Walking the Talk - VSO

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have no time for other sources of income to feed theirchildren and themselves. 196Secondary care providers’ right to be paidA survey in southern Africa in 2005 identified sevendifferent models of care services across the region,ranging “from the very basic community-driven modelwhich is reliant on home visits by volunteers, to the fullycomprehensive care model which provides a wholespectrum of medical, psychological and spiritual care.” 197The more comprehensive models, like Bwafwano homebasedcare in Zambia, provide good support for womencare providers, such as training and some form of pay.However, currently, many home-based care organisationsuse large numbers of what are collectively termed‘volunteers’ to provide secondary home-based care, whoreceive little or no remuneration at all.Volunteers are an immensely valuable and importantpart of society, especially in communities seriouslyaffected by HIV and AIDS. They will continue to providean essential part of the response to HIV and AIDS.However, because most secondary care providers arewomen, and women’s work is routinely undervaluedwithin societies, the term ‘volunteer’ in this context hasbeen expanded and applied incorrectly to include allwomen within the formal economy who provide care tomembers of their community, but who receive little or notraining or recompense for the work they do.The UN defines volunteering as having threeessential characteristics:“First, the activity should not be undertakenprimarily for financial reward… Second, theactivity should be undertaken voluntarily,according to an individual’s own free-will…Third, the activity should be of benefit tosomeone other than the volunteer, or to societyat large, although it is recognised thatvolunteering brings significant benefit to thevolunteer as well.” 198Some secondary care providers have the resources tovolunteer their time and thus meet the UN definition of avolunteer. However, most secondary care providers canonly be called ‘volunteers’ because they currently workwithout pay. These are non-volunteer secondary careproviders because it is not necessarily the case thatthey do not want (or have) the right to be paid, or thatthey are willing to be made poorer for the work they do.Many secondary care providers are not willingvolunteers in this respect and, as the epidemic worsensin their communities, many secondary care providershave too many people to care for and little or no time tomake an alternative living. With the many extra costs ofproviding care, this means that many secondary careproviders plunge into deeper levels of poverty.Secondary care providers, therefore, should no longerbe referred to as volunteers unless they explicitly andwillingly meet the UN criteria above.The situation is complicated by the fact that definitionsof volunteering vary around the world. For example, insouthern Africa, the concept of ubuntu, which reflects astrong community spirit and sense of responsibility tosupport other members of the community, means manypoor and unpaid women secondary care providers feela strong motivation and experience it as a source ofpride in being referred to as ‘volunteers’. Research toexplore and understand the differing national andregional varying definitions of volunteering is neededinstead of universally applying largely westerndefinitions. This research can only really take place at anational level with the active participation of careproviders whom it most affects. Only then can cleardistinctions be made between volunteering and workthat should be recognised as paid employment.Secondary care providers should have the right tochoose to be a volunteer or a paid worker, a choice thatis currently denied them.Until now, many governments have regardedcommunity care as a ‘cost-effective response’ to thecrisis – women’s free labour saving money for the healthsystem. This short-sighted, needs-driven approachignores secondary care providers’ right to earn a livingfrom their work. It is nothing more than the exploitationof unpaid labour. Given the cycle of deprivation itcreates, it is both unsustainable and a false economy.The realisation of the call for secondary care providers tobe recognised and remunerated as workers will beprogressive. The transition will need the involvement andsupport of secondary care-providers and all 'dutybearers'responsible for the rights of secondary careproviders, including community-based organisations,NGOs, governments, donors and multilateral institutions.Some countries have begun to address the lack ofremuneration given to secondary care providers byintroducing legislation to ensure they are paid. InMozambique, for example, the government legislatedthat care providers receive 60% of the minimum wage(the current minimum salary is £26). 199 However, thesewages/stipends are still very low, and as such reinforcethe low valuation of women’s work in society. In mostcases it is insufficient to sustain a woman or her familyand so forces her to seek alternative income generation.44 Walking the talk putting women's rights at the heart of the HIV and AIDS response
The stipends can also be hard to access. For example,in order to receive the stipend in South Africa, it is firstnecessary to take an expensive training course to beaccredited, something way beyond the means of manycommunity care providers.It should be recognised, though, that some regularfinancial remuneration is an important step forward. Arecent regional study of care providers in four countriesin southern Africa found some evidence that because astipend was available in South Africa, care providersthere now viewed providing care as a legitimate sourceof employment. 200 However, in order to recognisesecondary care providers as workers that deserve a fairwage, there must be a huge conceptual shift at all levelsin the understanding, appreciation and recognition ofthe work they do. This involves a massive change in theunderstanding of gender roles and of the value ofwomen’s work per se.One solution is the greater involvement of men inproviding care. A model project that encourages youngmen to become involved in home-based care is‘Changemakers’ in Cameroon. By training young mento understand gender and male and female sexuality,and demystifying traditional beliefs and myths about HIVand AIDS, the men are developing more positiveattitudes towards people living with the disease. Theyhave further demonstrated a willingness to care forthem. However, governments, CBOs and NGOs needto be careful not to marginalise women or entrenchgender inequality within the care system for the sake ofinvolving men. One important way of preventing thisfrom happening is to ensure women are involved indecision-making and take leadership roles within CBOsand NGOs providing care and support. Another is forgovernments, civil society and NGOs to work with men,and particularly community and traditional leaders, tochallenge gender norms, and encourage them to rolemodel ‘caring male behaviour’.Another crucial change is the recognition of nonvolunteersecondary care providers as healthcareworkers so that these low-income female care providersare no longer dismissed as invisible free labour. A rightsbasedapproach demands that governments, donorsand international institutions recognise this category ofsecondary care providers as workers within theheathcare profession. As such, this classification helpsjustify their right to a fair wage. 201 While the WHO hasrecognised that “current methods of identifying healthworkers do not allow unpaid carers of sick people orvolunteers who provide other critical services to becounted,” 202 a major step forward would be therecognition of secondary care providers within theupcoming International Standard Classification ofOccupations by the ILO in 2008.Furthermore, all community and home-based careorganisations, and the NGOs that support them, mustdevelop comprehensive policies that recognise andprotect community care providers’ rights. Internationalguidelines, such as the NGO Code of Good Practice 203and the WHO Care Guidelines, 204 should also be updatedto directly support the remuneration of care providers andprovide clear guidelines for community-basedorganisations and NGOs on how to develop such policies.These policies might include pay scales, regulated hours,numbers of patients and guidance on including careproviders’ pay as part of funding proposals.Finally, it is important to state that secondary careproviders who willingly meet the criteria of ‘volunteer’must receive sufficient training, counselling and financialsupport. Furthermore, workplace policies in homebasedcare organisations must ensure volunteers have –and are aware of – their rights within the workplace. Avolunteer charter that enshrines these rights, such asthat recommended by the Secretary General’s TaskForce report in 2004, 205 must be pushed forward by theUN, integrated into National AIDS Plans andimplemented within community-based organisationsusing volunteers.The denial of educational, social and cultural rightsWomen and girls are often unable to claim theireducational, social and cultural rights as a result of theirrole as care providers. As care provision and domesticduties increase, girls in the family are nearly always thefirst to be pulled out of school, thus losing their right toan education. This is demonstrated by the example oftwo provinces in Kenya in 2001. The province ofNyanza, for example, recorded a very high HIVprevalencerate, and only 6% of those graduating atgrade 5 were girls. In contrast, Eastern Provincerecorded the lowest HIV-prevalence rate and 42% ofthose graduating were girls. Education officials notedthat 20 years before, the two provinces had roughlyequal percentages of girls graduating to grade 5. 206The importance of girls attending and finishing school isrecognised by policy-makers worldwide for the positiveeffect that it has on empowering women, reducing childmortality, and reducing the prevalence of HIV and AIDS(see Chapter 3). When girls leave school to act as careproviders it perpetuates a cycle of female disadvantage,leaving girls more vulnerable to HIV and AIDS.Governments must therefore ensure that girls and theirWalking the talk putting women's rights at the heart of the HIV and AIDS response 45
Page 1 and 2: Walkingthe talkPutting women's righ
Page 3 and 4: ContentsContents 1Glossary 2Definit
Page 5 and 6: DefinitionsUniversal Universal acce
Page 7 and 8: Gideon Mendel/Corbis/ActionAidAdero
Page 9 and 10: Prevention, treatment and care and
Page 11 and 12: Gideon Mendel/Corbis/ActionAidStree
Page 13: Figure 1: Number of women and men l
Page 17 and 18: marriage, harassment or other socie
Page 19 and 20: childcare arrangements or to take t
Page 21 and 22: Multilateral organisations1) The Jo
Page 23 and 24: and testing. A few of the strategie
Page 25 and 26: Box 2. The Climbing to Manhood Proj
Page 27 and 28: some of the problems facing women a
Page 29 and 30: Box 3. The Gender Violence Recovery
Page 31 and 32: 3.5. Recommendations Donor governme
Page 33 and 34: non-discrimination. Failure to do s
Page 35 and 36: Box 4. The power of ART in Nigeria:
Page 37 and 38: 3) The Global Fund to Fight AIDS, T
Page 39 and 40: support. While their efforts suppor
Page 41 and 42: first point of contact for any illn
Page 43 and 44: ‘care provider’, rather than th
Page 45: In some circumstances, the cost of
Page 49 and 50: ecause they do not have access to t
Page 51 and 52: HIV rally, Nairobi, Kenya.Jess Hurd
Page 53 and 54: 2) The Global Fund to Fight AIDS, T
Page 55 and 56: 39Women’s rights and universal ac
Page 57 and 58: 114www.who.int/hiv/topics/prophylax
Page 59 and 60: 191USAID/UNICEF/UNAIDS/World FoodPr

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