By Eloke Onyebuchi
The response to the crisis of orphans and vulnerable children due to HIV/AIDS in Nigeria has been largely community driven with the extended family providing the safety net for protection, care and support.
Estimates indicate that 7 million populations were orphans in 2003, which 1.8 million were affected by HIV/AIDS. Consequently high levels of poverty resulting in low resource base and lack of basic credit and employment facilities in most rural communities have jeopardized the realization of the wellbeing of orphans and vulnerable children in Nigeria.
The objectives of this article are to present a summary of the national OVC situation and current policy responses. To outline the existing frameworks for responding to OVC and to identify the policy – level gaps in the national responses to the growing crises of OVC, and the need to intervene on these problems affecting orphan and vulnerable children affected or infected by hiv/aids in Nigeria.
Until recently, the scale of the national response has not been commensurate with the magnitude of the orphans and vulnerable children’s problems. In spite of some weaknesses where individual children living with caregivers are targeted, there are examplesA of best practice in pockets of interventions in the country. These are largely community driven responses that work in partnerships with civil society organizations to provide protection, care and support for most vulnerable children and their families. Evidence of such good practice remains limited in size and scope is highly uncoordinated, due to unavailable active policy environment.
Children, mainly of youth age have been the missing voice and face of orphans and vulnerability responses to date. Without taking determined steps to address the specific needs of children, there will be no chance of meeting the Millennium Development and NEEDS Goals (MDGs); and certainly no chance of halting and beginning to reverse the spread of HIV and AIDS. Failure to meet the goal on HIV and AIDS will adversely affect the country’s chances to meet the other MDGs, as HIV and AIDS will continue to impede efforts to reduce extreme poverty and hunger, provide universal primary education, and reduce child mortality and improve public health care. Millions of children under 15 years in the path of the pandemic are at risk and in need of protection.
In the light of emerging challenges, the Government of Nigeria through the Federal Ministry of Women Affairs and Social Development, National Agency for Control of HIV/AIDS introduced a 5-year OVC Costed National Action Plan, which is designed as a cost effective, advocacy and resource mobilization tool as well as a management instrument to address and improve the multiple needs of OVC in Nigeria. The Plan provides a solid guide for policy makers, programme planners and implementers at all levels for designing and carrying out interventions to reduce the impact of HIV/AIDS vulnerability on children, mainly youths in Nigeria.
“OVC” STATEMENT OF PLOBLEM IN NIGERIA
The position of children, mainly of youth age globally, echoes a deepening and widening neglect and invincibility of children in Nigeria. Since the discovery of the first HIV/AIDS case in Nigeria in a thirteen year old child in 1986, HIV/AIDS prevalence has been on a steady increase until 2005 when it declined to 4.4% from 5.8% in 2001. Estimates indicate that 1 million children orphaned by AIDS were living in Nigeria.
The impact of the increasing prevalence of HIV/AIDS is the increasing number of orphans, those that have lost one or both of their parents to AIDS and as a result of that, they have been exposed to series of vulnerability. The insufficient data available depicts a desperate picture of social exclusion, exploitation and abuse facing a large percentage of orphaned children in Nigeria: 39% of children aged between 5 – 14 years are engaged in sex; 43% of women aged 20 – 24 were married or in union before they were 18 years; high rate of infant, child and adolescent mortality; low access to health care services, high malnutrition, and high burden of diseases; low education enrolment rates; poor school performance or lack of education; intra household neglect, maltreatment and undue harassment from other peers are the cultural exigencies that vulnerable children encounter. A previous study indicates that 40% of children may have been involved in child trafficking, drug trafficking or engaged in prostitution to earn a living. An estimated population of 50 million Nigerians below 18 years are from the poorest areas and 40% of them do not attend necessary primary education due to multiple discrimination caused by either being affected or infected by AIDS.
The social consequence of the above problems amounts to inappropriate psycho – social well being, spread of diseases, malnutrition and deprivation of the learning and values that children need to become socially knowledgeable and economically productive adults.
RATIONAL TO RESPOND TO OVC PROBLEMS
Until recently, most OVC intervention has been community driven, where extended families offer care and support to the children related to them. However, these interventions have been a piecemeal, as it does not reflect with the size or scope of the problem that OVC portend to the nation. In the absence of protected environment of their homes, orphaned children face an increased risk of violation of their human right. Those living with adopted families might be malnourished or underweight when compared to non orphans of the same age bracket.
Evidence based study stated that in the absence of HIV/AIDS, OVC decline would be expected, due to recent improvements in adult survival rate as a result of better public health and medical care, nutrition and environmental situation in the country. However, this evidence failed to lay more emphasis to the fact that due to institutional structure of Nigeria the urban domain enjoys more health care services and its awareness than the rural inhabitants, therefore, even in the absence of HIV/AIDS the health of an OVC in the rural area still remains in jeopardy. This is because there is no active policy on the ground to cater for them and socioeconomic stress due the loss of one or both parents as financial providers.
To limit the impact of HIV/AIDS on lives of children, communities and the country, the Federal Ministry of Women Affairs (FMWA) conducted OVC participatory situation and needs assessment on knowledge, attitude and perception of OVC care and support in Nigeria.
Highlights of the qualitative findings indicated that catering for the needs of OVC are the responsibilities of those that have agreed to take care of them based on goodwill. This is a scenario where extended family/community feelings are informed by cultural arrangements on OVC and supported by religious prescriptions. The data confirmed that most of the relatives to the orphans show resentment, discrimination, and harshness to matters regarding the sharing of the deceased parents properties. In rural areas, HIV/AIDS awareness, prevention and control are still very low while people living with HIV/AIDS (PLWA) and OVC due to AIDS claimed that discrimination against them is high.
Government resources for OVC is restricted to children in government’s orphanage institution, which is uncoordinated or virtually absent in most rural communities and where one existed, there is poor quality of food, administrative bottleneck and lack of adequate health care services in the homes.
Younger OVC (8 – 12) posited that mother’s death and lack of primary education makes them vulnerable while the care givers and older OVC (13 – 17) claimed that their HIV status, poverty and inadequate care is what makes them vulnerable. Federal Ministry of Women Affairs (FMWA) and Health Ministry proposed for a policy to mitigate the vulnerability of individuals and communities to HIV/AIDS with focus to children; to promote AIDS care, social support, and protection of rights of children living with AIDS or orphaned due to AIDS, to promote counselling among those infected or affected by AIDS and provide financial assistance to them. After the analysis of the situation, a policy was enacted based on key recommendations for intervention from ‘FMWA’. Part of the recommendations were scale up implementation of the integrated maternal new born and child health (IMNCH) strategy by the Federal and State Ministries of Health with deliberate effort directed at OVC at all settings. This is to facilitate the establishment of inter – sectoral coordinating taskforce at the national and state levels to coordinate the implementation of the OVC national plan of action.
Inter – sectoral effort needs to be sustained and intensified to focus on awareness creation, behaviour change, counselling and medical checks on critical health concerns focussing on HIV/AIDS as priority.
Introduction of the national guideline and standard of practice on OVC affected by HIV/AIDS and establishment of child care institutions in Nigeria. The need to establish the approach to care would help advocate for government protection and the creation of supportive, stable, and enabling environments and the need to initiate universal social protection agenda for children.
Development of a comprehensive monitoring and evaluation system to guide policies, plans and programme down to the local level to ensure ownership and sustainability. This is to ensure a plan to sustain in whole or part the support to OVC and their household beyond the life span of the programme, including strategies to identify alternative sources of funding.
STRATEGY FOR ACTION
The 2003 report on advancing the 2001 United Nations declaration of commitments on HIV/AIDS goals indicates that 39% of countries with widespread epidemics have no national policies to provide orphaned and vulnerable children with essential support. While 14% of these countries are developing policies to cater for OVC in Nigeria, a wide range of drivers including international organisations in collaboration with Government agencies constructed a structured Costed National action Plan (CNAP) underscored best as a cost effective measure designed to address the multiple needs of OVC. The plan covers issues basically known to affect orphan and vulnerable children like nutrition, AIDS prevention among vulnerable children, access to education and health care, stigma and discrimination.
The action plan launched in 2007 includes six technical components: Service delivery environment, health, education, psycho – social needs and wellbeing, household care and economic strengthening and monitoring and evaluation. Some of the activities designed in the action plan which have been carried out include: Comprehensive survey to assess the exact number of OVC in the country and their situation. ‘A strategy called OVC mapped out in the country’. Adequate OVC policy and implementation portfolio handed over to National, State and local Ministries designed to integrate community based and Non Governmental Organisations in providing direct coordinated support and care to OVC and their families and to ensure ownership and sustainability.
Introduction of an alliance called ‘Voice of orphan and vulnerable children in Nigeria (AOVN)’. Created to implement OVC community coping strategies at National, State and local levels by engaging affected children on roll plays, psychosocial assessment tool with anchored scales including coping, depression, anxiety, trauma and basic needs are costed but are not in existence today.
National strategic framework on OVC and recent national HIV/AIDS policy, care and support carved out as a thematic area with some ‘SMART’ objective. This framework is designed to wedge factors causing problems for OVC in Nigeria and to educate children more about HIV/AIDS, but still not functional or practicable anywhere in the country today.
Other activities in the programme yet to be implemented include:
• Sensitization and training of state and local technical persons in provision of services that target orphans and vulnerable children.
• Capacity building of service providers and key actors in programme implementation, monitoring and evaluation to change the factors influencing problems to make it easier for OVC to cope.
• Display and encouragement of duty bearers to institute a level of transparency in ensuring that OVC and their caregivers participate fully in monitoring and assessing the intervention intended to benefit them.
Nigeria has succeeded in constituting a structured action plan but the following gaps needs to be addressed in Nigeria:
• There has not been a formalised and fundraising framework for OVC in the country. If there is existing one, then it is not known to the general public. This is because the government is yet to make their position clear on the amount that should be going to this project annually. While majority of the fund comes from international organisations, the actors of fund mobilisation should integrate top national policy makers into their committee. This is to allow the government sustain their own part of the commitment on this intervention.
• Inadequacy of national data for OVC which formed the basis for policy.
• Inadequate coordination of OVC service delivery activities at state and local levels. Infact, it is virtually non viable.
• Ineffective advocacy campaign for more awareness and action towards OVC issues like counselling on HIV/AIDS, early marriages, drug and child trafficking. Government should build on existing structures of families and community base care, which will improve the wellbeing of OVC’s not replacing them with institutions or external programmes.
• Inadequate framework for counselling of maternal OVC and caregivers on nutrition and breastfeeding support at the community level. More efforts and improvements on health education are needed here if governments want to bridge the gap between prevention and treatment, or possibly make prevention the mainstay of HIV/AIDS in the country.
Eloke Onyebuchi, is a public health specialist and facilitator of “Youth Global Platform.