Coping Strategies for the elderly looking after Orphans and Vulnerable Children (OVC) in rural Zimbabwe

TABLE OF CONTENTS

1 INTRODUCTION
1.1 Introduction
1.2 Background of the Study
1.3 Statement of the Problem
1.4 Purpose of the Study
1.5 Research Objectives
1.6 Research Questions
1.7 Research Hypotheses
1.8 Assumptions of the Study
1.9 Significance of the Study
1.10 Limitation of the Study
1.11 Delimitations of the Study
1.12 Chapter Summary

2 LITERATURE REVIEW
2.1 Introduction
2.2 Definition of Key Terms
2.2.1 Elderly
2.2.2 Care
2.2.3 Orphan
2.3 Effects of HIV/AIDS on the Elderly Caregivers
2.4 Aids Orphan Crisis
2.5 Challenges faced by the Elderly in caring for the OVC
2.5.1 Role Reversal
2.5.2 Loss of Income
2.5.3 Stigmatization
2.5.4 Psychosocial needs
2.5.5 Educational needs of the OVC
2.5.6 Health Care needs
2.5.7 Shelter needs
2.5.8 Food and Nutrition needs
2.6 Elderly Caregivers’ Coping Strategies
2.7 Role of Govt and NGOs in bailing out the elderly and OVC
2.8 Policies on the Impact of HIV and AIDS
2.9 Chapter Summary

3 RESEARCH METHODOLOGY
3.1 Introduction
3.2 Research Design
3.3 Research Methods
3.3.1 Population and Sample
3.4 Data Collection
3.4.1 Semi-Structured One-on-One Interview Guide
3.4.2 Data collection process
3.5 Data presentation and analysis
3.6 Validity of the Research
3.7 Chapter Summary

4 RESULTS AND DISCUSSION
4.1 Introduction
4.2 Responsive rate
4.3 Demographics
4.3.1 Age
4.3.2 Sex
4.3.3 Marital Status
4.3.4 Number of OVC in household
4.3.5 Number of Adult Children Deceased
4.4 Causes of Orphanage Care among the Elderly Care givers
4.5 Challenges faced by the Elderly in Caring for Orphans
4.5.1 Poverty – The major challenge affecting the elderly caring for AIDS OVC
4.5.2 Food and Nutrition Challenges
4.5.3 Education Challenges - Failure to send children to school
4.5.4 Health Challenges affecting the Elderly Caregivers
4.5.5 Housing and Accommodation
4.5.6 Psychosocial Support and Protection
4.5.7 Water Shortage
4.6 Coping Capacity of the Caregivers
4.7 Coping Strategies used by the Elderly to care for the OVC
4.7.1 Remittances from Children
4.7.2 Utilization of Safety Nets (Begging/Well wisher/Community)
4.7.3 Selling of Assets
4.7.4 Livelihood Projects
4.7.5 Child Labour
4.7.6 Food Consumption Adjustment
4.8 External Support
4.8.1 Government Assistance
4.8.2 Non-governmental Organizations
4.8.3 Churches
4.8.4 Politicians
4.9 The good aspects of the Elderly Care giving roles
4.10 Chapter Summary

5 CONCLUSION AND RECOMMENDATIONS
5.1 Introduction
5.2 Review of Objectives
5.3 Conclusions
5.3.1 Major cause of orphanage care in elderly headed households
5.3.2 Challenges faced by the elderly in Orphan care
5.3.3 Coping Strategies
5.3.4 Role played by Government and NGOs
5.4 Recommendations
5.4.1 Recommendations to Government
5.4.2 Recommendations to Non Governmental Organisations and other Stakeholders
5.5 Directions for further research
5.6 Chapter Summary

6 REFERENCES

ABSTRACT

This study was carried out against the background of HIV/AIDS having caused an orphan care crisis in Zimbabwe, with the brunt of care falling on the elderly who are themselves weak and frail due to age and socio-economic challenges. This burden fell on mainly the grandmothers who have had to bear the burden of caring for large numbers of orphaned grandchildren, with little or no support from the surviving members of the extended family or other sections of the community and Government. They faced a lot of challenges in their new care giving role which included lack of food, lack of money to pay for school fees for the orphans, etc, these challenges added on top of the health problems that the elderly caregivers were enduring with which were age related like BP, Back ache, Arthritis, diminished eye sight etc. Against this background the study sought to determine the major causes of orphanage care, to identify the major challenges faced by these elderly caregivers in taking care of the orphans, and also to establish the coping strategies used by these elderly caregivers in upbringing the orphans and vulnerable children (OVC) under their care. The study also determined the role played by Government and other stakeholders in assisting this group and also made recommendations of interventions that can help. This study would assist Government and other aid organisations in their planning, decision making and strategy formulation.

ACKNOWLEDGEMENTS

I would like to acknowledge the assistance received from the following people who made it possible for this dissertation to be put together.

My Supervisor Mr, Tomson. Dube who tirelessly guided me in conducting and compiling the entire project and Mr Shadreck Zhou a colleague, friend and church mate who spared his valuable time from his busy schedule to proof read my work and gave critical comments to improve my work.

I would also want to specifically acknowledge the great support I received from my wife, Tatenda, my lovely son Kudzai and my beloved daughter Fadzai who were very patient with me as I was going through sleepless nights compiling this dissertation.

Last but not least, I would also want to express my profound gratitude to all the elderly people in Mbembesi for agreeing to participate in my study their contributions were an eye opener.

To them all I say God bless!

DEDICATION

This Dissertation is dedicated to my lovely wife Tatenda and my beloved son Kudzai and the sweet little daughter Fadzai.

LIST OF TABLES

Table 4.1 Demographics of the Participants

LIST OF FIGURES

Figure 4.1: Frequency of Orphanage Care by the Elderly

Figure 4.2: Challenges faced by the Elderly Care givers in caring for Orphans

Figure 4.3: Frequency of Challenges faced by the Elderly caregivers

Figure 4.4: Summary of the Health Care challenges of the Elderly Caregivers

Figure 4.5: Coping Strategies used by the Elderly Caregivers in rural Mbembesi

Figure 4.6: Frequency of Suggestions by the Elderly Caregivers over their plight

LIST OF PICTURES

Figure 4.1: Gogo MaNdlela – 100 years old

Figure 4.2: Gogo MaMpofu showing Blankets that she barter trades for food.

Figure 4.3: Gogo MaDwili with her grandchildren and Poultry project

LIST OF ABBREVIATIONS

In this study, unless otherwise indicated, the words or phrases in the left hand column could bear the meaning stipulated in the right hand column

GOVT Government

HAI: HelpAge International

MDG: Millennium Development Goals

NGO Non Governmental Organization

OVC: Orphan and Vulnerable children

SGH Skipped Generation Households

UN: United Nations

UNICEF: United Nations International Children’s Fund

1 INTRODUCTION

1.1 Introduction

HIV/AIDS has led to an orphan care crisis in Zimbabwe, with the brunt of care falling on the elderly who are weak and frail due to age and socio-economic challenges. The elderly especially grandmothers have had to bear the burden of caring for large numbers of orphaned grandchildren, with little or no support from the surviving members of the extended family or other sections of the community and Government. This study went out to investigate the coping strategies being used by these elderly caregivers in raising up the orphans and vulnerable children (OVC) under their care.

The problem emanates from the fact that Zimbabwe is one of the countries worldwide that has been badly affected by the HIV and AIDS epidemic. According to a UNAIDS report on global AIDS epidemic, 16% of children in Zimbabwe have been orphaned due to AIDS and of these 60 percent is estimated to be under the care of the elderly, UNICEF (2007). Most of these elderly headed households do not have the necessary resources needed to sustain a family, leading to a situation of poverty and deprivation for the children. They face a lot of challenges in their new role but it remained unknown as to how these families cope with this very difficult situation of caring for the OVC with little or no form of livelihood or support.

In view of the above issues this chapter will now give an overview picture of the whole research; it presents the background of the study, purpose of the study together with research objectives, questions and hypothesis, problem statement, significance of the study, limitations and delimitations of the study.

1.2 Background of the Study

AIDS is one of the most destructive diseases recorded in human history. It is reported that since its first recognition in 1981 more than 25 million people worldwide have died to it; making it the most fatal disease. According to UNAIDS (2007) the number of people infected with HIV continues to rise in most parts of the world, despite the implementation of prevention strategies. Sub-Saharan Africa is said to be the worst-affected region with estimates saying that two-thirds of all the people infected with HIV in the world reside in sub-Saharan Africa, yet the region only contains little more than 10% of the world’s population. (UNAIDS, 2008). This revelation shows how devastating the disease has been on Southern Africa. Although access to antiretroviral treatment is starting to lessen the toll of AIDS, WHO (2009) also revealed that fewer than half of Africans who need anti retroviral treatment are receiving it meaning that the impact of AIDS will remain severe for many years to come.

In many African countries reviewed HIV and AIDS has eroded traditional practices of taking care of children who lose their parents by creating larger numbers of orphans than have never been seen before. The demand for care and support is now overwhelming with the care givers’ caring capacity severely reduced due to deepened poverty, medical and funeral costs. UNICEF (2003)

In Zimbabwe the disease has been devastating. The country is at the epicenter of the pandemic, with a national adult prevalence rate of 13.6 percent as at end of 2010, according to MOHW (2009). It is one of the 10 countries with the highest HIV prevalence rates in sub-Saharan Africa. Life expectancy has been reduced, poverty among vulnerable households deepened and institutional structures have been weakened.

One of the most devastating after-effects of the HIV/AIDS epidemic in Zimbabwe has been the large and ever increasing number of orphans created. Statistics have revealed that a quarter of all children in Zimbabwe have lost one or both parents to HIV/AIDS than other causes. ZDH (2006). The majority of these orphans are being cared for by their extended families, including grandparents or are living in child-headed households. They tend to be found in extremely poor households and are less likely to access health care, attend school or have basic clothing, footwear and bedding than other children from the same communities according to an assessment by the National Action Plan for OVC in Zimbabwe in 2009.

Most of these orphaned and vulnerable children are found in households headed by the elderly who have been embroiled into the aftermath of the AIDS disaster. According to a UNAIDS (2007) Report on Global AIDS Epidemic the burden of care for children orphaned by AIDS was said to frequently fall on the older persons, particularly older women. Many have had to care for their sick children and are often left to look after orphaned grandchildren, with the burden of providing financial, emotional and psychological support at a time when they would usually be expecting to receive more support as their energy levels drop with old age. In Zimbabwe there are estimates that say that grandparents (65years +) care for roughly 60% of all orphans in Zimbabwe (UNICEF, 2007).

This disease has been seen as a disaster in its own right by UNDP (2004) because it has created the elderly headed households, a situation which normally manifests itself as an aftermath of other disaster situations like wars and droughts that have negative shocks which fuel demographic changes by raising mortalities and migration. Barnett (1992) called the disease a “long-wave disaster” in his paper on Uganda.

Some of the challenges that these elderly care givers tend to face include financial hardships, grief and emotional upheaval, lack of knowledge and resources for dealing with HIV, exhaustion, conflicts with grandchildren, social stigma, discrimination and exclusion from information and support services. Other challenges are related to economic costs that emanate from the caring responsibilities. The cost related to the upkeep of the orphans is one of the major tasks that the elderly deal with on a daily basis. In most cases they have no source of income or remittance from somewhere yet they are expected to provide food on the table and pay schools fees for the orphans. Things like lack of free treatment, affordable medicines add to the care giver’s financial burdens. Other financial costs include the provision of food, educational needs, clothes and shelter.

With these challenges the researcher has been prompted to investigate how these elderly caregivers manage to look after their orphaned grandchildren with no support or assistance yet they both.

1.3 Statement of the Problem

HIV/AIDS is a disaster that is affecting the elderly, just like an aftermath of a volcano or an earthquake; it has brought to them a serious burden of care for the orphaned children left behind by their children who succumbed to it. This new role of parenting comes at a time in their lives when they are no longer economically active, frail, and of poor health with no reliable source of income. This has put them in a very difficult situation but they have no choice but to find means to bring up these OVC under their care.

1.4 Purpose of the Study

The purpose of this study is to investigate the coping strategies being used by elderly caregivers who are looking after children orphaned by HIV and AIDS, in rural Mbembesi, Zimbabwe. This study will inform Government, NGOs and the all stakeholders on the predicament of the elderly. The information will enable them to make informed decisions in order for them to intervene. At the end of this study the negative and positive survival strategies employed by the elderly caregivers will be established and shared as advocacy for future planning, decision making and programming by Government and all other stakeholders concerned.

1.5 Research Objectives

The general objective of this study is to unearth the coping and survival strategies used by elderly caregivers who are enduring a burden of care for the OVC. The specific objectives are:

1.5.1 To identify the major cause of orphanage in the rural households.

1.5.2 To identify the challenges faced by the elderly in taking care of the orphans in their households.

1.5.3 To establish how the elderly deal with challenges faced in their care giving role.

1.5.4 To determine the role played by Government and NGOs in helping the elderly in performing their care giving roles.

1.5.5 To make recommendations and suggestions on how Government and NGOs can intervene.

1.6 Research Questions

1.6.1 What are the major causes of orphanage?

1.6.2 What challenges are faced by the elderly in taking care of the OVC?

1.6.3 How do the elderly deal with the challenges they face in looking after the OVC under their care?

1.6.4 To what extent does government and NGOs help the elderly?

1.6.5 What can be recommended /suggested on how Government/NGO can support the elderly caregivers?

1.7 Research Hypotheses

1.7.1 The major cause of orphanage is HIV and AIDS

1.7.2 The major challenge that affects the elderly in taking care of the OVC is lack of food.

1.7.3 The elderly caregivers cope to the challenges of care giving by selling assets.

1.8 Assumptions of the Study

1.7.4 The elderly are looking after orphans but the coping strategies are not known.

1.8.2 The elderly caregivers will be welcoming and willing to give out information about their predicaments.

1.9 Significance of the Study

1.9.1 New knowledge and understanding on how the elderly cope in disaster situations will be generated

1.9.2 Recommendations for better management of disaster situations involving the elderly will be shared.

1.9.3 New information on the elderly will be discovered to benefit organisations like Help Age International.

1.9.4 Future programming will be informed in the context of emergencies like climate change in terms of coping strategies of the elderly

1.9.5 The research act as an advocacy tool which will benefit the elderly who are normally marginalized.

1.10 Limitation of the Study

1.10.1 The problems anticipated in this study include limited literacy levels of the elderly due to eye sight and age related problems.

1.10.1 The cooperation of the elderly may be a challenge as they may expect some form of assistance after the interview.

1.11 Delimitations of the Study

1.11.1 This study will be carried out in Mbembesi, Ward 13 under Umguza District; Matabeleland North Province in Zimbabwe.

1.11.2 The respondents will be elderly people sixty (60) years and above looking after the OVC.

1.12 Chapter Summary

This chapter focused on the introduction, background to the study, the purpose of the study, research objectives, research questions, hypothesis, and significance of the study, limitations and delimitations of the study. We now move on to the literature that was reviewed.

2 LITERATURE REVIEW

2.1 Introduction

This chapter will look at related literature on coping strategies used by older persons in their care giving role. The chapter will be organized into sections. The first section will review literature on the effects of HIV/AIDS focusing mainly on its impact on the elderly who are now caregivers to the OVC. This will be followed by a short section which will try and expose the orphan care crisis in Zimbabwe. Challenges being faced by the elderly caregivers in giving care to the OVC will follow. Next will be a review of other studies conducted in other countries on the elderly care givers and how they cope with their role of giving care to the OVC. Finally the last two sections will look at the role of Government, NGOs and other organizations in bailing out the elderly and the OVC. Policies on HIV/AIDS and orphan care will also be reviewed. But we first define key terms.

2.2 Definition of Key Terms

2.2.1 Elderly

According to the Cambridge International Dictionary of English (1995), ‘the elderly’ refers to old people. Old age in developing countries is considered to begin at the point when an active contribution to society is no longer possible. For the purpose of this study the chronological age of 60 years was used as a guide for the working definition of ‘old’. This is the age used by United Nations to define the beginning of old age. (UNICEF, 2003)

2.2.2 Care

Care is defined by the Longman Dictionary of Contemporary English (2003) as the process of looking after someone, particularly because they are ill, old, or very young.

2.2.3 Orphan

According to UNICEF (2007), an orphan is defined as a child under the age of 18 years whose mother, father or both parents have died from any cause.

2.3 Effects of HIV/AIDS on the Elderly Caregivers

HIV/AIDS has been referred to as a “long-wave” disaster by Gillespie et al (2007). They said so because many of its ramifications occur far into the future and at uncertain intervals. It has also been seen by UN (2001) as history’s single sharpest reversal in human development because it has changed family structures, wiped out the middle generation of adults, leaving behind the old and young to support each other (Geballe et al, 1995). The consequence of all this has been that the elderly got compelled to take on a new role of care and support for the AIDS orphans. Studies by Foster et al, (2004) and HelpAge Zimbabwe, (2002) found out that in South Africa and Uganda, 40% of children were living with their grandparents and in Zimbabwe; over 60% were under the care of the elderly.

This phenomenon of the elderly looking after children is however not new. They have always been giving care to some extent but because of HIV/AIDS, the extent of the problem has increased beyond their limits. The numbers under their care is now alarming. In Zimbabwe it is said that 60% of all the orphans are now under the care of the elderly. (UNICEF, 2007)

Another effect of HIV/AIDS is poverty; especially among the vulnerable communities like the elderly and their orphans. Foster (1998) confirms this in his study when he says that HIV/AIDS is a major cause of deepening poverty. This is so because AIDS-related infections do not only thrive in impoverished environments, but the disease itself has been demonstrated to accelerate poverty. This is in disagreement with Millennium development goal which demands the eradication of poverty but HIV/AIDS is exacerbating poverty in its own right.

When a household inherits a child it normally means that the caregiver’s time for other activities like market and working in the field will be limited. The elderly may spend more time caring for the family members with AIDS and may engage in activities to substitute for the income lost. In a study in Uganda, parents were most commonly cited as the principal caretakers for AIDS patients as well as orphans (Ntozi and Nakayama, 1999). Following bereavement, work time was diverted to performing mourning activities, and the elderly adult may have to increase participation in income earning activities to replace the productivity of the deceased individual (Barnett and Blaikie, 1992). But it remains a mystery how they do that when they had retired from active working due to age and other ailments.

The illness and death of a prime-aged adult was found to affect the health status or physical well-being of the elderly because of the impact of reduced household income. (Kneel et al, 2001) The burden of additional work like market work, housework and care giving can contribute to a decline in an older person’s health status. Given the tight financial constraints caused by an adult’s illness, the elderly may also receive less medical care or food so that more can be spent on the patient. In Thailand, Knodel et al, (2001b) found that elderly parents were the main source of funds for medical care for 60 percent of the AIDS patients who lived with their parents while ill. The loss of remittance income from adult children who die away from home may also result in lower incomes and poorer health status among the elderly.

HelpAge International (2002) has also highlighted that some of the orphans under the care of the elderly are sometimes HIV positive as well. Lack of access to basic materials such as gloves and water could further jeopardise the health of the care givers where they put themselves upon the risk of acquiring HIV or other bacterial infections. HAI also highlighted the fact that, because information campaigns do not target the elderly, many of these carers are not even aware that their children are HIV-infected, and so do not use “universal precautions” even if they have the means to do so. This lack of knowledge about HIV can also result in these women and their families spending scarce resources in the futile search for a cure, thus sinking them deeper into poverty. HelpAge International, (2002) described the elderly as the forgotten and invisible army in the war against AIDS.

2.4 Aids Orphan Crisis

The AIDS crisis has resulted in nearly one-quarter of all children in Zimbabwe to become orphans (CSO, 2006). The figure is said to approach historic levels set in Rwanda after the genocide in 1994. This means that the HIV/AIDS pandemic has struck at the heart of family and community support structures for the old and young, leaving a whole generation of children to be brought up by their grandparents. (HAI, 2002) Current global figures estimate that 16 million children under 15 have already lost either one or both parents to HIV/AIDS and that another 40 million children will lose their parents within the next 10 years. (UNAIDS, 2008) It is further estimated that millions of children are living with parents who are sick, and many more are living in households headed by older people who are struggling to provide care for orphans. (UNAIDS, 2008) The above scenario qualifies the accretion that HIV/AIDS is a Disaster that is affecting human kind including the elderly.

2.5 Challenges faced by the Elderly in caring for the OVC

After having reviewed the effects and the crisis of AIDS, there is ample need for us to now look at the challenges that are faced by the elderly caregivers when executing their duty of care for orphans. According to WHO (2009) the care for orphaned grandchildren has in most cases been left on the elderly parents and mainly the elderly women. A recent study in South Africa showed that 68% of caregivers were women or girls, with 23% of them being over the age of 60 years (Steinberg et al, 2002). This shows unequivocally that the burden of care falls categorically upon the women.

2.5.1 Role Reversal

The first challenge is that the elderly are forced to assume both productive and child-raising duties, (Chazan, 2008) with little or no support to endure the emotional, physical, financial and social costs that arise from their role as caregivers (HelpAge International, 2003). This challenge on its own places a mountain to climb for the elderly who have no energy and are unemployable for work to get income.

HIV/AIDS worsens the welfare of the elderly and cause a certain role reversal, as they are of an age when many would have become recipients of care and would have expected the rest and respect that comes with old age (Seeley et al., 2009). Circumstances have however forced them into roles that younger relatives would have performed had they lived and forced a reorganization of existing family structures (Lindsey et al, 2003). In times of crises when adult children are dying and leaving orphans providing care becomes a social obligation and reciprocity of kinship resources become less important (Madhavan, 2007).

2.5.2 Loss of Income

The elderly also face challenges in terms of access to money. This challenge results from the loss of the bread winner. The pandemic puts constraints on the finances of the elderly caregivers. The economic difficulties are manifested threefold; older people suffer as they lose income and support provided by children who become sick and die (Appleton, 2000). In a report on older persons and child care by Seeley et al (2009) an older person was quoted as saying;

‘It is our duty to make sure these children have a good future but we need money to provide it.’

This emphasizes the financial needs of the older care givers. Some experience this challenge of loss of income because of the caregiver’s inability to work because of old age (Nyambedha, et al, 2003) or the inability to leave the sick child or grandchild alone at home for work. The national means-tested non-contributory pension programme in South Africa appears to mitigate the impact of the lack of income and boosts the coping mechanisms of caregivers (Hosegood & Timaeus, 2006). However, old age pensions grant may now act as a substitute to support the needs of sick children and orphaned grandchildren instead of supporting the needs of older people. Income that was once intended to sustain older individuals in their old age is now maintaining extended households (Barrientos et al., 2003).

Besides the financial difficulties, older caregivers also endure challenges on the social level as loneliness and social isolation increase when caring duties require substantial amounts of time away from livelihood and social activities, such as going to church or funerals (Mwinituo & Mill, 2006).

2.5.3 Stigmatization

Closely related to the social burden of care, the elderly also have to face the issue of stigmatization of people living with HIV/AIDS and their caregivers (Mwinituo & Mill, 2006). Social stigma reaches far beyond HIV and AIDS and is also experienced by people with chronic and terminal illnesses and their caregiver says Lindsey et al (2003). The stigma associated with HIV and AIDS results in caregivers providing care to their relatives in absolute secrecy, with caregivers being cautious in disclosing the diagnosis of their patients (Lindsey et al., 2003). In Zimbabwe HIV/AIDS has often been considered as a form of punishment for wrongdoing, and is associated with promiscuity and witchcraft. (International HIV/AIDS Alliance, 2003) This has resulted in acute levels of exclusion for older people and orphans living with HIV/AIDS. Social ties and traditional support mechanisms can be weakened when ignorance and stigma marginalize a family affected by HIV/AIDS, leaving them feeling ashamed and alone.

2.5.4 Psychosocial needs

Next to financial and social consequences, caring for sick adult children and orphaned grandchildren places considerable emotional demands on caregivers, negatively impacting on their psychosocial status (Orner, 2006). Older caregivers are said to express feelings of hopelessness, worry, anxiety and depression not only about the state of things now, but also about the future (Ssengonzi, 2007). However many elderly caregivers expect that they will be rewarded one day for the care they provided to their children and grandchildren. It is hoped that children and grandchildren will return assistance when the older people themselves are in need (Schatz, 2007). However with the high prevalence of HIV and AIDS, this expectation is often not fulfilled, which could lead to possible disappointment and additional psychological stress.

2.5.5 Educational needs of the OVC

Studies have also shown that orphans and vulnerable children experience great difficulty accessing education services. The lack of free primary education in many HIV/AIDS-affected countries in Africa including Zimbabwe means that school fees are often unaffordable for vulnerable households, including those headed by older people. In a case study done in Katuba, Zambia, out of 22 orphans and vulnerable children in households affected by HIV/AIDS and headed by older people, only eight were attending school. (International HIV/AIDS Alliance, 2003) This to the researcher shows that there is a challenge because education is life. There are other educational needs like uniforms, books and the child’s transport costs to and from school. As a result the children will not be able to take up their right to education.

Provision of education remains one of the most pressing priorities for Zimbabwean households. Studies undertaken among orphan caretaker households (Wakhweya et al, 2002) indicate that education is one of the three primary priorities of orphan caretaker households and orphans themselves.

Education is considered the most fundamental need as it lays the basic foundation for most of the social and economic indicators. It is considered to be the main engine for human capital development and hence a key derivative of higher incomes and economic growth. Oxfam, cited by Wakhweya et al (2002) notes that education is associated with more choices and opportunities, especially for women, better family health and nutrition, lower maternal and child morbidity, lower birth rates and with a greater sense of security, morals, and ethics among children. Salaam (2005) further asserts that attaining basic education and the resulting employable skills constitute an important part of preventing the spread of HIV/AIDS and breaking the cycle of poverty. He argues that education has positive impacts, particularly for orphans because not only are they enabled to have a higher income but also that the educated are less likely to contract HIV, and tend to have children later in life.

In 1996, the government of Uganda introduced the Universal Primary Education (UPE), an initiative that was a hallmark to Uganda’s poverty eradication agenda. Orphans were among the disadvantaged children that were accorded the highest priority in enrolment under UPE. The programme ran increased opportunities for orphans to attend school with almost similar percentages of orphans and non-orphans attending school (Wakhweya et al., 2002).

2.5.6 Health Care needs

Due to limited resources, healthcare in orphan caretaker families, particularly those in rural areas is exclusively perceived to be curative and is only considered when children fall ill. Preventive aspects of care such as safe water, sanitation and hygiene may not be prioritized as essential needs. Kalibala and Elson (2009) note that sanitation supplies including soap, toiletries and sanitary towels for girls were found to be lacking in most orphan households. In their study of orphans and their needs in Zimbabwe, Mangoma, et al (2008) similarly found acute lack of sanitation supplies particularly for girls. Poor access to such supplies especially for girls was noted to be a high risk factor rendering girls potentially vulnerable to exploitation. It was also noted to potentially cause low esteem, social dysfunction and loss of interest in education.

Mainly as a result of financial difficulties facing most orphan caretaker families, healthcare for orphans is predominantly sought from public facilities. However, it is widely acknowledged that the reliability and quality of services offered at these facilities rarely meets expectations.

2.5.7 Shelter needs

In seriously constrained families, which unfortunately care for majority of orphans, the housing situation can be seriously worrying. In their study on orphan care in Ethiopia, Appleton et al (2000) found situations where families were in extreme forms of impoverishment, with thatched roofs leaking, children sleeping on mattresses made of dried grass and with no blanket to cover them at night. According to Nueman (1994), basic material needs of a child in a home are considered met if he/she has a pair of shoes, two sets of clothes, and a blanket in addition to a bed, mattress and bed sheets.

2.5.8 Food and Nutrition needs

Adequate nutrition is universally recognized as the foundation for proper physical and mental development, especially for children (UNICEF, 2006). Lack of adequate food resources, especially for children has dire long term consequences on their physical and mental growth. Alderman, et al, (2004) posit that malnourished children score poorly on tests of cognitive function and have poor psychomotor development. They tend to have lower activity levels, interact less with their environment and fail to acquire skills at normal rates. Inadequate food also directly impacts on the productive capacity of the adults and ultimately their sustained capacity to care for orphans.

The ability to provide adequate food and nutrition is considered to be the primary element of care by many Zimbabwean families and is often a major source of stress if parents are not able to adequately meet this need. In a study on the stresses and strengths of HIV-affected Ugandan grandmothers, Kamya and Poindexter (2009) found that the major concern of the caretakers was how to raise income to buy food for their grandchildren. The caretakers overwhelmingly reported that they feel happy when they see their grandchildren alive and they have food for them.

Nutritional status is directly linked to household food security. The International Fund for Agricultural Development (IFAD) cited in De Waal and Tumushabe (2003) describes household food security as the capacity of households to procure a stable and sustainable basket of food. Households are said to be food secure when food availability, equal access, stability of supplies and quality of food are in balance with each other.

2.6 Elderly Caregivers’ Coping Strategies

This study came out to find out how the elderly deal with the challenges they face when caring for the orphans under their care. So of the reviewed coping strategies are detailed below.

Lack of food is believed to be a major challenge being faced by the care givers. Matshalaga, (2007) in his study on grandmothers and orphan care in Zimbabwe, established that some of the coping strategies used by the elderly caregivers include the reduction of the number of meals, eating maize meal without relish, doing without necessary clothes, and the sharing of food and blankets. A symbiotic relationship was seen to exist between the grandmothers and the orphans, with both engaging in piecework in return for maize meal or cash, to pay for extra food or school fees.

In order to cope with food shortages, households react by reducing food intake, for instance by cutting the number of meals per day, which in the long term may lead to chronic malnutrition. Wakhweya et al (2002) noted that a significant portion of orphan households were not able to provide the three meals required in a day. Topouzis (1994) further noted that, the number of meals was in some cases reduced from three to two and in some cases from two to one. Some would regularly skip meals (especially lunch) thereby jeopardizing their health and their ability to take care of the orphans. Cutting meals in effect allows families enough food just to survive and remain alive. However, it does not guarantee the required nutrition for normal growth in the case of children or optimum physical and mental functioning for adults.

Another coping strategy is selling of assets. According to HelpAge International (2002) many older persons sold off assets as a coping mechanism to obtain treatment for ailing grandchildren; and were said to be too busy with care to engage in income generating activities, and as a result were unable to acquire daily necessities such as food and water. It was also noted that all the nourishment that these elderly caregivers were able to obtain they tended to give to the orphans in their household, thus putting themselves in danger of becoming malnourished and unwell. This can also be regarded as a coping mechanism where the caregivers starve to give food to the children under their care.

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