Jorge Arrone
Title: Hiv/Aids And Education: The Hidden Threat To Human Development
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TABLE OF CONTENTS

1. Introduction..................................................................... 3
2. AIDS and Its impact in Mozambique....................................... 5
2.1. HIV/AIS on Education........................................................................5
2.1.1. The true scale of the threat..................................................................5
2.2. The characteristic of the pandemic...........................................................5
3. An Unsustainable burden......................................................9
3.1. How does HIV/AIDS affect Human Development?.................................................9
3.2. Impact of the pandemic......................................................................10
3.3. Impact of on the demand ....................................................................10
3.4. Impact in Income......................................................................................................11
3.5. HIV/AIDS AND Education Sector.........................................................12
3.6. Impact on the Supply of Education..........................................................13
3.7. Impact on the equity of Education........................................................... 13
3.8. Additional costs resulting from HIV/AIDS epidemic.....................................14
4. Possible Solutions...............................................................14
4.1. Expected results............................................................................... 16
4.2. Are CABA activities PRE-existing or new?...............................................................18
4.3. Questions about alternatives..................................................................18
5. The motives for alarm..........................................................21
6. Protecting the Window of Hope..............................................21
7. References........................................................................22

1. INTRODUCTION
The purpose of this Assignment is to show the level of the impact of HIV/AIDS in
Mozambique in General and in the two abovementioned districts (Morrumbene and Maxixe)
in particular. I will explore the perception of different stakeholders, such as, community
leaders, traditional healers, teachers, health services providers, Community Based
Organizations, Faith Based Organizations and other people and institutions of greater
influence in the two districts.

Health as an economic resource

Health is an economic resource like knowledge or machinery. If a society invests in the
physical and mental health of its people, it is likely to have a financial pay off (Dr. Alberto
Setele, Reverend Bishop of Inhambane Diocese, 2008).
Agricultural, Industrial and commercial production will be efficient with healthy workforce
than with an unhealthy one. Studies show that working below par, or having time for sickness
are major costs in production. Preventive health is considerably cheaper than curative health
(Ministry of Health Annual Report, 2006); therefore, preventive health strategies are excellent
social investment strategies.

The issue of investment in health

The issue of investment is complicated when it applies to social goals such as education and
health. For states like Mozambique that have to survive in the global market, and therefore to
continually structurally adjust their economy, reduction of spending of health is an obvious
strategy.
This is done by:
Simply cutting health budgets;
Efficiency measures such as cutting expenditures on expensive drugs in favor of
simpler and cheaper drugs, or
Cost recovery methods, such as persuading people to invest in their own health
through healthy diets and exercise or, where possible, paying for private medical
treatment.

In this way, however, socially disadvantaged groups are deprived of resources that might be
made available to them if health care were under public control. In other words, like all
resources (consumer, goods, property, money, education), health is stratified by the market
and usually needs the state's intervention in the market to distribute health resources
equitably.
Structural adjustment and health

Because of global market strategies, debt and structural adjustment, it has become
increasingly difficult for the Government of Mozambique to intervene in the health matters
especially in rural communities. As a result, NGOs in Mozambique have filled more of the
gaps than they used to. GOAL MOZAMBIQUE is one of de NGOs working in Morrumbene
and Maxixe specifically in the area of HIV/AIDS. For the purpose of this work, I have
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Jorge Arrone, Student ID #: UD335BMN 8078;

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ATLANTIC INTERNATIONAL UNIVERSITY AIU

A New Age for Distance Learning

conducted many interviews in collaboration with this NGO, through direct involvement of its
activists and Peer Educators trained as sensitizers on HIV/AIDS programs in Inhambane
Province.

The objective of the programs carried out by GOAL MOZAMBIQUE in the communities is
to slow the spread of HIV/AIDS and mitigate its impact of those infected and affected by
reducing HIV infection among young people aged 10 to 24 years and mobile populations in
the two districts (Morrumbene and Maxixe) chosen as pilot districts. GOAL MOZAMBIQUE
is strengthening existing health systems and is making them more young-friendly and
accessible to women. During my work as a PROJECT SENIOR OFFICER in that
Organization I have learnt a lot and have used these lessons to strengthen the quality of HIV
Prevention Care and Support by privileging direct contact with Groups of People Living with
HIV/AIDS in these communities during the phase of data collection for my Final Thesis.

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Jorge Arrone, Student ID #: UD335BMN 8078;

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ATLANTIC INTERNATIONAL UNIVERSITY AIU

A New Age for Distance Learning


DESCRIPTION

2. AIDS AND ITS IMPACT IN THE RURAL COMMUNITIES OF MAXIXE
AND MORRUMBENE ­ INHAMBANE PROVINCEMOZAMBIQUE

The under mentioned data information have been collected from the following
Government and Non-Government Institutions:

Provincial Hospital of Inhambane

Provincial Delegation of the RCM (Red Cross of Mozambique) -
Inhambane

Provincial Nucleus of the Combat and Prevention of HIV/AIDS ­
Inhambane

District Directorate of Health Morrumbene

District Directorate of Health ­ Maxixe

Forum of Youth in Morrumbene

Catholic Church in Maxixe

League of Youth of Morrumbene

League of Women in Maxixe.

2.1. HIV/AIDS ON EDUCATION: THE HIDDEN THREAT TO HUMAN
DEVELOPMENT

2.1. The true scale of the threat

Education plays a fundamental role in broadening people's choices. Educated people
are more likely to invest their knowledge effectively and efficiently in creating
conditions for leading a long and healthy life, free from want. They are better placed
to use their rights and to carry out fully and consciously their duties as members of a
community.

The return of peace and economic recovery in Mozambique, together with
improvements in access to education, as a result of investments in rebuilding the
school network, allow Mozambicans once more to look upon the future with some
optimism, particularly as regards broadened opportunities for access to education.

However, the rebirth of hope among Mozambicans unfortunately coincides with a
new challenge, with the ingredients of a new curse: the HIV/AIDS epidemic, which
threatens to overturn all the efforts and resources spent over the last fourteen years of
peace in the education sector.

2.2. The characteristics of the pandemic

The fragility of the available data to some extent limits the scope of any assessment of
complex phenomenon such as the impact of the HIV/AIDS pandemic.

But analysing the impact of HIV/AIDS in Mozambique requires a brief review of the
situation of the epidemic in the country, in order to situate better the context in which
this analysis unfolds. The challenges presented by the tragedy of HIV/AIDS are not
confined merely to Mozambique; long before frightening statistics began to make
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Jorge Arrone, Student ID #: UD335BMN 8078;

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ATLANTIC INTERNATIONAL UNIVERSITY AIU

A New Age for Distance Learning

headlines in the national press, other countries in the region, under conditions of
peace, were already feeling the damaging effects of the so called "plague of the 20th
Century".

Since HIV/AIDS is a global problem, and considering the scarcity of domestic data,
comparison with other countries provides a basis for a better understanding of the
nature of the emergency, and to impacts of the epidemic.
In Mozambique there is a tendency to view the HIV/AIDS epidemic as less serious
than that facing the neighbouring countries. Unfortunately this is not the case. Despite
the fragility of the data, arising from the methods and the small number of sentinel
sites, the available estimates indicate that the levels of infection in Mozambique are,
at best, only a few years behind the most severely affected countries in the region.

By the end of 2000, about 40 million people in sub-Saharan Africa were carriers of
HIV/AIDS. A substantial part of this population of HIV-positive people were living in
countries located near Mozambique, such as Botswana, Swaziland, Namibia and
Zimbabwe, which have prevalence rates among the adult population of 20% or more ­
the highest rates in the world.

Three of these countries have extensive borders with Mozambique, and it would be
pretentious to imagine that the country can maintain its position as a relative oasis for
a long time. At worst, 2000 seroprevalence data could point to a maturing epidemic
on a par with neighbouring countries. The following table compares the HIV/AIDS
situation with that of other countries in Southern and eastern Africa:














Table 1 (please turn to next the Page)





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Jorge Arrone, Student ID #: UD335BMN 8078;

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ATLANTIC INTERNATIONAL UNIVERSITY AIU

A New Age for Distance Learning

Table 1. Comparative data on HIV/AIDS prevalence and impact
Number of people with HIV/AIDS in
1999




Deaths
Orphans

Rates of
Number of
Number
of Deaths
Number of AIDS
Country
prevalence
children
caused
by orphans
among adults people
infected
AIDS
(%)
infected
(0-14 years)
(15-49 years)
Botswana
35.8
280.000 10.000
24.000
66.000
Burundi
11.32
340.000 19.000
39.000
230.000
Ethiopia
10.63
2.900.000 150.000
280.000
1.200.000
Kenya
13.95
2.000.000 78.000
180.000
730.000
Lesotho
23.57
240.000 8.200
16.000
35.000
Malawi
15.96
760.000 40.000
70.000
390.000
Moçambique* 15.4
1.173.878 93.969
83.648
257.981
Namibia
19.54
150.000 6.600
18.000
67.000
Rwanda
11.21
370.000 22.000
40.000
270.000
South Africa
19.94
4.100.000 95.000
250.000
420.000
Swaziland
25.25
120.000 3.800
7.100
12.000
Tanzania
8.09
1.200.000 59.000
140.000
1.100.000
Uganda
8.30
770.000 53.000
110.000
1.700.000
Zambia
19.95
830.000 40.000
99.000
650.000
Zimbabwe
25.03
1.400.000 56.000
160.000
900.000
Total over





15 years old
13.95
16.560.000 692.600
1.531.100
8.080.000






Sub-Saharan
8.57
23.400.000 1.000.000
2.200.000
12.100.000
Africa











Global Total
1.07
33.000.000 1.300.000
2.800.000
13.200.000








Source: UNAIDS (2000). HIV/AIDS and Education, Africa Development Forum
* MISAU/MPF/UEM, 2000 Impacto Demografico de HIV em Moçambique, Maputo
Legend: MISAU ­ Ministry of Health; MPF ­ Ministry of Plan and Finance;
UEM - University "Eduardo Mondlane"










As table 1 shows, the prevalence rate among adults in Mozambique is somewhat
lower than the regional average, but much higher than the average for Sub-Saharan
Africa, and about 14 times higher than the world seroprevalence average.

In the 16 years since the first case was diagnosed in 1986, cases of HIV/AIDS in
Mozambique have risen at gallop. It is estimated that 1.5 million people in
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Jorge Arrone, Student ID #: UD335BMN 8078;

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ATLANTIC INTERNATIONAL UNIVERSITY AIU

A New Age for Distance Learning

Mozambique are HIV positive, with an incident in 1999 of about 15.4% for the adult
population (those aged between 15 and 49). According to some estimates, everyday
there are 700 new infections. The number of people who have already died from
AIDS-related illness is estimated at over 100.000, and projections indicate that the
cumulative number of deaths will rise rapidly, reaching 1.6 million in 2010.

Prevalence among women is, on average, 1.6% higher than among men, meaning that
women are 10.4% more likely to be HIV-positive than men. The age gap among
women is particularly worrying. For the year 2000, for example, 35.4% of new HIV
infections among women occurred in women under the age of 30, compared to only
13.2% for men. The inference is obvious: women are being infected at a younger age,
and are therefore dying at a younger age.

There are major regional differences in HIV prevalence, resulting from the
differentiated evolution between the regions (Southern region, Central region and
Northern region).
Prevalence is highest in the central provinces of Zambezia, Sofala, Manica and Tete,
with an estimated prevalence rate of 20.7% in 2000, compared with 13% in the north
(Cabo Delgado, Niassa, Nampula) and 11% in the South (Maputo, Gaza, Inhambane).

This suggests that, in a first phase, the epidemic will have differentiated impact on the
various regions, even after it has stabilised. In the central region it is forecast that
prevalence will level off at 21.4%, compared to 14.3% in the south and 14.4% in the
north, as shown in table 2.

The reasons for assuming that the epidemic will begin levelling off in 2004 are yet
clear. This is particularly relevant if we take into account the limitations of the
statistics and of the models that are described in the table 1. Furthermore, given the
experience of neighbouring countries, this assumption that Mozambique will achieve
early stabilisation may be overly optimistic.

Table 2: HIV/AIDS prevalence between 15-49 years
Region
Year
National (%)
South (%)
Centre (%)
North (%)
1999
15.4
11.0
20.3
13.0
2000
16.0
12.0
20.7
13.6
2001
16.4
12.8
20.9
13.9
2002
16.7
13.3
21.1
14.1
2003
16.8
13.7
21.2
14.2
2004
17.0
13.9
21.3
14.3
2005
17.0
14.1
21.3
14.3
2006
17.1
14.2
21.4
14.4
2007
17.1
14.2
21.4
14.4
2008
17.1
14.3
21.4
14.4
2009
17.1
14.3
21.4
14.4
2010
17.1
14.3
21.4
14.4

So urce: "HI V/SIDA em Moçamb iq ue" INE , MI SAU, MBF, UEM
Legend: INE ­ Instituto Nacional de Estatística;
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Jorge Arrone, Student ID #: UD335BMN 8078;

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ATLANTIC INTERNATIONAL UNIVERSITY AIU

A New Age for Distance Learning


3. An unsustainable burden

One of the specificities of the HIV/AIDS epidemic is that it not only robs the country
of many of its most productive individuals, but also imposes many burdens on
society. One of these heavy burdens is the sharp increase in the number of orphans. In
the 2000, there were about 500.000 orphans in Mozambique; in two-thirds of these
cases their parents had died of AIDS. This means that in a scenario without AIDS
only 162.000 children would be orphans.

Projections from the National Statistics Institute and from the Health Ministry (2000)
show that the worst is still to come.
By the year 2010 there will be about 1.4 million orphans, and in 80% of cases their
parents will have died of AIDS. In other words, in addition to a figure of some
280.000 orphans in a scenario without HIV/AIDS, the country will have to establish
the conditions to deal with the special needs of a further 1.1 million AIDS orphans ­
that is four times more (Annual report from the Council of HIV/AIDS, Maputo,
2004).




Table 3: Number of orphans by region, 2000-2010
South
Centre
North
National
Year AIDS
Other
AIDS
Other
AIDS
Other
AIDS
Other
Causes
Causes
Causes
Causes
2000 33,034
37,022 229,794 66,855 78,603 58,532 341,431 162,408
2001 47,197
36,934 282,180 71,824 104,298 60,121 433,675 168,878
2002 63,707
36,956 333,417 76,732 131,339 68,048 528,463 181,736
2003 82,153
37,353 382,665 83,314 158,781 75,124 623,599 195,791
2004 101,916 37,935 429,153 89,628 185,774 81,503 716,843 209,066
2005 122,062 38,422 470,402 99,941 210,827 86,640 803,291 225,003
2006 141,994 38,991 506,947 109,267 233,683 91,286 882,574 239,539
2007 161,086 39,445 539,447 116,784 254,421 95,042 954,954 251,271
2008 179,146 41,564 568,003 132,543 272,963 105,292 1,020,112 279,400
2009 196,006 41,988 593,870 139,552 289,819 109,057 1,079,695 290,598
2010 211,580 41,479 617,403 141,250 305,186 109,368 1,134,169 292,097

Source: INE/ Ministry of Health, 2000

3.1. How does HIV/AIDS affect human development?

Life expectancy in Mozambique, estimated at 43.5 years in 1999, is among the lowest
in the world. The 1998 Regional Human Development Report (RHDR) estimated that
life expectancy in the other 13 member countries of the Southern African
Development Community (SADC) in1995 varied between 72 years in the Seychelles
and, at the other extreme, 41 years in Malawi (UNDP-SADC-SARIPS, 1998).

Life expectancy at birth is one of the main indicators used to measure the well being
of a population, and is one of the three variables used to determine a country's Human
Development Index, alongside per capita income and educational level. HIV/AIDS
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Jorge Arrone, Student ID #: UD335BMN 8078;

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ATLANTIC INTERNATIONAL UNIVERSITY AIU

A New Age for Distance Learning

attacks all three indicators directly or indirectly. Life expectancy in Mozambique is
declining and within ten years it could be cut by a third because of HIV/AIDS.

3.2. Impact of the pandemic

HIV/AIDS results in the demographic, social and economic changes in society,
changes that affect the education sector. These include impact in the demand for
education, specially enrolment trends, school attendance, drop out and repetition rates,
and the growth in number of orphaned children. HIV/AIDS specially affects the
education sector in the following ways:

It has an impact on the demands for education pupils;

It has an impact on the supply of educators (teachers, administrators and
policy makers);

It has an impact on the quality of education;

It has implications for costs of the education sector, with rising, and the
efficiency of expenditure falling;

It has an impact on income.

3.3. Impact on the demand for education

For the purpose of this study, demand for education is measured as the number of
children likely to seek education over the period 2000-2010. In the Mozambican
context this has been measured by determining the number of children within a
specific age group likely to be in school.

The age group used conform to those actually in school, and not those who are the
correct age for school, since many pupils in Mozambique are, in theory, too old for
the grades they are attending due to the repetition rates, late enrolment and other
factors. These percentages were then applied to the population projections in the
demographic model for the "without AIDS" scenarios. The numbers in school were
progressively increased over the projection period, based on the average growth in
that particular level of the Mozambican education system over the past eleven years.

There are at present some 2.6 million children in the Mozambican education system.
The vast majority (87.9%) of these are in EP1 (the first level of primary school).
While the number of children in EP1 will continue to increase, even in the face of the
AIDS epidemic, the rate of increase will decline. This results from fewer children
being born as a result of the HIV/AIDS epidemic, while those are born already
infected with HIV die before they enter school. By 2010 it is estimated that there will
be 13% fewer children in EP1 than would be case without AIDS.

While the EP1 projections indicate a decline in the rate of increase in demand for
education at this level (that is, demand will flatten), this does not imply that EP1
access objectives outlined in the Education Sector Strategic Plan will be threatened.
The reason is that the system has expanded over rapidly over the past five years.
Gross enrolment was close to 90% in 2000, which is the 2002 objective. However, as
the epidemic progress and the demographic structure of the population changes, this
strategic planning objectives relating to access will be threatened.

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Jorge Arrone, Student ID #: UD335BMN 8078;

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ATLANTIC INTERNATIONAL UNIVERSITY AIU

A New Age for Distance Learning

In Mozambique, where many children are out in school, the understanding of the
impact of HIV/AIDS on enrolment is complex. The assumption is the lack of space at
EP1 is not the main reason for the non-attendance. Other, more qualitative, economic,
social and cultural factors are involved.







Table 4: Evolution of the gross enrolment rate in EP1 by Province and gender
(%), 1997-2000).
1 9 9 7
1998
1999
2000
Province
MW
M
W
MW
M
W
MW
M
W
MW
M
W
C. Delgado
91.1
105.5
76.8
99.2
112.8
85.7
103.7
114.8
92.9
134.7
149.1
120.5
Gaza
96.4
99.2
93.8
106.9
109.2
104.6
116.4
118.0
114.8
118.3
118.4
118.2
94.9
98.8
91.1
98.3
101.1
95.5
110.7
112.7
108.7
116.6
119.4
113.2
Inhambane
83.5
98.1
69.1
84.6
95.9
73.5
96.7
109.1
84.3
105.7
116.7
94.7
Manica
108.1
11.5
104.8
101.1
103.1
92.2
112.8
113.7
111.9
121.9
119.8
124.1
85.1
99.5
70.5
80.9
91.3
70.3
92.6
101.2
83.9
100.8
108.3
93.3
Maputo
97.6
110.9
84.2
105.2
115.6
94.7
97.2
104.2
90.3
115.0
124.1
105.9
Nampula
65.9
81.1
50.8
70.6
86.1
55.0
93.9
109.1
78.7
99.4
112.1
86.6
Sofala
77.0
85.7
68.4
92.2
100.6
83.8
94.6
129.1
86.9
102.9
109.1
96.7
90.8
104.7
76.8
88.4
100.2
76.5
115.2
102.2
101.1
125.6
137.1
114.0
Tete
73.0
74.5
71.5
80.1
81.6
78.7
92.0
91.2
92.9
106.3
104.6
108.0
Zambezia





Maputo City
Total
86.9
98.1
75.7
89.4
98.8
79.9
102.5
111.3
93.6
113.3
121.2
105.4
M ­ Men; MW ­ Men and Women; W ­ Women.
Source: Ministry of Education, 2000

3.4. Impact in income

The impact of the epidemic on the economy has not yet been duly qualified in
Mozambique. But preliminary estimates indicate that the aggregate value of Gross
Domestic Product (GDP) could be 8-10% lower than the level it would have attained
had the epidemic nor occurred. This affects another component, income, in a country
which, despite the improved performance in recent years, has one of the lowest per
capita GDPs in the world.

Estimating the impact of the pandemic on the economy is also based on examples
from other countries which faced HIV/AIDS earlier. For instance, it is estimated that
the epidemic cost Namibia about 8% of its GNP in 1996. GDP growth in South
Africa is forecast to be, on average, 0.3 to 0.4 percentage points below what it would
have reached in a scenario without HIV/AIDS during the next decade (Quatteck,
2000). In Kenya, it is estimated that by 2008 the GNP will be 14.5% smaller than if
there had been no AIDS (ONAP, 1999).

Overall economic growth has fallen drastically not only in countries with high levels
of intensive use of labour in exporting industries (such as Swaziland, Tanzania and
Kenya), but also in counties that are highly capital intensive in their exporting
industries. Botswana is an eloquent example of this phenomenon.

The diversion of resources to finance medical care, together with the expenditure on
combating opportunistic infections in HIV-positive people, as well as reduced
opportunities for access to education, and to other social services means that a large
proportion of Mozambican households will see their survival opportunities shrink as a
result of the epidemic, weakening still further their human development.

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Jorge Arrone, Student ID #: UD335BMN 8078;

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ATLANTIC INTERNATIONAL UNIVERSITY AIU

A New Age for Distance Learning

As the effects of the epidemic grow, so the ability of households to send their children
to school will diminish, at the same time as the capacity of the education sector to
carry out its task fully will also be severely affected.

Access to education, which is already very precarious in Mozambique, will be
substantially affected. The availability of specialist teachers will decline sharply in a
system where the available staff area already insufficient to cope with the needs. It is
estimated that there are 43,156 teachers in the country ­ 38,279 in the two levels of
primary education, 2,457 in the levels of secondary education, 998 in elementary
education, basic and mid-level technical education, and 1,422 in higher
education.(2005 Annual Report of the Ministry of Education - Mozambique).

These teachers are catering for an estimated school population of 2,360,798
pupils.(National Institute of Statistic, 2004).

3.5. HIV/AIDS and Education Sector

The HIV/AIDS pandemic presents multifaceted challenges to the education sector. On
the one hand, education must be structured so as to manage the effects of the epidemic
in their various forms, from sickness and loss of teachers and the presence of infected
children among the pupils, to the preparation of the system and the teachers to attend
to the special needs of a growing number of orphans. Furthermore, the sector will be
called upon at the same time to play a vanguard role in the efforts to prevent new
infections, while also discovering additional resources to sustain, maintain and
improve quality, and expand access to seduction. It is gigantic task, a well-nigh
impossible mission.

It is undeniable that the education sector can play a key role in stemming the rise in
the epidemic. The sector directly targets those who, because of their age, are part of
the so-called "generation of hope" ­ those young Mozambicans aged 6-15 who are
mostly not yet sexually active, and who are therefore not HIV-positive (with the
expectation of those cases in which the virus has not been transmitted sexually).

Education, in its widest sense, is crucial for an effective response to the epidemic.
This is an extra burden on the education system and an added responsibility. The
situation is worsened by the fact that the education system will have no struggle play
this multifaceted in a context where the sector itself is being severely affected by the
epidemic.

In order for the education system to respond to the needs of young Mozambicans, the
sector must be able to respond to the threats which the epidemic poses to itself.

In recent years education sector professionals and those familiar HIV/AIDS have
undertaken research on how to proceed with effective sectoral impact assessments.
While the number of such studies is limited, there is a growing understanding of the
importance of accounting for HIV/AIDS impacts when planning the way forward for
the education sector. (Kelly, Carr-Hill, Kataboro and Catahoire, 2000, and JTK
Associates, 1999).


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Jorge Arrone, Student ID #: UD335BMN 8078;

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ATLANTIC INTERNATIONAL UNIVERSITY AIU

A New Age for Distance Learning

3.6. Impact on the supply of education

The supply of trained educators is perhaps the most critical constraint on the ability of
the educational authorities to achieve their objective of universal access to basic
primary education and quality improvements, and the longer term goal of universal
access to full education. Unfortunately, it is precisely here ­ the supply of educators ­
where AIDS will take its toll in Mozambique.

Over the period of 2000-2010, the AIDS epidemic is projected to result in the
education sector losing some 17% of its personnel (Annual Report of The National
Council for combat HIV/AIDS-Mozambique, 20004).
Across all levels, some 9,200 teachers will die and an estimated 123 Senior Managers,
Planners and Administrators will be lost. (Statistic Department-The Ministry of
Education-Mozambique, 2003). For each if these educators months of productive
work time will be lost before they die (Annual Report of the Ministry of
Education/Mozambique, 2003).

Because the central region has the highest of HIV prevalence, it is projected to lose
the highest percentage of teachers (23.3%).
(Annual Report of the Ministry of Health/Mozambique). And because this is the
region with the highest number of educators in the system, over half of all teachers
(53%) who die welcome from the central Provinces of Manica, Tete and Zambezia.

In order to maintain the system at present levels access and quality, trained teachers
and senior personnel will need to be replaced. In order to accommodate the loss of
trained teachers alone, basic teacher trained will need to expand the number of
trainees in the system over the ten year period by 25% solely due to HIV/AIDS. In
order to replace teachers with University degrees who die of AIDS, training at this
level will need to expand by 28%. It is not clear to what extent the system is
structured to absorb these effects, but the fact that there is a reflection is, in itself, a
positive sign.

3.7. Impact on the quality of education

The description of the issue above does not take into account the reduction in the
demand for education due to the impact of HIV/AIDS at the household and
community levels (the results of the specific workshops and meetings held in
Morrumbene and Maxixe will be discussed in later stage). The discussion above
comprises qualitative impacts resulting from the systematic decline in household
economic status as AIDS progresses. Studies in Uganda, Tanzania and Zambia
uniformly conclude that children in households where one or more adults are affected
by AIDS, or where the children are orphaned, are the first to lose access to education
(UNDP-Mozambique Annual Report ­ 2000).

While the 16 years civil war provided Mozambique with experience in coping with
the problem of orphans, studies elsewhere demonstrate that, at the peak of the
epidemic, the expectation that communities and extended families can continue to
absorb orphans becomes, in practice, unworkable (Hunter and Williamson, 1997;
Hunter, 2000; Rugelema, 1999).
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ATLANTIC INTERNATIONAL UNIVERSITY AIU

A New Age for Distance Learning

Currently there are around 700.000 orphans in Mozambique, some two-thirds of
which are AIDS orphans. (Report from The National Institute for Statatistic, 2004).

3.8. Additional Costs Resulting from HIV/AIDS epidemic

The HIV/AIDS epidemic will reduce the efficiency of the education sector and
increase the costs throughout the system. Additional costs alone are expected to
exceed 1,900 billion Meticais (about US$ 110.5 Million). This represents additional
costs to the system of 6.9% just due to HIV/AIDS. This is an underestimate because
some costs cannot be quantified based on available data, and because it assumes that
the Ministry of Education will bear no costs associated with expanded HIV/AIDS
prevention activities by, or within the sector.

A large part of these costs arise from HIV/AIDS-related sickness and death benefits
(750 billion Meticais), and to a lesser extent from expanded teacher training costs
(187 billion Meticais). There are also costs associated with increased inefficiencies in
the system, most notably increased drop out and repetition rates (936 billion
Meticais). With education currently receiving 14% of the national budget, these losses
will have a significant impact on the ability of the state to cover these additional
expenses.


4. Possible Solutions

The school system is viewed, not only in its classic role as a vehicle for imparting
knowledge, but also as a means for informing children about the dangers of
HIV/AIDS, and empowering them to be able to respond effectively to the pandemic,
and protect themselves from infection. So that the system may play this role, the
challenges posed to it by HIV/AIDS must be considered. The most serious impact for
Mozambique will be on supply of trained teachers.

Since, in general, educators are respected people, or are among the few who have any
formal academic education in the community, they will be called upon to interact not
only with children and parents, but also with the surrounding communities to spread
messages on how to prevent HIV infection, and of respect for HIV/AIDS patients.
This increases the burden of responsibility on them, particularly because they must
also set an example of good social conduct in practice. The school can be an
important centre for activities aimed at blocking the spread of the epidemic.

When increasing numbers of people in Mozambique began to experience HIV-related
illness in the late 1980s, public health services were overwhelmed and as a result a
range of home-based care (HBC) initiatives were developed. Though many programs
were initiated by local health workers, they varied both in the way they were
organized and in the services that there were provided. At the same time, support
programs for Children Affected by HIV/AIDS and AIDS (CABA) were developed.
These built up the traditional caring and coping practices of families and
communities.

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ATLANTIC INTERNATIONAL UNIVERSITY AIU

A New Age for Distance Learning

The main advantage of integrating CABA initiatives into home-based care is that it
increases the ability of organizations to meet the needs and concerns of sick adults,
affected children and their cares.

Today, there are many programs in place that cater separately for people needing
home-based care, and children affected by HIV and AIDS. Such divisions, however,
make little sense for families and communities trying to provide care for both groups.
This has led to a growing interest in integrating responses in order to create more
holistic and comprehensive programs that address all these people's needs.

Organizations seeking to integrate HBC and CABA services face a number of
practical challenges. Central to these is the fact that sick adults and their children may
have different needs, problems, and fears that vary over time. Integration can also put
serious strain on the skills, time, and resources of cares, and pose significant
organizational challenges to community-based organizations (CBOs) and non-
government organizations (NGOs).

This study looks in detail at the process necessary to integrate CABA services into
HBC. There are a number of options that will be determined by the specific nature of
the existing programs, and the aspirations of the organization(s) concerned. Some
options for integration are described as:
Creating new services for CABA merging existing programs;
Radically redesigning HBC and CABA programs or changing them with
minimal disruption;
Using separate or shared volunteer groups;
Crisis interventions or programs that support affected people over a long time
frame;
Programs with a narrow medical focus or those are more holistic in outlook.

CBO/NGO support providers have a role to play in the integration of HBC and CABA
responses. They may catalyze and facilitate integration by supporting their partners in
research, planning and training. They may also provide financial support and
advocacy for integration. Effective information and advocacy work is also needed at
community level, among implementing CBOs/NGOs and at the government and
donor levels.

In the past, issues of care, support, prevention, treatment and income-generation were
often compartmentalized as "vertical" projects operating in the same community.
Now, the need to develop more of a comprehensive response to HIV and AIDS is
becoming increasingly clear. This is mainly because an integrated response mirrors a
community's natural coping mechanisms and also encourages local participation and
ownership. As the pandemic continues to pose the severest challenge to communities
across Mozambique, the time has come for all stakeholders to renew their
commitment to the development of more comprehensive responses at community
level. This publication focuses on one way to make such a response a reality.




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ATLANTIC INTERNATIONAL UNIVERSITY AIU

A New Age for Distance Learning


4.1. Expected results

The overall objective of the study is to look closely at what people believe to be
causes of the increase of new infections in Morrumbene and Maxixe districts, the
impact brought by HIV/AIDS in different social sectors in the two communities and
the possible solutions.

The second result to be achieved by this study is bound the competence of the two
communities to develop and manage effective, appropriate and sustainable responses
to HIV and AIDS.

These results will be achieved by focusing the following four components:
Strengthening integrated HIV Prevention, Care and Support Services;
Promoting positive behavior change amongst youth and mobile populations;
Increasing community capacity to respond effectively to the effects of
HIV/AIDS;
Enhancing advocacy for rights of people infected or affected by HIV/AIDS.

Through the implementation of these four components, my aim is to strengthen the
quality of HIV Prevention Care and Support Services at strategic locations of the two
districts (bus stations, schools, workplaces, markets and churches) and to improve the
access of youth and mobile populations to these services.

A special emphasis will be placed on integrated and linking these health services to
maximize efficiency and effectiveness of referrals among the two communities and
hospital based services.

The documentary research conducted in order to determine the causes of the
progressive increase of new HIV infections in the two communities, its consequences
and possible solutions found that an increase or decrease in the number of new HIV
infections in a certain period of time was not the main cause of the increase of HIV
rates.

Special studies have been undertaken during the course of the research to increase my
understanding of key issues. These included studies on Gender and Gender-based
Violence (GBV) issues, and on stigma and discrimination of People Living with
HIV/AIDS (PLWHAS).

The results of these studies will guide and inform the communities and the elaboration
of an advocacy Strategy. In my research, I promoted the adoption of GIPA (Greater
Involvement of PLWHA) principles and pursued the application of these principles
trough its close partnership with Mozambique's Network of PLWHA named
RENSIDA.

The preliminary work I have done with these Organizations of PLWHA and their
affiliates ensured that the PLWHAS representatives are playing a key role on the
HIV/AIDS campaign programs.

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ATLANTIC INTERNATIONAL UNIVERSITY AIU

A New Age for Distance Learning

My research also raised the awareness and knowledge levels of the key members of
society through direct contact with different stakeholders in the communities, such as
community leaders, traditional healers, teachers, health service providers, churches
and local organizations leaders on HIV/AIDS, youth organizations, gender and human
rights issues. This will enhance the effectives of the advocacy strategies adopted by
the research to protect and promote the rights of those infected or affected by
HIV/AIDS.

According to the four major components above described the expected results after its
implementation in the two communities will be the following:

Component 1: Activities to strengthen Integrated HIV Prevention, Care and Support
services (IPCS) in the two communities:
Increased knowledge and skills of IPCS service providers;
Improved linkages and referrals between components of IPCS;
Increased youth and mobile populations access to quality VCT services;
Improved availability and quality of services for treatment of Opportunistic
Infections;
Increased availability and coverage of Community HBC services;
Improved coverage of effective Sexual Transmitted Diseases (STD) services;
Increased awareness and capacity of provincial authorities regarding
HIV/AIDS, gender and rights of PLWHAS.

Component 2: Activities to promote sensitive health practices amongst youth and
mobile populations:
Increased number of peer education networks and higher awareness levels;
Increased adoption of safer sexual practices by youth and mobile populations;
Increased distribution of condoms;

Component 3: Activities to build the organizational and HIV/AIDS technical capacity
for local CBOs and faith-based organizations (FBOs) and PLWHA associations;
Increased awareness amongst local CBOs and FBOs on HIV/AIDS, gender
and human rights;
Increased capacity of PLWHA groups in management, leadership and
resource mobilization ;
Increased number of new PLWHA associations developed and functioning;
Increased linkage and networking among PLWHA associations.

Component 4: Activities to enhance advocacy for the rights of people infected or
affected by HIV/AIDS
Increased awareness among PLWHA, NGOs, CBOs, FBOs on advocacy
issues;
Increased awareness among policy makers on key advocacy issues, both at
provincial and district levels;
Development and implementation of advocacy plan.




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ATLANTIC INTERNATIONAL UNIVERSITY AIU

A New Age for Distance Learning

Integrating Support for Children Affected by HIV/AIDS into Home-Based Care
Program can be one of the possible solutions to mitigate the effects of HIV/AIDS in
the two Communities. This statement has been given by a group of stakeholders from
the two Communities in a meeting held in Morrumbene. The results of the "brain
storming exercises" performed in the two communities with the participation of
community leaders and other stakeholders from the two communities came to
conclusion that there are many benefits to integrating HBC and CABA activities.
Presented below, are some of the ideas shared with these stakeholders in separate
meetings held in each of the districts.

Merging two pre-existing Programs

4.2. Are CABA activities pre-existing or new?

Support for children affected by HIV and AIDS can be integrated into HBC programs
in many different ways. The questions presented below are part of many others that
can be posed as alternative that could be found in the tentative of mitigating the
impact of HIV/AIDS: The questions and possible solutions presented below were
shared by me and the community leaders and other stakeholders in Morrumbene and
Maxixe (8 groups composed by 30 people each).

An existing HBC program planning to introduce support to children might merge its activities
with those of a project already up and running. This is most likely to occur when an
organization has its own "separate" HBC and CABA initiatives. In reality, such activities are
rarely fully independent of each other and may in fact have several informal overlaps. For
example, the different groups of volunteers might already meet on a regular basis to share their
experiences. There might also be referral mechanisms between the projects, for example with
HBC volunteers notifying CABA volunteers when children are orphaned. Now, however, many
such Organizations are seeking to put these links on more formal footing.

If programs are to be merged effectively, it is important that management discussions and
decisions within the Organization are informed by consultations with HBC and CABA staff,
volunteers, community members and donors. The process of program design will typically
involve a needs analysis (to assess the needs of CABA and confirm o revise needs estimates for
HBC services), the development (or adaptation) of training materials, training and support for
existing volunteers, a reorganization of the workload and supervision arrangements of current
volunteers, developing criteria for selecting clients, and developing criteria for selecting clients,
and developing monitoring and evaluation tools.


4.3. Questions about alternatives

What might be the
What might be the challenges?
What might be help?
benefits?
More equally
HBC and CABA volunteers and staff Peers sharing their skills (e.g.
balanced emphasis on have different interests and skills
CABA volunteers training
adults and children
HBC volunteers)
New program, with The rivalry or "territory" issues
Team building activities to
stronger skills in both between those working on HBC and
develop a common vision
HBC and CABA
CABA
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ATLANTIC INTERNATIONAL UNIVERSITY AIU

A New Age for Distance Learning

Greater coverage of
Existing beneficiaries feel their
Strong leadership support from
clients in need
service is diluted
managers

Less immediate need HBC and CABA activities have
Active consultation with staff
to expand the number different donors, and thus different
and volunteers about merger
of volunteers or
donors, and thus different terms and
design
restrict the target area conditions for staff and volunteers, as
in order to cope with
well as restrictions that hinder
Consulting donors to create
needs/demands
integration
uniform terms and conditions

Organizational change is always
Tapping into the shared
challenging;
motivations of volunteers
Program managers can create
Expanding the merger to
uncertainties and fears among staff,
clients and stakeholders/or
volunteers and clients.
advocating the benefits of
more comprehensive
responses.

Adding new CABA services to an existing HBC Program

If an Organization does not have an existing CABA program, then rather than
establishing an entirely new and "vertical" project, it might chose to integrate new
services for children into its existing HBC work.

To add new CABA services into HBC programs effectively it is important to follow
similar steps to those outlined above. In addition, organizations may also find it useful
to hold community mobilization and awareness-raising workshops about the needs of
children affected by HIV/AIDS, as well as proactively and explicitly involving
children and their families during program design.

With this option, organizations need to carefully analyze the implications of increased
client numbers and increased workload. Unless catchment's areas are restricted, this
option will necessitate the recruitment of new volunteers, and new supervisory and
support staff, as well as additional resource mobilization.


What might be the
What might be the challenges?
What might be help?
benefits?
A more balanced
HBC volunteers need to develop a Training HBC staff and
emphasis on children new focus, role and skills
volunteers in relevant skills,
and adults
(e.g. child counseling)
Builds on the solid
Not all HBC volunteers want to work Allowing, or even
foundations of an
with CABA
encouraging, some volunteers
existing HBC
to specialize in HBC or CABA
program
The more explicit
The increased need/demand from
Recruitment and training more
recognition of
wider client group leads to an
volunteers and/or restricting
children's needs is a
increased workload for staff,
the program's catchment's
practical way to
volunteers and managers
area
increase the quality
care and support for
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ATLANTIC INTERNATIONAL UNIVERSITY AIU

A New Age for Distance Learning

families
Can be achieved
Extra resources needed to sustain a
Mobilizing resources for
relatively quickly
more comprehensive response
CABA
Many volunteers will Policies and materials for working Involving volunteers, staff and
be pleased to meet with CABA need to be developed
community members in the
the needs of CABA
development of policies and
more proactively
procedures (e.g. criteria for
identifying children in greatest
need)
Community
Donor demands and restricts may be
Explaining the evolution of the
mobilization and
a hindrance.
program to clients and
awareness-raising of
stakeholders and/or advocating
CABA issues is an
the benefits of more
important
comprehensive responses.
contribution to
increasing
community support to
children.

Minimal Disruption
Activities for children can be introduced without any noticeable change to the way
that can Organization delivers its HBC. This is more likely to be possible where the
HBC programs extensively uses community volunteers and already has a fairly broad
focus. This is also sometimes the preferred option, particularly when an Organization
feels that the upheaval associated with radical redesign would not worthwhile.

Taking this approach forward typically hinges on CABA-related training for staff and
volunteers. It also requires some attention to be paid to revising client selection
criteria, volunteer deployment and supervision arrangements, as well as implementing
activities to ensure community understanding of the shift in pro in programming
emphasis.


Does HBC change much as a result of integrating CABA activities?
What might be the
What might be the challenges?
What might be help?
benefits?
A more balanced
Problems in existing HBC programs
Careful pre-assessment of the
emphasis on children may continue
sustainability of an HBC
and adults
program for the inclusion of
CABA services
It builds on the
Activities for CABA may be as less
Addressing problems gradually
strengths of existing
important than core HBC services
HBC services,
including structures
and human resources
There is minimal
Staff and volunteers may not want to Holding discussions with staff,
disruption to existing
start activities for CABA.
volunteers and other
HBC services while
stakeholders so as to
new CABA activities
communicate importance of
are introduce.
new activities
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ATLANTIC INTERNATIONAL UNIVERSITY AIU

A New Age for Distance Learning


Involving staff and volunteers
in planning new activities

Advocating the benefits of
more comprehensive
responses.


5. The motives for alarm

Although the virus prevalence rate in Mozambique in general and in the two
communities in particular is, in relative terms, at what may still be considered
moderate levels for sub-Saharan Africa, the specific circumstances of the country
ensure that HIV/AIDS epidemic should be seen as a tragedy with damaging
consequences for development.

About 60.5% of the Mozambican population is illiterate. The country has 13,156
economically active individuals with higher education courses, of whom only 17% are
women (UNDP National Report ­ Mozambique, 2003). These data reflect the level of
vulnerability to the devastating effects of the epidemic in a country with limited
resources (Plano Estratégico do ensino Suprior, 2004).

The epidemic strikes two blows at the fragile base of education cadres ­ first through
the disappearance of trained and experienced people, and second though the waste of
resources spent on their training. This concerns, and with good reason, society at the
highest level, because the victims of AIDS include specialists trained with great
sacrifice over the 31 years of independency.

In attacking those aged between 15 an 49, the epidemic seriously compromises
development efforts, because it concentrates on a significant layer of present and
future producers, in a country where this stratum is that of economically active
individuals and estimated at only 37% of the population. In other words, one in six
Mozambicans regarded as fit for work is infected by the virus (National Council to
Combat HIV/AIDS, 2001). The epidemic will force the healthy to bear, directly or
indirectly, greater responsibilities and cost.


6. Protecting the "window of hope" and beyond...

The strategy for fighting the epidemic should rest fundamentally on protecting the so-
called "window of hope", that is, the children who are not yet sexually active, who
can learn early and better the lessons of abstinence, protection and prevention. This
implies targeting the current preventive campaigns on HIV/AIDS at younger age
groups, and therefore making appropriate adjustments in the messages of these
campaigns. Instead of stressing only the use of condoms or safer sex, for instance, the
messages could envisage aspects including changes in sexual behavior and attitudes.

Apart from children of when they are already regarded as sexually active, the
campaign should also, and quickly, cover sub-group in the 6 to 15 year olds range.
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ATLANTIC INTERNATIONAL UNIVERSITY AIU

A New Age for Distance Learning



7. REFERNCES

The Conceptual and methodological basis of Human Development
University Of South Africa press, 1999

The link between Human Development and Human Rights
"Eduardo Mondlane University press, Maputo-Mozambique;

The contribution of Education to Human Development
Annual Report - Ministry of Education/Mozambique, 1992;

The trajectory of Education in the choice of Mozambicans
Annual report-Ministry of Education/Mozambique, 1991;

Education in the Human Development of Mozambicans ­ Multifaceted challenges in
the 21st Century
Dr. Paulo Alberto Munguambe, 2003

HIV/AIDS and Education: The Hidden Threat to Human Development
National Council to Combat HIV/AIDS, 2001

Why talk about HIV/AIDS again?
National Council to Combat HIV/AIDS, 2001

The Characteristics of HIV/AIDS and the motive for alarm
National Council to Combat HIV/AIDS, 2001

How does HIV/AIDS affect Human Development?
National Council to Combat HIV/AIDS, 2001

HIV/AIDS and Education Sector
Annual Report-Ministry of Health/Mozambique, 1994

Impact of HIV/AIDS on the demand of Education Sector
Annual Report-Ministry of education/Mozambique, 1995;

Impact of HIV/AIDS on the Supply of Education
Monthly Report-Provincial Directorate of Education/Inhambane, June 2004;
Impact of HIV/AIDS on the quality of Education
Quarterly Report-Provincial Directorate of Education/Maputo, April 2001;

Making Human Development operational in Mozambique
Dr. Paulo Alberto Munguambe, 1989;

Recent Themes on the Global Human Development Reports for 2005
UNDP/Mozambique;

Origins, Evaluation and Management of the Human Development
Semi-annual report-Ministry of Education/Mozambique, 1988;
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ATLANTIC INTERNATIONAL UNIVERSITY AIU

A New Age for Distance Learning


Measuring Human development and the Methodology of Calculating Human Poverty
Index
UNDP/Mozambique;

Performance of Human Development Index in Mozambique
UNDP-Mozambique, 2000;

The Prospective Indicative Plan and the National Education System Plan
Annual report-Ministry of Education, 2001;

Education Trends in the post-war period
Annual Report-Ministry of Education/Mozambique, 2003;

The Education Strategic Plan
Annual Report, Ministry of education, 1975.


Armstrong, M. (1990). How to be even better Manager, Kogan Page Limited,
London;

Blunt, P. & Johns, M.L. (1992). Managing Organizations in Africa, Walter de Gruter,
Berlin;

Cattermole, F., Aires, M. & Grisbrook, D (1987). Managing Youth Services,
Longram; Group UK Limited, London;

Dale, M. (1993), Developing Management Skills. Techniques for improving learning
and performance, Kogan Page Limited, London;

Handy, C.B. (1985), Understanding organizations, Penguin Books limited, London;

Kate Millet (1970), Sexual Politics;

Annual Report of the Provincial directorate of Health ­ Inhambane Provenience
(2001);

ANDERSON, Benedict, Nação e Consciencia Nacional, São Paulo, Brazil, 1989.
ASSIS, Abel (National Coordinator for HIV/AIDS Prevention and Combat-
Mozambique), Avaliação das Capacidades dos Alunos das 8as, 9as e 10as classes,
1999;

BUENDA GOMEZ, Miguel ­ Educação Moçambicana: História de um processo.
Maputo, Livraria universitária, (2000).

CONCEIÇÃO, Rafael da & Alii. Inserção na Comunidade: Relatório das pesquisas
antropológicas sobre a interação entre a cultura tradicional e a escola Oficial,
realizadas nas províncias de Nampula, Manica e Inhambane. Departamento de
Arqueologia e Antropologia, FL-UEM, (1998).

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ATLANTIC INTERNATIONAL UNIVERSITY AIU

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DIAS, Patrick V. " Educação e desenvolvimento em Africa Sub-sahariana-
desajustamentos conceptuais e logros ideológicos. IN: Revista Internacional de
estudos Africanos e Asiáticos, Janeiro ­ Fevereiro (1990).

KHÓI, LÊ Thau, "Educação, Cultura e desenvolvimento em Africa. (2002).