Strengthening Configurations of Care in Kenya to Reflect Reciprocal Care Arrangements between Grandparents and Grandchildren
In Kenya, there has been a striking increase in intergenerational caregiving, largely resulting from the HIV/AIDS epidemic. Grandparents are increasingly caring for their grandchildren who have become orphaned as a result of HIV/AIDS. Children are progressively acting as the primary caregivers of their older family members living with HIV/AIDS (Andersen, 2012; Cappiccie et al., 2017; Ice et al., 2012; Skovdal, 2011; Skovdal et al., 2013; Wangui, 2009). In the case of child caregivers or “young carers,” when adult family members fall ill and external healthcare support is unavailable or limited, children in the household often take on the role of their grandparents’ primary caregiver (Andersen, 2012; Skovdal, 2011). Research reports that caregiving children often live in contexts of poverty and social exclusion and have impaired mental and physical health. Furthermore, they can experience restricted opportunities for developing friendships and social networking and can face disruption of schooling as they struggle to complete their homework (Skovdal et al., 2013; Skovdal & Andreouli, 2011). Nevertheless, a few studies observe some positive outcomes of child caregiving, including increased maturity, an expanded skillset, strong relationships with the people for which they care, and a developed sense of responsibility and self-worth (Skovdal & Andreouli, 2011).
In cases where both parents were infected with HIV/AIDS and died, grandparents fill an important role as caregivers for their orphaned grandchildren (Ice et al., 2012; Wangui, 2009). Reports by the Joint United Nations Programme on HIV/AIDS (UNAIDS) suggest that older caregiving Africans are at risk of malnutrition and poor health because they do not have the necessary social and economic resources to care for both themselves and their orphaned grandchildren (Ice et al., 2011). Grandparent caregivers lose an important conduit of financial support through the death of their adult children (Ice et al., 2012; Wangui, 2009). Due to a lack of socioeconomic support, caregiving grandparents can incur debilitating healthcare service costs, an inability to pay their grandchildren’s school fees, and inadequate food resources (Ice et al., 2011, 2012). Accordingly, studies confirm that grandparent caregivers generally have lower socioeconomic status (SES) and report poorer health than those of non-caregiving households (Ice et al., 2011). However, despite the many challenges that grandparent caregivers may confront, some studies suggest that the presence of orphans can be beneficial to older persons, particularly women, who may have limited access to external resources and are therefore able to utilize some of the care support provided by the orphans in their homes (Ice et al., 2012).
Despite this contemporary departure from traditional systems of family support for children and older people across Sub-Saharan Africa, a level of motivation exists at the community level to bolster commitment to intergenerational responsibilities and there also seems to be a strong political will to provide care for children and older people as governments are increasingly enacting relevant programs and promoting intergenerational solidarity through civic education campaigns. For example, in an attempt to ease the socioeconomic burden faced by caregiving grandparents, the Kenyan government launched a cash transfer program in 2004 for households containing orphans and vulnerable children (Ice et al., 2011): “The program provides between 1,000 and 2,000 KES ($9.30-$18.60 USD) per month, depending on the number of orphans in the household” (506).
The Kenyan government has also established a number of policies and programs to address pressing issues regarding the care of older persons, including the 2014 National Policy on Older Persons and Ageing. The overall goal of this policy is to create an environment that empowers older persons to participate in society and enjoy their rights and freedoms while facilitating the “provision of reasonable care and assistance to older persons by family and the state” (National Policy on Older Persons and Ageing, 2014, p. 4). Specific social protection programs implemented by the Kenyan government include social assistance, which comes in the form of cash transfers that target older persons, and financial assistance, which comes in the form of grants, food subsidies, and bursaries (National Policy on Older Persons and Ageing, 2014). A carer’s allowance is also available to those caring for a disabled older person (Sembajwe et al., 2007).
In Sub-Saharan Africa, families are the main unit of support for children and older people. Kenya is no exception: in the absence of comprehensive formal welfare systems, families are crucial for understanding the challenges and opportunities of caring for the young and ageing populations of Kenya, and the Kenyan government has already expressed its enthusiasm to act on issues within the care sector, emphasizing families as the basis for social and economic progress in the country (Aboderin & Hoffman, 2015). Moreover, the African Union has tressed the importance of advancing traditional values among the young, given that “the continuous cultural development of Africa rests with its youth” (Aboderin & Ferreira, 2008). Policy action is therefore necessary in order to improve traditional systems of family care throughout Kenya (Sembajwe et al., 2007). It is essential for the government of Kenya to design and implement policies that will provide services specifically targeted to intergenerational caregivers, both young and old; to instil traditional values of familial and intergenerational support; to organize and provide paid care services to enhance and strengthen family care; and to offer skills training and social protection mechanisms for family caregivers (Aboderin & Epping-Jordan, 2017).
A large proportion of existing policy arguments have assumed that intergenerational support schemes are neither desirable or beneficial for old and young populations, and therefore fail to consider whether there is actually a demand for formal mechanisms to take on these support functions (Aboderin & Ferreira, 2008). Therefore, the following recommendations are made:
Investing in data collection, analyses, and utilization
A lack of data has translated to a lack of awareness surrounding the challenges that intergenerational carers face and the support that they need; there is therefore a need to increase investment in the collection, analysis, and utilization of data on young and ageing populations for planning purposes (Policy Brief: Increasing Number of Older Persons: Is Kenya Prepared?, 2016). Research is needed to better understand not only the nature of customary values and expectations of family solidarity within Kenya, but also their application and interpretation within the context of care arrangements (Aboderin, 2019). Research is also needed to establish older and younger populations’ experiences of and perspectives on familial care to gain an understanding of the types of intergenerational care support older and younger people require (Aboderin & Ferreira, 2008).
Strengthening training and social protection mechanisms
The government should expand and strengthen community and family-based support systems by providing skills training and social protection mechanisms for family caregivers, along with organized and paid care services that enhance and strengthen family care (Aboderin & Epping-Jordan, 2017). In terms of caregiving children, the government should develop and make available social resources that young carers can utilize to construct positive social identities and cope with the difficult circumstances of being caregivers (Skovdal & Andreouli, 2011). The government should also develop a hybrid plan of support that actively promotes children’s ability to attend school while simultaneously building on traditional models of family care. The nature of these resources will differ across cultural contexts and will therefore be determined upon further research.
Reassessing the cash transfer policy
The government of Kenya should reassess its current practice of allocating cash transfers directly to older persons caring for orphans and vulnerable children. While this approach does indeed have redistributive benefits in the context of poverty, as older people often share their income with their children and grandchildren, it also creates a specific order of intergenerational support streams in which younger family members come to expect their older relatives to support them financially. In cases where children and grandchildren are unemployed with little to no social security provision, the provision of social pensions can cause youth and middle-aged persons to become dependent on older pension recipients (Aboderin & Ferreira, 2008). The government should therefore consider an alternative approach to providing support which will be determined upon further research.
Recognizing young carers as agents
According to Skovdal and Andreouli (2011), efforts should be made to “reframe negative and victimizing representations” of caregiving children, focusing instead on strengths-based representations. They argue that a great deal of research on caregiving children tends to focus on the issues surrounding their circumstances, leading researchers and policymakers to concentrate their efforts on the negatives of young caregiving. It is therefore suggested that policy interventions regarding caregiving children should actively recognize them as agents and highlight the potential benefits of caregiving, keeping Skovdal and Andreouli’s caution in mind that any policy shift should not undermine the responsibility of the state—welfare support remains crucial for caregiving children to cope with their difficult circumstances.
Promoting values of intergenerational and familial support
In collaboration with relevant stakeholders, including NGOs, religious organizations, and civil society organizations, the government of Kenya should defend and promote the family as an essential part of society that provides care to children and older persons (National Policy on Older Persons and Ageing, 2014), which necessitates instilling values of familial and intergenerational support in the young (Aboderin & Ferreira, 2008). The government should therefore, as Aboderin and Ferreira argue, adopt an “intergenerational approach” (p. 62) in its policies, which stresses intergenerational equity (equity between old and young) and unity as prerequisites for societal cohesion and development. According to Aboderin and Ferreira, such a perspective demands a comprehensive assessment of how both family-and individual-based policy measures would influence intergenerational support systems, and consequently intergenerational solidity or tension within families.
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