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SPH profs to Uganda: protect orphans or face national disaster

By David J. Craig

When a Ugandan man dies, one of his brothers traditionally takes in the man's wife and children and inherits his property. In the past, this arrangement offered assurance that a family affected by tragedy would be cared for, and polygamy in this situation was accepted.

	Angela Wakhweya, an SPH assistant professor of international health, says Uganda will face more civil unrest in the future if it does not do a better job caring for children who have lost parents to AIDS. Photo by Vernon Doucette

But the AIDS epidemic that has claimed 840,000 Ugandan lives changed that. Because women whose husbands die of the disease are likely to be infected with HIV, many are shunned by their husband's family. A recent BU survey of 326 Ugandan households caring for orphans found that 40 percent were headed by widows; most of the rest were headed by another female relative.

Angela Wakhweya, an SPH assistant professor of international health and co-principal investigator of the study, says the breakdown of this informal support system is one reason why Uganda must formulate a national policy for aiding orphans. About 2.3 million children in Uganda, or one in five, have lost at least one parent to war or to AIDS; 330,000 are parentless.

"AIDS, which is the leading reason why children become orphans in Uganda, is not letting up, and the nation eventually could have a huge number of adults who are angry and emotionally dysfunctional," says Wakhweya, who conducted the study with Kris Heggenhougen, an SPH professor of international health. The study, which warns that a "lost generation" of orphans could create a "breeding ground for future violence and civil unrest," was commissioned by the Ugandan government and funded by the U.S. Agency for International Aid. Wakhweya and Heggenhougen presented their results to Uganda's Ministry of Gender, Labor, and Social Development in February.

They recommend that Uganda protect better the human rights of orphans and widows, that it implement a system for counting and tracking orphans and for evaluating their needs, and that it provide grants and loans to households caring for orphans. The first step Uganda should take, they say, is to count its orphans using the national census planned for this year.
"The government doesn't know what channels of assistance work," says Wakhweya, "and there is no system for gathering information about orphans or even determining how many exist."

Families' plight
The situation of Ugandan women and children ostracized because of AIDS is particularly desperate -- the expense of having cared for someone through a long terminal illness is likely to have left them impoverished. And along with 80 percent of the Ugandan population, most struggle to survive by growing their own food, using the simplest hand tools, and in their case, without a man's help.

"When a man dies of AIDS, his extended family sometimes drives his wife and children off their property and takes it," says Wakhweya, who was raised in Uganda and came to the United States in 1993. She specializes in studying the impact of HIV and AIDS on African populations. "The legal community in Uganda must take a very careful look at this practice of inheritance, and of property grabbing, which clearly can't continue."

Even orphans taken in by extended family, however, face a dim future -- the BU study found that they are more likely to suffer malnutrition, to have inadequate access to health care and education, and to have unmet psychological needs.

And then there are the children who fall through the cracks of Ugandan society altogether: child-headed households are common, and on city streets, homeless children regularly beg for food or a place to sleep. "The situation of street children is compounded by the fact that they're shunned by law enforcers and other people who don't want them around," says Wakhweya. "They literally have nowhere to go."

Providing focus
No figures are available on how much the Ugandan government spends to help households caring for orphans, Wakhweya says, but 80 percent of the families she surveyed receive no such assistance. "Partly that's because the government doesn't know the best way to get money to people, whether it be through churches or government structures," she says, "and partly it's because people are unaware of how to access it."

One form of help that holds promise and should be expanded, Wakhweya says, is a government loan program that gives households caring for orphans livestock in return for some of the animal's offspring. "In addition to interventions in health care, education, and psychosocial support services, we're also pushing for these microcredits, which are small loans or grants in the form of an asset such as a cow or goat that can reproduce and in that way increase a family's assets," she says. "It's been shown to work."

Fortunately, Wakhweya says, there is wide public support in Uganda for additional government spending to help orphans. She expects to be involved in a series of follow-up studies to help Uganda formulate specific policy changes. "About 25 percent of households in Uganda care for orphans, so clearly they would want additional support, and the executive branch of Uganda's national government wants it, and UNICEF and USAID want it," she says. "The main objective is to create a system for distributing assistance effectively, and to get it done immediately."

26 April 2002
Boston University
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