THE IMPACT OF HIV/AIDS ON THE HEALTH AND WELFARE OF CHILDREN IN SOUTH AFRICA AND ON HEALTH AND WELFARE SERVICES FOR CHILDREN

Paper prepared by the Child Health Policy Institute

For: Health Economics and HIV/AIDS Research Division, University of Natal, Durban

Presented to Joint Monitoring Committee on Children, Youth and Persons with disabilities
6 June 2001

Contact details:
Sonja Giese
Child Health Policy Institute
Child Health Unit
University of Cape Town
Ph: (021) 685 4103
Email: [email protected]

CONTENTS

1. Children living in HIV infected households

By 2011, 56% of the population will live in households where at least one person is HIV-positive or has died of AIDS. The burden of caring for the sick and destitute will have an impact on the 44% of "uninfected" households.

1. Economic impact of HIV infection on a household

At the household level, the impact of HIV/AIDS on children is exacerbated by the fact that HIV usually strikes more than 1 member of an infected household and this usually includes the primary caregiver and / or breadwinner. When a family member has AIDS, the average household income may fall by between 52 and 67 % while expenditure quadruples with the costs of special medical treatment, transport to health facilities, nutritional requirements and ultimately, funeral costs. The financial impact of an AIDS related death on the average family is 30% greater than the financial impact of any other cause of death.

The financial burden of HIV/AIDS adversely affects the living standards and quality of life of all household members, leading to food insecurity, malnutrition, poor hygiene, loss of opportunity and other factors related to poverty.

With competing priorities for limited resources, children in infected households are often unable to afford school uniforms, school fees and books which are a prerequisite for school attendance. The combined socio-economic consequences of HIV/AIDS on children in infected households is far reaching, with reduced opportunity for growth and development creating a cycle of dependency, vulnerability and abuse.

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

Source: ChildrenFIRST.

 

2. Care giving in infected households

As the traditional primary caregiver of children, the impact of HIV on women in infected households has a direct impact on the children in those households.

More than 35% of households in South Africa are headed by women, and 60% of these households live in poverty. In HIV infected households, women carry the burden of caring for the sick and dying as well as the responsibility of caring for the children in the household.

Women are also more vulnerable than men to HIV infection for biological, social and economic reasons. For every 10 women infected globally, 8 are African women in SSA and for every 1 new male infection, 2 women are infected. Anything that threatens the health of a caregiver, impacts on the health and well-being of the child. Uninfected children born to infected mothers have a 2.4-3.6 times greater chance of dying than children born to uninfected mothersand there is a direct relationship between the severity of maternal disease and the risk of the child acquiring opportunistic infections and dying early in life.

3. Child health and well-being in infected households

Poor health and increased rates of stunting among children living in HIV infected families, is common. This is believed to be a consequence of HIV disease itself (in the case of MTCT), increased exposure to opportunistic infections, disease related poverty and psycho-social factors which impact on caregiving practices and child wellbeing. Children living in households with HIV infected persons are more exposed to opportunistic infections, such as TB and pneumonia. With caregivers sporadically sick or absent, the child is less likely to get the medical attention s/he needs and more likely to have repeat infections.

Food security in HIV infected households is affected by reduced household income and increased expenditure on health care which leaves less money available to purchase appropriate food. Preparation of food is also affected by compromised caregiving. The child may also be unable or unwilling to eat due to a range of physical, emotional and psychosocial factors which play a role in appetite suppression.

Two other features of HIV infected households which impact on the health and welfare of children are those of domestic violence and abandonment. Domestic violence is common among HIV infected families and has become one of the major stumbling blocks to disclosure among married women in South Africa. The fear of disclosure makes it difficult for women to make informed decisions on choices such as breastfeeding, family planning and planning for the future of her existing children without raising suspicion about her HIV status. She is therefore forced into continued child bearing and breastfeeding which may significantly compromise the health of her children. The fear of disclosure also means that women are reluctant to accept the assistance of home based carers who may have been able to assist with the care of the children in the infected household.

Abandonment may happen at two levels. The first is the abandonment of the family by a caregiver / breadwinner. It is commonplace to hear of women whose partners or husbands abandoned them when they disclosed their HIV status to the partner. The second is the abandonment of the child. Over the past 3 years, the South African National Council for Child and Family Welfare reported a 67% increase in the number of children abandoned in South Africa. This is corroborated by reports of an increase in the numbers of children being abandoned in hospital wards across the country. Many of these cases could have been prevented if effective social security measures were in place to support desperate families affected by HIV/AIDS.

Children living in infected households face the double burden of prejudice related to HIV and prejudice related to poverty. They are forced to endure teasing and are marginalized by their peers and other members of their community. Many of these children will be left without a concerned caregiver once their parent dies and the oldest child’s role in the family may change. Assuming the role of caregiver makes the girl child particularly vulnerable to sexual abuse by adult men in the household and in turn, vulnerable to HIV infection.

2. Children orphaned by HIV/AIDS

"The HIV/AIDS orphan crisis is one of the greatest humanitarian and development challenges facing the global community" .

"We have nothing. Some people chase us away when we ask for food or for little jobs to get some money. They say we are a nuisance" the words of Slindelo, a 16 year old orphan boy looking after his sickly 4 year old sister and his 8 year old brother.

Source: Cape Times, 17 April 2001.

The literature defines an "AIDS orphan" as a child under the age of 15 years whose mother has died of AIDS. The data available on the number of children orphaned by HIV/AIDS therefore does not include children between the ages of 15 and 17 years. The data also does not distinguish between children who have lost a mother and children who have lost both parents.

South Africa already has approximately 300 000 maternal AIDS orphans in South Africa, yet the ‘orphan epidemic’ is still in its infancy and over the next few years, is expected to grow to devastating proportions. In most parts of the industrialized world, no more than 1% of the child population is orphaned. In developing countries this figure was around 2.5% before the HIV/AIDS pandemic. If one combines all other causes of maternal death with the HIV/AIDS pandemic, 11% of children under the age of 15 years in South Africa are orphans and this figure is expected to rise to almost 17% by 2010. BY 2015, AIDS orphans will constitute between 9 and 12% of South Africa’s total population.

1. Care and support

In the developing world, societies traditionally absorb orphans into extended family or community. As a result of the HIV/AIDS pandemic, huge numbers of children are being orphaned and these traditional support structures are largely saturated. Furthermore, the stigma associated with AIDS is such that children orphaned by HIV/AIDS are being turned away by extended families fearful of the consequences of caring for them.

 

"Before this tragedy struck my family, I had a lot of friends and we lived in close community with our neighbours. But after my parents died, and it became known that AIDS had killed them, they all started to drift away. Today we can’t even ask our neighbours for a pinch of salt because, when we approach them, they demand to know what we want and don’t allow us to enter their yard" 18 year old Avhapfani, Northern Province.

Source: Sunday Time, 11 June 2000.

 

Degrees of vulnerability exist within the broad group of children defined as "AIDS orphans", with the most vulnerable orphans being those living on the streets or in child headed households. For those children for whom caregivers are found, groups of siblings are often split between households. It is quite common for orphans to be cared for by grand parents or great grandparents who die while the child is still young. Many children therefore experience a string of multiple caregivers before they finally reach the age of independence. Older orphans are frequently exploited by their "caregivers". They may be forced to leave school and perform chores in and around the house, or they may be expected to seek employment to subsidise the household income.

If suitable caregivers are not available, some children may become responsible for the care of younger siblings, living in child / sibling headed households. In South Africa, the problem of child headed households is poorly understood and data on the number of children currently living in child headed households is scant. In the Kwazulu Natal midlands, while there have been increases in the number of children living in households without parental supervision, home based carers report that older siblings (over the age of 18 years) are fulfilling the role of caregiver, having left school early to provide for the needs of younger siblings. Children living in child headed households typically live in conditions of poverty, without adequate adult supervision and suffer from stunting and hunger. These children have reduced opportunities for education, limited access to health and welfare services and no access to social security. For many, they assume the role of caregiver at a very young age. Older children may be exploited and forced into child labour, prostitution or early marriage. Some leave home to supplement the household income through begging in city centers, thereby increasing the numbers of street children.

Many child headed households face eviction from their homes, either through property grabbing by greedy relatives or because they are unable to sustain mortgage agreements and are too young to access a housing subsidy.

"Shouldering a burden weightier than his 15 years, Langanani Mugodo picks up a cast-iron pot and, seemingly without a second thought, breaks centuries of Venda tradition. He walks outside into the sun-baked center of the kraal, squats on the earth near a hollow and, gathering his domestic tools about him, lights the cooking fire. This is exclusively women’s work and Langanani has trespassed, breaking the gender barriers which still define social roles in this far flung rural part of the Northern Province. After his parents died of AIDS, as the eldest son, Langanani became head of the household and responsible for feeding his 5 siblings. "After my mother died when I was 13, I had to stop going to school and instead had to learn how to cook meals for my brother and sisters. I also sweep the home and fetch water, all the things which women usually do. But there was no one there to help us. At first my school friends mocked me because I was doing girls’ work. But now I think they understand I have no choice".

Source: Marie Claire, November 2000.

 

2. Impact on child health and well-being

Children who have been orphaned are more likely than their peers to be malnourished, sick, abused and sexually exploited. They are at greater risk of dying from preventable diseases and are less likely than other children to be fully immunised. This has implications for all children in South Africa. As immunization coverage decreases, the "herd immunity" declines and all children become more susceptible to common childhood illnesses which, in the case of HIV infected children, can be fatal.

With limited resources and inadequate adult supervision, orphans are more likely than their peers to drop out of school , leaving them with fewer opportunities for growth and development. They are also denied the benefit of the monitoring and support of teachers and peers and the nutritional support offered through the primary school nutrition programme which targets poor children at schools.

17 year old Nyawo cares for her 3 younger siblings. The family fails to qualify for government child support grants as all the children are over the age of 7 years and Nyawo is too young to access a foster grant. "I am very worried because I can’t understand why, being so young, I have to carry the burden of elders. If there is no food at home, these children look to me to do something." The plea from Nyawo and other orphans is for the government to feed and clothe them and pay their school fees.

Source: Cape Times, 17 April 2001.

While these issues affect children orphaned for any reason, as a result of the stigma and discrimination surrounding AIDS and the devastating socio-economic consequences of the virus, children orphaned by HIV/AIDS are at greater risk than other orphans .

The psychological impact on the child of witnessing the suffering and death of a parent is extreme. For many children this is exacerbated by the fear and insecurity of not knowing who will care for and support them after their parents’ death. Many households with terminally ill AIDS patients survive on the Adult Disability Grant or a pension which is stopped once the adult recipient dies. AIDS orphans often face the additional burden of not being able to grieve openly for a deceased loved one because of the stigma associated with an AIDS related death. The long term effects of this is likely to plague South Africa for many years to come, with desperate and disillusioned youth turning to anti-social and risk taking behaviour and crime.

One of the most severe and lasting consequences of parental death is childhood malnutrition (this is looked at in more detail later). The impact of HIV on the nutritional status of a child is felt long before the parent’s death and, if ongoing and severe, can have a long term impact on the development of the child. Many of these children will also be infected with HIV and for most of them, access to essential drugs and social security will be limited.

3. Children infected with HIV

HIV/AIDS attacks not only the most productive members of our society but also the most vulnerable. There are at present at least 120 000 children under the age of 13 years who are infected with HIV.

Children infected with HIV live in affected households and for many of these children, one or more of their parents will also be HIV+. All the stresses and socio-economic consequences of living in an HIV infected household therefore apply to these children in addition to the burden of HIV infection.

1. HIV transmission in children

The majority of HIV infected children under the age of 13 years acquire HIV from their infected mothers during pregnancy, at the time of delivery or after birth, through breastfeeding. Over 105 000 babies will be born HIV+ this year. 60% of these children will not live beyond their 5th birthday. 40% of them will and the majority of these children will join the 60-70 % of children in South Africa who live in conditions of extreme poverty. These children will be vulnerable to abuse, neglect and exploitation and will almost certainly have reduced opportunities and limited access to basic services.

15 to 18 year olds fall within the age category most vulnerable to HIV infection through sexual contact. Within this group, girls are particularly vulnerable to infection. Physiological, cultural and social factors contribute to the vulnerability of the girl child and girls between the ages of 5 and 14 years are more than 8 times more likely to be infected through sexual abuse than their male counterparts . In Sub Saharan Africa, the rate of HIV infection in teenage girls is 5 times higher than the rate of infection in teenage boys.

The extent to which sexual abuse contributes to HIV infection in children is not known. Models (such as the ASSA2000 model), used to calculate the number of people infected in South Africa, are based on the assumption that maternal to child transmission is 100% accountable for infections in children under the age of 14 years. This is despite the fact that there has been a marked increase in the numbers of children who are sexually abused over the last 10 years. At Edendale hospital for example, 2 cases of child sexual abuse were reported in 1989. By 1996, the number of reported cases rose to 306. While it is acknowledged that this increase could be a result of increased awareness or improved services for children, HIV could be playing a significant role in this upward spiral. One way in which HIV could be contributing is that, with the high rates of infection, young children are seen as "safe" partners. The myth that sex with a virgin cures AIDS is another potential contributing factor. A study conducted at a child abuse center in a tertiary hospital in Kwazulu-Natal found that, taking into account the likely rate of transmission in children and the HIV prevalence in the area, a disproportionate number of children who were raped acquired HIV. This supports the hypothesis that virgins (children) are the victims of targeted rape by HIV+ adults.

There are also no accurate figures on the number of children infected through unsafe health practices (such as unscreened blood products or the use of contaminated medical instruments) and traditional practices such as scarification and circumcision.

Certain groups of children are particularly vulnerable to HIV infection. These include child sex workers, street children, children in detention, children using intravenous drugs (or other substances which lead to risk taking behaviour) and orphans .

 

2. HIV disease progression in children

1. The impact of HIV on health services for children

Studies of paediatric admissions in South African hospitals have shown a marked increase in HIV related admissions, with HIV+ children spending an estimated 3.4 times longer in hospital and requiring multiple admissions. In 1997, 20% of paediatric admissions at Chris Hani Baragwanath Hospital were HIV related and in 1998, over half of the admissions to King Edward VIII Hospital in Durban were HIV related. Increases in paediatric admissions in general over the past few years are significant and entirely attributable to HIV/AIDS. In areas of the country with very high rates of infection, up to 75% of beds in the children’s wards are occupied by children with AIDS related conditions. As a result of the increased burden on health services, children suffering from conditions other than HIV will have to wait longer for access to a hospital bed and we can expect to see an increase in mortality among HIV-negative patients due to delayed treatment. As the epidemic progresses and more HIV positive people develop AIDS, the impact on the health sector will grow exponentially.

The most obvious costs in caring for HIV+ children are those incurred by the health care facility itself, but additional costs such as the cost to the parents for transport to and from hospital, reduced household income and the cost of outpatient visits need to be considered when calculating the overall impact of HIV on child health and service delivery.

Nosi is 2 years old. She was diagnosed HIV+in February 2000. The father deserted the mother and their 3 year old child, before Nosi was born. Nosi was admitted to Red Cross Children’s Hospital with AIDS related symptoms a month ago. Her mother’s visits are scarce because there is no money for busfare to and from the hospital and no-one to care for Nosi’s sister if her mother is away from home.

Source: personal correspondence: Red Cross Children’s Hospital

 

On the basis of current interventions offered to HIV+ patients at health care facilities, acute health care costs for South Africa are expected to double in the public sector by 2010. The estimated cost per year of treating an HIV+ individual with the interventions currently available at public sector health care facilities is R17 000 (stage 4 of disease), R6200 (stage 3) and R1300 (stage 1 and 2) . With an estimated 4.7 million people currently infected with HIV in South Africa, the government will be pressurized into increasing its expenditure on health services and the specific share of the budget allocated to the care of HIV infected individuals. At the same time, rationing of services will have to occur as projected expenditure requirements are not sustainable.

Rationing of services for HIV+ children in healthcare facilities has already begun with HIV+ children being denied access to intensive care units in some provinces. Many HIV+ children are also diagnosed early as "rapid progressors" and denied access to medication on the assumption that the medication will do little to extend their life. In a further attempt to deal with the epidemic, patients are being referred away from health facilities to more community based programmes such as home based care. Home based models of care have been found to be very effective in reducing rate of hospitalization and length of stay in hospital, reducing the impact of HIV/AIDS on primary health care services, reducing the costs and providing support for the family and increasing compliance to treatment regimes. It is not surprising then that this model is being promoted by policy makers, but the existing health system lacks the infrastructure and resources to provide the necessary training and support to home based carers .

Health care workers face difficult decisions as hospitals move towards providing palliative care for children with AIDS. They also face the very real risk of HIV infection from their patients. All of these factors are likely to have an impact on the psychological well being of service providers and increase rates of burnout and incidence of job related stress.

The growing demand on health care services is exacerbated by an escalating TB epidemic, developing in the shadows of HIV. Currently, about half of all TB cases in South Africa are thought to be attributable to HIV. As HIV weakens the immune system, if makes people more vulnerable to opportunistic infections and to developing active TB. With a greater number of HIV positive people developing TB, HIV-positive and HIV-negative children will be exposed to a greater number of potential sources of TB infection. The World Bank estimates that 25% of TB related deaths in HIV-negative people in the coming years will be a direct result of the HIV/AIDS pandemic. In the Western Cape, the number of TB cases continue to increase, mainly due to HIV/AIDS and each new case of TB represents a further drain on the health system.

The impact of HIV/AIDS on the health sector will also be felt through HIV-related illness and death of health care workers. While increasing the demand on the health care system, HIV simultaneously reduces the system’s capacity to cope with the pandemic by killing health care workers, the majority of whom are women. Rising rates of HIV infection among health care workers will lead to increased absenteeism, reduced productivity and greater spending on treatment, death benefits, staff recruitment and training of new personnel.

The burden of the HIV/AIDS pandemic will divert resources from other essential health care services and make it difficult to implement and maintain other key primary health care programmes.

2. The impact of HIV on social security and social development services for children

1. Existing social security for children in South Africa – shortfalls in meeting the needs of children infected / affected by HIV/AIDS

Approximately 60% of children in South Africa live in poverty and research suggests that this number is increasing, at least partly as a result of the HIV/AIDS pandemic. The burden of poverty is one of the biggest problems that children infected / affected by HIV/AIDS face, with hunger and denied access to schooling being the primary related concerns among HIV affected youth. The government’s poverty alleviation measures include the allocation of social assistance in the form of cash grants, to the caregivers of children who qualify in terms of certain criteria. At present, social assistance is solely the responsibility of the department of welfare.

In many households, the diagnosis of HIV in a family member has an immediate socio-economic impact. It is not uncommon for example for the father to abandon the family when the child / mother’s status is disclosed. If the father was the primary breadwinner, the family is thrown into financial crisis and it is at this late stage that help is sought from the state. The lengthy processing of grant applications usually means that the child/caregiver lacks support during a time when material and psycho-social support is critical.

While there are no special provisions for children infected / affected by HIV/AIDS, these children can access some financial support in the form of the child support grant or foster grant. For adults in the terminal stages of AIDS, a disability grant is available. For children with full-blown AIDS, there are no special provisions available although some caregivers have managed to access the Care Dependency Grant on behalf of the child.

1. Child support grant (CSG)

The child support grant is targeted at poor children between the ages of 0 to 6 years. The amount of R100 per month (increasing to R110 in July 2001) per child is provided, subject to a means test based on the personal income of the caregiver.

The grant is being phased in over a period of 5 years, between 1998 and 2003, with the target being 3 million children. The target was based on estimates of the number of children living in poverty in South Africa and does not take into account the impact of HIV/AIDS. Other estimates of the number of 0 to 6 years olds who qualify for the grant in terms of the means test are as high as double the department’s figure of 3 million. The target of 3 million set by the department is used to determine the budget allocated to the grant. In spite of this, national and provincial statistics reveal that the budgetary allocations for the CSG do not match the projected targets. In Kwazulu-Natal for example, the provincial budget for the CSG was exceeded even though they only had a take up rate of 53% of the targeted number of children. If the budget for child and family grants is not substantially increased many children and families will be turned away.

Two of Thembikile Shezi’s daughters died of AIDS, each leaving 5 children for her to raise. Her eldest daughter is also dying and has left another 8 children. Several of these children have tested HIV-positive. The family’s plight is made worse by the fact that most of these children do not have birth certificates and Thembikile does not even know the names of the children’s fathers. She does not have money to go to the nearest town, Pietermaritzburg, to have the children registered. Without birth certificates, she cannot apply for financial assistance. Even with the correct documents, she will only be able to apply for grants for a maximum of 6 of the 16 children. "When the older children come home from school they cook, take care of the younger ones, and do the washing and ironing. When we had no food they never complained and on many nights I had to make them sleep with an empty stomach … even the babies used to sleep without crying"

Source: Natal Witness, 5 July 2000.

 

The means test for accessing the CSG discriminates against larger households and will therefore discourage families from taking in AIDS orphans. The income of the primary caregiver has to be below a certain amount, regardless of how many children are dependent on that caregiver. Furthermore, it is only payable in respect of a maximum of 6 children per household. The grant therefore does not offer much assistance to families/grandparents caring for large numbers of young children.

Despite the fact that any adult primary caregiver, including the child’s biological parents, may apply for the grant, the current uptake of the CSG is, at best, 33% of the targeted 3 million. This is due in part to the difficulty in accessing the grant. Applicants must know the child’s ID number and the parent’s ID number, and must have proof of guardianship and a copy of the child’s clinic card. Administrative delays in processing grant applications, poor attitude of administrative personnel, lack of knowledge of the available grants among communities, inaccessibility of grant application offices in rural areas, together with the fact that 51% of children do not have birth certificates, means that many families living in desperate poverty are still denied the grant.

2. Foster child grant (FCG)

For children who have been formally placed in the care of foster parents, through a children’s court, a foster grant (R390, increasing to R410 in July 2001) is available. The amount of the foster grant is almost 4 times greater than the child support grant, thereby providing a disproportionate amount of support to caregivers who are not the biological parents of the child, and to the small minority of alternative caregivers who have gone through the lengthy process of formal fostering. There are at present approximately 72 000 children in foster care in South Africa. With an estimated 300 000 AIDS orphans in South Africa today, and an expected 2.7 million more within the next 10 years, we can expect the demand on the foster care system to increase 10 fold.

Foster care is an expensive model of care and placements have to be reviewed every 2 years. Apart from the actual monetary cost of the grant to the state, there is also the cost associated with children’s court enquiries, statutory supervision services and grant administration.

While service providers warn of the impending crisis in the child and youth care system, the current formula for provincial budgetary planning does not include reference to the foster child grant. Provincial welfare budget allocations are calculated on the basis of the old age pension, disability grant and child support grant (i.e. children aged 0 to 6 years) . The government therefore appears to be basing its budgetary planning on the assumption that caregivers of AIDS orphans will not be applying for the FCG.

3. Care dependency grant (CDG)

Children in South Africa with severe disabilities are eligible for a care dependency grant (R540 per month, increasing to R570 in July 2001). Few children in the terminal stages of AIDS have managed to access this grant but no formal policy exists to guide practitioners on whether and when HIV+ children may be awarded this grant.

The majority of infections in children under the age of 13 years are through vertical transmission from mother to child. The child’s HIV+ status therefore implies that at least one of his/her parents are also HIV+. The impact on the family of a child’s HIV+ diagnosis can therefore be devastating with immediate and long term socio-economic consequences.

In children, the interval between infection and mortality is compressed when compared to the same interval in adults, and the child’s prognosis is dependent on a number of factors, including socio-economic conditions and nutritional status. These factors make it imperative that young children who are diagnosed as HIV+ are given as much support as possible, as soon as possible. The CDG could offer these children the support they need.

2. Designing a comprehensive social security system for all children in South Africa

1. Care dependency grant

Children who are HIV+ require additional care, the cost of which may not be covered by the child support grant. It has therefore been recommended that the care dependency grant be extended to children who are HIV+. The stage of disease at which an HIV+ child would qualify for the grant is not clear and while this recommendation is critical to improve the health and welfare of infected children, it would be extremely difficult to implement and very costly.

2. Foster child grant

The Department of Welfare currently receives an average of 260 foster grant applications a month, each of which takes a minimum of 3 months to process and it is not uncommon for foster parents to wait for up to a year for their grant. With the impact of HIV/AIDS on children, it is likely that an increasing number of caregivers will apply to become foster parents. It is therefore recommended that the procedure for applying for a foster grant be simplified and that subsidized adoptions for children in long-term foster care be introduced. Simplifying procedures would allow for a greater number of children orphaned or abandoned as a result of HIV/AIDS to be fostered. The subsidized adoptions would provide children living in long term foster care with the security of knowing that they have a future with the family caring for them.

3. Alternative forms of social assistance

Social security provisioning is currently almost entirely the burden of the Department of Social Development, with very little contribution from the other government departments. We need to explore alternative forms of social assistance such as free health care (for all children), food vouchers, subsidized transport and free education. Those departments that do provide some form of assistance need to review the criteria governing accessibility so as to ensure that children infected / affected by AIDS can benefit. An example is the housing subsidy, which is only available to adults over the age of 21 years. Children living in child headed households are therefore unable to access the subsidy.

For two years after their parents death of AIDS, the family of 5 young siblings lived alone, surviving on handouts from friends and relatives. No one offered to take them in because of the superstition surrounding AIDS. Then, during the February floods, the children’s family home collapsed. "When our house collapsed, the local authorities only gave us a little maize meal and some soya beans so we could survive. I don’t think they did enough" the oldest sibling, 17 year old Fulufhelo.

Source: Sunday Times, 11 June 2000.

 

4. Intersectoral collaboration

Poor intersectoral collaboration between health, welfare and home affairs has a direct impact on the administration of all grants. Corrupt officials in the Department of Home Affairs have been known to charge applicants elevated fees before issuing birth certificates, essential if the caregiver wishes to apply for a grant. Mobile home affairs offices have been cut back and dates and times of visits are changed without prior notice to recipients. This adds yet another stumbling block for caregivers in desperate need of social assistance.

One of the recommendations that have been made is that birth registration procedures are introduced at health facilities so as to ensure that newborns are issued with birth certificates so that their caregivers are able to access a grant should they need one. This would require extensive collaboration between the departments of health and home affairs.

5. Administrative issues