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Washington, D.C., National Council for International Health [NCIH], 1991 Mar 31. , 27 p.AIDs provides a unique and unprecedented opportunity to affect behavioral change, open up discussion on sexuality, and strengthen health and educational programs. This National Council for International Health policy report encourages collaborative multisectoral programs to deal with the issues of AIDs orphaned children. The contents include introductory chapters as well as chapters on the economic, public health, and social implications of AIDs in the Third World; supporting the child, family,and community; recommendations for the role of NGO's and the role of donor agencies; and conclusions. It is hoped that NGOs and donors will be mobilized to deal with a problem that will strain the already inadequate health, social and financial resources of developing countries, and thereby affecting the increasing demand for long term child care. WHO estimates of HIV infected children <5 years are 10% of 25-30 million by the year 2000. The current problem also includes children orphaned from the estimated 3 million women who will die in 1990. The economic implications are that economic productivity is reduced, low income families will be unable to provide for the additional orphaned children, and debt and low prices for exports have already reduced national budgets and reflect less social spending. The public health implication is the 1-10 US dollars/per person health spending cannot accommodate AIDs screening which alone cost 1 US dollar. AZT costs 20,000 US dollars a year/per child, or the combined annual income of 133 Mozambique farmers. A child's AIDs hospitalization in Zaire costs 4 months wages for the average workers. A funeral costs 11 months wages. In Rwanda, the doctor/patient ratio is 1:36,000. Child survival may be reversed because of reduced credibility in breastfeeding and immunization, confidence in common health remedies, and of confusion between AIDs symptoms with other treatable ailments. AIDs confronts Africans with a challenge to their cultural beliefs and marital, family, and sexual patterns. The alternatives for care are the extended family, alternative residential facilities, and adoption and foster placement. It is recommended that NGO's increase information exchange/program coordination; balance short term emergency assistance with long term sustainable solutions; give priority to maintaining a child's sense of identity and ties with family, clan, and community; involve communities in all phases of project planning, implementation, and evaluation; provide resources to empower women to make choices; and ensure the discrimination due to HIV infection does not occur. Donor agencies should encourage NGOs to pursue multisectoral solutions; increase funding and improve dispursement means for NGOs; facilitate information exchange, funding, conducting research, offering strategic guidance, and taking responsibility for program coordination; ensure the sustainability of AIDs orphan's projects; and realize the goal of improved status of women and children legally, socially, and economically.
In: Child care: meeting the needs of working mothers and their children, edited by Ann Leonard and Cassie Landers. New York, New York, SEEDS, 1991. 1-4. (SEEDS No. 13)The overwhelming majority of women in the world work to make a living. In 1985 the female labor force amounted to 32%. In the developing world industrialization, urbanization, migration, and recession in the 1980's forced women to seek employment. In Ghana over 29% of households are headed by women. In the US 57% of women with children under 6 are employed. In Bangkok, Thailand, 1/3 of mothers were back to work within the 1st year of after childbirth. In Nairobi, Kenya, 25% of mothers were working when their child was 6 months old. Availability of child care is often scarce: in Mexico City during the recession of 1982 mothers were forced to take their child to work, or left them with neighbors or older children. Grandmothers live in only 15% of homes and extended family members in only 10.8%. A serious problem arises when older siblings drop out of school to take care of the young. Organized child care programs vary: in India a nonformal preschool program covers 25% of children aged 3-6. However, inadequate resources often result in operation of only 3-4 hours a day, no provisions for breast feeding, and custodial care instead of nutrition and health benefits. In India mobile creches at construction sites provide child care for female workers. The International Labour Organization fostered the classic factory day care facility, but transportation distances and costs have diminished the popularity of these. The community-supported model in Ethiopia has been successful, and similar projects are tried in Mexico. Child care workers are paid little: in Ecuador trained preschool teachers make 40% of the salary of primary school teachers; and in the US in 1989 they were earning only 30% of the salary of elementary school teachers. Better options for child care are needed for the safe and normal development of children.
In: Child care: meeting the needs of working mothers and their children, edited by Ann Leonard and Cassie Landers. New York, New York, SEEDS, 1991. 19-24. (SEEDS No. 13)In Ethiopia among the Melka Oba Farmers Producers' Cooperatives which are 120 km from Addis Ababa, child care was managed by the cooperative itself with the assistance of UNICEF and the Integrated Family Life Project (IFLE) interagency committee in 1983. Funding was used to employ a consultant to train child minders and establish the center, pay the cost of training, purchase resource materials for the training, equip the creche and kindergarten, and buy tools for construction of play items. A villa was donated to house the day care program. 8 child minders were selected for their interest in children and their educational level. Training was for 8 months. The child care center has flexible hours to accommodate working mothers and allows breast- feeding visits during the day. It is open to children aged 45 days-6 years, and includes a national preschool curriculum and immunization and health care services. As a byproduct of the center's activities, a family planning, health, and family life education program are operating. The evaluation in 1985 found that there were many reports of improved health among the children and less anxiety for the parents about child care. Production has increased and absenteeism has fallen. Pressure was applied successfully to obtain a local elementary school. A literacy program for adults was also begun. Of the problems encountered, the most difficult was persuading men, who felt that there was not a child care problem and that the women took care of it, to share in child care responsibilities. IFLE and UNICEF replicated the effort in Melka Oba within the Yetnora Agricultural Producer's Cooperative in Dejen, Gojjam Region. 12 lessons learned from this experience are identified: 1) child care needs must also take into account the interrelated needs of working mothers, infants and young children, and child care providers; 2) child care must be accessible, available during work hours, affordable, and trustworthy to mothers; 3) high quality care must have an appropriate curriculum; 4) local women should be trained as providers; 5) need is dependent on the child's age; 6) providers need payment and support; 7) community involvement increases commitment and learning; 8) byproducts are parent education and more schooling options for siblings; 9) teaching needs to be learner centered; 10) no 1 solution is best; 11) quality of care must be contextually judged by mothers and the community; and 12) political commitment is necessary.