Education And Debate

Public policies and the orphans of AIDS in Africa

BMJ 2003; 326 doi: (Published 19 June 2003) Cite this as: BMJ 2003;326:1387
  1. Alok Bhargava, professor (,
  2. Betty Bigombe, consultant
  1. Department of Economics, University of Houston, Houston TX 77204, USA
  2. World Bank, 1818 H Street NW, Washington, DC 20433, USA
  1. Correspondence to: A Bhargava
  • Accepted 17 March 2003

International help to care for Africa's orphans is essential not only for their immediate welfare but also to protect the long term prosperity of these countries. A researcher in child health and former Ugandan government peace minister assess how to make the best use of resources

The AIDS epidemic is wreaking havoc in sub-Saharan Africa. The HIV seroprevalence among young adults is nearly 40% in some countries,1 and millions of children have lost their parents. Although the extended family can alleviate these children's plight, it is unrealistic to assume that the children can escape from poverty without massive support from agencies such as the World Bank and the United States Agency for International Development. We visited Ethiopia, Malawi, and Tanzania in March 2002 as consultants to the World Bank to assess the ongoing programmes and to suggest strategies for improving child welfare. This article outlines our findings from visiting over 20 non-governmental organisations and national ministries responsible for caring for orphans of AIDS.

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Grandparents (and other relatives) often need help with funding education of orphans


Maternal and infant health

Although maternal nutrition, access to antenatal care, and vaccination programmes are important for improving infant health,24 the high prevalence of HIV among women in sub-Saharan Africa is a more urgent problem. The median survival time for HIV positive infants in Rwanda was 12.4 months.5 Antiretroviral drugs can reduce transmission from mother to infant, but so far only a tiny proportion of African women in pilot programmes have had access to these drugs.6

Several approaches are important for reducing the birth of HIV positive infants. The first is counselling about size of families. Demographic surveys in Ethiopia found that the ideal number of children was 5.6.7 However, couples' preferences depend on factors such as the need …

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