‘Long-Term, Low-Level’ Support of Community Programs Helps AIDS Orphans Most, Commentary Says
While U.S. funding of programs that assist orphans of the African AIDS epidemic is "important," how that funding is spent is "even more critical," Dr. Geoff Foster of the Mutare Provincial Hospital in Mutare, Zimbabwe, writes in a New England Journal of Medicine "Sounding Board" commentary. Very few children are "slipping entirely through the safety net" of the traditional fostering systems in Africa, he says. According to evidence so far, these systems, which are supported by community programs, "will continue to meet most of these children's basic needs," Foster says. Therefore, the funding that supports existing community-based programs is the most useful. While these programs often have "minimal resources" and consist of the "poor helping the destitute," they are "very efficient" and "promising," Foster writes. These community-run self-help groups lack essential "external funding" because foreigners are often unaware that they exist. However, such locally initiated programs can support AIDS orphans and other children at "a fraction of the cost of international projects," which can sometimes cost 10 times as much as local programs even when providing the same service or support. External organizations should be careful not to "inadvertently undermine local efforts" by getting involved in "complex areas of social development." Implementation of interventions, such as HIV prevention programs, are effective and do not negatively affect community coping systems, but these programs largely do not benefit AIDS orphans. "[L]ong-term, low-level" support for locally initiated programs is preferable to larger donations over a short time for projects that use a "deficiency-oriented model" to determine a community's need, thus "disempowering" the citizens and resigning them to "position themselves to receive external aid rather than [determine] how they can best solve their own problems," Foster states. "There are tens of millions of orphans who need our help, and it is vital that external agencies learn from the affected communities and allow them to assume the primary role in providing support to these children," Foster concludes (Foster, New England Journal of Medicine, 6/13).This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.