Caregiver supportive policies to improve child outcomes in the wake of the HIV/AIDS epidemic: an analysis of the gap between what is needed and what is available in 25 high prevalence countries

Figures & data

Figure 1. Conceptual framework to identify HIV-affected caregiver support needs and guide policy development.

Table 1. Caregiver needs, supportive policies, and existing policy gaps in 25 highest HIV prevalence countries.

Target	Social policy	Policy gap	Notes
Economic security	Minimum wage	13 of 22 countries	In 12 countries the minimum wage is set too low to guarantee a worker and his/her dependent child would be above the $2 PPP/day global poverty line. In one country, there is no national minimum wage
	Cash family benefit	19 of 21 countries	In 12 countries, there are no known cash family benefits. In additional 7 countries, benefits are less than $20 PPP per month for a family with two preschool-age children
	Pensions for the elderly	16 of 21 countries	One country has no pension system. In an additional 15 countries, pensions are only provided through a contributory system, limiting income protection to workers in the informal economy and those who have had caregiving absences from work
	Financial support for families with disabled children	18 of 19 countries	Ten countries have no or limited family benefits. An additional eight countries provide family benefits, but do not have specific benefits for family with disabled children
	Short-term income protection during illness (leave available from 1st day)	3 of 23 countries	Three countries do not guarantee any income protection during illness (i.e., paid sick leave)
	Long-term income protection during illness (at least 26 weeks)	16 of 23 countries	In addition to those countries that do not guarantee any short-term sick leave, another 8 countries provide less than 26 weeks of paid leave
	Unemployment benefit	23 of 23 countries	None of the countries ensure unemployment benefits extend to workers in the informal economy. In 21 countries, unemployment is provided only through severance pay. The two countries that have unemployment benefits exclude self-employed workers
Work-family balance	Leave to care for sick children	22 of 25 countries	Sixteen countries do not have leave available specifically to meet children’s health needs. In four countries, leave for children’s health needs is limited to serious illnesses, hospitalizations, or imminent death. In one country leave is only available to mothers for children’s everyday health needs and in an additional country this leave is unpaid
	Leave to care for sick adults	23 of 25 countries	In 21 countries, there is no leave specifically to meet adult family members’ health needs. In additional two countries, leave is available but it is unpaid
	Leave to attend teacher conferences at school	17 of 24 countries	Seventeen countries have no form of leave that can be used to meet children’s educational needs (discretionary or family needs leave)
	ECD (age 0–3)	Not available
Access to education	Free pre-primary school (age 4–5)	17 of 17 countries	None of the countries have free pre-primary education
	Free primary school	3 of 22 countries	Three countries report tuition in primary
	Free secondary school	14 of 20 countries	Eleven countries report charging tuition at the beginning of secondary and an additional three charge tuition before completion
	Inclusion of children with special needs	3 of 18 countries	One country has no public special education and an additional two countries only provide education for children with disabilities in separate schools
Access to health care	Constitutional guarantee to health	15 of 25 countries	Three countries have no constitutional provisions guaranteeing the right to health, medical services, or public health. In 12 countries, this provision is only aspirational
	Free mental health services for children and adults	Not available
	Free HIV-related medical services (e.g., provision of ARVs; home-based care)	Not available
Equal rights & discrimination	Constitutional guarantee of equal pay for women	20 of 25 countries	Only five countries constitutionally guarantee women equal pay for equal work. In an additional six, it is either aspirational or guaranteed broadly to citizens, but not specifically on the basis of gender
	Constitutional guarantee of protection from discrimination at work (general)	18 of 25 countries	Eighteen countries have no relevant constitutional provisions to protect all citizens or citizens with disabilities specifically from discrimination at work
	Constitutional protection of the right to education based on disability, health, or HIV status	18 of 25 countries	Five countries have no constitutional guarantee of the right to education. Fifteen countries guarantee citizens the right to education, but do not explicitly guarantee it to children with disabilities. One country aspires to guarantee the right to education for children with disabilities
	Constitutional protection from discrimination based on disability, health status, or HIV status	13 of 25 countries	In two countries, the constitution takes no approach to equality and non-discrimination based on disability or HIV status. In 13 countries, equality and non-discrimination is guaranteed to citizens but not specifically based on disability or HIV status. In an additional two countries, citizens with disabilities are guaranteed equal rights except for those that they are “unable, or not fully able, to enjoy or carry out”
Expanding social services	Family outreach and case management	Not available
	Support for guardianship (e.g., birth registrations; streamlined administrative processes)	Not available

Notes: The countries included are Angola, Botswana, Cameroon, Central African Republic, Chad, Congo, Cote d’Ivoire, Equatorial Guinea, Gabon, Guinea-Bissau, Kenya, Lesotho, Malawi, Mozambique, Namibia, Nigeria, Rwanda, South Africa, South Sudan, Swaziland, Togo, Uganda, United Republic of Tanzania, Zambia, and Zimbabwe. Missing policy data may occur for a variety of reasons, including if the full legislation is not available for a country or when it is not clear/contradictory. “Not available” indicates that globally comparative data on the policy were not available. For more information on the methods used to generate the policy data, please see http://worldpolicycenter.org/methodology.

Table 2. Existing policy landscape in the 25 highest prevalence countries, by country and domain.

Country	Adult (15–29) HIV prevalence	World Bank income level^a	Known number of recommended social policies	At least one policy in each of the following domains
				Economic	Work-family	Education	Health	Equal rights
Swaziland	27.7	Lower middle	4	✓		✓
Botswana	25.2	Upper middle	5	✓		✓
Lesotho	23.4	Lower middle	5	✓		✓
South Africa	18.9	Upper middle	8	✓	✓	✓	✓
Zimbabwe	16.7	Low	5	✓			✓	✓
Namibia	16	Upper middle	6	✓	✓	✓
Zambia	12.4	Lower middle	3	✓		✓
Mozambique	10.6	Low	4	✓		✓	✓
Malawi	10	Low	6	✓		✓		✓
Uganda	7.3	Low	4	✓		✓		✓
Equatorial Guinea	6.2	High	4	✓				✓
Kenya	5.3	Lower middle	7	✓		✓	✓	✓
Tanzania, United Republic of	5.3	Low	6	✓	✓	✓		✓
Cameroon	4.8	Lower middle	5	✓	✓	✓
Central African Republic	4.3	Low	5	✓	✓	✓		✓
Gabon	3.9	Upper middle	6	✓	✓	✓
Guinea-Bissau	3.7	Low	0
Cote d’Ivoire	3.5	Lower middle	4	✓	✓		✓	✓
Nigeria	3.2	Lower middle	4	✓		✓
Rwanda	2.8	Low	7	✓		✓	✓
Congo, Republic of	2.8	Lower middle	3	✓	✓	✓	✓
South Sudan	2.7	Low	4			✓	✓	✓
Chad	2.5	Low	4	✓		✓
Togo	2.4	Low	5	✓	✓	✓	✓	✓
Angola	2.4	Upper middle	7		✓	✓	✓	✓

^aThe World Bank divides economies into four categories (low, lower middle, upper middle, and high) using gross national income (GNI) per capita (The World Bank, 2016).

The World Bank. (2016). Country and lending groups. Retrieved February 29, 2016, from http://data.worldbank.org/about/country-and-lending-groups

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