

?/font>        Communities are at the foundation of affordable, equitable and effective health care.

?/font>        Community –based approach is a mechanism through which households and communities take an active role in their health and health-related development issues by increasing their control over their environment in order to improve their own health status.

?/font>        Community-based approach will tend to build the capacity of communities, to assess, to analyze, to plan, to implement and to manage health and health related development issues – such as AIDS so as to enable the population within that community to be able to contribute effectively to the country’s socio-economic development.

?/font>        Community-based approach will impact communities by empowering them to be able to demand their rights and seek accountability from the formal system for the efficiency and effectiveness of health and other services. 

3)         Overall goal of community based approach.

?/font>        Ensure that communities have access to health care in order to improve productivity, thus to reduce poverty, hunger, child and maternal deaths and improve education performance across all stages of development within children.

Eradication of poverty is essential because poverty compounds powerlessness and increases ill health, as ill health increases poverty. 

XV.      The Strategic Objectives needing to be addressed:

?/font>        Provide services for all cohorts and socioeconomic groups including orphans –taking into account their need and priorities.

?/font>        Build the capacity of community health extensions workers (CHEW) – caretakers, social workers, and community-owned resource persons (CORPS) to provide services at level 1. - All activities will be focused on ensuring that individuals, households and communities carry out appropriate healthy behaviors and recognize signs and symptoms of conditions that need to be managed at other levels of the system- in this case, HIV/AIDS.

?/font>        Strengthening health facility-community linkages through effective decentralization and partnership for the implementations of level one service.

?/font>        Strengthening the community to progressively realize their rights for accessible and quality care and to seek accountability from facility-based health services.?/font>         

a)      How to be effective.

1.      Building a capacity at village level and use it to manage community –based activities effectively- this is because communities can be organized into functional units such as villages or sub-locations that are linked to or part of a legal structures of the country, for effective action for health. Health committees and resource persons can be elected by these structures. They should be trained for effective actions for health at the village level. Now all these structures will work best when linked to administrative structures such as health facilities, where they can be in control of tangible decisions guided by clear defined roles. Further linkages to local structures such as schools, churches, and women groups are better than introducing new structures. The community will need facilitation and support from the formal system- Ministry of Health and Non-governmental Organizations (NGOs) 

2.      The use of Community- Owned Resource Persons (CORPs) as volunteers to provide services at the household level – includes community-based information system, dialogue based on information, health promotion, diseases prevention.

3.      The establishment of a revolving fund need to take place- consisting of users, referral system established by the local health committees. Thus simple curative care using drugs will able to be supported and supplemented for.

 

b)      Limitations to using Community- Owned Resource Persons (CORPs)

1.      CORPs nominated by the communities without a guiding criteria, may not be adequately literate to undertake all the tasks assigned. Thus a guiding criteria such as the ability to read and write, being a permanent resident of the community, and having demonstrated attitudes and valued by the community are but a few examples of criteria to go by, that needs to be established before a nomination process. 

2.      Incentives are crucial to boost and sustain the morale and motivation of CORPs. Example of incentives are uniforms, drug kits, protective wear, reimbursements or direct cost, periodic rewards, allowances, stipend, regular salaries, grain and labor from the villagers themselves. It is important to note that incentives will best be handled by the local committee rather than them being paid to CORPs centrally, because this will enhance loyalty and accountability to the people served.  

3.      The use of Community Health Extension Workers (CHEWs). These address the problem of attrition that affects the effectiveness of volunteer CORPs. They should be recruited by the health system and assigned to the local structures.

c)         Limitations to using Community Health Extension Workers (CHEWs).

1.      This approach does not address the problem of loyalty to the community.

2.      Training of CORPs.

3.      The application of theoretical and practical training modules and programs.

4.      Training should be take place in the community but with periods of practice at various facilities.

5.      Training within the community should include community organization, community entry and situational analysis, the community information system, community dialogue for behavior change, and first aid. Periods of practice should include community –based integrated management of childhood illness, reproductive health, malaria, acute respiratory care, water and sanitation, community nutrition, business management, record keeping, and project implementation and counseling, poultry keeping and project implementation, and monitoring and evaluation. 

6.      Self –sustaining actions to be properly governed by the community

7.      Remember, sustainability is promoted when community-based activities are built into existing initiatives and based on available resources.

8.      Systems of accountability and transparency must be established and practiced.

9.      Ways of enhancing resource generation include sales of drugs- at low and affordable process to the community through a social franchise set up to maintain standards, external contributions can be used to cover gaps in cost and for households that can not be able to cover the costs, cost-sharing.

10.  The coordination of structures is key to success of any community- the bringing together of key players at the national and provincial levels to organize and guide in the implementation of policy guidelines and key activities. The key to success is consistency and sustainability.

11.  Activities that need to be conducted in order to make this possible include periodic forums for disseminating result, sharing of experiences and the use of indigenous knowledge for wider consumption. At the local level village health days once a month to sustain the improvement in health outcomes. At the formal level, cooperation between the Ministry of Health and non-governmental organizations (NGOs) with particular experience in Community –based health care. 

XV.      Recommendation II.

Moving from Community –based approach to AIDS orphans. 

?/font>      Need to be committed to providing and promoting leadership, collaboration and enhancing capacity among civil society Organizations for collective action towards effective responses to HIV/AIDS and its impact. 

  1. The Strategic Objectives needing to be addressed:

?/font>        Information access and documentation.

?/font>        Capacity building.

?/font>        Policy development  and advocacy.

?/font>        Grant making and grant management.

I would recommend that they use the KANCO model approach of Child-to-child programs to target the AIDS orphans.

 

  1. Child –to child approach- (CTC).

What type of program is this?

?/font>        An educational process that links children ‘s learning with taking action.

?/font>        Provides activities that children can participate in for their own personal, physical, social, emotional, moral and intellectual growth- engage children in active learning so that their critical thinking and life skills are developed.

?/font>        A rights based approach to children’s participation in health promotion and development that is grounded in the United Nations Convention on the Rights of Children- principles of inclusion and non-discrimination- be inclusive and involve as many children without selection or exclusion on the basis of gender, disability, ethnicity and religion.

?/font>        Recognize the role of children as citizens and community members in contributing to health and development of themselves and others- encourage children to work cooperatively to find solutions that are safe and helpful for themselves, their families and communities.

?/font>        Ensure that adult facilitators work in responsible ways with the children, protecting them from any actions that may physically, emotionally or socially put them at risk.?/font>          

3)         The benefits of CTC to AIDS orphans

?/font>        Builds self-confidence.

?/font>        Provides useful knowledge

?/font>        Empowers them with life skills

?/font>        Builds on their personal development

?/font>        Builds on their social development

?/font>        Positive channel of energy and creativity.

 

4)         The benefits of CTC to the community.

?/font>        Promotes peers solidarity

?/font>        Creates community awareness and concern for children’s issues.

?/font>        Improves the status of children in the community.

?/font>        Enhances community development.

 

5)         The challenges to CTC approach.

?/font>        Display of power relation between adults and children

?/font>        Display of power relations among children (bullying).

?/font>        The role children play in their families, communities and the society.

?/font>        A child’s competencies and age of children.

?/font>        Culture.

References.

 

Ansell, Nicola  and Young ,L. ( 2004, January). Enabling Househld to Support Successful Migration of AIDS Orphans in South  Africa. AIDS Care, 16(1), 3-10.

 

Case, Anne, Paxson M, et al. (2004, August). Orphans of Africa: Parental Death, Poverty and School Enrollment. Demography, 4 (3),483-508.

 

Chatterrji, Minki, et al.( 2005). The Wellbeing of Children affected by HIV/AIDS in Lusaka, Zambia and  Gitarama province, Rwanda. Community REACH Work. Washington D.C. Paper No.2.

 

Chatterrji, Minki, et al. (2004-2005). Orphan  and Other Vulnerable Chldren in Rural and Urban High  Density Zimbabwe. United Nations Children’s Fund and Ministry of Public Service , Labor and Social Welfare Survey

 

Chatterrji, Minki, et al. (2005, June). Report on the Pilot survey on Orphans and  Other Vulnerable Children in Blantyre, Malawi. United Nations Children’s Fund

 

Evans, D. ( 2005, December). The Spillover Impacts of Africa’s Orphans. Rand Corporaation Working Paper. Santa Monica.10-11.

 

Floyd, Sian, et al. (2005, September). HIV and Orphanhood. UNICEF Project.

 

Monasch, Roeland and Boerma, J. cit pp S55-S65.

 

Nhate, Virgulion, et al.(2005). Orphans and Discrimination in Mozambique. An Outlay Equivalence Analysis. International Policy Research Insitute, 1-2, 12.

 

Seaman, Petty .J, Petty .C, Acidri. J. 2005. The Impact of HIV/AIDS  on household Economy in two villages in Salima District. Save the Children.

 

Verhoef, Heidi.  (2005). A child Has Many Mothers. Views of Child Fostering in Northwestern Cameroon. Childhood. 12(3), 369-390.

 

 

August 2006. Africa’s Orphans and Vulnerable Generations. Africa’s Orphaned and

Vulnerable Children. (1), 4.

 

Child ACT 2001, Ministry of Health .

 

KICOSHEP Training Manual, Action AID International Kenya. 2004. Pg iii. 

 

National AIDS Control Council Report for 2002.

 

(2005, May).  National Policy on Vulnerable Children, Draft 5 on National Consensus Meeting.

 

 The Macroeconomic Impact of HIV/AIDS.

 


 

Orphanages

Nyumbani
 
Nyumbani-- "home" in Swahili--provides a true home to these abandoned children until a correct determination of their HIV status can be made. Children who are eventually found not to be infected with HIV are then placed in appropriate settings to be adopted or cared for by traditional social services agencies. The children found to be truly HIV+ are given the best nutritional, medical, psychosocial, and spiritual care available and live the rest of their days at Nyumbani.

 
Frances Jones Abandoned Baby Center (Nairobi)
 
We are offering hope for the future of many Kenyan children by building a facility to care for and nurture babies who have been discarded and left to die. We believe that every effort should be made to give them homes in their communities with a caring family. Affiliated with Feed the Children ministry.

 

 

Web sites

U.S. Government Agencies

CDC Fact Sheet: Kenya
 
Kenya arguably has the world's most magnificent game parks, unspoiled beaches, thriving coral reefs, mountains and ancient cities. It is one of nine African countries hardest hit by the HIV epidemic.

 
US Department of State - Travel Advisory
 
Travel Warnings are issued when the State Department decides, based on all relevant information, to recommend that Americans avoid travel to a certain country. Countries where avoidance of travel is recommended will have Travel Warnings as well as Consular Information Sheets.

 
USAID Global Health: Kenya
 
The U.S. Agency for International Development (USAID)/Kenya's current HIV/AIDS program (1998-2005) focuses on prevention of HIV infection, policy and advocacy, community-based care and support, integration of AIDS with family planning and child health programs, blood safety, operations research, and multisectoral activities. In FY 2001, HIV/AIDS funding for Kenya was $11.5 million, including $2.0 million for vulnerable children and $1.0 million for tuberculosis. FY 2002 funding levels include $17.5 million in HIV/AIDS and $1.75 million for tuberculosis activities.

 
World Fact Book
 
The Factbook was created as an annual summary and update to the encyclopedic NIS studies. The first classified Factbook was published in August 1962, and the first unclassified version was published in June 1971. The 1975 Factbook was the first to be made available to the public with sales through the US Government Printing Office (GPO).
 

 

 

 

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