1. 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
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2. We are losing the battle for children’s lives
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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
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3. 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
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4. A family-centered approach
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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
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5. 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
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6. Rwanda: scaling up integrated, family-centered services for vulnerable children
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7. 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)
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8. Linking multiple actors
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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
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9. 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

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