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Challenges Faced by OVCs

2.1 Social

Children being forgotten in ARV rollout
April 22, 2005— Children are being forgotten in the eagerness to provide antiretroviral treatment to the thousands of people in need of the life-extending drugs. This is according to Dr Haroon Saloojee of Wits University's Community Paediatrics Division who was speaking this week at the first "Priorities in AIDS Care and Treatment (PACT)" conference. At best 3 000 children are on antiretroviral (ARV) drugs countrywide, whereas between 30 000 and 45 000 of the country's 230 000 HIV positive children needed the drugs, said Saloojee. Saloojee, one of the respondents in the historic Constitutional Court case that led to Government being forced to provide Nevirapine to pregnant HIV positive women, said the most basic right, the right to life, was not being respected in this country. "Even more so in the case of children who cannot toyi-toyi in the streets and do not elect politicians into parliament," he added. ... Read more
The extended family network that has traditionally existed in Africa and South Africa is finding itself increasingly under strain because of HIV/AIDS and poverty – capacity and resources are simply too overloaded to care for the sheer number of children orphaned or made vulnerable by AIDS. The illness or death of a mother or caregiver can jeopardise a child's most basic needs, such as access to adequate health care, sanitation and nutrition. In a 2004 article in Development Update, Belinda Beresford writes about the particular challenges that lie in providing antiretrovirals for HIV-positive children at Coronation Hospital in Johannesburg. These challenges range from the much more complex process of providing ARVs for children as opposed to adults, to the lack of space in which to run the paediatric ARV clinic. Click here to read the full article. The death of caregivers from AIDS can put children at risk of further discrimination and isolate them from a community because of the stigma associated with HIV/AIDS. Often the children themselves are perceived to be HIV-positive, which may not necessarily be the case. Orphans and other children made vulnerable by HIV/AIDS are often exposed to violence, abuse and exploitation. Children, especially girls, that have to drop out of school to work or care for their families often engage in hazardous labour or are otherwise exploited.

2.2 Psychological

The loss of a parent can deprive a child from a family environment which is crucial in the development of a positive self-identity and self-esteem. Because the burden of care and responsibility is likely to fall onto the children in the case of a sick parent or death, these children experience a loss of childhood – in other words, play, rest, and recreation, the opportunity to participate in community, religion, cultural activities and sport. Children who have lost one or more parent experience grief and loss that may not be adequately dealt with in an environment that lacks psychosocial support because of competing pressures.

2.3 Economic

There is a loss of income when caregivers become sick or die of AIDS. Often children have to forego education and instead assume the adult role of providing for their families. Further pressure can be exerted by increased health care costs and eventually funeral costs. Under the Child Care Act No. 74 of 1983 and Social Assistance Act No. 59 of 1992 (now the Social Assistance Act No. 13 of 2004) there are two types of grants that are available to assist OVC, depending on eligibility. According to South Africa.info in an article, Millions benefit from social grants, South Africa has 9-million children on social grants, which does not reach all orphans but does reach a great number.The primary care giver of children up to the age of 15, who qualifies in terms of an income-based test, is eligible for a Child Support Grant (CSG) of R240 per month. This is intended as a poverty alleviationgrant. The Foster Child Grant (FCG) provides assistance to the primary care giver of children formally placed in foster care. These children need to be considered "in need of care". There is no means test and the primary care giver receives R680 per month per fostered child up to the age of 18. The mechanisms for securing this grant are much more complex. A child has to be identified as formally "in need of care", thus it is rather aimed at child protection. An article published on South Africa The Good News in May 2009, Social grants alleviate poverty states that at present, eight million children receive the social grants, while more than 400,000 receive The Foster Care Grant (FCG).

Fast Facts: Child Grants

R240pm Child Support Grant in 2009. R680pm Foster Child Grant in 2009. Source:

South African Government Services-Child Support Grant.

South African Government Services- Foster Child Grant.

The FCG is often touted by both government and civil society as the key social security response for OVC. Yet, Meintjes et al. (2004) argue that many children orphaned and made vulnerable by HIV/AIDS are not necessarily formally "in need of care" and so cannot qualify for this grant, creating many inequities in the system. According to Meintjes et al., a much more appropriate response is to implement a universal CSG to all children up to the age of 18 and the removal of the means test. Although this may seem counter-intuitive in the light of the FCG being of a higher monetary value, the authors argue that the broader spread of the CSG would result in a greater net monetary transfer to households and neighbourhoods.
Orphans playing in the playground of Hillbrow Children's Home in Johannesburg where they live. Photo by Pirozzi for UNDPI/UNAIDS.
Yet in South Africa many orphans and children made vulnerable by HIV/AIDS, especially those in child-headed households, are unable to access the child support grant because they lack appropriate documentation. In order to access a grant, the following documentation is needed, amongst others:
  • ID of parent or primary care giver; or
  • Death certificate of parent(s)
  • ID document or birth certificate of the child
Because of home births, or non-registration of births and circumstances exacerbated by the fragmentation of family structures caused by HIV/AIDS and poverty, many OVCs have great difficulty in obtaining these documents and as a result, are not eligible for the CSG. There are community-based efforts, for example the Thandanani Children's Foundation Campaign, "Your Right" (see story here) to alleviate this problem, but the current system still alienates many of these children.

Fast Facts: Grants

7-million children receive the Child Support Grant in South Africa Source: State of the Nation Address, 2006.
The feature film Nikiwe (2004) highlights to problem of access to social grants by following the story of three orphans in Limpopo province. (see trailer)

2.4 Child-Headed Households

A press release issued by the South African Institute for Race Relations claimed that in recent years the number of child-headed households has grown by 25% from 118 000 in 2002 to 148 000 in 2007. The proportion of child-headed households is small— less than 1 percent— but this figure vastly underestimates the scale of the problem. Though a parent may be formally the head of a household, if s/he is too sick, the burden of care and responsibility often falls to the oldest children. All of the abovementioned psychological, social, economic challenges will be further exacerbated in this case.
Wits Journalism Anova Health

The project is jointly managed by the Anova Health Institute and the Journalism and Media Studies Programme at the University of the Witwatersrand, and supported by the Health Communication Partnership based at the Johns Hopkins Bloomberg School of Public Health Centre for Communication Programmes and the President’s Emergency Plan for AIDS relief through the United States Agency for International Development under terms of Award No. JH/HESA-02-05.