Child Sensitive Social

Unite for Children, Protection for Children

Unite against AIDS. Affected by HIV/AIDS in
Asia-Pacific
Disclaimer: The views expressed in this paper/presentation are Rachel Yates Wing-Sie Cheng
the views of the author and do not necessarily reflect the views
or policies of the Asian Development Bank (ADB), or its Board of Ketan Chitnis Rachel Odede
Governors, or the governments they represent. ADB does not
guarantee the accuracy of the data included in this paper and
accepts no responsibility for any consequence of their use.
Terminology used may not necessarily be consistent with ADB UNICEF
official terms.

ADB Social Protection Workshop

Manila, 21-22 April 2010

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Growing Momentum behind social protection
for children affected by AIDS

• 2008 Global Partners Forum (GPF) for Children affected by

HIV/AIDS recommended social protection as a key intervention to
support children affected by HIV and AIDS.

• UNICEF prepared joint statement on child sensitive social protection

(2009) endorsed by World Bank, ILO and others

• Social protection priority new priority area within UNAIDS outcome

framework (2009)

• Growing interest amongst UNAIDS co-sponsors in interface

between HIV/AIDS and Social protection and how to ensure safety
net programmes AIDS sensitive

“
 Global Partners Forum Dublin 2008 – strong
inter-agency consensus on social protection

Key recommendation from Global

Partners Forum to:

“Support the development and

implementation of comprehensive
national social protection
programmes including cash and
other social transfers, family support
services, early childhood care and
alternative care”
Child sensitive social protection
June 2009 Joint Statement released by UNICEF and endorsed by
DFID, HelpAge, IDS, World Bank, ODI, ILO, UNDP, SCF UK,
Hope and Homes for Children

Key components include:

•Social transfers (cash, food)
•Social insurance (health insurance, maternity provision)
•Social services - (child welfare services, psychosocial support,
alternative care)
•Policies legislation and regulation

Components need to be seen as complementary and mutually reinforcing

Social Protection and HIV/AIDS

• Identified as 9th priority area in UNAIDS outcome framework

• Business case developed – showing links between social protection
and prevention, treatment, care and support
• Focus on AIDS sensitive social protection – rather than exclusively
targeting people affected by AIDS
• Bold Actions identified to scale up social transfers, social health
insurance and care and support services at country level
• State of the evidence paper forthcoming on social protection and
AIDS outcomes (June 2010)
The Economic Crisis and Children – adding to the 
momentum behind child sensitive social protection
• “About 55 million more people will live on less than $1.25 a day (in
2005 purchasing power parity terms) in developing countries than
expected pre-crisis.” – The World Bank, 2009

• The economic crisis along with climate change, food insecurity and
HIV/AIDS places huge burdens on poor households.

• World Bank increasing funding for social safety nets and growing
interest in AIDS sensitive social protection

• Growing UN momentum behind social protection floor – universal

access to basic social protection
Adato, M & Bassett, L. (2008) What is the Potential of Cash Transfers to Strengthen Families affected by HIV and AIDS? A Review of the Evidence on Impacts and Key Policy Debates, JLICA.
Malawi - Importance of cash plus – finding opportunities
to link and enhance different components of CSSP

In Malawi OVC from households

receiving social cash transfers are
linked to Community Based Child
Care Centres (ECD).

To facilitate these linkages, the

Ministry has put in place 800
Community Child Protection
workers who interface with the
households, the community and
state run facilities such as the
Police, Schools, CBCCs,
Children’s Corners, social
welfare services, justice
services and community welfare
services.
 Draft Outline Social Protection Programme
52% MALAWI POVERTY LINE
CATEGORIES AND POTENTIAL SOCIAL
THEIR SOCIAL PROTECTION
PROTECTION NEEDS PROGRAMMES/
INTERVENTIONS
PROTECTION AND PROMOTION
• Employment ∗ Inputs subsidy
Moderately • Skill building ∗ Public works programmes
30%
Poor • Capital • Insurance programmes
• Productive Assets (Social, Crop & Livestock)
• Protection from • Village savings loans
asset/capital erosion • Micro-credit / Micro-
finance
• School feeding
22%

Ultra Poor PROMOTION

Ultra Poor with • Survival ∗ Public works programmes
• Productive Assets ∗ School Feeding
12% Labour • Cash and food for assets
• Employment
Capacity combined with skills
building and cash for
consumption/ Adult
lit t i i
PROVISION
Ultra Poor & • Survival ∗ Social cash transfers
10% Incapacitated • Investment in ∗ School feeding
human capital

* To be funded out of the Government of Malawi Basket Fund for Social Protection
HIV/AIDS and Children in Asia Pacific

• Asia Pacific has estimated 151,000 children, 0-14 yrs, living with HIV
• Breakdown not available, except Cambodia 4,400; PNG 1,100; Thailand 14,000
• Majority of children on treatment are in Thailand, Cambodia & India
• 21,000 new infections among children in 2008

• Estimated children affected by AIDS not known but estimated from

the 4.7 million people (mostly adults) living with HIV/AIDS

• 1.75 million children lost one or both parents to AIDS in Asia Pacific
(11% of AIDS orphans globally, 1.3 million in South Asia and 450,000 in East Asia
and the Pacific, 2005 estimates), and with low ART coverage for survival (about 30%)
there is a possibility of increase in orphans in the region
• Estimated 67.5 million orphans due to all causes in Asia Pacific

• Most affected children are of injecting drug users, sex workers and
men who buy sex, facing dual or multiple discrimination and at the
same time making them vulnerable to HIV infection
Source: The State of the World’s Children, 2009, UNICEF & UNAIDS epi update 2008 & 2009
Consequences of HIV/AIDS on Children in Asia

• Households affected with HIV do have lower incomes, and often

experience lost productivity and economic decline related to
increased expenditures, especially on health
• More than half of the AIDS affected children (56%) have lost either
one or both the parents (45% had fathers alive and 88% had
mothers alive)
• Poverty is a major factor in reduced access to education in the
region. Fewer HIV affected children are in school and those in
school perform poorly (Malaysia)
• Paternal orphans have lower school attendance than non-orphans
(Cambodia)
• Older orphans appear more vulnerable to school drop out
(Thailand) as they seek employment
• Orphans are less likely to attend school than non-orphans
• Children still experiencing stigma & discrimination across the region
Source: Protection and Care for Children Faced with HIV/AIDS in East Asia and the Pacific: Issues, Priorities, Responses in the Region,
2009, UNICEF EAPRO.
 Select country
examples of
child and AIDS
sensitive social
Unite for Children, protection
Unite against AIDS. programmes

China, PNG, Thailand,

India and Nepal
China – Moving from AIDS focused to AIDS
sensitive policies

• 2003 issued “4 free and 1 care” policy to provide free treatment,

education and care for HIV affected adults and children
• 2006 the national Regulation on Prevention and Control of HIV/AIDS;
• 2009 Opinion on Further Enhancing the Care and Support of CABA
issued with new approaches to care and support
- Pilot demonstrates the per capita annual income of affected families
increased by 38% (control group, 20%) and the disparity between affected
and unaffected families has lessened
- over 90% of CABA live in extended or foster families, attend schools and
receive living assistance in the project areas
• 2010 with HIV as the entry point, the UNICEF taskforce supports the
MCA on a more comprehensive child welfare system in China
PNG – Community-based model for care

• PNG has a generalized epidemic,1.61% prevalence

• 1,727 children were living with HIV and about 3,730 children
orphaned from AIDS-related causes (2007)
• Most vulnerable children strategic plan as part of government policy
is to mainstream HIV into a systems approach to child protection
• Objective is to strengthen household and community social
protection systems and to promote extended community care by
ensuring access to essential services
• Cash transfer feasibility study conducted, framework developed used
by government to implement policy on social protection of MVCs
• Pilot cash transfer programme has been implemented reaching
MVCs including children affected by AIDS
Thailand – managing social and economic risks

• Thailand has 14,000 children living with HIV/AIDS and some 400,000
affected by children (2009 estimates)
• Community-based care programmes effective in 14 provinces for
orphaned and HIV infected children
• Ministry of Social Development and Human Security supports
vulnerable families including those affected by AIDS, e.g. family
support fund (approx 1,000 baht per family every 2 months) and
support for children living in kinship/foster care which includes a
monthly cash stipend and supplies.
• Decentralized fund available in every province
• Opportunities to strengthen child and AIDS sensitive social
protection with Global Fund support (round 10)
India – Integrated child protection and
development programme

• 94,000 children with HIV, affected not known

• National policy and taskforce exists on protection, care and support
including mechanisms of PLHWAs to deliver services
• Integrated Child Protection Scheme was adopted in 2009 as a
national policy to address needs of all vulnerable children including
children affected by AIDS
• The Integrated Child Development Scheme (ICDS) started in 1975 to
deliver a nutrition and welfare package for children below the age of
six years remains the most comprehensive package
• Scheme covers 22.9 million children under six through a network of
4,200 projects, covering rural and urban children in need
• Numerous other targeted interventions for children (working children,
street children, rescued children, etc ) and cash transfers to promote
educational enrollment exist to benefit all children in need
Nepal – addressing needs of vulnerable
households

• Estimated1,800 children HIV infected and many more affected

• National social protection measures on social security of formal
workforce, micro-credit options as well as social assistance
• Less than a quarter of the population in poverty receives some form
of social protection assistance, primarily micro-credit
• Cash transfers in the form of pensions for elderly, widows, people
from socially excluded castes (dalits) and people with disabilities
• Child-related interventions include scholarships for girls and children
from poor Dalit families to promote primary school attendance and
through access to books and meals
• Child Grant programme for children in Karnali zone and for poor
Dalits all over Nepal
• Pilot reaching over 1,200 children affected by HIV/AIDS with an
external package of support for education, nutrition, medical and
home based care in Accham, Sunsari and Syngja districts
Way forward for Child Sensitive Social Protection
as part of the AIDS Response
• Growing evidence that social protection can reduce susceptibility to
infection and vulnerability to the impact of increased morbidity and
mortality caused by HIV and AIDS
• Social protection investments in children, e.g. nutrition/ cash transfers
and family support shown to have life-long impacts. Yet children less
able to advocate for social protection expenditures
• In concentrated epidemics more social exclusion analysis needed to
see who is not accessing HIV prevention, treatment and care and
tailored transformative social protection initiatives (e.g. sex workers,
street children, drug users).
• Social transfers and family based support need to ensure children
kept in supportive family environment and reduce the need for
institutional care
• Greater investments needed in social protection systems to
complement growing health systems strengthening.
 Health Systems •Health information systems

Strengthening •Service delivery including

medical products, vaccines &
WHO defines health systems technologies
as “all organizations, - Drug supply chains
people and actions whose
•Leadership & governance
primary intent is to promote,
restore or maintain health”. •Health Financing
•Human Resources for Health
•Training and retaining health
workers
•Training and
Community employing
community health
Social Protection-
Systems workers, including •Care & Support
Social health
financing- e.g. social systems
strengthening PLHIV and MARPs Psychosocial health
strengthening
support insurance
•Community empowerment
marginalised groups –voice •Home based Social transfers- pensions, cash
accountability care transfers, food and nutritional support,

•Programmes, activities & •Community child •Predictable/sustainable financing for

services Community service
delivery mechanisms
•Community networks,
linkages & partnerships
•Communication & Outreach
•Planning and M&E
•Resources and capacity
building
•Management, accountability
and leadership
protection social welfare ministries
committees •Initiatives to promote access to
•Community services- e.g. school fee waivers
social workers •Child protection systems
strengthening inc alternative care OVC
•Employment + public
works •Strengthened family and community
•Job training, income support services to support vulnerable
generation and job households and excluded groups
creation programmes
•Social work strengthening
•Livelihoods support
•Social transfers •Legal and policy environment-anti-
•Savings and credit stigma measures and anti-
discrimination laws and policies
 Thank you!

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