Families, communities, faith-based organisations and NGOs try and support the welfare needs of children affected by HIV and AIDS whether they can afford to or not.
Families in particular carry the bulk of the costs associated with current support (Foster 2005). Is this provision adequate? If not, can developing countries’ governments afford to support those families caring for children so that the care provided is at least adequate? And what constitutes ‘adequate’? This article argues that governments can afford to provide support and specifically examines the affordability of cash transfers.
Children are affected by HIV and AIDS in a number of ways. Children are themselves infected, they live with ill caregivers and in households that lose income and support as a result of illness, and many suffer the loss of parents and providers. If they are unable to stay in their homes, most dislocated children including orphans are taken in by other households. This can affect the welfare of children already present in these households as resources are then more thinly spread (Monasch and Boerma 2004). In highly affected regions, arguably almost all children are affected as illness and death increase and children experience the loss of community members, teachers, healthcare providers and others who play a role in their care and communities.
The impacts of infection are magnified by poverty which concentrates impacts in poor communities. Families which respond in these difficult contexts have the fewest resources with which to provide care (Foster 2005) and often struggle and need support. The literature examining household-level impacts of HIV and AIDS provides many examples of the hardship undergone by households during adult illness and eventual death (UNAIDS 1999). The literature further documents how, as a result of the impact or unequal treatment by their new carers, many fostered children suffer and have poorer outcomes than other children (Arnab and SerumagaZake 2006; Beegle et al. 2005; Gregson et al. 2005). The problem is not limited to those directly affected by illness in the household and parental and caregiver loss; children in households that take in dislocated children also suffer materially (Ainsworth et al. 2005; Monasch and Boerma 2004). These impacts must be considered in context, as in some instances the situation of children in general is so poor that it is indistinguishable from the situation faced by orphans (Richter and Foster 2006).
Both practically and morally those caring for children affected by HIV and AIDS need support. They are often unable to provide care even to the same low standard provided to other poor children and they are taking on the cost of what is a national problem. For the poor to do this without support, or to receive support only from other poor people, is difficult to justify.
Providing for access to water, sanitation, and freely accessible health and education services are obvious governmental responsibilities.
The focus here is the provision of support for the care of children. Alternatives to family care are expensive and particularly for young children, damaging to their development and, except as a last resort or as a temporary measure, have no place in a large-scale response. Families are the only institution capable of providing direct care to children on the required scale and more importantly, they are generally the best environment for children to develop. Given these factors, the role of government is to support families in providing care to children.
This article examines the affordability of providing such support. An argument can be made that governments cannot afford not to support the care of children, as the adverse long-term impacts of lack of support on their health, education and development will be too great in terms of future economic losses. This argument, however, still frames the problem in cost–benefit analysis terms and suggests a trade-off between economic growth and child wellbeing. The question is reframed as: Can a country afford the costs of providing adequate care to children taking into consideration the impact of these efforts on economic growth? However, the objective of development needs to be clarified – it is broader than just economic growth and includes child welfare itself. A country can hardly claim to be developing if the situation of its children is deteriorating, regardless of its economic growth. Rather, child wellbeing is part of the goal of development and any thought of sacrificing child wellbeing for growth cannot be justified except, possibly, if the benefits of growth achieve broader development at a later stage. Without economic growth, development is difficult, if not impossible, so it is necessary to consider if there is a trade-off between development today and development in the future and, if there is, to ask where the sacrifice should be made. The question from this perspective is then: to what extent can developing countries’ governments afford to support families in caring for children affected by HIV and AIDS today without making too great a sacrifice of future development? Even following reformulation, this question is only relevant if we assume that responding to children today will have a negative impact on economic growth and the prospect of providing for children in the future.
This article argues that much can be done, even though there is a ceiling that must be considered to prevent too great a sacrifice of future development. Below the ceiling, responses to children today can actually positively affect economic growth and increase the potential for future development. Furthermore. the height of the ceiling is not fixed and will vary depending on the manner of intervention. The argument will be made that, for countries without the tax base to finance such responses, international aid will be required, but that to begin the response and start to meet basic needs the amounts involved are a small fraction of current pledges and that their use for this purpose will not have negative impacts on the macroeconomic stability of recipient countries. Finally, it will be argued that, while aid is a viable short-term option, it is not an appropriate long-term solution and that the call for a fairer global economic system should be directly linked to debates such as this.
The arguments presented in this article are based on the generic situation in highly affected regions. There will of course be variations in country context that cannot be dealt with here.
This article comes from the IDS Bulletin 39.5 (2008) Affording Support in the Response to the Welfare Needs of Children Affected by AIDS