Capacity and resources are stretched to breaking points, both at the private and the public level. National budgets are completely strained. By 2005, the health sector costs related to HIV/AIDS are expected to account for more than a third of all government health-spending in Ethiopia, more than half in Kenya and nearly two-thirds in Zimbabwe (UNAIDS, 1999). It is important to put pressure on governments and pharmaceutical companies to ensure greater African access to AIDS treatments, and to health infrastructure.
Drug treatments, however, will not solve this crisis. There are still many obstacles and challenges to overcome. A serious commitment from African leaders and high-level government officials has to occur for these trends to change. It is essential that they speak about the problem and make it a national priority, helping create a climate in which AIDS victims decrease in numbers, and are not stigmatized. Their role is critical in setting priorities straight, and putting policies and programs in place. Thus, for example, public education campaigns, condom distribution, voluntary testing, counseling and support services, are some of the strategies Ugandan President Yoweri Museveni embarked his country upon. This policies have paid off: HIV infection has dropped from 15 percent of the population to 9.7 percent. South African former and current presidents, Nelson Mandela and Thabo Mbeki are good examples as well.
One of the Governments' main strategies in many countries has been to promote and support community-based programs. It is important to support orphans in their own communities, and for communities to meet soon to discuss problems due to the impact of AIDS. Governments encourage communities to provide care for orphans and to rely on institutional care only as a last resort, because communities are in the best position to asses their needs, and also because of the increasingly limited governments' ability to provide basic services...while at the same time there is an increase in the demand for them!
Care for orphan children should be provided in culturally-appropriate ways. In Africa, for example, the first line of approach in orphan care must be community-based. Formal foster care and institutional care should be only provided as secondary and ultimate options respectively, and play a transitional role. These provisions are, e.g., part of Zimbabwe's orphan policy on care and protection of orphans, adopted by the Cabinet in May 1999.
It is important to build upon communities' existing capabilities, and to channel material support and assistance in developing income-generating activities through community groups to strengthen family coping mechanisms at critical times. Outside organizations should help those communities help themselves by providing material resources and assistance with planning, monitoring, and evaluation. Priority should be given to establishing programs in high risk communities such as low-income urban areas and the surrounding rural areas.
Orphan enumeration is essential for planning and mobilizing support by and from policymakers (Foster et al., 1995). Currently, there are systems for surveillance of the size of the orphan population, yet it is necessary to establish monitoring and evaluation systems to assess the impact of AIDS on children, as well as that of pilot family and community-support interventions have upon orphaned children, other children in the community, families and the communities in general. Identifying those who are more vulnerable and exposed to higher risks and deprivations is important in order to plan their assistance.
Government commitment to AIDS education and prevention efforts for young people are crucial. Fighting shame and denial, stigma and discrimination through education and support, as well as through national policies that protect the property rights of orphans, and their rights to health care and education, and ensure that services are provided to all orphans regardless of the cause of death of the parent or parents, or their gender or religion.
Finally, whenever possible, children should be allowed to speak for themselves. Foster et al.'s study of orphaned children and community members in Mutare, Zimbabwe, proved that a first step in enabling children to self-advocate was to listen to their concerns (Foster, 1997c).