A MINI THESIS IN PARTIAL FULFILMENT OF THE MASTER IN DEVELOPMENT STUDIES (MDS)
ASSESSMENT OF THE IMPACT OF HIV/AIDS ON RURAL LIVELIHOODS
CENTRE FOR DEVELOPMENT SUPPORT P O Box 339 University of the Free State BLOEMFONTEIN 9310
Willys C Simfukwe
January 2003
ACKNOWLEDGEMENTS Willys Simfukwe, a Project Manager with Catholic Relief Service (CRS) in Zambia, together with Mathews Ngosa, the Agricultural Coordinator for the Catholic Diocese of Ndola, have been responsible for facilitating the study.
The study has been conducted both as dissertation for a Masters of Development Studies (MDS), with the Center for Development Support (CDS), University of the Free State, Bloemfontein, and as a community assessment for designing a long-term food security project in the rural areas of the Diocese of Ndola. Funding for the study has been provided by CRS, under the direction of Michele Broemmelsiek, the Country Representative in Zambia.
The study has been made possible by high investment of time and energy. Fifty-eight people who included Community Health Workers and Clinical Staff from Fiwale Mission Hospital, Mishikishi Rural Clinic, Kafulafuta settlement, and Kafubu Health Center. The contributions of Mathews Ngosa and Chanda ChimpwenA throughout the stages from design to monitoring the research process are highly appreciated. I would also like to thank Joackim Kasonde for the encouragement and interest in the study. I cannot forget to appreciate the inputs of Mrs. Kunda who typed the translated version of the questionnaire.
I would like to express my sincere gratitude to Michele Broemmelsiek and John Donahue for the financial support and allowing me time to conduct the study in Masaiti. Special thanks to Dorie Olivier, Professor Lucius Botes and Professor Herman van Schalkwyk for the timely support and advice. Lastly, my sincere gratitude go to my wife Brenda who endured the lonely moments without complaints when I was away conducting the study. Bravo to my son Alinani who always jumped on my laps and joined in typing with his toddler fingers.
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ABSTRACT Because of lack of data to inform the design of a food security project in an HIV/AIDS environment in Masaiti District in Zambia, a Study was conducted in three farming blocks of Mishikishi, Kafubu and Fiwale. The objective was to explore and review literature on the impact of HIV/AIDS on rural livelihoods and food security, establish steps to build the capacity of rural communities in analyzing and mitigating the impact of HIV/AIDS on their livelihood systems, and generate information for designing a long-term Livelihoods and food security program in the rural areas of the Diocese of Ndola. The study shows that applying the Sustainable Livelihoods Approach (SLA) provides a holistic and participatory approach to engage local rural households in analyzing the impact of HIV/AIDS on their livelihoods. The study provides some insights on the impact of HIV/AIDS on livelihood assets and activities. It proposes a number of coping and mitigation strategies.
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ACRONYMS AND ABBREVIATIONS AIDS BMI CBO CBOH CCZ CDS CHAZ CIDA CMAZ COPE CRS DANIDA EFZ FAO GDP GTZ HBC HIV INGO JACH MOH MSF NGO NHAC NPO PLA PRA PRS ROSCAs SAP SARO SL SLA STD STI TAC TB UNAIDS UNDP UNICEF USA USAID VSO WHO ZEC
: Acquired Immune Deficiency Syndrome : Body Mass Index : Community Based Organization : Central Board of Health : Christian Council of Zambia : Center for Development Support : Christian Health Association of Zambia : Canadian International Development Agency : Christian Medical Association of Zambia : Community-based Options for Protection and Empowerment : Catholic Relief Services : Danish International Development Agency : Evangelical Fellowship of Zambia : Food and Agriculture Organization of the United Nations : Gross Domestic Product : German Technical Assistance to Zambia : Home-Based Care : Human Immuno Virus : International Non Governmental Organizations : Jerusalem Association Children’s Home in RSA : Ministry of Health : Medicien San Frontier : Non-Governmental Organization : National HIV/AIDS Council : Non-Profit Organization : Participatory Learning and Action : Participatory Rural Appraisal : Poverty Reduction Strategies : Rotating Savings and Credit Associations : Structural Adjustment Programme : Southern Africa Regional Office for CRS : Sustainable Livelihoods : Sustainable Livelihoods Approach : Sexually Transmitted Disease : Sexually Transmitted Illness : Treatment Action Campaign in South Africa : Tuberculosis : Joint UN Programme on HIV/AIDS : United Nations Development Programme : United Nations Children Emergency Fund : United States of America : United States Agency for International Development : Volunteer Services Organization : World Health Organization : Zambia Episcopal Conference
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CONTENTS ACKNOWLEDGEMENTS ........................................................................................................ 2 ABSTRACT................................................................................................................................ 3 ACRONYMS AND ABBREVIATIONS ...................................................................................... 4 LIST OF TABLES...................................................................................................................... 7 LIST OF FIGURES ................................................................................................................... 7 MAPS .........................................................................................Error! Bookmark not defined. CHAPTER ONE ........................................................................................................................ 8 1. Introduction......................................................................................................................... 8 1.1 General Background......................................................................................................... 8 1.2 The sustainable livelihoods approach .............................................................................. 9 1.2.1 Livelihood definition ...................................................................................................... 9 1.3. The HIV/AIDS situation in Zambia................................................................................. 12 CHAPTER TWO: THE STUDY .............................................................................................. 14 2.1 Rationale of the study.................................................................................................. 14 2.2 Aims and Objectives of the study ................................................................................ 15 2.3. Methodology ................................................................................................................. 15 2.3.1 Study Design ................................................................................................................ 15 2.3.2 Data sources, collection tools and techniques............................................................. 16 2.3.3 Site Selection................................................................................................................ 17 2.3.4 Sample size and sampling ............................................................................................ 18 2.3.5 Ethical Considerations................................................................................................. 19 2.3.6 Study management and Quality Control...................................................................... 19 2.3.7 Data Analysis ............................................................................................................... 20 2.4.7 Limitations of the study................................................................................................ 20 Chapter 3: Literature Review ................................................................................................ 21 3.1. AIDS as a development Issue...................................................................................... 21 3.2 AIDS as a rural Issue.................................................................................................. 23 3.3 Impact of HIV/AIDS on rural households................................................................... 25 3.3.1 Impact on rural women................................................................................................ 25 3.3.2 Impact on nutrition and food security.......................................................................... 26 3.3.3 Labour Loss or Stress .................................................................................................. 29 3.3.4 Loss of agricultural knowledge and management skills .............................................. 30 3.3.5 Declining yields. .......................................................................................................... 31 3.3.6 Loss of Income ............................................................................................................. 32 3.3.7 Increased Household expenditure................................................................................ 32 3.3.8 Impact on the livestock sector................................................................................. 34 3.3.9 Impact on natural resources .......................................................................................... 38 3.4 Household and community responses to the impact of HIV/AIDS ............................. 38 3.4.1 Household responses aimed at improving food security ............................................... 40 3.4.2 Household responses aimed at raising income and maintaining expenditure .............. 40 a. Income diversification......................................................................................................... 40 b. Shifting, reducing or cutting back expenditure................................................................... 41 c. Sale of farm produce, assets and use of savings ................................................................. 41 d. Loans................................................................................................................................... 42 e. Role of the extended family ................................................................................................. 43 3.4.3 Household responses aimed at alleviating the loss of labour........................................ 43 a. Intra-household reallocation of labour and taking children out of school ........................ 43 b. Hiring labour ...................................................................................................................... 45 c. Changing household crop production and substitution of crops ........................................ 45 5
d. Decreasing the area cultivated .......................................................................................... 45 e. Lengthening of the working day.......................................................................................... 46 3.4.4 Other household responses ............................................................................................ 46 3.5 Vulnerability of rural households to the impact of HIV/AIDS.................................... 47 CHAPTER FOUR: STUDY FINDINGS............................................................................ 50 4.1 Background information (Demographics)........................................................................ 50 4.2 Livelihoods........................................................................................................................ 52 4.2.1 Physical Assets............................................................................................................... 54 4.2.2 Social Capital................................................................................................................. 55 4.2.3 Financial Assets ............................................................................................................. 56 4.2.4 Intra-household asset control and use of Assets............................................................ 57 4.2.5 Livelihoods activities and labour distribution. .............................................................. 58 4.3 Impact of HIV/AIDS on Livelihood assets and activities (shocks and stresses) ............... 60 4.3.1 HIV/AIDS Prevalence and people’s perceptions........................................................... 61 4.3.2 Impact of HIV/AIDS on the households and their livelihoods....................................... 62 4.2.3 Coping Strategies and Building Resilience.................................................................... 64 4.2.4 Lessons Learnt in Applying SLA to analyze the impact of HIV/AIDS ........................... 65 Chapter 5: Recommendations................................................................................................ 67 REFERENCES ........................................................................................................................ 68
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LIST OF TABLES Table 1. Zambia’s trends in growth rate with and without AIDS 2002 and 2010 .......................... 21 Table 2 potential impacts of AIDS on households ..........................Error! Bookmark not defined. Table 3 The three stages of loss management ................................................................................ 39 Table 4. Household coping strategies ............................................................................................. 40 Table 5: Community responses towards HIV/AIDS.........................Error! Bookmark not defined.
LIST OF FIGURES Figure 3.1 Relationship between poverty and HIV/AIDS .............................................................. 22
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CHAPTER ONE 1. Introduction 1.1 General Background Southern Africa is one of the regions most severely affected by HIV/AIDS. Although HIV/AIDS epidemic started late in Southern Africa, it has been explosive, reaching prevalence rates of above 30 percent in some countries such as Botswana and Swaziland. In the midst of many other challenges, Southern Africa has the world’s worst HIV epidemic, and indeed some analysts suggest that all developmental activities in the region should be seen through an HIV/AIDS lens. Roughly one-third of HIV-infected people — 11 million, the majority of them women — live in Southern Africa. While HIV-prevalence ranges from 0.15 percent in Madagascar to 35.8 percent in Botswana, Malawi, Zambia, Zimbabwe and South Africa have prevalence rates greater than 15 percent (CRS SARO, 2002). In Swaziland, 33.4 percent of the Swazis aged 15 – 49 years are affected by HIV/AIDS (Muwanga, 2002). A CORDAID country situational analysis 2001 report indicates that 139 people die every day from an AIDS-related illness in Malawi (Kapwepwe and Siamwizia, 2001).
The impact of HIV/AIDS is challenging the development gains in Sub-Saharan Africa. Based on the Millennium goal of halving the proportion of people living in absolute poverty by 2015, there is increasing focus on the critical importance of poverty reduction for people-centered sustainable development. This calls for a shift in the definition of development from purely economic growth to socioeconomic and human development. The recent debate on the measurement of poverty has led to emphasis on the use of poverty indicators and human development indexes rather than measurement purely in terms of per capita income or economic growth. This has resulted in the development of Poverty Reduction Strategies (PRS) that are linked with macroeconomic and structural reforms. It is important to note that the PRS follow on to the Structural Adjustment Programmes (SAP), which had a knocking-effect on the livelihoods of the majority of people in Sub-Saharan Africa. The PRS address three key elements: a) economic growth with use of labour of the poor as one of their most important assets; b) investment in human capital; and c) creation of safety nets for the most vulnerable.
In addition to that PRS are macro oriented, meso and micro level strategies are required to adequately mitigate the impact of HIV/AIDS on the individuals, households and local communities. These meso and micro level strategies should be formulated on the basis of community and household level empirical data. This study seeks to explore the information on the 8
impact of HIV/AIDS on rural livelihoods, to establish steps to build the capacity of rural communities in analyzing and mitigating the impact of HIV/AIDS on their livelihood systems. It is anticipated that the application of the Sustainable Livelihood Approach (SLA) in the study, will generate information for designing a long term Livelihood and food security program in the rural areas of the Diocese of Ndola. The following section provides an overview of the SLA.
1.2 The sustainable livelihoods approach The Sustainable Livelihood Approach puts people at the center of development. It recognizes that the poor are the managers of complex asset portfolios. It seeks to understand the multiple livelihoods that people pursue and the changes occurring over time, the resources used in livelihood activities, the constraints faced and available opportunities. The approach aims to build the capacity of local people, for them to be better able to pursue their own livelihood strategies. The SLA requires action in enhancing the participation of people in devising their livelihood intervention options and adopting people-centered strategies; raising the human capital status of households and communities; combating the devastating impact of HIV/AIDS epidemic; promoting formal and informal employment; and ensuring appropriate utilization of natural resources (UNDP, 2001).
1.2.1 Livelihood definition A livelihood is combination of activities, assets (natural, physical, financial, human, social), and the access to these, and capabilities that are mediated by institutions and social relations to enable an individual or household to gain a living (de Satge, 2002). The figure below provides a simple pictorial view of livelihood definition A livelihood is depicted by a triangle formed by the interaction of capabilities, assets (and access them), and activities that are influenced by institutional and social relations. Every livelihood is one way or the other exposed to, and affected by shocks and stresses (see figure 1.1 below). Assets are the resources used for gaining a livelihood. Capabilities are the combined knowledge, skills, state of health and ability to labour or command labour of a household (de Satge, 2002)
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A S S E T S Shocks Stresses
Shocks Stresses
ACCESS
LIVELIHOOD
ACTIVITIES
CAPABITILITIES
Shocks Stresses
FIGURE 1.1 LIVELIHOOD MODEL Source: Adapted from CARE, DFID, Oxfam and LAL livelihood frameworks
Assets are subdivided into five categories. The categories include
Natural assets these include water, rainfall, forests, wildlife, and land. Natural assets can be enhanced or augmented when brought under human control and usage that increases productivity.
Human assets refer to the labour available to the household, skills, education and health status, and the ability to find and use information to cope with, recover from and adapt to shocks and stresses. Investing in education and training increase it. The human assets in a household are dynamic, constantly changing due to internal demographic changes (death, birth, marriage, etc) or external pressures.
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Physical assets refer to the basic infrastructure (housing, buildings, transport, energy, communication, etc.) and production equipment and inputs (tools, seeds, etc.) that enable people or households to pursue livelihoods.
Financial assets refer to cash, loans, savings, gifts, regular remittances or pensions, and other financial instruments, which are available to people and provide them with diverse livelihood options.
Social assets refer to networks, membership of groups, relationships of trust, access to wider institutions in society, freedom from violence. It also includes reciprocity within and between families, and in communities, the support provided by religious, cultural and informal organizations. Social assets are enhanced and maintained by a culture of human rights and democracy and by vibrant local institutions. Political capital should be considered as a sixth asset. It refers to citizenship, enfranchisement and membership political parties (Adato & Meinzen-Dick, 2002).
In addition to assets, shocks, risks, vulnerability and sustainability are common terms in the livelihoods vocabulary. These terms are defined below
Shocks are sudden events, which undermine household livelihoods. These include loss of employment, death of an economically active household member, as well as impact of natural hazards like drought, floods or extreme weather conditions that are often made worse by mismanagement of the environment. Stresses are ongoing pressures, which face households and individuals. They include long-term food insecurity and limited access to essential services and facilities. The degradation of the natural resource base is another stress that may force people to travel long distances for fuel and other natural resources (de Satge, 2002).
Risk is the chance of a shock or disaster event occurring or the chance of a loss or the loss itself.
Vulnerability refers to the capacity of an individual or household to deal with a risky event. The capacity to deal with risks depends on the resources available to an individual or household to protect against risks and manage losses afterwards. Vulnerability also refers
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to the characteristics that limit an individual, a household or a community to anticipate, manage, resist or recover the impact of shocks (a hazard or natural trigger).
Sustainability refers to specific characteristics and values in relation to the way people carry out their activities as well as utilize assets and resources. Households have sustainable livelihoods when they can cope with, and recover from shocks and stresses. Livelihood sustainability entails that the natural resource base is maintained and capabilities are enhanced now and for future generations (UNDP, 2002).
Gender is a key component of livelihoods analysis. It refers to the socially constructed roles ascribed to males and females. It is important because the entitlements to resources and vulnerability to shocks and stresses vary within the household based on gender. Entitlements are resources, which people have the right to access.
1.3. The HIV/AIDS situation in Zambia In Zambia, the first cases of AIDS-related sicknesses and deaths were reported in the early 1980s. However, limited knowlegde about HIV/AIDS at that time coupled with lack of acceptance and political will, delayed the response to the HIV/AIDS epidemic. At the time of wake up call, in the early 1990s, the epidemic had spread to every corner of the country. The HIV/AIDS prevalence in Zambia is among the highest in Southern Africa - almost 20 percent of the adult population is infected with HIV virus (MOH/CBOH, 1999).
HIV/AIDS is a major social and economic challenge to the development process in Zambia. More and more adults and children are getting infected every day. An estimated 25,000 babies are infected each year with HIV through their mothers either during pregnancy or at birth, or through breast milk. High rates of HIV prevalence have now been followed by sharp increases in mortality due to AIDS. Women typically become infected with HIV much earlier than men, reflecting their lack of knowledge about HIV/AIDS and their inability to protect themselves, and their physiological vulnerability (MOH/CBOH, 1999). With its direct impacts on people’s health (increased illnesses) and socioeconomic well being, HIV/AIDS is contributing to rising workload especially for women, increasing costs in the health services and the depletion of human capital in the Zambian economy. Vast differences in HIV prevalence are obvious both between urban and rural areas and between regions. In urban areas, the prevalence rate among 15-49 year olds is 12
more than 28 percent while in rural areas it is 13.6 percent. In 1999, the highest HIV prevalence was reported in the Lusaka and Copperbelt provinces (27.3 percent and 26.3 percent respectively). Prevalence rates range between 15 percent to19 percent in the other five provinces – Luapula (16.2 percent), Eastern (16.5 percent), Central (18.7 percent), Southern (15.7 percent) and Western (18.9 percent). Prevalence is slightly lower in the Northern (13.5 percent) and Northwestern (11.7 percent) Provinces (MOH/CBOH, 999).
The determinants of the HIV prevalence in Zambia have been identified as: a largely young population; high mobility and internal migrations; high levels of poverty; high prevalence of sexually transmitted illnesses (STIs); multiple sexual relations; lack of male circumcision; low social and economic status of women; early sexual activity and some cultural practices. Among the macro determinants is the impact of the Structural Adjustment Program (SAP) and the high debt burden (Kapwepwe and Siamwizia, 2001)
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CHAPTER TWO: THE STUDY 2.1
Rationale of the study
Despite Zambia being one of the highly urbanized countries, the majority of the people in Zambia still lives in rural areas and depends mainly on agriculture for their livelihoods. Achieving food security is one of the main objectives of the agricultural policy in Zambia. The need for food and livelihood security in a country where almost fifty percent of child deaths are caused by malnutrition cannot be overemphasized (UNICEF, 2001). The failure of agricultural policies and extreme weather conditions has had a detrimental effect on the food security in Zambia. The HIV/AIDS pandemic has exacerbated the poverty situation among rural households making them more prone to food insecurity. The rural areas in Zambia are overwhelmed with high levels of poverty- as high as 89 percent in some parts of the country (UNDP, 2001).
Since the early 1990s, anti-HIV/AIDS programs have been designed and implemented mainly in the urban areas. The anti-AIDS programs have focused on HIV/AIDS awareness (information on the causes and the spread of HIV/AIDS), while efforts to mitigate the impact of HIV/AIDS have emphasized on the care for the sick (Home-Based Care and Community-Based Care) and support of orphaned children. The anti-HIV/AIDS programs have resulted in the reduction of HIV/AIDS infection rates especially in urban areas. Although there is a general stabilization and reduction in HIV infections rates in urban areas, the rate of HIV infections in rural areas is rising rapidly (UNDP, 2001). The rising rates of HIV/AIDS infections and the high levels of poverty are major threats to the sustainability of rural livelihoods.
This study is important both as an explorative activity to understand the impact of HIV/AIDS on rural livelihoods, and as capacity building activity to enhance the local communities’ capacity to improve and sustain food security. The study is based on the principles of applied development research, which emphasize a holistic approach and community ownership of the development process and outputs. The study focuses on involving the local communities in analyzing their own situations and determining their own courses of action. It is anticipated that the completed study will provide useful information to organizations and individuals involved in HIV/AIDS programming for rural areas in Zambia.
The application of the Sustainable Livelihood Approach (SLA) is based on the understanding that while HIV/AIDS affects or impacts on every aspect of human life, the livelihoods approaches offer a holistic way of addressing the HIV/AIDS epidemic which promotes joined up thinking
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across sectors and disciplines, that can look not just at the impact on health but also at the impact on social support, finances, housing, land-use and land tenure (Steely and Pringle, 2001). The study is based on the premise that the impact of HIV/AIDS on agricultural production systems and rural livelihoods cannot be generalized, even within one country, but must be disaggregated into spatial and temporal dimensions. Studies conducted in Uganda, Tanzania and Zambia shows that HIV/AIDS follows a different pattern in each village and district. Geographic and ethnic factors, religion, gender, age, marriage customs and agro-ecological conditions play a role in the pattern and impact of HIV/AIDS and in people's perception of the disease (FAO, 2001).
2.2
Aims and Objectives of the study
The study aims at the applying the Sustainable Livelihoods Approach in understanding the impact of HIV/AIDS. It seeks to ascertain how to involve rural communities in incorporating HIV/AIDS in livelihood analyses in order to improve the food security of HIV/AIDS affected households. The specific objectives of the study were
1. To explore and review literature on the impact of HIV/AIDS on rural livelihoods and food security. 2. To establish steps to build the capacity of rural communities in analyzing and mitigating the impact of HIV/AIDS on their livelihood systems 3. To generate information for designing a long-term Livelihood and food security program in the rural areas of the Diocese of Ndola
2.3.
Methodology
2.3.1 Study Design The study was designed as an explorative and interventional study. Firstly, it was designed to explore and review information on HIV/AIDS and its impact on rural livelihoods and food security. Secondly, the study was designed as a participatory intervention - involving local communities in analyzing the impact of HIV/AIDS on their lives, and in designing long-term strategies to mitigate its impact. The involvement of local community members in the study was based on the appreciation of the extant local knowledge and initiatives in mitigating the impact of HIV/AIDS. Local communities are already responding to the HIV/AIDS challenge in their own way (home and community care systems, moral support to affected, etc). It was intentional that 15
this study should build on the existing local capacity to analyze and develop interventions to mitigate the effects of HIV/AIDS.
2.3.2 Data sources, collection tools and techniques For the literature review, published data was obtained from Zambian government agencies that included the Ministry of Agriculture and Cooperatives, Ministry of Community Development and Social Services; UN agencies FAO, UNDP, UNICEF; and CRS library. The key words used on the Internet searches included HIV, AIDS, rural, livelihoods, food security, impact, and agriculture in various combinations. A data compilation checklist was developed to focus the literature review and Internet search on the necessary information needed for the study and to avoid being swamped with too much information.
In addition to literature review and Internet searches, Participatory Rural Appraisal tools were applied to engage the community and collect qualitative data. Key informant and normative interviews were used to get information in the study areas - Fiwale, Mishikishi and Kafubu rural settlements in Masaiti District. The initial process involved preliminary discussions and meetings in communities for almost a month. Follow up meetings were then held with the Ndola Diocese Development and Agricultural Team, Masaiti District Health Management Team, Fiwale Mission Hospital, Mishikishi and Kafubu Health Center staff, and the Community Health Neighborhood Committees. A second series of community meetings involved the selection and training of the research teams. The research teams comprised of community health volunteers, staff from health centers, the Diocesan Deanery Coordinator, and Agricultural Coordinator. The selection of the community health workers to be involved in the study was based on the number of health neighborhood committees in each study area. The minimum requirement for the team member was the ability to read and write, and to translate the local language into English and vice versa. Gender equity and wider community representation were key elements in assembling the research teams. The table below shows the HIV prevalence in the study area.
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TABLE 2.1. HIV PREVALENCE ESTIMATES FOR COPPERBELT PROVINCE OF ZAMBIA 1999 Province/District
HIV Prevalence 15-49
HIV+ Total 15-49
HIV+ Urban 15-49
HIV+ Rural 15-49
HIV+ HIV+ Total 15 and 50+ Older
______________________________________________________________________________________________ Provincial
26.2%
197,543
185,618
11,917
Chililabombwe
25.8%
7,666
7,177
489
417
8,083
Chingola
28.1%
23,757
23,714
43
1,465
25,223
Kalulushi
24.4%
8,511
7,614
897
479
8,990
Kitwe
28.7%
54,762
54,762
-
3,502
58,264
Luanshya
26.6%
20,463
19,570
893
1,304
21,767
Lufwanyama*
12.8%
3,128
462
2,666
281
3,410
Mpongwe*
12.8%
2,294
339
1,956
207
2,501
Mufulira
26.9%
20,845
20,138
707
Masaiti*
12.8%
5,006
740
4,266
Ndola Urban
28.4%
51,100
51,100
-
12,591 210,125
1,188 22,034 450 3,297
5,456 54,397
______________________________________________________________________________________________ Source: Ministry of health and
Central Board of Health 1999. * These are rural districts in province. The study sites are in Masaiti District.
2.3.3 Site Selection Site selection was a three-step process; the selection of a district from among the three rural districts in the province, followed by the settlements or villages within the district, then the Health Neighborhood Zone in the village. The Lead Investigator based on the existence of the CRS partner’s agricultural and rural resettlement activities chose the district. The Diocesan Agricultural Team and local Community Health Volunteers who were more conversant with district and settlement characteristics chose the farm settlements and Health Neighborhood Zones. The sample sites for the study covered Fiwale, Kafubu and Mishikishi farm settlements in Masaiti district. The three farm settlements were selected on the basis of:
i)
Availability of a Rural Health Center; 17
ii)
Existence of Community Health Committees;
iii)
HIV/AIDS prevalence as recorded by the RHC and MOH/CBOH;
iv)
Proximity and easier access to the urban centers; and
v)
Existence of CRS partner agricultural activities
TABLE 2.2 STUDY SITES Farm Settlement Mishikishi
Kafubu
Fiwale
Health
Kango-Moni
Zone 1
Makubi-Kanshiwa
Neighborhood
Nkumbwe
Zone 2
Munkulungwe
Zones
Mabungo/Mpangamumba
Zone 4
Nkomesha 1
Fipempele/Chankute
Zone 6
Ngwenya
Busalala
Lumano West
Kalalangabo-Matipa
Mwelemuka-Chikoti
Fipwika-Mushitu
Chinkuli-Mbalashi
Kashilalyashi
Kangwena
Own source
2.3.4 Sample size and sampling The household was used as a unit of measure. Sample size calculations were based on the percent of the local population as recorded by the RHC. The Ministry of Health in collaboration with the Central Statistics Office (CSO) has established standard population counts for every RHC in all districts in Zambia.
The research team conducted the mapping and demarcation of Health
Neighborhood (HN) zones to allow for a systematic random sampling. The households in each of the HN zones were selected based on: i)
Presence of a terminally ill person for a period of six months or more;
ii)
Death of a terminally ill person within the last five years;
iii)
Membership in the community home-based care program
iv)
Female headed and or child headed household; and
v)
Well being of the household as classified by the local community members
The sample included female-headed, child-headed, and male-headed households. The study targeted a total 498 households in the three selected sites. Community health workers and volunteers in the Home-Based Care (HBC) programs were the key informants on the households to target for interviews and focused discussions.
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TABLE 2.3 TARGETED AND ACTUAL INTERVIEWS Site/Area Targeted Actual Mishikishi
202
181
Kafubu
100
87
Fiwale
196
168
Total
498
436
Own source
2.3.5 Ethical Considerations Discussions were also held with research teams and general community to avoid reinforcing of stigma and discrimination. In addition to that sensitive information regarding HIV/AIDS was only obtained after establishing good rapport with informants and with their consent. The inclusion of a household on the interview list was done after consultations with, and gaining consent from the members of the household. Pre-survey discussions with provincial and district health management officials ensured that ethical concerns were considered and properly addressed during the study.
2.3.6 Study management and Quality Control A clinical officer at each of the three health centers in the study area was selected as team leader and process supervisor. In each study area, the research team provided their daily or weekly feedback on the field experiences to the Clinical officer. The Diocesan Deanery Coordinator and the Diocesan Agricultural Coordinator provided the supervisory back up to clinical officers and monitored research process in the field. The lead investigator did the overall coordination and management of the research process. In order to avoid complacence and bias during field interviews, the interviewers within the research teams were swapped so that they interviewed in the areas, which they knew but were not too familiar with the people that they interviewed. The diversity of research team members ensured that wide aspects were covered with minimal omissions of vital information. The interviewing of several members in a household helped to clarify or refute uncertain responses. In addition to that the Supervisors provided assistance in interpreting the responses. Apart from the
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targeted HIV/AIDS affected households, interviews were also conducted with some that had no terminally ill person or experienced AIDS related deaths
2.3.7 Data Analysis The analysis of data was done in two phases. Firstly, community level analysis was done through group meetings. This provided a chance for community members to ascertain the data collected by the research teams and appreciate the similarities and differences in selected sites. Secondly, the lead investigator applied Microsoft Excel and Access for quantitative analysis.
2.4.7 Limitations of the study A number of problems were encountered and noted in this study. The high level of poverty in the study sites provided a potential source of bias. It was not easy to differentiate the households impacted by poverty from those impacted by HIV/AIDS. The limited number of in-country studies and reports on impact of HIV/AIDS on rural households, made the lead researcher to rely more on literature from other countries for review.
The second limitation relates to the selection of study sites. The study sites chosen could not ensure complete representation at district or national level. The study sites were chosen on the basis of the existing geographic coverage of the Catholic Diocese of Ndola agricultural department, and the need to establish a long-term livelihoods improvement programme. Only a full-scale district or national survey could provide complete and good representative data.
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CHAPTER 3: LITERATURE REVIEW The study design was based on the understanding that some work has been done on the subject matter by other researchers. Reviewing what has already been done on HIV/AIDS and its impact on rural livelihoods formed part of the study. The following section provides the results of the literature review focusing on HIV/AIDS as development and rural issue, its impact on rural households, and the household and community responses.
3.1.
AIDS as a development Issue
AIDS is not just a health problem though it is often presented as one (Loevinsohn et al, 2001:7). The UN Special Session on HIV/AIDS indicates that by killing so many people in the prime of their lives, AIDS poses a threat to development. By reducing growth, weakening governance, destroying human capital, discouraging investment and eroding productivity, AIDS undermines countries’ efforts to reduce poverty and improve living standards (UN Fact sheet, 2001).
HIV/AIDS has a profound impact on growth, income and poverty. Over (1998) notes that the third major impact of the epidemic is on households and, in the aggregate on the extent and depth of national poverty. The UN estimates that the annual per capita growth, in half the countries of subSaharan Africa is falling by 0.5-1.2 percent as a direct result of HIV/AIDS. It is also projected that by 2010, per capita GDP in some of the hardest hit countries may drop by 8 percent and per capita consumption may fall even further (UN Fact Sheet, 2001). The table below shows trends in economic growth in Zambia with and without HIV/AIDS in 2002 and 2010. TABLE 3.1. ZAMBIA’S TRENDS IN GROWTH RATE WITH AND WITHOUT HIV/AIDS 2002 AND 2010 Growth rate YEAR With HIV/AIDS Without HIV/AIDS Net Decrease 2002 1.6 2.9 1.3 2010 1.0 2.6 1.5 Source: adapted from Stanecki. K.A. Draft report July 2002, Barcelona Conference on AIDS
People at all income levels are vulnerable to the economic impact of HIV/AIDS with the poor suffering more acutely. HIV/AIDS pushes people deeper into poverty as households loose their breadwinners to AIDS, livelihoods are compromised, and savings are consumed by the cost of health care and funerals. The number of people living in poverty has increased up to 5 percent in some countries as a result of AIDS. The AIDS epidemic is jeopardizing the efforts to reach the Millennium Summit goal of halving the proportion of people living in extreme poverty by 2015 (UN Fact Sheet, 2001) 21
With increased poverty as a result of HIV/AIDS, impoverished people resort to commercial sex and other coping strategies that increase the chances of contracting HIV/AIDS and hence creating a vicious cycle. The links between HIV/AIDS and poverty are presented figure 3.1 below. Structural vulnerability -> high-risk situations Lack of access to preventive interventions Lack of access to affordable care Lower education status -> reduced access to information on AIDS
POVERTY
HIV/AIDS
Lost productivity Catastrophic cost of health and death Increased dependency ratio Orphans with worse nutrition, lower school enrolment Decreased capacity to manage households headed by orphans, elderly Reduced national income Fewer national resources for HIV/AIDS control
FIGURE 3.1 RELATIONSHIP BETWEEN POVERTY AND HIV/AIDS Source: adapted from UNAIDS/World Bank 2001, A Toolkit for Mainstreaming HIV/AIDS in Development Instruments
As a result of the impact of HIV/AIDS on household economics, poverty is likely to deepen as the epidemic takes its course.
The above aspects of the socio-economic impact of HIV/AIDS
combine to create a vicious cycle of poverty and HIV/AIDS in which affected households are caught up. As adult members of the household become ill and are forced to give up their jobs, household income will fall. To cope with the change in income and the need to spend more on health care, children are often taken from school to assist in caring for the sick or to work so as to contribute to household income. Because expenditure on food comes under pressure, malnutrition often results, while access to other basic needs such as health care, housing and sanitation also comes under threat.
Consequently, the opportunities for children for their physical and mental development are impaired.
This acts to further reduce the resistance of household members and children
(particularly those that may also be infected) to opportunistic infections, given lower levels of immunity and knowledge, which in turn leads to increased morbidity and mortality (Tanya, 2002). Households headed by AIDS infected widows are also particularly vulnerable, because women
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have limited economic opportunities and traditional norms and customs may see them severed from their extended family and denied access to an inheritance (UNDP, 1994). In many third world situations, therefore, HIV/AIDS exposes already vulnerable, resource-poor households to further shocks (Tanya, 2002). The impact is worse if the family is a low-income household, because such households generally possess few resources, and thus are less able to cope with increased medical care and other related expenses (Pitayanon et al. 1997).
At national level, governments lose valuable skilled staff and are faced with mounting expenses for health and orphan care, reduced revenues and lower return on social investment (UN Fact Sheet, 2001). World Bank studies indicate that the average cost of treating an AIDS patient from time of diagnosis to death ranges from US $100 to US $1100 in Africa. In Zambia, AIDS care expenditures are projected to increase from US $3.4 million in 1989 to US $18.3 million in 2004 and to US $22.1 million (MOH/CBOH, 1999). The AIDS epidemic has increased the prevalence of opportunistic infections such as tuberculosis, which was contained before the 1980s. The interaction of tuberculosis and HIV infections has contributed to almost a five-fold increase in the TB rate (UNDP, 2001).
As result of HIV/AIDS, the public, private, and civil society sectors are faced with higher costs in training, insurance, benefits, absenteeism and illness (UN Fact sheet, 2001). Productivity falls even among people not living with HIV/AIDS as they have to take time off their productive activities to care for sick relatives and friends or attend funerals. Absenteeism and death have plagued the labour force, and have affected the quality of education, food security and quality of health care (UNDP, 2001). The ultimate result is reduction in annual per capita growth in GDP. If AIDS epidemic trend continues, productivity growth may be cut by as much as 50 percent in hardhit countries. HIV/AIDS overburdens social systems and hinders health and educational development. It undermines social cohesion in many countries and is increasingly recognized as a threat to social and political stability.
3.2
AIDS as a rural Issue
One of the common characteristics of developing countries is the substantial dependence on agricultural production for food and income. The vast majority of people in developing countries lives and works in rural areas. Over 65 percent are rural based, compared to less than 27 percent in economically developed countries (Todaro, 1997).
HIV/AIDS, which was once an urban 23
problem, has moved to rural areas. Chief David Lingazwe of Amambisi Tribal Authority in South Africa said the AIDS epidemic had taken every one by surprise. “…We thought it was a town thing, we didn’t know it would kill our families like this…” (IRIN-SA 2001 quoted in Steely and Pringle, 2001). In Zambia, the UNDP observes that the rate of HIV infections is rising faster in rural areas than in urban areas where it is stabilizing (UNDP, 2001). The Food and Agricultural Organization (FAO, 2001) reports that HIV/AIDS was no longer restricted to cities. The disease was spreading with alarming speed into rural areas and affects the farming population, especially people in their most productive years (ages 15 to 45). More than two-thirds of the population in 25 most affected African countries lives in the countryside.
Although interrelations between the epidemic and overall development have been acknowledged, the linkages to agriculture have received less attention because the epidemic was perceived as being largely urban. The existing evidence of the spread of the epidemic to rural areas was often overlooked because of poor data, the irregular patterns of spread and lower prevalence than in urban areas (FAO, 2001).
Pitayanon, Kongsin and Janjaroen (1997) noted that the largest
proportion of AIDS cases had been reported in Thailand’s Northern Province mainly in rural areas. Labourers and agricultural workers, who are generally the poorest and least educated, are the most vulnerable to HIV/AIDS. In Sub-Saharan Africa, millions of rural people suffer from chronic poverty, socio-economic marginalization, food insecurity and, most recently, the devastating impact of the HIV/AIDS epidemic. In a study in Malawi, Loevinsohn et al (2001) reported HIV to be more prevalent in urban than non-urban areas in early stages of the epidemic. Though the differences in prevalence have remained, the gap is steadily narrowing. The median prevalence among non-urban sentinel sites (antenatal clinics) increased in relation to urban sites from about 20 percent in 1992 to 70 percent in 1998. Gari (2002) reports that the combined threat of the food insecurity and the impact of AIDS are leading to a rural development crisis. In poor rural households, HIV/AIDS causes severe labour and economic constraints that disrupt agricultural activities, aggravate food insecurity, and undermine the prospects for rural development. The HIV/AIDS pandemic is undoing the decades of economic and social development causing rural disintegration.
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3.3
Impact of HIV/AIDS on rural households
3.3.1 Impact on rural women From the gender perspective, women and girls are more vulnerable to HIV/AIDS and shoulder the largest burden. Girls are removed from school to care for sick relatives. The reduced education for girls and women further impedes national development (UN Fact sheet, 2001). Since HIV/AIDS is above all a sexually transmitted disease, very often more than one family member is affected and dies. As a result, the entire assets and savings of many families, which are generally meager before the onset of the disease are completely depleted, leaving the surviving family members without means of support. A study in Uganda has shown that the burden of the socio-economic impact of HIV/AIDS is disproportionately affecting rural women. In the districts studied, more households were found to be headed by AIDS widows than by AIDS widowers. Widows with dependent children became entrenched in poverty as a result of the socio-economic pressures related to HIV/AIDS. Widows lost access to land, labour, inputs, credit and support services. HIV/AIDS stigmatization compounded the widow’s situation further as assistance from the extended family and the community; their main safety net was discontinued.
The loss of productive labour force in agriculture - the mainstay of rural areas, excessive use of natural resources, lack of good policies, and extreme weather conditions have had a devastating effect on the food security in rural areas. As stated earlier, the socioeconomic impact of HIV/AIDS includes among others the loss of livelihood at household level; increased vulnerability to food insecurity and increased malnutrition; and the break up of family structures. The lack of food in already impoverished rural populations is reinforcing the effect of HIV/AIDS by weakening long established rural survival mechanism of subsistence agriculture thereby trapping the rural communities in a poverty vicious cycle. The inter linkages between the increase of HIV/AIDS-related mortality and morbidity, the lack of farm inputs and labour force, the deterioration of household economy and the impact on education, health and the social system, which eventually lead to a breakdown of the traditional coping mechanisms, are presented in figure 3.2 below. The figure indicates that immediate effects of increased HIV/AIDS morbidity and mortality on rural economies are shortage of labour; loss of agricultural and community organization skills; and a marked increase in poverty among women. With increased stigmatization, the immediate effects are followed with severance of assistance from extended family and the community. As a result affected households become more impoverished, education
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for children is discontinued, and health status declines, and social values are eroded leading to the collapse of both nuclear and extended families.
Increase of HIV/AIDS mortality and morbidity
Shortage of labour
Loss of agriculture and community organization skills
Marked increase in poverty among women
AIDS widows lose access to land, labour, cash, income, credit, farm outputs and support services
Farm households lose access to cash, income, credit, farm inputs and supply services
AIDS stigmatisation
Severance of assistance from the extended family and community
Breakdown of nuclear family
Household economy impoverished
Education discontinued
Health status declines
Social values eroded
Extended family network strained to breaking point
FIGURE 3.2 THE IMPACT OF HIV/AIDS ON TRADITIONAL COPING MECHANISMS IN RURAL ECONOMIES (ADAPTED FROM FAO)
3.3.2 Impact on nutrition and food security The trend towards increasing food insecurity in Zambia and the region as a whole should be viewed within the context of a deepening HIV/AIDS crisis, just as the HIV/AIDS pandemic must be understood as inter-related on many levels to the region’s food security situation (CRS SARO, 2002). The HIV/AIDS epidemic in Sub-Saharan Africa is strongly intertwined with issues of food and nutrition. On one hand, malnutrition and food insecurity may force households to adopt 26
livelihoods that increase the risk of HIV transmission, such as migration to find work. On the other, HIV/AIDS may precipitate or exacerbate malnutrition and food insecurity (Gillespie and Haddad, 2002). The extent to which malnutrition rates in affected households rise depends on the type of coping mechanisms, household resource constraints, socio-cultural context and emotional stress. As the ability to produce and accumulate food and income decreases, the household falls into a downward spiral of increasing dependency ratios, poorer nutrition and health, increasing expenditure of resources (time and money) on health problems, more food shortages, decreasing household viability, and increasing reliance on support from extended family and the wider community. The effects of HIV/AIDS on rural households, and the likely impact of the disease on farmers’ health and the nutrition of farm families are depicted in figure 3.3 below.
Reduced labour
Reduced land use
Reduced agricultural production
Loss of other income sources
Reduced access to wild food
Reduced extension
Increased health costs
Reduction in schooling
Reduced income
Reduction in food available at farm level
Reduced food purchases
Reduced access to food (household food security)
Increased sale of farm assets
Increased funeral costs
Reduced clothing & shelter
etc…
Increased nonfood expenses
Reduced K.A.P
Reduced time
Reduction in food selection, preparation and distribution
Reduced food intake
Reduced access to water
Reduced health services
Poor sanitation
Poor hygiene
Reduced Health status
Poor Nutrition
FIGURE 3.3 IMPACT OF HIV/AIDS ON THE FOOD AND NUTRITION SITUATION OF RURAL HOUSEHOLDS (ADAPTED FROM FAO)
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The risk of HIV transmission may precipitate or exacerbate malnutrition and food insecurity (Gillespie and Haddad, 2002). The main link between HIV/AIDS and food security is the potential for people living with HIV/AIDS to use nutrition to enhance the quality and longevity of life. Conversely, malnutrition leads to an impaired immune response, which accelerates AIDS (CRS SARO, 2002). Gillespie and Haddad (2002) state that HIV/AIDS has direct impacts on nutrition for the individual, the household, and the community. HIV infection, compounded by inadequate dietary intake, rapidly leads to malnutrition. They further state that people living with HIV have higher than normal nutritional requirements: as high as 50 percent more protein and 15 percent more calories. However, they are likely to suffer from loss of appetite and anorexia, which reduces the dietary intake at the time when nutritional requirements are greatest. Loevinsohn et al. (2001) state that AIDS strain already meager diets and pushes many into a vicious cycle – failure to maintain nutrition status weakens immunity and increases susceptibility to opportunistic infection, which in turn undermine the nutritional status.
Research in Zambia, for example, has indicated that the labour loss resulting from AIDS deaths are particularly critical in rural areas, with deaths often resulting in increased food insecurity (Nampanya-Serpell, 2000).
The four in-depth profiles of affected families in rural Uganda
presented by Topouzis and Hemrich (1994) paint a similar picture. Ikamari (1991, in Forsythe and Rau, 1998: S51 quoted in Tanya 2002), in a survey of the families of 52 individuals who had died of AIDS, found that these deaths had a significant impact on the household's nutritional status. It, however, is unclear how exactly changes in nutritional status were monitored in these two studies. The impact of HIV/AIDS on nutritional status has been explored extensively in the household impact study the World Bank conducted in Kagera district in Tanzania between 1991 and 1994. Increased consumption on health care and burials saw per capita food consumption drop by 16 percent amongst the poorest half of households affected by an adult death. Stunting amongst AIDS orphans was higher than amongst other children (Over, 1998b).
HIV/AIDS undermines food security through its impact on: households’ ability to produce food due to labour shortages or stress. The cumulative scale of morbidity and mortality due to HIV/AIDS causes increasing labour losses in affected households (Gari, 2002). AIDS morbidity forces infected individuals within households to cut back the number of hours that they work. A study in Rwanda showed that 56 percent of HIV-positive household members lost or missed at least one day of work in within two weeks due to ill-health, nearly 35 percent missed one week or more, while 20 percent could not work at all (Nandakumar et al, 2000, as quoted in Tanya, 2002).
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In Tanzania, it is estimated that a sick man will loose 297 days of work and a sick woman 429 days over an 18-month period (Rugamela, 1999). The estimates were based on the assumption that the AIDS illness is 18 months in duration and that 12 of the 18 months are spent in bed. Rural households affected by AIDS suffer labour stresses that affect farm, off-farm, and domestic work. Labour loss disrupts agricultural practices and, hence aggravates livelihood vulnerability and food insecurity (Gari, 2002).
3.3.3 Labour Loss or Stress Rapid population growth has often been considered the greatest population problem in Africa. However, in some rural communities HIV/AIDS is now causing labour shortages for both farm and domestic work. HIV/AIDS has quantitative and qualitative impacts on labour in rural communities by reducing the household's workforce, as people die or spend time on mourning, attending funerals and caring for sick household members; and by reducing skills and changing the gender division of labour depending on how the farm-household members are affected (du Guerny, 2000). HIV/AIDS escalates the morbidity and mortality predominantly on the most active and productive segment of the rural society (Gari, 2002). The impact of HIV/AIDS on the households has three stages – illness, death and the longer-term consequences of AIDS morbidity and mortality (Loewenson and Whiteside, 1997). When HIV/AIDS strikes, it strips away assets of all forms – human, financial, social, physical, and natural. Human capital is the first casualty. Infected individuals die prematurely, before which their productivity declines progressively as they succumb to opportunistic infections (Gillespie et al, 2002). A study by FAO in East Africa found that labour-intensive farming systems with a low level of mechanization and agricultural input were particularly vulnerable to the impact of AIDS. Some of the effects of labour shortage in full impact communities in Eastern Africa were: reduction in the acreage of land under cultivation; delay in farming operations such as tillage, planting and weeding; reduction in the ability to control crop pests; decline in crop yields; loss of soil fertility; shift from labour-intensive crops (e.g. banana) to less labour-intensive crops (such as cassava and sweet potatoes); shift from cash-oriented production to subsistence production; reduction in the range of crops per household; and decline in livestock production (FAO, 2001).
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Figure 3.4 Projected Labour Loss: source FAO The figure indicates that the loss in agricultural labour force in the nine hardest hit African countries will range from 13 percent in Tanzania to 26 percent in Namibia between 1985-2020.
3.3.4 Loss of agricultural knowledge and management skills Agro biodiversity and indigenous knowledge represent locally available agricultural assets with enormous value and potential in rural food and livelihood security (Gari, 2002). HIV/AIDS leads to loss of agricultural knowledge. People die before passing knowledge and expertise to the next generation. A study in Kenya showed that only seven percent of agricultural households headed by orphans had adequate knowledge of agricultural production. In Kenya's Ministry of Agriculture, 58 percent of all staff deaths are caused by AIDS, and in Malawi's Ministry of Agriculture and Irrigation at least 16 percent of the staff is living with the disease. One study found that up to 50 percent of the time of agricultural extension staff was lost through HIV/AIDS in sub-Saharan Africa (FAO, 2002). 30
HIV/AIDS generates a paradox regarding agro biodiversity and indigenous knowledge. It disrupts customary agricultural systems, socio-demographic structures, and community dynamics; it further impairs the maintenance of agro biodiversity and indigenous knowledge (Gari, 2002). Gillespie and Haddad (2002) indicate that AIDS drastically abbreviates that the ability of parents and other elders to transfer knowledge, both within their own generation and to the next. AIDS impairs the ability of children to acquire and use information even through formal education, as children are pulled out of school to reinforce the family’s ability to care for the sick, to maintain its current livelihood, or to develop new livelihoods. In many areas, the usual way for children to learn the required agricultural skills is by working with their parents. Given the AIDS pandemic, this is often no longer possible and, owing to the gender division of labour and knowledge, the surviving parent is not always able to transfer the skills of the deceased one. In a study in Namibia, Du Guerny et al. (2000) note that in households where both the husband and wife died there was total inability of the child-headed households to produce enough food for their own consumption. This was a result of both inadequate resources and inability to use and manage the limited available resources for optimum crop production. In addition to poor crop and weed management, the children also lacked skills for livestock management resulting in the death of the few livestock inherited. Such events ill intensified the food security problems of the child-headed households unless appropriate mitigating interventions are put in place. Muwanga (2002) states that the death of parents may signal the end of farming in the household. This illustrates also the limits of community and family solidarity.
3.3.5 Declining yields. Du Guerny (1999) noted that reduction in yields are less immediately visible but important and are caused by a variety of factors including delays or poor timing in such essential farming operations as tillage, planting and weeding. Delays occur because of sickness or dependency on outside labour, which is not always available when needed (e.g. relatives who assist through solidarity first care for their own fields). It also seems that the fertility of the soil is affected negatively owing to the priority given to immediate survival concerns over longer-term land conservation measures. In Swaziland, Muwanga (2002) found that households that had experienced an AIDS related death had 54.2 percent reduction in maize production and 29.6 percent reduction in cattle herd growth. In Zimbabwe, households that experienced an AIDS death had 61 percent reduction in maize production.
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3.3.6 Loss of Income HIV/AIDS damages financial capital in number of ways. Expenses on drugs, funerals, burial and related transport costs strain already limited family budgets (Gillespie and Haddad, 2002). A study in the rural areas of Thailand indicated that the economic impact of an HIV/AIDS death on a rural household measured in terms of direct and indirect costs per death were substantial, and were greater than costs of death from other causes that occurred in the community during the same period. The negative impact of an HIV/AIDS related death on the household labour supply for family production was substantial, and affected about 52 percent of households that engage in economic activities. The loss was almost 50 percent, leading to about a 47 percent loss in household income (Pitayanon et al, 1997). Households living in rural Chanyanya in Kafue district in Zambia that were affected by chronic illness had an annual income 46 percent lower than households in the same area that were not affected by chronic illness (Mutangadura and Webb, 1999). Nampanya-Serpell (2000) shows that households in Zambia that had suffered a paternal death had experienced a drop in monthly disposable income in excess of 80 percent.
The FAO study showed that the second factor of household agricultural production that HIV/AIDS would affect was the availability of disposable cash income. During episodes of illness, household financial resources may be diverted to pay for medical treatment and eventually to meet funeral costs. Such resources may otherwise be used to purchase agricultural inputs, such as occasional extra labour or other complementary inputs (e.g. new seeds or plants, fertilizer, pesticides, etc.). In Rakai district in Uganda, families with orphans, which in most cases were female headed, had a lower household income compared to families without orphans. In terms of financial capital services (credit, savings, and insurance), poor families either have to borrow or sell stores of value. A family affected by HIV/AIDS is less able to avoid default, and hence is less attractive to group-based liability schemes (Gillespie and Haddad, 2002)
3.3.7 Increased Household expenditure HIV/AIDS will cause affected households to spend more on medical care and funerals.
In the
Democratic Republic of the Congo, the cost of hospital care for a child with AIDS amounts to three times the average monthly household income (Davachi et al, 1988, as quoted in Tanya, 2002). In Burkina Faso, the cost of the lifetime care of an AIDS patient equals twice the country's per capita income. A study in New Zealand, which required respondents to keep a diary of their HIV/AIDS-related expenditure over a period of one month, found that private direct costs increase sharply as the illness progresses (FAO, 1997). 32
The changes in the supply of household labour caused by AIDS morbidity and mortality, which is accompanied by a drop in household income, will also result in changes in the aggregate level of expenditure. In affected households, aggregate levels of expenditure will increase initially as households need to spend more on medical care and funerals. In the Kagera study, the total level of expenditure was the only statistically significant difference between affected and non-affected households. The total level of expenditure was 25 percent higher in households suffering an adult death than in household where no adult death occurred. However, levels of expenditure will also depend on the ability of the affected household to finance these expenses from transfers of income received from outside the household, which, as explained elsewhere, is ultimately dependent on the socio-economic status of the affected household. There is evidence for this in the published findings from household impact studies. In Kagera, Tanzania, consumption dropped dramatically in poor households following an adult death (decreased 11 percent among poorest 10 percent), while the total level of expenditure in less poor households actually increased (Tanya, 2002).
Tanya (2002), reports that differences in per capita equivalent adult expenditure are small and are not statistically significant, except when controlling for socio-economic status and vulnerability by for example allowing for differences in education of the household, gender of the deceased and the duration of illness. In the longer term, as households meet these expenses but are still faced with a reduction in labour supply, affected households will spend less, an argument supported by evidence from household impact studies. In rural Thailand, the per capita expenditure in households affected by an adult death dropped by 43.5 percent with the drop being worse when the deceased was an adult woman than when it was an adult man (Kongsin et al, 2000; Parker et al, 2000).
Changes in the level and pattern of household expenditure have wider impacts. The decline in expenditure on food and other basic needs described above may affect the nutritional status of household members negatively. Children and the elderly are particularly vulnerable to cutbacks on expenditure on food. Substantial reductions in the nutritional status of children will in turn cause changes in infant and child mortality within affected households.
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3.3.8 Impact on the livestock sector Engh, Stloukal, and du Guerny (2000) state that Livestock products account for a considerable percentage of the agricultural gross domestic product in a number of developing countries, and livestock contributes to agricultural development in various ways. As an example, draught animal power is the most important source of power in the fields in developing countries. In addition to draught power, the livestock sector serves as a food security bank, directly through milk and meat products, and indirectly as a converter of inedible foodstuff (such as cellulose) into milk and meat. Furthermore, livestock dung serves as manure, fuel, and building material. In addition, various kinds of animals may have a high socio-cultural value for traditional medicine and at death and funerals of community members. The effects of HIV/AIDS on rural labour have, in turn, severe consequences for the livestock sector, directly and indirectly as illustrated figure 3.5 below.
HIV/AIDS in rural households and communities
Increased costs Medical fees, traditional healers fees, transport, special food and funeral expenses, etc
Loss of Labour Due to death, sickness, caring for the sick, attending funerals (Quantitative and qualitative loss of livestock management capacity and skills, at both household and administrative levels; commercial and noncommercial)
Impact on livestock sector (mediated through and within time/space-specific political, socioeconomic and cultural context) Decreased management of livestock resources (e.g. manure, fuel, building materials); Decreased ability to contain and elimnate livestock diseases; Crop failures, including fodder for livestock Loss or transfer of livestock according to property inheritance culture; Sale or slaughter of livestock and reduce draught power Decreased livestock products (subsistence and cash crops) FIGURE 3.5 HIV/AIDS IMPACT ON THE LIVESTOCK SECTOR (ADAPTED FROM DU GUERNY ET AL, 2002)
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Du Guerny et al. (2000) noted that the various factors are interlinked, the figure above is therefore highly simplified. Furthermore, the political, socio-economic and cultural context makes time and space-specific impacts on the linkages illustrated. The impact of HIV/AIDS on the rural livestock sector is at three levels namely
Reduced capacity for livestock management and production Du Guerny et al. (2000) state that in addition to the quantitative reduction of the household workforce, which occurs when adults fall ill or die, the remaining household members may lack the skills or physical strength to maintain livestock management and production. Naturally, this has the strongest impact on households which are child-headed or where the majority of the members are children and older people. Furthermore, mourning and attending funerals are both time- and energy-consuming. During the mourning period work is reduced or postponed, including the production of crops and fodder. In a study in Oshana and Caprivi in Namibia, du Guerny et al. (2000) observed that mourning time for relatives was reported to range from four to eight days, and for immediate neighbours, it was estimated that they sympathized and consoled the bereaved family for about half the mourning period. The rest of the community had to stop work on the funeral day. It was also important to take into account the time perspective. HIV/AIDS had both short- and long-term effects as daily care was reduced as well as the capacity to make plans and investments regarding future agricultural and livestock production. It was estimated that extension staff in north-central Namibia spent at least 10 percent of their time attending funerals. Farmers were also spending an equal proportion of their time to attend the funerals of their relatives. To this must be added the extended mourning time in the village as well as the time for consoling and sympathizing with bereaved neighbours and attending funerals of dead community members. Therefore, the lost production time may be more than 25 percent of short critical production periods such as sowing and weeding. Moreover, delayed weeding demands higher labour inputs. Consequently, in situations where labour is becoming scarce due to HIV/AIDS morbidity and mortality, the reduction of potential crop yields due to poor weed management can be severe. Du Guerny et al. (2000) further stated that apart from HIV/AIDS killing part of the active workforce involved in livestock and crop tending, it also has serious effects on the veterinary service, and thus on the country's ability to contain and eliminate livestock diseases. Where 35
local veterinarians and experienced livestock inspectors have been claimed to AIDS, this may seriously compromise the veterinary service's ability to react to epidemic diseases. In countries such as Namibia, which are dependent on livestock exports for much of their foreign exchange, this may have serious consequences. There is reason to believe that these countries may, in the long run, risk losing markets if they are not effectively able to monitor, control and eliminate trade-threatening diseases.
Inheritance systems and livestock management Du Guerny et al. (2000) noted some difference on the impact of AIDS related death on livestock ownership depending on the cultural practices. In Oshana, immediate effects of an AID related death on household resources, including livestock, were distinctly different for households where husbands died and those where wives died. This was probably due to the matrilineal property inheritance culture, as a result of which there may be a substantial redistribution of family property following the death of the male spouse. No such distinctions were obvious in the Caprivi where the inheritance culture is patrilineal. A common observation in Oshana households where the husband died of HIV/AIDS was the practice of taking livestock away from the remaining family (wife and children), although there was legislation, which should have prevented this. In extreme cases all cattle were taken. Besides the immediate loss of the mobile bank constituted by livestock for use in times of crop failure, household food security was also threatened due to loss of draught power which precluded timely sowing and loss of an organic fertilizer source. Consequently, the levels of grain produced by the affected households fell despite the maintenance of the cropped area. Besides cattle, sheep and goats as well as chickens are also taken. A striking case in a relatively poor household was where all small stock was taken. Where the relatives of the deceased were more considerate, they only took some of the livestock leaving the wife and children with some. While this was less disruptive, the effect on crop production was seen through reduced cropped area and grain production. The trauma associated with the death of the husband and lack of resources to hire casual labour would also be factors contributing to the reduction in the intensity of cropping activities. A prominent feature of the affected households where the wife died was the lack of disruption of production resources and assets. The assets were less affected than when the husband died and the household grain production levels were usually maintained. However, in some situations there was a decline in cropping intensities, crop and weed management. 36
Coverage of HIV/AIDS-related costs by sale and slaughter of livestock Family assets including livestock might be sold off to meet AIDS related costs. The findings of Du Guerny et al. (2000) obtained in Caprivi and Oshana in Namibia, indicated that a common strategy for covering direct costs associated with sickness and death was the sale of livestock followed by the sale of crops. Borrowing and savings was the least common. Among the affected households in Oshana, sale of crops and livestock had occurred in 10 cases, while benefits from insurance and the National Social Security Fund had been used in five cases. Savings and pension had only helped meet direct costs in two cases each. In Caprivi all four affected households interviewed cited sale of livestock as the means of meeting direct costs of sickness and death. One household had sold both crops and livestock. One of the consequences of high sales of livestock was that production resources were taken out of the farming system. The important contribution of livestock through draught power, manure, food security bank, meat and milk products is compromised when large numbers are diverted to support increasing costs of sickness and death. In the case of the Oshana region, in addition to the sale of the livestock, the cultural norm is to slaughter at least one ox during the funeral to feed the mourners. Where the number of cattle owned allows, several oxen may be slaughtered during the mourning period. In the absence of oxen, sheep may be slaughtered at the funeral while goats are not culturally acceptable. In Caprivi, providing meat at funerals was a recent development as tradition considers eating meat on such occasions as taboo. There is normally less feasting at funerals in the Caprivi region. Widespread sale and slaughter of livestock to support the sick and to provide food for the mourners at funerals do not only jeopardize the livestock sub-sector but also the crop production sub-sector due to reduced availability of draught power and manure. Thus, when the forced expenses due to HIV/AIDS-associated sicknesses and deaths are met by the sale of livestock, this is generally setting the stage for serious future household food security and malnutrition problems. The loss of draught animal power in areas where integration of crop and livestock is prominent - as in sub-humid eco-zones in southern Africa - strongly hits the livelihood of rural communities as less draught power results in reduced cultivated areas. The sacrifice or sale of cattle might be regarded as one of the most destructive processes related to HIV/AIDS in the livestock sector (du Guerny et al, 2000).
37
3.3.9 Impact on natural resources Land, forests, water, crops and animals are all affected by the HIV/AIDS epidemic. Land may not be cultivated and certain crops may not be grown because of the loss or lack of labour, and land may also be sold to pay the increased medical fees, funeral costs or other household expenses. Forests may not be managed, with some areas being over harvested because they are close to home of labour starved households. Water bodies may be over-exploited as households with sick persons who require frequent washing take more than the usual share (Steely, 2002). The conservation workforce in Africa has been particularly vulnerable to HIV/AIDS. Both its “formal” side,
i.e.
protected
area
authorities,
university/research
specialists,
non-governmental
organizations staff and its partners in rural natural resource-dependent communities are affected (Dwasi, 2002). Gillespie et al (2001) summarize the impact of HIV/AIDS on rural and agricultural dependent households as follows: An adult becomes sick; sick adult reduces work; replacement labour is “imported”; all adults work longer hours on the farm; healthcare expenses rise; household reduces food consumption; household switches to less intensive crops and farming systems, small livestock; nutrition status of the sick adult deteriorates; sick adult stops work; family members spend more time caring for sick adult, less time on childcare; divisible assets are sold (e.g., livestock); debts increase; children drop out of school to help with household labour; sick adult dies; household incurs funeral expenses; household may fragment as other adults migrate for work; household reduces cultivation of landa (more leftsome fallow);ofinappropriate resourceand management may lead that to increased The following chapter gives reviewis of the copingnatural mechanisms support systems spread of pests and disease; effects of the loss of farming knowledge intensify; mining of common property resources increases; access land and property formitigate surviving widows) ruraltohouseholds have(particularly adopted to AIDS. may be affected; solidarity networks are strained or totally collapse; surviving partner becomes sick; and the downward spiral continues and accelerates.
3.2.10 Coping mechanisms and support systems
Households and communities for developed various responses to mitigate the impact of HIV/AIDS. The following section outlines of some of the households and community responses.
3.4
Household and community responses to the impact of HIV/AIDS
Jackson, Mutangadura and Mukurazita (1999) state that households adopt a range of strategies to cope with effect of HIV/AIDS. Coping strategies not requiring any cash are the most frequently adopted. These include intra-house labour relocation, taking children out of school, diversifying household crop production and decreasing the area cultivated. The coping mechanisms employed by households affected by HIV/AIDS can be categorized into responses that deal with practical realities such as income loss due to loss of labour and those more personal mechanisms with regards to care and support by other household members. In an analysis of the literature Donahue 38
(1998) reveals that most loss-management strategies are employed in stages. The first phase involves the use of reversible mechanisms and disposal of self-insuring assets. Secondly, affected households dispose productive assets. In the final phase, the household enters into destitution. The table 3 below highlights the three stages of loss-management to mitigate the impact of AIDS. TABLE 3.2 THE THREE STAGES OF LOSS MANAGEMENT Stage
Loss-management strategies
1. Reversible
♦ Seeking wage labour or migrating temporarily to find work
mechanisms and
♦ Switching to producing low-maintenance subsistence food crops
disposal of self-insuring assets
(which are usually less nutritious) ♦ Liquidating savings accounts or stores of value such as jewelry or livestock (excluding draft animals) ♦ Tapping obligations from extended family or community members ♦ Soliciting family or marriage remittances ♦ Borrowing from informal or formal sources of credit ♦ Reducing consumption ♦ Decreasing spending on education, non-urgent health care, or other human capital investments
2. Disposal of
♦ Selling land, equipment, or tools
productive assets
♦ Borrowing at exorbitant interest rates ♦ Further reducing consumption, education, or health expenditures ♦ Reducing amount of land farmed and types of crops produced
3. Destitution
♦ Depending on charity ♦ Breaking up household ♦ Distress migration
Source: Donahue, J. (1998); Tanya, A. (2002)
In addition to the three coping phases noted by Donahue, Jackson et al. (1999) report that the household coping strategies can be divided into three basic categories. The categories include strategies aimed at improving food security; Strategies aimed at raising and supplementing income so as to maintain household expenditure patterns; and Strategies aimed at alleviating the loss of labour. The table below provides a summary of the household coping mechanism categories
39
TABLE 3. 4 HOUSEHOLD COPING STRATEGIES Strategies aimed at improving Strategies aimed at raising and Strategies aimed at alleviating food security
supplementing income so as to the loss of labour maintain
household
expenditure patterns -
Substitute
cheaper -
commodities -
-
-
Income diversification
-
-
labour
Migrate in search of new jobs
reallocation and withdrawing
Reduce consumption of the -
Loans
of children from school
item
Sale of assets
-
Put in extra hours
Use of savings or investments
-
Hire
-
Send children away to live with relatives
-
Intra-household
Replace
food
labour
and
draught
power item
with
-
Decreasing area cultivated
indigenous or wild vegetables
-
Relatives come to help
Beg
-
Diversify source of income
Source: Jackson et al (1999)
3.4.1 Household responses aimed at improving food security The following some of the strategies aimed at improving food security: •
Reducing consumption of food,
•
Substitution with cheaper alternatives,
•
Relying on wild foods, and
•
Begging.
Studies in Tanzania, Burkina Faso and rural Uganda found that some households cut back the number of meals when faced with food shortages. Begging as a survival strategy is practiced when the households that are at risk have been pushed into calamity (Sauerborn et al. 1996 as quoted in Jackson et al. 1999).
3.4.2 Household responses aimed at raising income and maintaining expenditure a. Income diversification In a study conducted in Burkina Faso, respondents that had to raise additional income used their leisure time to engage in a wide variety of income-generating activities such as fetching firewood for millet beer breweries, building fences, weaving straw mats and honeycombs, and tailoring
40
(Adams et al.’s 1996, as quoted in Tanya, 2002).
Migration to urban areas in search of
employment is common. In Zambia, some members of rural households were reported to have migrated to urban areas in search of employment so that they can remit some income in their rural area, while some work in neighbours’ fields as casual labour so as to earn some income (Jackson et al. 1999). In ability to diversify income sources increases the vulnerability of affected households to the epidemic. Prevailing poverty drives women into sex work as a course of income. In Malawi, girls as young as 12 years old were driven to fulfill short-term income needs (Little, 1996 as quoted in Jackson et al. 1999)
b. Shifting, reducing or cutting back expenditure Increased spending on medical care and funerals crowds out other household expenditure, which may see a drop in expenditure on food and other basic needs. In Rwanda, 73, 82, 86 and 57 percent of affected households could respectively not meet their clothing, housing, education and nutritional needs or could only do so with difficulty The death of an adult female in Zimbabwean households caused the consumption of most food items to decrease, with the drop in consumption being particularly pronounced in the case of meat, bread, milk and eggs (Mutangandura, 2000). In Kagera district in Tanzania the expenditure on food by the poorest half of households affected by an adult death fell by 32 percent in the short term. The impact of HIV/AIDS on expenditure on medical care and funerals has been documented extensively, while fewer studies have reported on changes in expenditure on other items. This suggests that many household impact studies have perhaps collected detailed data on HIV/AIDS-related expenditure only, in the process failing to collect data on other types of household expenditure, which is crucial in determining how the epidemic causes consumption patterns to change (Tanya, 2002).
c. Sale of farm produce, assets and use of savings Households affected by AIDS morbidity and mortality, and the resulting drop in household income and increased pressure on household expenditure, normally cut back on savings and even dissave in order to cope with these pressures on household finances. Kawaramba (1997) in Zimbabwe reported that the sale of agricultural produce was a predominant coping strategy to raise income to meet additional health costs (Jackson et al. 1999). Drinkwater (1993) in Zambia and Barnett et al. (1995) reported similar findings and indicate the sale of farm produce as a widely coping strategy. Some households pledge future crops to meet immediate cash needs 41
(Rugalema, 1998, in Jackson et al. 1999). Households that do not have enough income to buy food or to pay for health care, funeral expenses or education costs sale assets in response to the crises (Tibaijuka, 1997; and Rugalema, 1998 as quoted in Jackson et al. 1999). A SAfAIDS study in Zambia indicates the range of assets commonly sold as cattle, bicycles, chickens, furniture, carpentry tools, radios and wheelbarrows. When AIDS strikes, it stripes away assets of all forms. To meet large health and funeral expenses, poor families may sell productive equipment or mortgage land (Gillespie and Haddad, 2002). Twenty-four percent of Zimbabwean households affected by an adult female death sold assets to cope with the death (Mutangadura, 2000, as quoted in Tanya, 2002). In Burkina Faso found that most households in a study used any available cash or savings to pay for medical expenses. The sale of assets was the second most common method of meeting medical costs. Livestock was the primary asset sold, with villagers emphasizing the dangers of selling cereal to overall food security (Adams et al. 1996, quoted in Tanya, 2002)
d. Loans To cushion the impact of AIDS on household income rural families resort to borrowing. The informal financial sector is an important source of income used during the times of need (Sauerborn et al. 1996, Aryeetey and Hyuha, 1990 as quoted in Jackson et al. 1999:20). The informal financial sector includes 1) relatives friends and neighbours, 2) rural cooperatives, 3) rotating and savings club associations, 4) rural traders, and 5) rural moneylenders. Adams et al. (1996 as quoted in Tanya, 2002) report that in both of the villages sampled in the Burkina Faso study, it was customary to take loans. In one village debtors had to pay interest on their loans whereas the loan was interest free in the other village. Loans were seen as short-term solutions to tide the cash-strapped households over until their financial status improved. Loans were seen as less of a risk than selling livestock or other assets. In Rwanda, 18 percent of affected household had to resort to borrowing in order to finance health care expenses, of which 64 percent borrowed from friends or neighbors and 16 percent from family (Nandakumar et al, 2000). In Kagera, Tanzania, households affected by adult deaths made limited use of credit (Lundberg and Over, 2000), which may be because households lack access to credit facilities and/or because households prefer to adopt alternative coping mechanisms available to the household (Tanya, 2002).
42
e. Role of the extended family The extended family plays a crucial role in mitigating the impact of AIDS on rural households. Mukoyogo and Williams (1991, as quoted in Jackson et al, 1999) state that the extended family as a safety net is still by far the most effective community response to the AIDS crisis. Pitayanon et al. (2000) state that during difficult times households may receive monetary support from relatives or their extended family members living away from home. In their study in Thailand, 15 percent of the households affected by an HIV/AIDS – related death received transfers-in from outside. The average amount received was US$328 per year. The people who provided the money were mainly adult children of the household head working away from home or the siblings of the head of the household.
Based on evidence from Uganda (Rakai) and Zambia, the extended family has been described as the national strength of African countries in terms of coping with the orphan problem. Affected households that are need of food send their children to live with relatives. Relatives and friends provide
may provide both moral and material support to the sick on the assumption of future
reciprocation (Jackson et al. 1999). Existing family support systems have also been found to continue to function before and after the death of household members thus underlining their importance as a coping mechanism (UNAIDS, 1995). Ryder et al. (1994, as quoted in Tanya, 2002) argues that the presence of a concerned extended family substantially minimizes the adverse impact of HIV/AIDS on the health and socio-economic status of orphans. The threat to extended family as a safety net is that over time the ability of families and social networks to absorb these demands will decrease as more adults die of young of HIV/AIDS (Jackson et al. 1999). The traditional family-care system may further
be undermined as demands on time and resources
increase and as stigma and the danger of infection forces the extended family to shy away from fulfilling their traditional role.
3.4.3 Household responses aimed at alleviating the loss of labour a. Intra-household reallocation of labour and taking children out of school Over (1998) reports that to cope with the loss of adults in prime of life to AIDS, households and extended families often reallocate their resources including the withdrawing of children from school to help at home, working longer hours and adjusting household membership. Pitayanon et 43
al. (2000) in Thailand observed that many households tried to cope by reallocating the time household members spent on various activities. Most of the reallocation involved other members taking on more work than previously to make up the lost income, helping with family business to substitute for the lost labour, reducing the time spent at work to help the family, needing to find work, changing to a new job that paid more, needing to find supplementary work, or quitting a job to help with family chores and take care of the sick person. In addition, children of the deceased as well as other school-aged members of the households were in some cases withdrawn from school to start work and to help with family production. Jackson et al. (1999) highlights the importance of the removal of children from school as a common coping strategy of households. The uptake of schooling requires both cash and time. Hence, the fact that AIDS morbidity often results in children being taken out of school to care for the ill is also at stake here. Gillespie and Haddad (2002) state that HIV/AIDS impairs the children to acquire and use information through formal education as younger generations are pilled out of school to bolster the family’s ability to provide care for the ill, to maintain its current livelihood, or to develop new livelihoods. In Zambia, researchers found that changes in school enrolment resulting from AIDS deaths are more pronounced in urban than in rural areas. In urban areas, respectively 21 and 17 percent of females and males dropped out of school following an AIDS death, compared to only 8 and 6 percent of females and males that dropped out of school in rural areas following an AIDS death (NampanyaSerpell, 2000). This is a destructive coping strategy as it undermines the children’s future income earning potentials. The children in 13 percent of Zimbabwean households where an adult female had died were unable to attend school following the death, with 75 percent of these children being absent from school for more than six months due to financial constraints (Mutangadura, 2000). Jackson et al. (1999) state that girls are more likely to be withdrawn from school than boys, either to take on the labour role of the mother whilst the latter cares for the sick person, or to be the primary caregiver.
Another strategy involved changing the sick person’s task from physically demanding ones to more sedentary ones such as weaving or sewing clothes. The four in-depth profiles of affected families in rural Uganda presented by Topouzis and Hemrich (1994) present similar evidence of the impact of HIV/AIDS on the division of labour within the household. One impact study, though, has not found a significant change in the division of labour within affected households. A large proportion of households in rural Thailand did not change the allocation of activities between household members significantly following an adult death (Tanya, 2002)
44
b. Hiring labour Gillespie and Haddad (2002) note that human capital is the first casualty to AIDS. Infected individuals die prematurely, before which their productivity declines progressively as they succumb to opportunistic infections. In Zambia, Burkina Faso, Tanzania, Malawi and Zimbabwe, affected households reported hiring labour and draught power to meet their production requirements (SAfAIDS, in press; Sauerborn et al. 1996; Rugalema, 1998; Kwaramba, 1997 as quoted in Jackson et al. 1999). Only households with stable income or source of remittance were able to hire labour and draught power. Pitayanon et al. (2000) in Thailand, report that 10 percent of all the households that experienced an HIV/AIDS related death, or 40 percent of the households that had a family business, hired substitute labour to replace the ill and deceased person. Furthermore, they state that with rising household expenses and falling income, the additional expenditure on hiring substitute labour could result in a shortage of production capital of the household, leading to an adverse impact on family production in future.
c. Changing household crop production and substitution of crops In a study in Swaziland reported by Muwanga (2002) 42.3 percent of the households that experienced an AIDS death showed changes in cropping patterns. This involved substitution of labour intensive crop like cotton with less intensive crops like maize, and moving from cash crops to purely subsistence crops Jackson et al. (1999) report on research done in East Africa that reports that households involved in agricultural production may cultivate a mixture of subsistence and cash crops. Crops that are sensitive to timing services were substituted for those that were not. Where there was a threat to the agricultural production of a household due to temporary labour loss, families substituted cash crops for crops that required less labour and expensive inputs such as fertilizer and pesticides. The four in-depth profiles of affected families in rural Uganda presented by Topouzis and Hemrich (1994 as quoted in Tanya 2002) support these arguments. Du Guerny (1999) states that cash crops are often abandoned owing to the inability to maintain enough labour for both cash and subsistence crops. Switching from labour-intensive crops, to less labour-intensive ones, is observed. This could have an impact on the nutritional quality of the diet.
d. Decreasing the area cultivated Jackson et al. (1999) in their research review report that in Burkina Faso, Uganda and the Ivory Coast the amount of land being cultivated by households that were struck by morbidity and mortality decreased. Du Guerny (1999) notes that reduction in area of land under cultivation is 45
common among AIDS affected rural households. Community authorities often allocate land to families on the basis of their size. He reports that the sickness and death of an adult can result in the inability of the household to cultivate all the land at its disposal. Tending for the sick can take a considerable amount of time, which is no longer available for agriculture. Thus, more remote fields tend to be left fallow and the total output of the agricultural unit consequently declines. In a study in Swaziland, Muwanga (2002) found that there was a significant reduction in area under cultivation in households that experienced an AIDS related death. The average reduction in land under cultivation was 51 percent compared to 15.8 percent in households that experienced a nonAIDS related death. The reduction in land area under cultivation attributed to the study in Swaziland was 34.2 percent.
e. Lengthening of the working day Jackson et al. (1999) found that many households put in extra hours of labour per day to make up for losses due to illness. In a study in Thailand, Pitayanon et al. (1997) report that many households tried to cope with impact of AIDS by reallocating the time household members spent on various activities. This involves taking up more work and working longer hours to make for the lost income.
3.4.4 Other household responses The other notable household responses are migration of members in affected households and family displacement. Tanya (2002) notes that few household impact studies have explored the impact of HIV/AIDS on migration, which is a loss-management strategy adopted by affected households that become destitute and which is not included in Jackson et al.'s (1999) typology of coping strategies. Over (1995, in WHO, 1997) noted in a study in Kegare region in Tanzania that at the level of individual households, movements of household/family members into and out of the household were evident both in the six months prior to death and in the period immediately following the death of a household member. These movements, which frequently commence in apparent anticipation of death, most probably have an important role to play in household coping.
In a study in Zambia, Nampanya-Serpell (2000) reports that 61 percent of urban households in Zambia that were affected by an AIDS death had to move to cheaper housing where access to public services was worse than where they lived before. Of the 141 households who had moved 31 (almost 22 percent) had lost electricity when they moved while, 55 (approximately 39 percent) lost access to piped water in their homes. In Uganda, urban children orphaned by AIDS were often 46
uprooted from their places of birth and sent back to villages where their extended family resided. Other orphans have run away from home in order to escape the stigma and poverty (Topouzis et al, 1994 in UN Economic Commission for Africa, 2002). The four in-depth profiles of affected families in rural Uganda presented by Topouzis and Hemrich (1994 quoted in Tanya, 2002) paint a similar picture.
Some causes of vulnerability to the impact of HIV/AIDS and community responses are discussed in the following section.
3.5
Vulnerability of rural households to the impact of HIV/AIDS
Topouzis and du Guerny (1999) state that awareness with regard to the magnitude and impact of HIV/AIDS on project target groups and operations is important for sustainable rural development. They further state that an analysis of factors contributing to vulnerability to the spread of HIV is very instrumental. They noted that vulnerability to poverty, food/livelihoods insecurity, gender inequality, migration, war and civil conflict etc. has a catalytic effect on vulnerability to HIV.
In a study in Zambia, Drinkwater (1993) described the underlying causes of vulnerability in household (and cluster) livelihoods security with reference to three factors – production, social and health. The relative diversity of the farming system did have a bearing on household food security and the relative position and vulnerability of women within the household. In situations were divorce generally increased the vulnerability of women, the vulnerability was heightened in the context of maize based farming system. In addition to relative diversity of the farming system, ill health and mortality had effects on production systems and hence provided the lead to a more specific and detailed look at the impact of HIV/AIDS. Drinkwater (1993) identified maize based production system driven by credit and inorganic fertilizer, lack of draught power, and lack of crop diversification as causes of vulnerability in agricultural production. Lack of crop diversification as a cause of vulnerability has been observed in Swaziland as well. Muwanga (2002) identified the limited range of crops in an area with erratic rainfall and poor soils as one of the factors pointing to the vulnerability of subsistence farming to impact of HIV/AIDS. The Swaziland subsistence farm systems predominantly have maize as the main crop cultivated.
On the social side, high divorce rate was a major cause of vulnerability to HIV/AIDS. One obvious consequence of high divorce rate is that both men and women commonly through their lives have a large number of sexual partners. This practices leads to the spread of HIV/AIDS even 47
among older men. The other factor that exacerbated the break up families and had negative impact on agricultural production was the inferior status of sons-in-law. In Mpongwe in Zambia, the sons-in-law go to live in their in-laws village. The son-in-law has an inferior status and is rarely motivated to work hard even on the field of his own wife. In clusters dominated by women, it was observed that any sons-in-law married to junior daughters nearly always engaged in income activities elsewhere – working at private farming company, doing piecework for others, or going fishing. Inheritance practices and the nature of kin was another social custom that affected production negatively, and increased the vulnerability of women and children. The general practice among the matrilineal Lamba in Zambia, is that women do not inherit property from their husbands, and children receive only a limited amount at the mercy of the husband’s kin. Even in patrilineal communities husband do commit adultery and divorce does occur. This also increased exposure to HIV/AIDS. The relationships between men and women in Zambia’s rural, matrilineal societies are quite clearly difficult and fraught with tension. In patrilineal societies, the tension arises from the greater authority that women have – women have more means to livelihoods and food security and therefore a better basis to negotiate working relationships with men (Drinkwater, 1993).
In a study in Swaziland, Muwanga (2002) identified several factors that point to the vulnerability of subsistence farm systems to the impact of HIV/AIDS. In addition to lack of crop diversification, other factors include •
The dependence of production on labour input means that as the younger members who are disproportionably affected by HIV/AIDS dies, the reduction in labour supply will affect production
•
The dependence on remittances for survival in many households, means that as member of the household that remit money die of HIV/AIDS the reduction in income will lead to reduced production on the farm
•
The wide use of hired labour on the farms. Dependence on hired labour means that farms or households are vulnerable to changes in income, which is used to hire the labour. The income could be from remittances, sale of farm produce or sale of household labour. These sources of income are affected by increased morbidity and mortality of the productive members of the household. The makes hired labour an unsuitable household labour saving technology when faced with epidemic
48
•
Female headed household. The death of heads of households – usually men, means loss of institutional memory that is vital to sustain production on the farm. As women take over as heads of households, they do so with limited skills and knowledge of the farm systems. It is therefore difficult for them to cope with reductions in labour supply and interruption of flow of remittances. In the study in Swaziland, a female head of household lamented that she did not even know how many herds of cattle and land they owned since it was her husband who managed the farm. In Malawi, it was found that female-headed households were especially vulnerable to changes in labour supply and to reductions in the flow of remittances.
•
Increase in number of orphans. With the death of parents, knowledge, skills and experience of agricultural practices, farm management and marketing are lost. The young member of the household may not have the necessary knowledge, skills and experience in farming to continue managing the household farm. In households were parents had died, the orphans lamented that they did not have the necessary knowledge to continue with farm activities.
The findings of the study are presented in the following chapter.
49
CHAPTER FOUR: STUDY FINDINGS This chapter presents the findings of the study. It provides information the demographics, livelihoods assets and activities as well as some indicators of the impact of HIV/AIDS on the livelihoods and food security of households in the study sites. Its also outlines some of the lessons learnt in analyzing the impact of HIV/AIDS using the SLA.
4.1 Background information (Demographics)
There were 436 respondents in the study as indicated in table 4.1 below. Female respondents accounted for 58.3% of the total sample. The households included 44.7% female headed and 48.9% male headed. The age of the heads of households ranged from 15 to 89 years, with an average age of 47 years. Twenty-eight households (6.4%) were child headed. The family size ranged from 1 to 14 members. Almost 68% of households had 4 – 9 family members. The average family size was 6.6. Of the total 436 respondents, 22.7% were single, 45.5% married, and 9.9 divorced. Widows and widowers accounted for 15.1% and 6.9% respectively. Of the married 198, seven were child couples (wife and husband below 18 years). A total of 204 households (47.7%) reported that they were sad while 162 were happy and 66 were very happy respectively.
TABLE 4.1 DEMOGRAPHIC INFORMATION RESPONDENT HOUSEHOLDS Variable Mishikishi Kafubu Fiwale
Total
Gender
N
%
N
%
N
%
N
%
Male
77
42.5
31
35.6
74
44.0
182
41.7
Female
104
57.5
56
64.4
94
56.0
254
58.3
436
100.0
%
Age
N
%
N
%
N
%
N
< 18
4
2.2
3
3.4
6
3.6
13
3.0
19 – 24
13
7.2
6
6.9
16
9.5
35
8.0
25 – 29
36
19.9
13
14.9
20
11.9
69
15.8
30 – 39
45
24.9
20
23.0
37
22.0
102
23.4
40 – 49
43
23.8
21
24.1
31
18.5
95
21.8
50
50 – 59
22
12.2
17
19.5
38
22.6
77
17.7
60 – 69
7
3.9
4
4.6
11
6.5
22
5.0
> 70
11
6.1
3
3.4
9
5.4
23
5.3
436
100.0
%
Marital Status
N
%
N
%
N
%
N
Single
49
27.1
14
16.1
36
21.4
99
22.7
Married
77
42.5
34
39.1
87
51.8
198
45.4
Divorced
19
10.5
13
14.9
11
6.5
43
9.9
Widow
25
13.8
19
21.8
22
13.1
66
15.1
Widower
11
6.1
7
8.0
12
7.1
30
6.9
436
100.0
%
Household Type
N
%
N
%
N
%
N
Female headed
87
48.1
35
40.2
73
43.5
195
44.7
Male headed
83
45.9
44
50.6
86
51.2
213
48.9
Child headed
11
6.1
8
9.2
9
5.4
28
6.4
436
100.0
%
Family Size
N
%
N
%
N
%
N
1–3
17
9.4
7
8.0
13
7.7
37
8.5
4–6
56
30.9
32
36.8
59
35.1
147
33.7
7–9
68
37.6
29
33.3
52
31.0
149
34.2
10 – 12
22
12.2
11
12.6
23
13.7
56
12.8
12+
18
9.9
8
9.2
21
12.5
47
10.8
436
100.0
%
Well-being
N
%
N
%
N
%
N
Sad
81
44.8
46
52.9
81
48.2
208
47.7
Happy
75
41.4
28
32.2
59
35.1
162
37.2
Very happy
25
13.8
13
14.9
28
16.7
66
15.1
436
100.0
51
Migration Status
N
%
N
%
N
%
N
Non-migrant
58
32.0
29
33.3
65
38.7
152
34.9
Trading migrant
69
38.1
33
37.9
58
34.5
160
36.7
Employment migrant 54
29.8
25
28.7
45
26.8
124
28.4
436
100.0
%
%
Level of Education
N
%
N
%
N
%
N
No formal
98
54.1
28
32.2
83
49.4
209
47.9
Primary
55
30.4
41
47.1
67
39.9
163
37.4
Secondary
19
10.5
14
16.1
10
6.0
43
9.9
College
9
5.0
4
4.6
8
4.8
21
4.8
436
100.0
A total of 152 (34.9%) households reported that there was no migration for livelihoods activities. Of those that migrated, 36.7% were in trading while 28.4% migrated for seasonal formal employment. Households with college level accounted for 4.8%, secondary level 9.9%, primary 37.4% while non-formal educated households represented 47.9% of the total 436.
4.2 Livelihoods
Agriculture is the main source of livelihoods for the people in Fiwale, Mishikishi and Kafubu. The main agriculture activities include rainfed crop growing (maize, sunflower, beans, paprika, sweet potatoes, soya beans, sorghum, pumpkins, and beans); livestock rearing (goats, cattle, pigs, and poultry); and dambo gardening (rape, cabbage, tomato, onion, impwa – local egg plants, carrots, and green maize). Mangoes and bananas are the other agriculture products that provide food and income especially in the rain season. Table 4.2 below shows the characteristics of the study areas in Masaiti District.
52
TABLE 4.2 CHARACTERISTIC OF SAMPLED AREAS IN MASAITI DISTRICT Areas
Fiwale
Kafubu
Mishikishi
Areas population
7781*
6465*
8841*
Lamba-lima mixed with
Lamba-Lima mixed with settlers
No of Households Ethnic grouping
District
HIV
Lamba-Lima
mixed
with
settler
settlers
12.8%**
12.8%**
12.8%**
-
-
-
adult and child malnutrition.
Malaria, TB, Malnutrition,
High malnutrition, malaria, TB,
Malaria, TB, Pneumonia,
Diarrhea, Pneumonia,
STIs, Diarrhea
prevalence Rural Health center prevalence record Disease prevalence
Diarrhea, Skin rashes, STIs Village wealth
Low - High
Low
High
Access to social
Good
Good
Good
Baptist Mission Hospital,
Rural
four primary and one basic
primary and basic school; a
laboratory and surgery. Primary
schools,
market
shops.
and basic school. Big market
Hammermill; CHAZ and
Health neighborhood HBC
place, Ndola Diocese micro
local
program;
finance program.
services
Postal
HBC
agency,
activities,
health
with
center,
local
Orphanage
one
and
Rural
health
center
with
agriculture extension office.
OVC hospices;
Good year round feeder
Year
roads connected to tarred
connected a dilapidated tarred
high way
road
Migration patterns
In and out-migration
In and out-migration
In and out-migration
Farming
Rain fed and dambo farming
Rain-fed and dambo farming
Rain fed and dambo farming
Food crops:
Food crops: maize, sorghum,
Food crops: maize, sorghum,
beans,
cucurbits and sweet potatoes
State
of
road
infrastructure
and
systems
round
feeder
roads
Feed roads with easy access to a tarred highway.
ecological
areas
maize,
sorghum,
sweet
potatoes, beans, cucurbits
cucurbits
and
groundnuts Cash
Cash
crops:
maize,
vegetables, soybean, paprika
Cash
crops:
maize,
fresh
vegetables, groundnuts
crops:
groundnuts,
vegetables,
maize,
sweet
potatoes, paprika,
and groundnuts
Free-range
and
Intensive
poultry production
Free-range small (goat, poultry, pigs)
livestock Free range small livestock (goat, poultry, guinea fowls
Food security
Often insecure to highly
Insecure to secure
Insecure to secure
secure
53
Own source: * Rural Health Centre 2002 statistics, ** Ministry of Health/Central Board of Health 2003
Maize, sorghum and sweet potatoes are the major crops grown in Mishikishi, Fiwale and Kafubu. Maize, beans, cucurbits and sweet potatoes are grown by almost all households largely for subsistence and surplus is for sale. Other crops such as paprika, soya bean, groundnuts, paprika and vegetables are grown as cash crops. Most households employ at least three cultivation types:
Upland flat production of maize, sorghum, groundnuts, and soya beans;
Upland mound production of sweet potatoes, beans ad paprika;
Dambo cultivation of maize, beans, cucurbits and vegetables
The agricultural production in the study is labor based and is highly labor intensive. In addition to agriculture, the households also depend on charcoal, wild fruits, mushroom, and remittances from relative, pensions and trading. The livelihood assets are shown in the sections below.
4.2.1 Physical Assets
Almost all the households possess hoes, axes, kitchen utensils and chairs. Of the total 436 respondents, 424 (97.2%) own houses while 342 (78.4%) have access to land. Of the 94 households (21.6%) that had no access to land 84 (89%) were female headed and 8 (8.5%) were child headed. Other assets included bicycles (26.4%), radios (36.2%), cupboards (28.7%) and wheelbarrows (6.9%). The ownership of Hammer mill, oil presses and carpentry tools accounted for 1.4% of the total 436 households.
TABLE 4.3 MATERIAL ASSETS IN STUDY AREAS Variable Mishikishi N
Material Assets
Kafubu
%
N
Fiwale
%
N
%
Total N
%
Hoes & axes
181
100
87
100
168
100
436
100.0
House
175
97
87
100
162
96
424
97.2
Wheelbarrow
7
4
15
17
8
5
30
6.9
Radio
68
38
39
45
51
30
158
36.2
54
26.4
Bicycle
65
36
23
26
27
16
115
oil press
2
1
0
0
1
1
3
pots + other kitchen utensils
181
100
87
100
168
100
436
100.0
Bed
173
96
85
98
165
98
423
97.0
Hammermill
1
1
0
0
0
0
1
Chairs
181
100
87
100
168
100
436
100.0
Cupboard
67
37
34
39
24
14
125
28.7
Land
108
60
79
91
155
92
342
78.4
Carpentry tools
1
1
1
1
0
0
2
0.5
Oil press
2
1
0
0
1
1
3
0.7
0.7
0.2
4.2.2 Social Capital
The social assets are list in table 4.4 below. Church and agricultural extension groups are the most popular social groupings. Of the total 436 respondents, 83.5% reported having household members who belonged to Church and agricultural extension groups. Other sources of social capital are health and market committees, Parent and Teachers Associations (PTA), and political parties. TABLE 4.4 SOCIAL NETWORKS AND GROUPS Membership in community Mishikishi
Kafubu
Total
Fiwale
groups N
%
N
%
N
%
N
%
Church and church groups
160
88
68
78
136
81
364
83.5
Village Health committee
58
32
23
26
45
27
126
28.9
School PTA
67
37
28
32
44
26
139
31.9
Market committee
25
14
17
20
15
9
57
13.1
Agriculture extension group
136
75
76
87
152
90
364
83.5
Political party
57
31
11
13
19
11
87
20.0
55
4.2.3 Financial Assets
In addition to the physical and social assets, the following were identified financial assets: •
Savings
•
Remittances from relatives
•
Pension schemes
•
Sale of crops
•
Sale of Livestock
•
Mango and Bananas
•
Charcoal
•
Other forest products (mushroom and wild fruits)
•
Hammer mill
•
Oil press
TABLE 4.5 FINANCIAL ASSETS Mishikishi
Kafubu
Financial Capital
N
%
N
Savings
8
4 16
Remittances
from
family 29
Fiwale
Total
%
N
%
N
6
7
7
4
21
34
39
22
13
85
members
% 4.8
19.5
Pension scheme
35
19
18
21
14
8
67
15.4
Crops
176
97
81
93
162
96
419
96.1
Livestock
123
68
67
77
78
46
268
61.5
Mango & banana
97
54
72
83
54
32
223
51.1
Charcoal
14
8
8
9
13
8
35
8.0
Other forest products
99
55
56
64
102
61
257
58.9
Hammer mill
1
1
0
0
0
0
1
0.2
Oil press
2
1
0
0
1
1
3
0.7
56
Crops, fruits, and livestock are the main sources of income. Crop sales accounts for 96.1% as a source of income for the 436 households while livestock accounts for 61.5%. The livestock includes mainly goats, poultry and pigs. None of the households included in the study had cattle. The sale of forest products (mushroom and wild fruits) is another important source of income or financial capital. Pension schemes and family remittances account for 34.9% as income sources. Of the 436 households, 21 (4.8%) had savings in the bank. The processing of crops milling and oil pressing were the least in terms of income sources. The following section looks at the access and control of assets within the studied households.
4.2.4 Intra-household asset control and use of Assets
The control and use of resources varied among the types of household table 4.6. Among male headed and child headed households, men have more power and control on the access to and use of physical and financial resources, while women have big voice on the type of social grouping to belong to. Of the 213 male headed households, 55% and 86% men were the sole decision makers on the use of physical and financial asset respectively, while 48% women made decision on social grouping. Among the 195 female headed households, 39% had men as key decision makers on physical assets, 30% and 44% on social assets and financial assets respectively.
TABLE 4.6 ASSET CONTROL AND USE Control and Male headed Use of Assets
Physical
Social
Financial
Female Headed
Child Headed
Household
Household
Household Male
Female
All
Male
Female All
Male
Female
All
117
86
10
75
104
16
18
7
3
55%
40%
5%
39%
53%
8%
64%
25%
11%
86
102
25
58
101
36
13
5
10
40%
48%
12%
30%
52%
18%
46%
18%
36%
184
17
12
85
97
13
21
2
5
86%
8%
6%
44%
50%
6%
75%
7%
18%
The table above indicates that women have more control on the use of physical, social and financial assets in female headed households. However, even in female headed households the 57
female heads have to consult some male relative in case of asset transfer or sale. Households that reported consultative family decisions on use of assets accounted for 10% to 12% among the male headed, 13 to 18 % of female headed, and 11 to 36% of child headed. The livelihood activities are outlined in the section below.
4.2.5 Livelihoods activities and labour distribution.
In addition to agricultural production activities (land preparation, planting, weeding, harvesting, tending livestock, and selling crops or livestock), the household members are involved in caring for and visiting the sick, attending funerals and other community ceremonies. Other activities include household maintenance (cooking, sweeping, washing clothes, nursing children) and harvesting and collection of forest products (firewood, charcoal, mushroom and fruits). Other household members are involved trading and doing piecework.
Except for the age group 18years and below in which the male spend more time in agriculture, women above 18 years spent more time in agricultural activities than men. Among the 18 to 60 years category, women spend 30% of their time on agriculture activities while men spend 23% of their time on the same activities. Figure 4.1 illustrates the percentage time spent of agriculture production by age and gender. Labour input in Agriculture Production 35
Male < 18
30
Female 60
10
Female > 60
5 0 Agricultural production Age and Gender
FIGURE 4.1 PERCENTAGE OF TIME SPENT ON AGRICULTURE PRODUCTION ACTIVITIES Compare to females, males in all types households spend less time on household maintenance and childcare activities. Figure 4.2 shows that while women there is decrease in time spent on child 58
care as women get above 60 years, there is an increase in time spent on caring for the sick, visiting the sick and attending funeral by both gender (male and female) in over 60 years category. Girls below 18 ages spend almost equal time on childcare, household maintenance and caring for the sick. The study found that boys in the same age category spent more time on visiting the sick.
20 18 16 14 12 10 8 6 4 2 0 < Fe 18 m al e Fe 60 m al e > 60
child care household maintenance caring for the sick visiting the sick attending funerals
M
al e
% time spent
Time spent of household maintenance and health care and funerals
Age and gender FIGURE 4.2 PERCENTAGE OF TIME SPENT ON CHILDCARE, HEALTH CARE AND HOUSEHOLD MAINTENANCE The percentage of time spent by respondent households on harvesting forest products, community maintenance and piecework is indicated in figure 4. 3 below.
59
40 35 30 25 20 15 10 5 0
Male < 18 Female 60 Piecework
Gardening
Community maintenance
Female > 60 Forest product harvesting
% Time spent
Harvesting Forest products, community maintenance and Piecework
Activity
FIGURE 4.3 PERCENTAGE OF TIME SPENT ON HARVESTING FOREST PRODUCTS, COMMUNITY MAINTENANCE The male under the age of 18 and below spend 36% of their time doing piecework while the female of the same age group spend about 11%. Men in age group 18 – 60 spend 23% of their time on piecework while womenfolk spend less than 5% of their time on the same activity. Like agriculture production, women and girls spend more time than men and boys in harvesting forest products. The only exception is the production of charcoal that is dominated by men. Men in the 18 – 60 year age group spend more time on community maintenance than women in the same age group.
4.3 Impact of HIV/AIDS on Livelihood assets and activities (shocks and stresses)
This section seeks to show identify the links between HIV/AIDS and the elements of the livelihood systems in the study sites. While the study deliberately focused on HIV/AIDS, it is not the only shock or stress that the households are exposed. The relationship HIV/AIDS to other shocks and stress factors is not captured in this study. The following section shows the prevalence and perceptions about HIV/AIDS in the study sites
60
4.3.1 HIV/AIDS Prevalence and people’s perceptions
Proxy Indicators were used to separate AIDS affected from non-affected households. The proxy indicators included presence of chronically ill adult and household head, and death of adult or household head from terminal illness in the past 12 months. The targeting of households was based on information from the Health Neighbourhood Committee and the village home care. This increased the prevalence rate in the study when compared to the national prevalence that indicated 12.8%. Table 4.8 shows the prevalence rate among the study sample.
TABLE 4.8 HIV/AIDS PREVALENCE AMONG THE STUDY SAMPLE Female Male Headed
Headed
Child Headed Total
Proxy Indicator N
%
N
%
N
%
N
%
Chronically ill adult
56
26
37
19
0
0
93
21
Household head chronically ill
34
16
57
29
0
0
91
21
Adult died from Chronic illness
28
13
16
8
2
7
46
11
Household head died from Chronic illness
18
8
9
5
26
93
53
12
Not affected
77
36
76
39
0
0
153
35
Total
213
100
195
100
28
100
436
100
Of the 213 male-headed households, 136 (64%) were affected by HIV/AIDS. Among the 136 affected households, 56 (26%) of the total had an adult who was chronically ill while 34 (16%) had a household head who was ill. Male-headed households that had lost a person from a long illness were 28 (13%) and 18 (8%) for adult and household death respectively. Non-affected male headed households were 77 representing 36% of 213.
Among the 195 female-headed households, 111 (61%) were affected by HIV/AIDS. These included 37 (19%) who had an adult suffering from chronic illness, 57 (29%) that had a sick household head, 16 (8%) that had lost an adult from chronic illness and 9 (5%) that lost a household from a terminal illness. Non-affected households among the female-headed households accounted for 39%.
The entire 28 child headed households had been affected by HIV/AIDS mainly through the death of household heads and adult family members. 61
The affected households attributed the deaths and sicknesses of household members to malaria, diarrhea, TB, pneumonia, hunger/malnutrition, witchcraft, and HIV/AIDS. This is show in figure 4.4 below. Of the 283 affected households, 25% mentioned malaria, 24% diarrhea, 16% hunger and malnutrition, 12% TB, and 9% pneumonia. Witchcraft and TB accounted for 8% and 6% respectively.
It is interesting to note that some household members are able to mention
HIV/AIDS is a cause of death or illness of their family members. The impact of death HIV/AIDS related sickness and death on the household is discussed in the following section.
Perception on causes of death and illness
Diarrhea 24%
Malaria 25%
HIV/AIDS 8%
TB 12% hunger/malnutri Pnuemonia, Witchcraft tion 9% 6% 16%
Malaria TB Pnuemonia, Witchcraft hunger/malnutrition HIV/AIDS Diarrhea
FIGURE 4.4 PERCEPTION OF CAUSES OF DEATH AND CHRONIC ILLNESSES
4.3.2 Impact of HIV/AIDS on the households and their livelihoods
The impact of HIV/AIDS ranged from perception and attitude change among household members to changes in asset use and control and in application of family labour. Of the 283 affected households, 48% reported that the illness and sickness of their relative had changed their own thinking about HIV/AIDS. One household member said that “..I thought it was out in the streets but it has now entered our bedrooms. We all need to be careful and do something to stop it from spreading...”. Another 36% reported changes in use of material and financial assets. There was increased depletion of savings and sale of assets to meet both the food and medical needs of the 62
sick person. In addition to the patient, more money was required to feed other relatives that came to visit the sick person.
Figure 4.5 shows the household observations on the effect of the HIV/AIDS sickness and death on their physical assets. Of the 283 affected households, 66 said the physical asset status was the same, 20 reported an increase through contributions of relatives and friends while 165 reported a reduction in physical assets. The other 32 were not sure of the status of the physical assets. The later was common in situation were the sick person still remained in control of assets and hence other household members were aware of what assets had been transferred sold. Among the child headed households 21(75%) had reduction in physical assets, 7% had not change while 18% were not sure.
Changes in Physical Assets 80 78 70 60 50 Number 40 33 30 20 1312 10 0 N Male Headed
66
31 15 7 N
21 20 5 N
same increased reduced not sure
Female Child Headed Headed change
FIGURE 4.5 EFFECT OF HIV/AIDS ON PHYSICAL ASSETS In addition to changes in physical assets, all the 283 affected households reported a reduction in both financial and social capital. Increased costs of nursing and feeding the sick and funeral expenses eroded the financial base. The reduction in social capital was attributed to lack of time as the patient needed more attention and to stigma that made affected household members reduce or cut off their interaction with other community group members. Consequently, there was reduced capacity to engage in household and community livelihood activities. Non-affected households reported the changes in relationships and disintegration of some community groups has a major 63
effect of HIV/AIDS. In parts of Mishikishi and Kafubu, the communal lending groups have collapsed as a result of members being sick or caring for the sick.
The death or sickness of the head of household also led to reduced inflow of food and income. The adult was supplementing household food and income source was no longer able to do so. As result there were reduction in food stock and food consumption. Of the 283 affected households, 67% reported a reduction in food available at home and eventually in the amount of food consumed in the household.
The other effect of HIV/AIDS on households is the increase in the number of orphans and the emerging child couple scenario. Among the 408 male and female headed households, 52% reported having taken an orphan in the past 18 months. This has contributed to the increase child care role among aged (above years old). The following section outlines some of the coping and resilience building strategies.
4.2.3 Coping Strategies and Building Resilience
The households and communities in study sites have developed diverse coping mechanism. The coping strategies being applied by affected households include
Reallocation of household labour on livelihood activities. This includes increased use of both child and adult labor for selected activities.
Reducing land under cultivation and focusing on easy to grow crops. HIV/AIDS has led to changes both in land under cultivation and the types of crops grown. Affected households are slowly shifting from high input cash crops to low input food crops. In some cases there was total abandoning of on-farm production in preference to selling labour (doing piece at other farms).
Working longer hours than before to cover for lost labour and time
Adopting new cultivation techniques – minimum and conservation tillage
Shifting to traditional healers instead of medical institutions
Sale of household assets to raise money for medical and household needs
Engaging in small scale trading with increase use of children in vending
64
Increased utilization of forest resources
Early and forced marriages
Many of the coping strategies have a negative effect on the long-term sustainability of livelihoods. While they meet immediate needs of the households, they undermine the future income earning potential of households and individual members. Mitigation strategies should overcome the negative effects of HIV/AIDS at the household and community levels.
The next section provides the lessons learnt in applying the Sustainable Livelihoods Approach to assess the impact of HIV/AIDS on rural households
4.2.4 Lessons Learnt in applying the SLA to analyze the impact of HIV/AIDS
Working with communities and attempting to elicit livelihoods strategies is complex and time consuming. It requires a multi-disciplinary and talented team. The livelihoods approach generates a large amount of information making compiling difficult. The pre-assessment survey and collection of secondary data is critical to the success of the final study. Involvement of the community from the start in terms clarification of objectives, approaches and community role is equally important.
Despite being complex and time consuming, the SLA can be used as an icebreaker on sensitive issues like HIV/AIDS. It was noted during the study that the analysis opened a way and provided an opportunity for community members to talk openly about HIV/AIDS and relate it to their own livelihoods. It also builds the momentum that is needed for communities to move forward with development interventions. The SLA provides the opportunity to learn and build on the strengths of what is already known, tried and tested. The ‘livelihoods lens’ enables us to look ‘cross-sectorally’ being able to recognize with the HIV/AIDS epidemic that it is inappropriate to look at rural households or areas in isolation. We can and must learn with people who have ‘mainstreamed HIV/AIDS’ in their own lives out of necessity, and have developed successful ways to mitigate the impact of the AIDS epidemic. The SLA allows for a good systems approach in targeting action to prevent and mitigate the impact in rural communities. Although national responses to the AIDS pandemic in most developing countries are multi-sectoral, there is a need to further integrate the holistic perspective 65
by increasing the understanding of the complete cause-effect relationships. This will enable local communities to develop appropriate activities to remove the root causes identified. The SLA could be useful in facilitating the complete understanding of cause-effect relationships. This study has led into the formulation of an HIV/AIDS and food security pilot project. The project targets 75 AIDS affected female headed household. The objective is to extend the production period from six months to year round through small-scale irrigation technology. In addition to the women, the project is testing the involvement of the rural youth in agriculture and HIV/AIDS activities. The combination of quantitative and qualitative assessments provides a good mix to triangulate and reduce biases and errors in the study.
66
CHAPTER 5: RECOMMENDATIONS Many of the findings of this study are similar to what other people have found before. However, it the participatory process and approach to the analysis that provides another window of doing things. The multi-sectoral and participatory nature of the study encouraged and educed enthusiastic community involvement. Addressing the impact of HIV/AIDS on rural household required a multi-sectoral approach that allows linkages across sectors and the interaction of shocks and stresses. The following should be considered to prevent asset loss and build resilience in rural households
Increasing land ownership and improving management:
Increasing access to land control over land use is one of the building blocks of resilience. Ownership induces stewardship. This means rural households will be motivated to improve and maintain soil productivity.
Extending the crop growing season: promotion of low-labour water harvesting techniques is necessary to increase food and income security especially among female headed households
Crop diversification to reduce the risk of crop failure and diversify the income source.
Linking agricultural production to forest resources: Allow communities to appreciate the interdependence of agricultural production on the ecological system. This will reduce over exploitation of environment for either agriculture or forest products.
Strengthen social networks: institutional support to strength community groups and create networks for information sharing
Development of human assets through farmer training and consolidation of local knowledge transfer systems
Promote behavior change: Negative cultural practices and community behavior that promote the spread of HIV/AIDS and reinforce stigma should be discarded. Gender equity is key factor in facilitating behavior change in rural communities. Encourage openness about HIV/AIDS in communities
Promoting community based operations research that allow communities to learn by doing and as result maintain the skills to address the HIV/AIDS problems at community level.
Integrating HIV/AIDS and agriculture with other sectors, and providing linkages to wide national and regional interventions.
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REFERENCES Barnett. T, Whiteside. A, and Smart. R (2000) Eds. AIDS Brief for sectoral planners and managers: Subsistence Agriculture Sector. Carney, D. and Ashley, C. (2000). Sustainable Livelihoods: lessons from early experience. DFID, London. CRS (2002). Regional Strategy for Southern Africa. Harare, Zimbabwe De Satge. R, (2002). Learning about livelihoods: insights from Southern Africa. Periperi publications and Oxfam publishing. Donahue, J. (1998). “Community-Based Economic Support for Households affected by AIDS,” Health Technical Services (HTS) Project, for USAID, June 1998. Donahue, J. and Williamson, J. (1999). “Community Mobilization to Mitigate the Impacts of HIV/AIDS,” Displaced Children and Orphan Fund, September 1999. Donahue, J. (2002). Children, HIV/AIDS and Poverty in Southern Africa, SARPN April 9 and 10th 2002. Drinkwater, M. (1993). The Effects of HIV/AIDS on Agricultural Production Systems in Zambia: An analysis and field reports of case studies carried out in Mpongwe, Ndola Rural District and Teta, Serenje District. A study undertaken by the Adaptive Research Planning Team, Ministry of Agriculture, the FAO of the United Nations Du Guerny, J. (1999). Aids and agriculture: Can agricultural policy make a difference? in Food, Nutrition and Agriculture, No. 25 , FAO, Rome Du Guerny, J, Engh, I. and Stloukal, L. (2000). HIV/AIDS in Namibia. The impact on the livestock sector, FAO, Rome. Du Guerny, J. (2002). Agriculture and HIV/AIDS UNDP South East Asia HIV and Development Project. Dwasi, J. (2002). Working together to help conserve Africa’s biodiversity. Contributed Paper Sessions (http//www.ecosystemhealth.com/hehp/papersessions/session3-5.htm) FAO (1995). The effects of HIV/AIDS on Farming Systems in Eastern Africa. FAO Farm Management and Production Economics Service, Rome. FAO, (1997). The rural people of Africa confronted with AIDS: A challenge to development. Rome, December 1997. FAO (2002). Rural Livelihoods. FAO message to the Barcelona AIDS conference. Gillespie, S, Haddad, L. and Jackson, R. (2001). HIV/AIDS, Food and Nutrition Security: Impacts and Actions. IFRPI and WFP.
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Gari, J. (2002). Agrobiodiversity, Food Security and AIDS mitigation in sub-Saharan Africa. Strategic issues for agricultural policy and programme responses. SD:People:Population. FAO, Rome. Gillespie, S. and Haddad, L. (2002). IFPRI 2001-2002 Annual Report Essay—Food Security as a Response to AIDS ITDG (2002). ITDG Southern Africa 2002 Annual report. (http://www.itdg.org/html/itdg_southernafrica/annual_report/annual_report_2002.htm) Kapwepwe, M. and Siamwiza, R. (2001). CORDAID HIV/AIDS Programmes Assessment: Zambia. Martin, A. (2002). Southern Africa Regional Poverty Network (SARPN), HIV/AIDS and its Impacts on Land Tenure and Livelihoods in Lesotho: Comments on Lesotho Country Study. (http://www.eldis.org/static/DOC10745.htm) Ministry of Health/Central Board of Health, (1999). HIV/AIDS in Zambia. Background Projections, Impacts, Interventions. Mutangadura, G, Mukuratiza, D. and Jackson, H. (1999). A review of household and community responses to the HIV/AIDS epidemic in the rural areas of sub-Saharan Africa. UNAIDS best practice collection. Geneva, Switzerland. (http://www.unaids.org) Muwanga, F.T. (2002). Impacts of HIV/AIDS on Agriculture and the Private Sector in Swaziland: The Demographic, Social and Economic Impact on Subsistence Agriculture, Commercial Agriculture, Ministry of Agriculture and Cooperatives and Business. Nampanya-Serpell. N, (2000). Social and Economic Risk Factors for HIV/AIDS Affected Families in Zambia. Paper presented at the AIDS and Economic symposium in Durban 7 – 8 July 2000. (http://www.iaen.org/library/files.cgi/196_67nampanya.pdf) Ngwira, N, Bota, S. and Loevinsohn, M. (2001). HIV/AIDS, Agriculture and Food Security in Malawi. RENEWAL working paper number one. Lilongwe and The Hague. Over, M. (1998). Coping with the Impact of AIDS. Article based on a World Bank Policy Research Report, Confronting AIDS: Public Priorities in a Global Epidemic. New York: Oxford University Press for World Bank 1997 Over, M. (1995). The Economic Impact of Fatal Adult Illness from AIDS and Other Causes in sub-Saharan Africa. A study conducted jointly by the World Bank and the University of Dar es Salaam, Tanzania. Pitayanon S, Kongsin , and Janjareon WS (1997). The economic impact of HIV/AIDS mortality
on households in Thailand, in Bloom, David and Peter Godwin, eds, “The economics of
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HIV and AIDS: The case of South East Asia.” UNDP 1997. (http://www.iaen.org/impact/thai/thai.pdf) Staneck, K.A (2002). Draft report on the Barcelona AIDS conference. Steely, J. and Pringle, C. (2001). Sustainable Livelihoods Approaches and HIV/AIDS. A preliminary resource paper Steely, J. (2002). Co-editor, Khanya-Managing Rural Change. Sustaining Livelihoods in Southern Africa Issue: 6 June 2002. HIV/AIDS and Sustainable Livelihoods. Tanya, A. (2002). The Social and Economic Impact of HIV/AIDS. A review of literature. Centre for Health Systems Research and Development, University of the Free State, Bloemfontein. Todaro, M. (1997). Economic Development. Addison Wesley Longman Limited, UK (Chapter 2 – Diverse structures and Common Characteristics of Developing Nations) Topouzis, D. (1998). The implications of HIV/AIDS for rural development policy and programming: Focus on sub-Saharan Africa. FAO, Rome. (http://www.fao.org/sd/WPdirect/WPre0074htm) UN (2001). Fact sheet: Global crisis-Global action: HIV/AIDS, Food Security and Rural Development. UN special session on HIV/AIDS 25-27 June, 2001. New York. UN (2001). Fact sheet: Global crisis-Global Action: HIV/AIDS and Development. UN special session on HIV/AIDS 25 – 27 June 2001. New York. UN (2001). Fact sheet: Global crisis-Global action: An overview of the HIV/AIDS Epidemic. UN special session on HIV/AIDS 25 – 27 June 2001. New York. UNAIDS/World Bank (2001). A Toolkit for Mainstreaming HIV/AIDS in Development Instruments UNDP (2001). Zambia Human Development Report 1999/2000. Mission Press, Ndola, Zambia USAID, (2002). Coming Together, Caring Together: A report on the Communities Responding to HIV/AIDS Epidemic (CORE) Initiative, January 2001 – June2002. Washington, DC World Bank, (2001). Indigenous Knowledge and HIV/AIDS: Ghana and Zambia. IK Notes No. 30 March 2001. (http://worldbank.org/afr/ik/default.htm)
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QUESTIONNAIRE STUDY
OR CHECKLIST FOR THE HIV/AIDS AND LIVELIHOODS
Name of Data Collector(s)________________________
Date____/___/______
Location/Site: ________________________
SECTION A. HOUSEHOLD DETAILS
1. Respondent/Interviewee:_Male/Female____________________
Age:_____
Marital Status. ______________ List the names of family members present during the interview 2. Relationship of Interviewee to the Household: Mother
Father
Son
Daughter Uncle
Aunt
Grandmother Grandfather
Other (specify). _______________________ 3. Family Type: (Mark with X) CHILD HEADED ___, FEMALE HEADED (WIDOR)___, FEMALE HEADED(UNMARRIED) ____, MALE HEADED (WIDOWER) ____, MALE HEADED (UNMARRIED) MALE HEADED (MARRIED) ____ 4. Family Size: ____ No. of Adult Male ____ No. of Adult female _____ No. of female children ____ No. of Male children ____ 5. Household Well-being Category (mark X) Sad _______
Happy___________
Very Happy________
6. Household Migration: How long does each youth and adult member reside permanently in the household? Where do they reside when they are away from the household? Why do they spend the other time residing away from the household?
7. Education Levels What is the education level of the all members of the household? 71
NB. The information on the names will be used for follow up but will not included in the report on ethical grounds
SECTION B. LIVELIHOOD ASSESSMENT
1. Assets A. What material assets does the household possess or own? List all the assets Who in the household owns each of these assets? Who in the household has the access to the assets? Who decides how the assets should be used? How is the decision made? What is the quality of each of these material assets? B. What social groupings does the household have access to? List all the assets Who in the household belongs to each of the social groups? Who decides on family member to join thegroups? How is the decision made? What is the quality of each of these social assets? Do any members of the household have specific social status? List and indicate the status. C. What financial capital does the household possess or access to? List all. Who in the household has access to each of these financial assets? Who in the household has the control over the use of these assets? Who decides how to use these assets? How is the decision made? What is the quality of each of these assets? 2. Livelihood activities in the households (indicate who is involved in the activity) a. Productive Activities Activity Male Adult
Male Child
Female Adult
Female Child
Include other activities in the notebook.
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b. Reproductive Activities Activity Male adult
Male child
Female Adult
Female Child
Include other activities in the notebook c. Community development or maintenance Activities. Record as in a and b above Community Activities Activity Male adult
Male child
Female Adult
Female Child
3. CAPABILITIES a. What skills does the household possess? Indicate who in the household has the skill Skills
Male adult
Male children Female adult
Female child
b. What knowledge does the household possess? Indicate who has the knowledge within the household.
c. Who in the household is able to work productively? Indicate the type work each member can do. 73
d. What is the quality of each of the capabilities that household members possess?
4. Resource Flows What resources (food and goods) does the household have access to?
What are the sources of these resources?
How do these resources flow in and out of the household over time (year)?
How do individual household members gain control or access to the resources? What is the composition of household meals? How many meals are consumed per day by the household? one
two
three
> three
Total
Fiwale Kafubu Kafulafuta
5. Shocks and Stresses (Impact of HIV/AIDS) a. How many members of the household died in the recent past or are suffering from a terminal illness? What illness were or are they suffering from?
c. What does the household attribute the illness or death to?
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d. What changes have been seen in the household since the illness and or death of the family member or members?
e. What has been or is the impact of the terminal illness and or death of a family member or members on Household material/physical assets Same
Increased
Reduced
Not sure
Total
Increased
Reduced
Not sure
Total
Increased
Reduced
Not sure
Total
Increased
Reduced
Not sure
Total
Fiwale Kafubu Kafulafuta
Household social assets
Same Fiwale Kafubu Kafulafuta
Household financial assets Same Fiwale Kafubu Kafulafuta
Household capabilities Same Fiwale Kafubu Kafulafuta
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f. Has the death and or terminal illness changed the food resource flow in and out of the Household?
If yes how has the food resource flow changed?
Same
Increased
Reduced
Not sure
Total
Fiwale Kafubu Kafulafuta
g. What is the current income expenditure?
h. What was the expenditure pattern before the terminal illness and or death of the family member?
Expenditure patterns Same
Increased
Reduced
Not sure
Total
Fiwale Kafubu Kafulafuta
I. What factors have contributed to the situation in which the household is? list micro and macro environmental factors.
6. Coping and building Resilience a. How is the household coping with the current situation? List the coping strategies and the role of each household member.
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b. How would the household like to prepare itself to a handle similar situation in future? List the suggested interventions and the role of each household member.
c. How would the household like the community to prepare itself to assist the households affected with terminal illness and death of family members?
d. Which other stresses and shocks apart from terminal illness and or death has the household experienced or is experiencing now?
e. How can the factors micro and macro that contribute to the current household situation be adequately addressed? Indicate the role of individuals, households, community, government, International actors.
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