Monday, April 21
Grant Miller: Managerial Incentives in Public Service Delivery
Knodel, John E., Zachary S. Zimmer, Kiry Sovan Kim, and Sina Puch. 2006. "The Impact of AIDS on Older-age Parents in Cambodia." PSC Research Report No. 06-594. September 2006.
Most adults who die of AIDS have older-aged parents who survive them. This, the first quantitative study in Cambodia to look at the impact of the death of a child due to AIDS on their older parents, directly contributes to “improving data collection and analysis on the status, trends and socioeconomic impact of the epidemic,” a recommendation specifically set out by Cambodian government in their efforts to meet the United Nations Millennium Goals. Findings from this study can inform policy aimed at mitigating the impact of the epidemic on older persons. Some of the significant policy relevant findings from this study are:
Older adults who have experienced the death of a child due to AIDS in Cambodia almost universally play a key role during the child’s illness. Almost 80% were among the main persons who provided direct personal care. The average length of the care period was over 7 months. Just over 60% lived with the AIDS victim at the terminal stage of illness. A substantial majority provided assistance with expenses.
The involvement of parents in their children’s illness crosses demographic lines. Parents provide assistance whether they live in rural or urban areas, whether they are married or unmarried, and whether they are poor or not.
More than half of the children dying of AIDS left behind orphans who frequently live with and receive support from their old age grandparents.
Expenses related to an AIDS illness and death can be a considerable drain on resources amongst older adults already facing harsh economic conditions. Three-quarters of those that supported a child reported the expenses to be a serious burden. Moreover, in most cases the child that died had provided material or physical support to the elderly person. In many instances, the deceased child was the main provider of material support.
Despite the burden faced by older Cambodians caring for a child with AIDS, formal assistance is not often available. Only one-quarter received any assistance from formal sources, mostly from NGOs and only very rarely from government sources. It is a particular concern that those among the poorer half of the sample were the least likely to receive formal assistance.
Multivariate analyses confirm that the loss of a child due to AIDS results in a reduction in economic well-being. Parents experiencing an AIDS death are more likely to report that their economic condition worsened during the prior three years compared to those who lost a child to other causes or those who did not experience the recent death of a child. Those experiencing an AIDS death also owned fewer liquid assets than others, consistent with reports from a substantial share of respondents that those assets were sold in order to pay for expenses related to the illness and death of their child.
Country of focus: Cambodia.