Children orphaned and otherwise affected by HIV/AIDS are at very high risk for nutritional, health, educational, and psychosocial disadvantages and have been found to experience symptoms of depression, anxiety, anger, grief, and traumatic grief (e.g. difficulty completing the normal grief process associated with loss).

child interview

These children are less likely to complete school, and they have higher rates of morbidity and mortality. There is growing consensus in the international community: if the economic, educational, health-related, and (increasingly emphasized) psychosocial needs of orphans and children with HIV-infected parents in sub-Saharan Africa are not addressed, these children are not likely to become stable and contributing adult members of their society.

Child being weighed

Malawi is one of the countries in sub-Saharan Africa worst affected by HIV/AIDS.  The estimated prevalence rate for adults (15 years and older) is 14.1, compared to 6.1 for sub-Saharan Africa overall.  That means that the number of persons with HIV in Malawi is approximately one million. The number of children estimated to have had a parent die of AIDS in 2006 was 550,000 out of approximately 950,000 total children orphaned from all causes. Malawi has a total population of approximately 14 million, and nearly 50% of these are under 14 years old. The dire situation for children who have been orphaned in Malawi is compounded by the country’s severe poverty and food insecurity, the latter of which is related to a series of recent droughts in this primarily agrarian economy.  For example, the 2005 season saw 26% less maize production than the year before. Further, there is weakened governmental capacity related to recent decentralization of financial and service systems for providing care to children and families. This unfortunate combination of food insecurity, decreased governmental capacity, and high prevalence of HIV/AIDS creates a potentially devastating situation for Malawi’s next generation.

MOVE chart

Almost two-thirds of persons living with HIV are in sub-Saharan Africa (63%). More than 43 million children in sub-Saharan Africa have had at least one parent die, and at least 12.3 million of these children lost their parents due to HIV/AIDS. By 2010, it is predicted that 50 million children will be orphaned in sub-Saharan Africa, one-third by AIDS. While local extended-family and social networks traditionally cared for most orphans in Africa, these systems are now being stretched beyond their capacity and many parents are dying without replacement care for their children. The crisis of children who have lost a parent due to HIV/AIDS has had an important secondary effect; many other children are more vulnerable to malnutrition, lack of education, and lack of safety and security in their care because their guardians are not able to provide as well for their biological children when others come into their household. Still other non-orphaned children are extraordinarily vulnerable because one or more parent is sick and cannot maintain economic and agricultural activities, much less be available to provide loving care. Children drop out of school to care for their sick and dying parents and to provide for their younger siblings, at times resulting in early marriage and/or child labor as well as the trauma of grief and loss.

The Funder’s Collaborative for Children (FCFC), a collaboration among Comic Relief, the Princess Diana Memorial Fund, Elton John AIDS Foundation, and the Children’s Collaborative Investment Fund, comes at a time of critical need and increased international attention to providing resources to Malawi and, more importantly, to assist in increasing district and central governmental capacity to care for vulnerable children.  The goals of the FCFC involve addressing in an integrated and comprehensive manner the needs of orphans and vulnerable children in Malawi.  The Program aims to establish a collaborative, replicable, and sustainable model of prevention, treatment, and care for districts in Malawi, creating a “system of care” more able to support children and their families than the many fragmented agencies and groups that, ultimately, fail the children they serve (Noerine Kaleeba, personal communication, January 9, 2007.)  The external monitoring and evaluation (M&E) of the impact of the intervention is an effort by Duke University and the Malawi College of Medicine designed to be longitudinal, evidence based, participatory, and empowering of the district and national government.  The Malawi M&E (MOVE) is conducted so that it can be used in a formative manner for program planning and to influence governmental and international policies about the provision of OVC services in less wealthy countries, vulnerable by HIV/AIDS.