Orphans and Vulnerable Children (OVC)

1. Orphans and Vulnerable Children (OVC) Presentation prepared by Anne Kielland and the World Banks’ OVC Thematic Group, up-dated for the OVC Toolkit in November 2004

2. Content 1. Background OVC Defining OVC Estimating the numbers of OVC OVC and the Millennium Development Goals Operational implications 2. 3. 4. 5.

3. 1. Background OVC

4. What is vulnerability? • Within a Social Risk Management (SRM) Framework ”Vulnerability” is defined: • ”the likelihood of being harmed by unforeseen events or as susceptibility to exogenous shocks” • A vulnerable household is a household with a poor ability to: • prevent the likelihood of shocks hitting the household, • reduce the likelihood of a negative impact if shocks were to hit, • cope with shocks and their negative impact.

5. What then is Child Vulnerability? • In the perspective of SRM, vulnerable children are those who face a higher risk than their local peers of experiencing: • infant, child and adolescent mortality, • low immunization, low access to health services, high malnutrition, high burden of disease, and • low school enrollment rates, high repetition rates, poor school performance and/or high drop out rates. • intra-household neglect vis-à-vis other children in the household (reduced access to attention, food, care), • family and community abuse and maltreatment (harassment and violence), • economic and sexual exploitation, due to lack of care and protection.

6. Although the orphan*rate in SSA has increased only marginally, over the last decade the AIDS pandemic has contributed to increase the number of orphans in SSA by 11 millions (30%) and by 2010 will be responsiblefor 18 millions (36%) of Africa’s orphan population. Orphans in SSA: A Growing Concern * An ”orphan” is defined as a child 0-17 who has lost one or both parents. Source: Children on the Brink 2004

7. Increased general child vulnerability • The growing number of orphans and the high number of adult deaths have caused a shock to traditional child protection mechanisms in many areas, and social capital is weakening as family and community systems disintegrate. • Traditional absorption mechanisms for children have become strained (in some places completely exhausted) and this affects also non orphaned, critically vulnerable children. • Child social inequalities have increased within countries, within communities, and even within households. • As a result, it has become harder to reach a large number of critically vulnerable children with regular education, health and social protection programs.

8. 2. Defining OVC

9. Operationally defining OVC Challenge: So many children in SSA are vulnerable. Beyond vulnerable orphans, how do we define the larger group of OVC? OVC are the children who, in a given local setting, are most likely to fall through the cracks of regular programs, policies and traditional safety nets and therefore need to be given special attention when programs and policy are designed and implemented.

10. To plan for the integration of these most critically vulnerable children we need a more precise definition. • We will need to: • identify a reasonably well determinedcore group of OVC, • add some flexibility to take into account local circumstances (a gray zone), but • define a reasonably clear external demarcation for who is not to be counted as OVC. Demarcation Needs

11. 3. Generally vulnerable non-OVC Narrowing Down the OVC Concept 1. Core group of OVC 2. OVC gray zone Demarcation

12. Children affected by HIV/AIDS. • (UNAIDS, pharmaceutical companies, charities, NGOs, HPN family) • Children in and of the street. • (UNICEF, various charities/NGOs, child rights advocates) • Children affected by armed conflict. • (UNHCR, OCHA, Red Cross, NGOs, conflict/post conflict unit) • Children with disabilities or chronic illnesses. • (Disability organizations, NGOs, charities, HNP family) • Children in hazardous forms of child labor. • (ILO/IPEC, UNICEF, UCW, NGOs, labor market experts) • Each group is internally diverse, and many OVC fall into several categories. Core OVC Interest Groups NB!

13. The “gray zone” of OVC: Examples of groups that could be locally eligible butthat do not (necessarily) belong to the core OVC groups • Children forced into arranged early marriage (Somalia). • Child substance abusers (Kenya). • Children in conflict with the law (South Africa). • “Talibés” i.e. children who beg for Koranic tutors (Senegal). • Children accused of witchcraft (DRC). • “Cursed” children (Benin). • Twins (Niger). • Albino children. • Ethnic or religious minority children. • ...

14. Children who face collective deprivation or risks typical for most of their local peers, or large groups of peers. For instance: • All children at risk of malnutrition, where this is common. • All children exposed to locally common diseases. • All children in areas with poor access to schooling. • All girls in areas where girls are generally discriminated against. • Where risk is collective, more global projects need to be implemented (education, nutrition, immunization etc.) • BUT: Children who are likely to fall through the cracks of such programs, do qualify as OVC and must be given special attention to ensure inclusion and equal program participation! Who are not OVC?

15. The Family Situation of OVC OVC are: • orphaned, • separated from their parents, • living with caretakers with serious problems like illness, disabilities, trauma, substance addictions, abusive habits, or • have normal families, but special needs that even well functioning parents will need help to cover (trauma, disability, behavioral problems).

16. An OVC Taxonomy

17. Pros: • The grid model is easily recognizable for the main existing OVC stakeholders, interest groups/partners. • While OVC in general is a widely diverse group, the grid gives a fairly good overview of sub-groups. • Each cell represents a sub-group requiring similar interventions, and the rows and columns also do so more generally. • Stakeholder projects, research, and number estimates can more easily be classified based on the grid model. Cons: • Considerable overlaps (tentatively 40%). • Some interest groups focus on shocks/causes (AIDS/war), and others on outcomes/consequences (streetism, harmful labor). • Suggestion: Converting the grid into a cause-consequence tree: Taxonomy Pros and Cons

18. A dynamic model: Where to find the OVC • HH unable to cover child’s special needs • child disabled • child traumatized • parental limitations • extreme demands • HH in extreme distress/poverty/crisis • hunger • conflict • desperation • parental illness • /mental illness • HH neglecting, abusive or ignorant • alcohol/drugs • ignorance • violence • step-parenthood • HH affected by war or natural disaster • displacement • refugee • migration • Death of parents • AIDS • war • maternal death • other cause Positive outcome Child headed households Expulsion of child/ child runs away • In the street or public places • car stations • other stations • markets • street lights • other public places • In the worst forms of child labor • mines/quarries • abusive domestic servitude • brothels • armed forces • abroad • abusive farms • Institutions • orphanages • SOS villages • juvenile detention • jails • shelters • Abusive/neglecting households • bad foster care • child domestic servitude • Households unable to cover children’s needs • elderly relatives • too many ch. • ch.traumatized by parental death • disabled ch.

19. The Cause-Consequence Tree gives a first impression of the degrees of child vulnerability: children are vulnerable in the upper part of the tree, but even more so after an additional shock sends them to the lower part. While in fact all children by nature are vulnerable to some extent, they are not equally so: The Relativity of Child Vulnerability Child vulnerability is a relative, not an absolute state. The seamlessdegrees of child vulnerability can be seen as a downward spiral where each loop downward in the spiral leads to a situation where the child is more likely to experience a negative outcome as a result of a shock. The 'spiral' concept adds to the vulnerability definition by allowing for multiple stages of vulnerability. • From Cause Consequence Tree to Downward Spiral

20. The Downward Spiral of Child Vulnerability Even an ordinary child depends on the support and supervision of caring adults. A child in a poor household or a household with poor social network is even more vulnerable. A shock to the household worsens the situation (parental death, disease, addiction; drought, devaluation, conflict) The child looses protection and/or is gradually forced to support him/her self. The child disconnects completely from family and household.

21. In summary Many, if not most African children are vulnerable to risks and shocks. OVC are the most critically vulnerable among them, those who, due to certain characteristics, are at a considerably higher risk that their local peers. The risks that face OVC more often than others are early death, poor health, educational deprivation, abuse, neglect and exploitation. OVC are either orphaned, separated from their parents (social orphans), live with somehow dysfunctional parents, or need special protection measurements beyond what can reasonably be expected to be provided by normal homes. OVC are mainly found within five core groups, but do not necessarily include all children who are: 1) affected by AIDS, 2) affected by war, 3) disabled, and all children who 4) live in the streets, and 5) work in the worst or most hazardous forms of child labor. Also, locally defined special groups of children can be considered as OVC beyond these core groups, but the OVC term can not be used to describe the majority of children in a community or a country.

22. 3. Estimating the Number of OVC

23. Presenting good number estimates is a challenge because: • the sub-groups are internally diverse and often hard to trace, • global definitions are hard to operationalize in a local context, • good surveys based on solid methodologies are often missing. • The following figures are mostly ”guestimates” based on the best of available sources. Detailed sources are referenced in the ”Notes Page” attached to the following slide. • Note: Grand totals would be misleading due to considerable overlaps between categories (e.g. a former, injured child soldier, living from prostitution in the street, and being HIV infectedwould fall in all categories.) How to estimate the numbers of OVC

24. Numberestimates by the grid • NB! Grand totals are misleading due to considerable overlaps between categories. • If there is a 50% overlap, there are around 60 million OVC in SSA –- or 20% of all children.

25. 4. OVC and MDG

26. The inclusion and protection of OVC is needed to reach at least 6 of the 8 Millennium Development Goals. Directly: Goal 2: Achieve universal primary education by 2015. Goal 4: Reduce child mortality by 2/3 by 2015. Indirectly: Goal 1: Halve the proportion of people who live on less than $1 a day by 2015. Goal 3: Eliminate gender disparity in primary and secondary education by 2005. Goal 5: Reduce maternal mortality rate by ¾ by 2015. Goal 6: Halt and begin to reverse the spread of HIV/AIDS, malaria and other major diseases by 2015. OVC and the Millennium Development Goals

27. Indicator: Children everywhere able to complete primary school by 2015. • Only 49% of all children in SSA reach 5th grade. • Approximately 20% of SSA 150 million school-aged children are OVC (around 30 million). • Double-orphans living in household have an estimated 35% chance to reach 5th grade. • Children affected by conflict, street children and child laborers are almost never in school, children living with a disability are also often excluded. For the entire group of OVC the share is therefore probably much lower. • Based on this we assume that OVC overall have around 1/3 the chance of reaching 5th grade as non-OVC, or around 20%. (Non-OVC=56%) • OVC then represents 31% of the children who do not reach 5th grade. • (See slide notes page for numbers and backgroundestimates) Goal 2: Universal Education

28. Indicator: Reduce U5MR by 2/3 by 2015. • U5MR in SSA is currently averaging 174‰, and will need to be reduced to 58‰ to comply with the MDG. • OVC core group children generally have higher mortality rates than average due to their greater exposure to shocks, and limited access to mechanisms. • In the case of U5MR we only count children living with a disability or a chronic illness, AIDS and war affected children. (Street children and child laborers are normally older). If 15% of SSA’s youngest children are OVC in this respect, and if their U5MR is 300‰ they would represent 1/3 of U5 deaths. (In war torn countries like Angola and Sierra Leone, U5MR is around 260-280, and we should expect it to be even worse among OVC.) • If so, OVC comprises 26% of all current U5 deaths, or a global mortality rate of 45‰ all by it self. • If OVC are not reached in the reduction efforts, OVC will come to comprise 78% of the 58‰ mortality rate target that needs be achieved by 2015. (See slide notes page for numbers and backgroundestimates) Goal 4: Reduce Child Mortality

29. Goal 1: Half the proportion of people who live on less than $1 a day by 2015. • Currently 50% of SSA’s population live on less than $1 per day, and at least half of them are children. • OVC have slim chances to advance from extreme poverty. • If 80% of the OVC of today live up to become poor young adults in 2015, and if half of them by then have 2 children, they will together comprise as many as 116 million extremely poor. • Goal 3: Eliminate gender disparity in primary and secondary education by 2005. • Being a OVC and a girl is by many perceived to be a double curse, multiplying the risk of educational loss. • Child domestic service is the largest commercial labor market for children in SSA and a special focus on reducing child domestic servitude and increase the schooling of the many girls who are likely to remain servants will be necessary. Indirect effects

30. Goal 5: Reduce maternal mortality ratio by ¾ by 2015. • Suffering from widespread neglect and limited protection, OVC girls are at high risk for early pregnancy. They are often in poor health, and their typical economic situation strongly reduces the likelihood that they will have health care professionals assisting them at birth, all factors increasing their already high risk of maternal mortality. • Goal 6: Halt and begin to reverse the spread of HIV/AIDS, malaria and other major diseases by 2015. • High risk of sexual abuse and irresponsible sexual behavior make many OVC a special public health risk group. • OVC have low enrollment rates and thereby poor access to information, and are also believed to be neglected in many health immunization campaigns, maintaining the livelihood of viruses and the continued dependency on immunization. Orphans’ school attendance rate is therefore defined as an importantindicator under this MDG (Indicator 20) … indirect effects (cont.)

31. In conclusion • The share of OVC among those who do not yet benefit from health, education and protection services and projects is increasing. It therefore becomes gradually more challenging to reach those who remain excluded. • Doing more of what we already do will not be adequate to include the hard-to-reach remaining children, since they often have special needs that must to be considered. • We will not reach the MDGs, unless we can identify an effective strategy for including the children who consistently keep falling through the cracks of communities, policies and programs, and to secure their equal participation. • Including OVC and ensuring their equal participation requires new approaches and innovative thinking.

32. 5. Operational implications

33. Inclusion and equal participation of OVC will require higher per-child costs than inclusion of non-OVC. • But including OVC can be comparatively cost-effective because: • non-included OVC are more likely than other children to remain non-working net-consumers in the future; • non-included OVC have a higher likelihood of developing antisocial outcomes than other children. • Moreover: • Inequality and social exclusion have beenproven to hamper economic development and social stability. Inaction is costly!

34. Rehabilitating a former street child, child delinquent, child soldier or child prostitute is difficult and costly. • If the child is addicted to substance abuse, the cost multiplies. • But leaving such children unassisted is a moral dilemma, and can also pose serious crime and public health risks to community and society. • Prevention is believed to be much more cost effective than rehabilitation but it will need to target a larger group of children who are at risk of falling into the worst outcome categories. Rehabilitation vs. prevention

35. Interventions for OVC should happen at all levels of the Downward Spiral of Child Vulnerability! Prevention for children@risk Coping for the most critically vulnerable

36. Principles: • All OVC are equally needy and deserving of protection and inclusion. • The economic responsibility for most interventions should be gradually taken over by local government and local communities. • But: • Local government and communities have a very limited revenue and many other urgent priorities. • Implications: • Develop low-cost models because high-cost models only reaching the lucky few are socially unacceptable. • Focus on a few, cost-effective priorities because a poor country cannot afford to do ”everything”! Ensuring the sustainability of OVC interventions

37. In all projects: • Give special attention to participatory identification of local groups of OVC in the project planning phase by asking: • Can my project cause an increase or decrease in the number of OVC? • Might my project have a negative or positive impact on children who are already OVC? • Could my project improve the wellbeing of OVC/potential OVC if we add some special features? • If the answer to the last questions is ”yes”, you should start considering how this can best be done. Approaching OVC issues

38. The OVC Toolkit at http://www.worldbank.org/ovctoolkit/ • will guide you towards designing a good and appropriate OVC intervention. It describes how you can go about; • doing good background research on OVC, • working with the relevant partners, • consulting with the children themselves, • deciding what to do, • avoiding common pitfalls, • targeting your resources, • monitoring and evaluate the intervention, • allocating roles and responsibilities, and • costing your intervention. Defining your intervention