Child-Headed Households in Africa APHA 140th Annual Meeting (2012) Session: Late Breaking Developments in Public Health ______________________________ Joseph Telfair, DrPH, MSW, MPH Professor and Director, Public Health Research and Practice Center for Social, Community and Health Research and Evaluation The University of North Carolina Greensboro

Thank You

Presenter Disclosures The following personal financial relationships with commercial interests relevant to this presentation existed during the past 12 months: Joseph Telfair, DrPH, MSW, MPH “No relationships to disclose”

Challenges of Child-Headed Households (1) Part of the broader issue of child and family poverty in Africa result from a myriad of adverse events including: HIV/AIDS mortality among adults Violent conflict Mal-distribution of resources Lack of social and structural support for families So forth

Challenges of Child-Headed Households (2) Programs and services to address these challenges exist in Southern African countries like Swaziland: Fragmented Exist little collaboration among government and non-government agencies in addressing Single-problem focused Lacks a clear understanding of their efficacy and effectiveness

Child-Headed Households - Solution (1) Sawziland Demo & HSH Survey 2006/7 & 2010: Southern Africa, land locked, SA & Moz 1mil pop - 54% female, most yrs & urban [~60%] 69% below pov/37% extreme pov21% food insecure Highest HIV prevalence in world [26% adults/49% women 25 to 29] 0.63% HSH headed by children < 18 [1.9 % in poorest 2 regions]

Child-Headed Households - Solution (2) Planned Study rationale and purpose: Government & Non-Government Collaborative Title: Improvement of programming for children’s issues The proposed study (broadly speaking) is to have a dual focus: Expansion of smaller study (Save the Children and UNICEF 2009) to the whole country Engagement in a systematic approach of defining and comparative testing of “service package” or “service clusters” in catchment areas where currently discreet (individual and targeted) services are delivered

Child-Headed Households - Solution (3) Goal: Assure improvement in the management and delivery of child and family social and health services in order to enhance the QOL of children. Strategic Objectives: To implement the establishment and sustainment of a collaborative partnership for purpose of strengthening coordination of social and health services that are targeted at children and their families To implement an evidence [data] generation process (start, Implement and complete) for: a) planning; b) resource allocation; and c) monitoring and evaluation of social and health services that are targeted at children To utilize findings from systematic services studies and evidence gaps assessment to inform: a) the design and b) implementation of - the strategy and approach to improve outcomes of social and health services for children and families in Swaziland To design and execute a comprehensive monitoring and evaluation plan for the project

Child-Headed Households - Solution (4) Planned Study rationale and purpose (cont): Need for a common language and extension of the definition of orphans (single, double orphans) Presently an “anti-orphanage” Pro-unit/pro-community sentiment in Swaziland Issue largely anecdotal with little systematic knowledge about characteristics & situation There does exist a number of services targeting children and families, provided in ‘silos’ (e.g., clothing, food, health care, so forth) linked to the specific NGO, government agency/program, organization or individual Way decisions are currently made by Government, there is no support for a study focuses solely on orphans

Child-Headed Households - Solution (5) Planned Study rationale and purpose (cont): Need is to engage in prevention-based interventions that pools resources, builds and sustains capacity to meet the reduction goal of the collaborative Focus on achieving a better understanding of the social and political capital already invested in for purpose of mitigating existing challenges Integrate issue as part of a larger effort concentration in the public health arena with attention to child and family poverty, HIV & AIDS & general service provision challenges

Child-Headed Households - Solution (6) The study would proceed in two phases: A pilot phase that involves: reviewing existing data [quantitative & qualitative] on the services scope & quality definition and viability of individual services that allow for resources study design would be secured and refined (anticipated funding by philanthropic groups) A study implementation phase building on the pilot study results (anticipated funding by government agencies)

Child-Headed Households - Solution (7) The approach: Has a public health solution-building - results focused model Designed to produce social-cultural-technical best practice case examples with replicable outcomes that can serve as a national model (all four regions)

Child-Headed Households - Solution (8) The four core questions to answer: “What model(s) work best?” “What resources are needed to get the job done?” “What is the nature and extent of Child headed household phenomenon?” “What are the priority needs of children who find themselves in this predicament?”

Child-Headed Households - Solution (9) Expected Outcomes Planned Study: Understand the Potential (Assets) and limitations of Government and Non-Government Organizations (NGOs) Better understand effective service cluster Strengthen budget management and quality of social and health services expenditures Build political will and good governance service programs Take advantage of favorable development partner policies and build on internal momentum to best serve population

QUESTIONS AND DISCUSSION

References UNICEF (2009) A situation and needs assessment of Child-Headed Households in drought prone areas of Swaziland’. The focus of the publication was on poverty and AIDS (Treatment, support, gaps) UN Resident Coordinator (2010) The Complementary Country Assessment The Kingdom of Swaziland. Source site: The World Bank (2000). Swaziland reducing poverty through shared growth United Nations Children’s Fund. (2003). Swaziland Statistics. In Info by Country. Retrieved from tml/