Focus on the Family: the Key for Ensuring Children’s Wellbeing Agnes Binagwaho, MD, Paed Executive Secretary, National AIDS Control Commission, Rwanda Co-Chair, Joint Learning Initiative on Children and HIV/AIDS XVII International AIDS Conference, Mexico City, 6 August 2008 Organization | Month 00, 2008 1

We are losing the battle for children’s lives Organization | Month 00, 2008 We are losing the battle for children’s lives In 2007: 2 million children under 15 living with HIV 270,000 children under 15 died from AIDS 370,000 children under 15 newly infected, 17% of new infections globally Families and communities bear ~90% of the costs of care and support for affected children; families are children’s best hope—but they need support Text-based slide 2

The global response must refocus on families Families care best for children; outside interventions can enhance, but not replace, family care Vast majority of AIDS-affected children in Africa, including orphans, live within extended families 80% of orphans have a surviving parent 90%+ live in extended family structures An effective, scaled response must work through and strengthen families Text-based slide 3

A family-centered approach Organization | Month 00, 2008 A family-centered approach Takes the family, not the individual child, as the unit of intervention—seizes opportunity to reach additional family members with services Strengthens long-term family caring capacities while improving children’s short-term outcomes Is cost-effective: institutional care costs 8-14 times more per child, with worse outcomes Text-based slide 4

Looking at family needs in multiple dimensions Strengthening families in multiple dimensions Takes the family, not the outcomes A family-centered approach must address all aspects of wellbeing: Health Education Housing Psychosocial needs Economic security Text-based slide 5

Rwanda: scaling up integrated, family-centered services for vulnerable children Text-based slide 6

National strategy 2007-2010: a ‘minimum package’ of services for children and families -health services -education -nutritional support -financial support for host families -safety (including housing) Text-based slide 7

Linking multiple actors Organization | Month 00, 2008 Linking multiple actors National government: sets policy, regulates funding, ensures geographical equity, monitors results District governments: define their own objectives and implementation plans Key role of district mayor Communities: identify children and families in greatest need NGOs: deliver services Text-based slide 8

The leading edge of change: economic strengthening To benefit from other services, destitute families need basic economic security Most effective way to provide economic support to poor, AIDS-affected families is through national social protection programs One option is income transfers, for example Mexico’s Oportunidades program -Agnes introduces Julio Frenk. 9

Thank you. http://www.jlica.org -Agnes introduces Julio Frenk. 10