Abstract
Despite the decline in AIDS-related deaths worldwide, the consequence of the disease continues to be felt. This is exemplified in the unprecedented numbers of adult deaths and inability of the extended family to cope. These factors have impacted the welfare of children negatively. Focusing specifically on sub-Saharan Africa, a region severely struck by the pandemic, we examine the effects of the label ‘Orphan and Vulnerable Children’ (OVC), which has been utilized to identify children affected by HIV/AIDS, on the welfare of the affected children. Implications for policy, practice, and scholarship are suggested.
Introduction: Background to the study
The issue of HIV/AIDS and its impact on children has received considerable attention worldwide. During the past two decades substantial progress has been made on the scientific front, and the focus has been mainly on preventing and controlling opportunistic diseases associated with HIV/AIDS. Worldwide, the number of people newly infected with HIV and AIDS has declined by about 58 percent since 2000 (Joint United Nations Programme on HIV/AIDS [UNAIDS], 2015). In addition, the number of AIDS-related deaths has gone down from 2.3 million in 2005 to about 1.1 million in 2015 (UNAIDS, 2016), a decline of about 50 percent since 2004 when the rate of AIDS-related deaths was at its highest. Despite this, the consequences of the epidemic, especially in regions such as sub-Saharan Africa where mechanisms for prevention, treatment, and care are limited, continues to be felt. Indeed, the data in place indicate that sub-Saharan Africa has experienced a disproportional loss of individuals in their most productive years, raising concerns about the welfare of surviving members of affected families – especially children (AVERT, 2015; Stover et al., 2008; UNAIDS, 2013). According to AVERT (2015), at the end of 2001 an estimated 14 million children worldwide had lost a parent or both to AIDS or related causes. Current estimates put the figure at 90 percent for sub-Saharan Africa alone (Embleton et al., 2014).
Mainly because of the unprecedented numbers of adult deaths, the inability of the extended family to cope, and high levels of poverty, the label ‘Orphan and Vulnerable Children’ (OVC) has been used to capture the growing challenges experienced by children affected by HIV/AIDS. The label has facilitated implementation of programs focused on mitigating social malaise faced by children so classified. The other side to this story, which has received little attention, is that the label has become a permanent identity for children on a continent that is overburdened with debilitating characterization such as the dark continent, land of poverty, corruption, and disease. The label, in this context, may have unintended negative social and psychological effects on children classified as vulnerable.
In fact, in recent years, mainly because of their potential to compromise outcomes for labeled individuals/groups, many of the negative characterizations that have traditionally been used to group people have been revised, replacing words with adverse connotations. For example, people once categorized as disabled or handicapped are now referred to as physically challenged or person with a disability (Services for Independent Living, 2012; Snow, 2008). In addition, mental retardation is now defined as an intellectual disability, while people once seen as victims of AIDS are now referred to as ‘People Living with HIV/AIDS’ (PLWHA). This consideration, however, has not been extended to children classified as OVC despite the fact that the label has the potential to negatively impact their outcomes. Furthermore, systematic investigation of the utility of the label, to our knowledge, has not been undertaken, leaving the question of beneficial effects of the label largely unanswered.
From this backdrop, we attempt to draw attention to the label of OVC and its implications for the care and welfare of children so categorized. We utilize a systematic review of the literature on the subject. Specifically, we trace the historical origins of the label, its uses and effect on the systems of care as well as its impact on the welfare of children classified as vulnerable. We conclude with reflections on the way forward. The modest objective of this work is to facilitate a dialogue that pushes social commentators, including social work practitioners, affected children and their communities, to re-imagine a future that is free from negative categorizations; a future that highlights the capabilities, potential, and dignity of children. We believe that this is attainable and starts with appropriate and empowering nomenclature.
The label of OVC: Overview and historical evolution
The origins of the label OVC are not well known. Evidence exists to suggest that use of the label gained traction in the early 1990s when the United Nations Children’s Fund (UNICEF) hosted its first conference focusing specifically on the welfare of children impacted by AIDS. Around that time, the phrase ‘children affected by AIDS and other vulnerable children’ was used considerably (UNICEF, 2008). The label of OVC grew out of this and was initially used to identify a child whose parents had died due to HIV/AIDS-related causes. This categorization, at that time, provided a platform for facilitating the development of holistic programming, targeting the needs of children who were affected by HIV/AIDS. The label ensured that resources and services reached those most in need (Handa et al., 2010).
The use of the acronym evolved to include children in dire situations, such as children living on the street, children with disabilities, abandoned children, children in conflict zones, and children facing harsh conditions of living (Ferguson and Heidemann, 2009; Kirkpatrick et al., 2012). The label is said to be attractive in that it seeks to address factors associated with the optimal development of the child (World Bank, 2007). It also takes into consideration the welfare of the child in relation to the rights guaranteed under the Convention on the Rights of the Child (CRC), which are articulated in the African Charter on the Rights and Welfare of the Child (ACRWC, 1990; World Bank, 2007). Areas of concern embraced under the label include health, food, shelter, education, leisure, and protection from abuse. As debates over AIDS-related funding and programs intensified, the label of OVC became a tool employed to call attention to the gravity of the problem faced by children affected by the pandemic and their communities. The label also helped reveal the primary duty bearers’ lack of capacity to respond adequately to the rights and needs of affected children. Moreover, it has been used to mount pressure on governments to intervene in the plight of children so classified. In a way, therefore, the label provides justification for the involvement of multiple actors, including human service agencies in the lives of children classified as vulnerable.
Despite its promise to positively affect the welfare of children, the label of OVC may have adverse effects, compromising the life chances of children classified as vulnerable. For example, it may negatively influence the way labeled children interact with the world and vice versa. Indeed, children so classified may engage with the world from a position of diffidence and the world may respond accordingly. In addition, the label may perpetuate the notion that children classified as vulnerable are inherently different from other children, limiting their potential and capabilities. Furthermore, vulnerability, for many children under this label, may be seen as a state of being. Moreover, it can be argued that the label has allowed both familial and communal systems of care to abdicate their responsibility. Indeed, the OVC label may have made it easier for the shift in the responsibility of caring for Africa’s orphaned children to occur. The principal duty bearers – the family, community, and government – have withdrawn, placing the responsibility for nurturing and protecting children defined as vulnerable on the shoulders of external entities, including nongovernmental organizations (NGOs), bilateral agencies, and similar groups. To help explicate this, we draw upon literature on labeling and locate this discussion within the context of the systems of care in which children classified as vulnerable are nested.
Labeling and the welfare of labeled individuals/groups
The need to place people, events, and objects into categories has been part of human history from time immemorial (Goffman, 1959, 1963). Labels have been employed to draw attention to things and to highlight difference. The main argument advanced for the use of labels is that most bureaucratic systems operate in ways that rely on categorization and reductionism to help deal with complex phenomenon. Hence some degree of labeling, whether useful or not, may be inevitable. In the field of education, for example, Norwich (1999) suggests that labeling has allowed for identification of children with special needs and has ensured that they are provided with the necessary support, thus minimizing their position of disadvantage. Indeed, labeling has enabled children with learning disabilities to access specialized teaching, different assessment mechanisms, and other accommodations (Brocks Academy, 2013; Morelli and Dombeck, 2014).
Furthermore, labels are said to drive funding for development programs since they have the potential to appeal to funders. For example, a general appeal for funding for children’s education in an African village may not be as effective as a funding drive targeting the education of children classified as vulnerable (OVC). It could be that the word ‘vulnerable’ embedded in the label OVC is likely to evoke a situation of helplessness and desperation, compelling donors to support ‘OVC’ initiatives. Additionally, circumstantial evidence exists to suggest that labels play a useful role in helping professionals plan and deliver services to labeled groups (World Bank, 2007). In the case of OVC, the label may have facilitated the establishment of a formula for identifying affected children, helped set targets for minimum care, and instigated mechanisms for resource allocation.
Notwithstanding the positive outcomes associated with labeling, as observed earlier, the label may have negative effects on those labeled. In fact, labeling theory suggests that the self is socially constructed and reconstructed through interactions between the individual and her community (Goffman, 1959, 1963; Lemert, 1974; Mead, 1934). Labels may also have the pygmalion effect, shaping interactions and outcomes for the carrier (Boser et al., 2014; Guyll et al., 2010). In the specific case of children classified as vulnerable, the label may influence how affected children are viewed by society and how they, in turn, relate to others (Davis, 2004). Indeed, scholars (see e.g. Bernburg et al., 2006) suggest that being labeled a ‘delinquent’ earlier in one’s life has the potential to negatively impact a child’s outcomes. The child may behave according to the label, and the more she does, the more she comes to believe that this is an acceptable and valid persona. Similarly, carrying the label ‘retard’ may have a bearing on how one is treated, possibly influencing behavior and vice versa (Hickey, 2009). Moreover, some labels, for example lunatic, which is discouraged in many African cultures, have been linked to negative consequences such as discrimination, exclusion, and stigmatization. The label of OVC, in our opinion, may influence not only a child’s behavior/actions but ultimately a child’s perception of her opportunity structure. Indeed, a child labeled ‘OVC’ may internalize the view that she/he is vulnerable, weak, without agency, and severely disadvantaged. The community within which such a child is nested may also start believing that it lacks agency and is ill-equipped to provide adequate care for its children. From this perspective, the label may act as a disabler, inhibiting both the child and the community from aspiring to and realizing their full potential.
Furthermore, labels are said to dehumanize and deindividualize the bearer in that they create and reinforce the disposition to relate to people as labeled categories, promoting stereotypes and bias while diminishing opportunities for personal development and self-actualization. Labels also tend to draw attention from the individual to focus primarily on what the individual may be having difficulty with (Blum and Bakken, 2010; Davis, 2004). Moreover, evidence (see e.g. Bandura, 1986; Erikson, 1968; Nesdale and Flesser, 2001) suggests that from an early age, children tend to assess others relative to themselves by making social comparisons. For children labeled OVC this may have a dual effect: the labeled child may develop a strong sense of injustice and otherness leading to low self-esteem, especially in the absence of caring adults. However, other children may begin to see labeled children as different, heightening potential for objectification, ‘otherization’ and stigmatization (Moses, 2009).
Decades after its first use, there is still a dearth of evidence with regard to the effects – negative or otherwise – of the label on the welfare of labeled children. Indeed, the evidence in place is largely circumstantial. Hence, a number of questions remain unanswered. For example, has the label of OVC empowered labeled children? What are the effects of the label on OVC programming? How has this benefited children so classified? What are the effects, if any, of the label on the traditional African systems of care? Have these effects been beneficial to labeled children and their communities? In subsequent sections, focusing specifically on formal and informal models of care, we utilize available literature to document the effects of the label on the welfare of children classified as vulnerable. Attention is placed on the benefits and challenges inherent in the label.
The label of OVC and the care of orphaned children in sub-Saharan Africa
Generally, the care of children classified as vulnerable, in sub-Saharan Africa, takes two forms: formal care and informal care (see Figure 1). Formal care normally falls outside the traditional intervention provided by the immediate and extended family. It may include care provided in a residential facility such as an orphanage and similar institutions. Formal care can also be provided in a family environment under the mandate of a legal administrative body or judicial authority. Formal care by legal mandate, however, is uncommon in sub-Saharan Africa. Services provided range from basic provisions such as feeding programs and respite to the more complex continuum of services such as system strengthening through cash transfers, early intervention, and prevention of acute vulnerability (Santa-Ana-Tellez et al., 2011).
Systems of care for children classified as vulnerable.
Informal care connotes a private arrangement located within the jurisdiction of the family and may include fostering by relatives, grandparent-headed households, as well as various forms of domiciles such as child-headed and single-parent-headed households (UNICEF, 2011). It is important to point out that the two systems of care, formal and informal, often interface and feed into each other. It is therefore not uncommon to see children living on the street receiving food from feeding programs as well as support from the community and extended family (Desmond and Gow, 2001). In the following we present an overview of the two systems of care.
Informal system of care
The burden of caring for orphaned children falls heavily on the extended family and communities. These account for about 90 percent of the total care for children classified as vulnerable (UNICEF, 2005). A number of reasons exist to explain this. In many parts of Africa, the extended family is seen as well positioned to provide long-term, stable, and balanced care for children in the absence of biological parents, meeting psychosocial, emotional, and physical needs (International HIV/AIDS Alliance, 2014; UNICEF, 2011). The extended family is also seen as a source of nurturing and comfort for a child experiencing the trauma of losing a parent or both parents. Indeed, African history is alive with examples of provision of care and support to defenseless and susceptible groups, including children, the poor, the sick, and the elderly. Strong familial and communal bonds are, in fact, at the core of ‘Africanness’, which is defined by the spirit of ‘ubuntu’. Africans practice kinship care where the extended family, clan, and community may play an integral role in the nurturing of children, hence the adage ‘it takes a village to raise a child’ (Freeman and Nkomo, 2006; Maclean, 2003; Ndebele et al., 2012).
Kinship care
Kinship care is the most common type of informal care for children who have lost one parent or both parents. Care assumed by kin or extended family often lies outside state regulation (Roby and Shaw, 2008). Examples of this include fostering, child-headed households, and households headed by a grandparent (see Figure 1). Policies around kinship care are not well developed in many parts of sub-Saharan Africa. Despite this, it is the preferred mode of care for children in vulnerable situations (Freeman and Nkomo, 2006). An important feature of kinship care is that it emanates from a sense of responsibility and commitment to the family. Kinship care, for the most part, does not directly fall under the label of OVC unless it intersects with formal care, for example through cash transfers and similar programs. Here we highlight a few models of kinship care, including fostering by relatives, female-headed households, and households headed by children.
Fostering through the extended family, in many parts of sub-Saharan Africa, represents an informal temporary arrangement outside of state regulation, which is often crisis driven and may be the only form of care available to children categorized as OVC. Relations, mainly women and the elderly (e.g. grandparents), are more likely to take responsibility for fostering and provision of psychosocial support to children defined as OVC. Care by a grandparent is especially common for children who have lost both parents. Indeed, prior to the AIDS crisis, care by grandparents was uncommon. Grandparent-headed households often emerge out of necessity and are likely to experience multiple challenges. Such homes are usually vulnerable to poverty due to lack of stable income, advanced ages of the primary caregivers, together with the large numbers of children who may be under their care (UNICEF, 2005). Also, just like children in their care, grandparents may be struggling with the emotional loss of their child/children who might have been their primary caregivers.
Another common avenue utilized for the care of children defined as OVC is the single-parent household. This is often headed by a maternal caregiver. It is important to note that female-headed homes are common compared to male-headed households in that men tend to remarry faster following the death of their spouse (Boston University OVC Care Project, 2012; Schenk et al., 2010).
Collective foster care is a form of guardianship used in child-headed households, which have emerged as a type of sociological domiciliary composed of children often from the same family unit (Meintjes et al., 2010). These children remain in the homes of their parents where one person, often an older child, acts as the caregiver. The rationale behind this is to keep sibling units together and provide care for orphaned children in their home. This model has the potential to reduce incidences of abuse and emotional distress resulting from separation, and is often used in cases where blood relatives do not live close by or the extended family does not have the capacity to absorb the children. Child-headed households are said to be on the borderline between formal and informal systems of care mainly as a result of their multiple support systems.
Children living on the street
Another type of living arrangement for children defined as OVC is the street. Street living depicts a situation in which children experiencing homelessness reside on the streets (including unoccupied dwellings and wasteland) of the major cities. The street has become a refuge for OVC seeking reprieve from stigma, hunger, and abuse. Children living on the street represent a clear interface between the informal and formal systems of care. Indeed, children may be living with a grandparent but go to the street for panhandling and may also participate in formal care through attending feeding and respite centers. Although there are no specific figures on the number of children living on the streets in sub-Saharan Africa, estimates for heavily affected countries such as Kenya and Sierra Leone put that number at 250,000 and 50,000, respectively (IRIN, 2007). The street is perhaps the least desirable form of living arrangement for OVC. While on the street, these children are vulnerable to exploitation, abuse, child prostitution, and even trafficking.
Formal system of care
Formal care of children in challenging situations is characterized by a variety of living arrangements, including statutory adoption, statutory residential care, orphanages, and a hybrid of familial/community-based care. It is often organized under the umbrella of the label ‘OVC’ and may involve specialized programming. In the following, we provide an overview of formal models of care.
Statutory adoption
Many countries in sub-Saharan Africa do not have national provisions for legal adoption or formal foster care. In fact, this model of care does not exist on a large scale and is provided mainly through residential care facilities or welfare departments often nested in government ministries such as those responsible for youth development and health. The primary goal of agencies providing services under this model is to protect labeled children through provision of a safe environment that respects their welfare and rights. Services offered by such agencies include shelter, food and clothing, counseling, health care, and education. Placement of children under statutory care is a multifaceted process which begins with identification of children considered OVC. Identification is often carried out by members of the community, including chiefs, headmen, and village or district welfare committees. Community-based service providers may also play a role in this. In addition, children may be identified by health-care providers or their schools. Selected children are referred for placement with a foster family.
Statutory residential care
Another type of living arrangement under the formal system is the statutory residential care where children are committed to a residential facility by court order. Statutory residential care could be in the form of Cheshire homes, detention, or preparatory center. Mainly because of the high overhead associated with this model, it is rarely used and is seen as the last resort. Funding for statutory residential care is often from grants provided by local governments.
Orphanages
Orphanages are one of the most common models used by international organizations for the care of children in sub-Saharan Africa. Local orphanages are also set up in communities by humane individuals, churches, or groups that operate from a mandate to serve and protect affected children. The major challenge of this model is that it is costly and can only serve a limited number of children (Zimmerman, 2005). Furthermore, many capacity-building agencies argue that orphanages deny children the benefit of being raised in their communities (Leinaweaver, 2014). Although the benefit of community care over orphanages has been supported by research evidence (see e.g. Managed Care Weekly Digest, 2010; Whetten et al., 2009), there is some evidence indicating that the overall well-being of children in orphanages tends to mirror their counterparts under kinship care (Managed Care Weekly Digest, 2010).
Community-based care
Community-based care is another response to the challenges presented by children classified as vulnerable. Community-based care is an alternative quasi-institutional model that has emerged in many parts of sub-Saharan Africa. Community-based care serves as a link between the formal and informal systems of care. It often comprises community-based groups that provide support directly to the extended family or children considered vulnerable. The model encompasses community-based day centers where children can receive respite and care while they continue to live in their homes. Services provided range from meals and education to medical attention. Adult supervision may be provided where needed. There is some subjective evidence to indicate that some communities, by consensus, have appointed designated caregivers to monitor and support children who live on their own. A good example of this approach is the Kenneth Kaunda Children of Africa Foundation in Zambia, which has established daycare centers in five high-density locations of Lusaka to provide support to children between the ages of 3 and 9 years (Singhal and Howard, 2003; see Table 1).
Models of care: Benefits and challenges.
CBO: community-based organization; NGO: nongovernmental organization; OVC: Orphan and Vulnerable Children.
Impact of the OVC label on systems of care and the welfare of labeled children
Labeling and the informal system of care
The informal system of care does not fall directly under the label of OVC. However, the system has been affected by this categorization. In recent years, mainly due to overwhelming rates of adult mortality, the extended family has turned to OVC programs for support. Under the auspice of community-based support and OVC programming in general, resource constrained households with dependent children classified as vulnerable have been able to obtain material and in-kind support. OVC programs have helped reduce their financial and emotional burdens (Whetten et al., 2009). In addition, quasi-institutional models, implemented under OVC programming, have allowed affected children to live in their homes. In the absence of the label and entry of external actors into this space, outcomes for children in such homes would have been dire.
Despite this, many challenges may be connected to the label with regard to the care and welfare of children nested within the informal system. Indeed, it can be argued that the label of OVC has complicated the relationship between the African child and her community, affecting the child’s welfare and developmental trajectory. Specifically, the label has allowed for the abdication of responsibility by the traditional systems of care – making the adage ‘it takes a village to raise a child’ redundant. Other challenges associated with the label include objectification of labeled children. The identity of the child is tied to resources which he/she can only access through the label. Connected to this is the abuse of OVC programming. It is not uncommon to hear of families that have taken in orphaned children so that they can receive resources/services connected to the label. In fact, the badge of ‘caring for an OVC’ is now worn with pride – with individuals describing themselves as ‘OVC compliant’. This frame is likely to comprise the dignity and spirit of self-reliance that characterized traditional African communities. Furthermore, orphaned children are likely to be mistreated if they fail to ‘deliver’ the resources linked to the label. Indeed, it is not uncommon to hear of children classified as vulnerable who have suffered abuse, neglect, exploitation, and even stigma while in the care of the extended family.
Labeling and the formal system of care
As observed, the label OVC has facilitated development of programs and policies which, for the most part, have been of benefit to both the children under its umbrella and their communities. The label has called attention to the plight of children so defined by placing them at the center of a discourse on vulnerability and has allowed for targeting in service delivery. For example, under this label, affected children have been able to access lifesaving health-care services such as antiretroviral drugs (ARVs) and psychosocial support. Furthermore, the label has given agencies working with children classified as OVC a platform from which to lobby governments and schools to reduce impediments to education – for example, requirements such as school uniforms, books, and user fees. This effort has resulted in less stigma and increased school enrollment for children classified as vulnerable. The OVC label has empowered human service organizations to advocate for children affected by issues such as trafficking, child labor, property rights, and land tenure. Children under the OVC label have gained voice, allowing them to be heard on matters pertaining to their welfare.
Negative effects have also been connected to the label and OVC programming. Under this tag, children have become objects of programs and mere recipients of services, compromising their ability to be effective rights holders with the capacity to make a claim on those who have the responsibility to fulfill claimed rights. Moreover, affected children and their communities, in many cases, are not consulted with regard to programming and policy decisions. Furthermore, the perception that children classified as OVC are receiving external assistance may inadvertently impact the level of support available from their communities, resulting in resource gaps and social isolation (Thurman et al., 2008). As indicated by the data available on the subject, formal programs for children classified as OVC account for only about 10 percent of the total support (Santa-Ana-Tellez et al., 2011), a fact lost to many actors. In addition, under this label external actors have become key players in the care of children – providing housing, food, and education, and in so doing, making traditional moral duty bearers (the extended family and community) irrelevant in the lives of children in difficult circumstances. This role substitution stands in contradiction to the traditional kinship norms which value collective responsibility in the upbringing of children, especially those in challenging situations. This practice is likely to weaken the social contract between the child and his/her community. Another adverse impact of the label and OVC programming is the potential to foster dependency and stifle creativity. Affected communities may lose the capacity to develop sustainable solutions to problems and may rely solely on OVC programs to meet their needs. Furthermore, the ‘alien hand’ syndrome promoted by the label and OVC programming is said to limit accountability, especially in a context where monitoring has been problematic.
As noted earlier, the label of OVC has allowed for the institutionalization of the care of the African child. Orphanages have emerged not only in many parts of sub-Saharan Africa, they are also seen as the preferred model even when this type of care has been discontinued and discouraged in other regions of the world (Allen and Vacca, 2011; UNICEF, 2016). Although data on the subject are scarce, estimates indicate that Ghana, for example, has seen a steady increase in orphanages – from a total of 10 in 1996 to about 113 in 2015 (UNICEF, 2015). Children raised in these facilities are likely to experience loss of cultural and context-specific survival skills that are passed on from generation to generation. The label and programming under its umbrella fail to acknowledge the fact that many traditional African communities do not even have a term for ‘vulnerable orphan’, as every child, in the absence of biological parents, was connected to a caring and nurturing unit of adults (Skinner et al., 2006). Moreover, the meaning of vulnerability in many African languages, for example, abalanda, mashikini, and bana ba matshelo a bone a leng mo diphatseng (in Bemba, Kiswahili, and Setswana), 1 is rarely applied to children because it carries a negative connotation of isolation and lack of care. The label of OVC, furthermore, tends to contradict the essence of OVC programming, which is undertaken to combat challenges experienced by children. Under the label, programs rather than the children tend to be the centerpiece.
Conclusion: Way forward
The modest objective of this article is to facilitate a dialogue on the label of OVC and its implications for the care and welfare of children so categorized. The label and programs implemented under its umbrella have benefited labeled children and their communities. However, the label also has potential to compromise the capacity and agency of labeled children to be forward-looking individuals with capabilities to contribute to the development of their communities and countries. Indeed, the concept of vulnerability, even when well intended, is disempowering and does not breed resilience and survival skills in children. Children so classified may internalize vulnerability, constraining their capabilities and structure of opportunity.
The preceding discussion calls attention to the potential of labels to disempower and the need for a world in which all children, regardless of location, can attain dignity and realize their full potential. Re-imagining such a world may demand a reconceptualization of labels such as OVC. It may require refocusing perceptions of vulnerability among children as a social justice issue and a systemic failure, a failure of systems that are charged with the responsibility of nurturing, protecting, and safeguarding the welfare of children.
At the policy and program levels, we call for an effort to restore the agency and dignity of children impacted by HIV/AIDS. This process could begin with consulting affected children and their communities on OVC programming. Indeed, the children may have something to say about the label of OVC, their care, and their welfare. Labeled children, despite their vulnerable status, are agents with the potential to influence outcomes in their favor. Evidence suggests that children in challenging circumstances have a preferred label – they just want to be called ‘children’ (Children on the Brink, 2004; Lombe and Ochumbo, 2016). Policy and programming efforts could also be devoted to strengthening the capacity of the extended family to help it become a strong voice for and effective custodian of the welfare of children under its care. Government effort could go into facilitating and strengthening the interactions between external actors and communities. Such collaborations have the potential to ensure that the integrity of traditional African systems of care is preserved and the role of external actors in the care of children is legitimized.
With respect to scholarship, efforts could be devoted to understanding the effects of the label on the care and welfare of children classified as vulnerable, using rigorous research designs incorporating both qualitative and quantitative approaches. This effort is important in that it has the potential to provide answers to more complex hypothesis than we are able to offer in this study.
To sum up, if indeed a label is needed for accountability and effective programming, this study calls for a label that celebrates the individuality, dignity, and potential of the African child: a label that is informed by the primary stakeholders – affected children and their communities. This effort could start with revisiting the traditional African systems of care. Our goal is not to romanticize the traditional system of care, but to call attention to its role in this discourse. After all, the traditional systems of care, including the extended family and communities, have been and still are the primary line of protection for children in the absence of biological parents.
Footnotes
Funding
The author(s) received no financial support for the research, authorship, and/or publication of this article.