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Children - 5.3 Resources for addressing the needs of children
Specific needs were identified during discussions with participants. Some needs could potentially be met with existing resources, and those mentioned by participants are detailed below. Where relevant, barriers to these resources being accessed are also detailed in the text. Specific details of NGO, UN agency and government resources for HIV/AIDS prevention and care can be found in the regularly updated UNAIDS Country Profile. Details of the activities of other NGOs can be found through CCC and also through MEDICAM.
The Resources of Children
Brothers and sisters were seen to be a powerful support for one another, except where the pressure for resources and food becomes so great that they eventually need to compete with one another. Participants said that siblings can and do care for one another, teach each other skills and look out for each other's interests.
The Resources of the Families
As already mentioned, mothers are generally concerned for their children, but women headed households, especially where the woman is sick, were shown to be greatly disadvantaged. Grandparents were shown to be willing to provide good quality care for orphans, but that often they lacked the means to do so.
Grandparents and other relatives were seen to be important both to support a family where parents are sick, and also to care for children orphaned by AIDS. They are seen to be important in the social education of children, as parental role models and to provide information about a range of life skills. Sometimes the extended family are not able to help because they themselves are too poor or because they are afraid of infection or being associated with bad karma. Sometimes extended families are far away, or have themselves died.
The Resources in Communities
The usual community support systems of neighbours, community leaders, community associations, the Pagoda, traditional healers and teachers were all seen to be important resources for children affected by AIDS and their parents. Again, fear of infection was seen to be a barrier, as was poverty in most communities.
A small number of community associations were reported for self-help for funeral costs. Monks were seen to have potential for ongoing emotional support for the whole family, but they were considered to need some training in HIV/AIDS specific issues. Friends and neighbours can provide practical support in household tasks, house repairs and caring for small children. With some training they can also provide respite care for those who are sick or dying. Friends and neighbours can also check on newly orphaned children and provide household materials, clothes and food.
Community and religious leaders were seen to be able to persuade head teachers to reduce school fees, although other parents would then have to contribute more. Teachers can allow poor students to economise on materials (for example to use one book for all subjects), although any concessions at school need to be implemented sensitively to maintain confidentiality and reduce discrimination. Community leaders can and do mediate in domestic conflicts when families are under stress. They could also protect the land and property inheritance rights of widows and children, but sometimes even they were not considered powerful enough to do this.
Community members in general were also seen to be important for providing social opportunities and friendship to children affected by AIDS to prohibit isolation, alleviate stress and promote their development into adulthood. Traditional healers were said to provide treatment for opportunistic infections and psychological support to families. With some incentive they could also monitor the health of children in families where parents are sick and the health of orphans.
Resources provided by People living with HIV/AIDS
There are still few formal support groups for people living with HIV/AIDS or for people affected by AIDS in Cambodia, although indications are that such groups are on the increase. Some participants talked about informal self-help activities whereby children will be cared for by another family affected by AIDS when one or both of their parents die. Although this was seen as extremely positive, it was recognised that these families themselves live in poverty and under stress with little support, and that there is a danger of further ostracisation. Children would also be liable to losing a series of substitute parents.
Resources provided by Businesses
Very few participants mentioned business people as resources. Some said local businesses could be encouraged to take on vulnerable children as apprentices, or to offer other job and training opportunities. Others said they could be made aware of the situation of children affected by AIDS and asked to contribute food, materials, drugs and money through communities or NGOs.
Resources provided by NGOs
International and local NGOs were mentioned most often by participants as existing resources for children affected by AIDS. Many local NGOs described themselves as small-scale holistic community developers providing a range of services to their communities. For example, the same NGO may have projects in irrigation, credit, and reproductive health with 10 villages in the area. Most NGOs are also located in urban centres of Cambodia, which leaves the majority of the population in rural areas underserved. Many participants in the provinces remarked that there were few NGOs in their area. In addition, participants felt that many local NGOs were in need of technical and organisational support, particularly when they have no existing links with HIV/AIDS work. A small number of NGOs provide capacity building services of this kind to local NGOs, including Khana itself.
In addition to those NGOs who specifically work on HIV/AIDS and who can be accessed through the HIV/AIDS Co-ordinating Committee (HACC), there are other NGOs who work with families and children. Some NGOs provide counselling, although these are few and far between and there is little expertise in AIDS counselling or counselling for children. In Cambodia only one local NGO is known to be dedicated solely to HIV/AIDS work in the provinces, there is currently only one independent support group for people with HIV, and there are no NGOs focussing solely on children affected by AIDS. NGOs are also helping to provide access to credit in poor communities, it is difficult for them to extend credit without collateral which means that the poorest and most vulnerable (also the very old and the young), are often excluded. Other NGOs focus on agriculture and rural development, but families often need to be landowners to take advantage of these programmes.
Some NGOs help children to access education and primary health care. Others teach a range of life-skills to young people (hygiene, sexual health, family planning, relationships, decision making etc.). A few work in the field of children's rights - both practical implementation and community-based training. There are some projects aimed at preventing trafficking, or at rescuing children who have been trafficked. Some NGOs work to reduce the incidence of domestic violence and to raise the status of women in Cambodia.
Some NGOs focus exclusively on widows or female headed households. Others work directly with sex workers or the families of migrant laborers. A few NGOs work directly with street children, offering a range of services and training. Drug use is the focus of a very few. Other NGOs provide complete care for orphans in centres and in children's homes. Many of these also work to integrate orphaned children back into communities or with extended families. Some NGOs are medicalised and provide free or cheap treatment to poor families. One organisation mentioned in the appraisal organises overseas 'foster parents' who donate money and toys to orphaned children. Another INGO has a formal foster care programme which regularly monitors the status of the children.
Government Resources
Government resources mentioned in the appraisal included HIV counselling and testing facilities which are provided by the government but limited to 5 provinces and only in the provincial town. Also mentioned was the training of government health workers in HIV, but participants reported that many still do not know about the needs of people with HIV even if they are tested, and that this especially applies to children.
National Guidelines have been drawn up on a range of HIV/AIDS related issues including on the management of paediatric AIDS, although appraisal participants felt it was not clear when or how these guidelines will be disseminated and staff in the provinces trained.
Participants said that some Phnom Penh hospitals have the capacity to treat the more severe AIDS-related infections and that home care staff from 10 health centres in Phnom Penh and 2 in Battambang have some experience in supporting children with HIV and their families. It was also reported that there are government plans to scale up home-based care in the provinces, but as yet no funding is secured for this.
With regard to education, participants reported that research on the situation with regard to the education of children with HIV and their status within the school system has been planned. Also that in some areas HIV is already integrated into school curriculums. This is in order to provide knowledge about prevention, but also to dispel fear and discrimination.
On-going training in HIV for field workers from the Ministry of Social Affairs was also reported. Participants in the community mentioned the potential for extension workers particularly from the Ministry of Women's affairs and from the Ministry of Rural Development to support children affected by AIDS.
Local authorities were mentioned most often by street children. Some had been allowed to squat in an illegal area, or had been helped in some way by the police. Most often, however, participants felt that local authorities did not prioritise the situation of vulnerable children let alone those affected by AIDS. They also felt that street children were beginning to be seen as a nuisance, rather than as children in need of assistance, and that the police were inclined to harass rather than to help children.