Succession Planning in Uganda: Early Outreach for AIDS-affected Children and Their Families

Executive Summary

"This publication reports on an intervention study that evaluated the effectiveness of a succession planning (SP) programme in Uganda. Unlike most other programmes for AIDS-affected children, succession planning reaches children and their families while their HIV-positive parents are still living and in a position to plan for their children’s long-term well-being.

The focus of this report is on the impact of the SP intervention on HIV-positive parents’ and standby guardians’ efforts to prepare for the future of children who will experience parental loss. The report also presents findings on the impact of the programme on children and discusses the programme and policy implications of the research.

The succession planning programme was implemented by Plan/Uganda, Grasslands (Tororo), and the National Community of Women Living with AIDS (NACWOLA, Luwero), while the research was carried out by the Department of Sociology at Makerere University (Kampala) and the Horizons Programme. To assess programme impact, researchers conducted structured interviews with HIV-positive parents, standby guardians, and children who were and were not exposed to succession planning at baseline (1999) and two years later (2001)."

Key findings include the following:

"Succession planning was associated with a significant increase in the proportion of parents who appointed a guardian.

Nearly half (47 percent) of HIV-positive parents had not appointed a guardian at baseline. Reasons given for not having a standby guardian included the following: not knowing anyone willing or able to be a guardian, still being in good health themselves, and not wanting to reveal their serostatus to a potential guardian. Implementers of the SP program reported, however, that parents responded very positively to encouragement and support for appointing guardians. Indeed, there was a significant increase over the two-year period, from 56 to 81 percent (p < 0.05), in the proportion of parents exposed to succession planning who had appointed a standby guardian.

Will writing doubled among parents in succession planning, but still only one in five parents had written wills.


Baseline findings showed that fears about and experiences with property grabbing were
widespread, but that few parents had taken steps to ensure that their property would be passed on to their children. The proportion of parents with written wills in the SP area more than doubled from 9 percent to 20 percent, yet the same pattern was found among comparison parents, making it impossible to prove program effects. This was one of the most challenging components of
succession planning in the Ugandan context due to taboos about writing wills, low literacy, and
other factors. Nevertheless, the demand for assistance with wills and legal matters grew among
HIV-positive parents, suggesting that the approach is feasible and acceptable.

After two years in the SP program, parents were significantly more likely to have disclosed
their positive serostatus to at least one child.


At baseline, most older children wanted their parents to “tell them the truth” about being HIVpositive because they wanted to know the truth, avoid HIV/AIDS, know what to do when the
parent dies, prepare for the parent’s death, and discuss guardians and wills. While only 51 percent
of parents in SP had disclosed at baseline, 75 percent had done so two years later. This increase in
parent-to-child communication fulfills an important need for open discussion, as expressed by older children of HIV-positive parents. Nevertheless, disclosure can be upsetting and may not be
appropriate for younger children, so it must be handled with sensitivity.

Planning for the future is a process that can stir many emotions, so parents require sensitive, reliable program support.


Appointing guardians, disclosing serostatus, and writing a will are all steps that a parent can take to reduce fears and uncertainty about the future and ensure long-term well-being for children. These actions are also, however, emotionally, culturally, and logistically complex. Families engaging in this process require strong, ongoing program support.

Standby guardians appointed by parents are predominantly male, but it is women who ultimately assume much of the responsibility for orphaned children.


It was more difficult than expected to reach and engage standby guardians in the SP program. Not all parents were able to find an appropriate standby guardian, and others had appointed someone living far away. Thus, relatively few standby guardians were available to participate in the
program. The characteristics of standby guardians were also different from individuals currently serving as guardians. For example, 57 percent of the parents in the baseline survey who had
appointed a standby guardian chose a male. Yet 63 percent of current guardians (i.e., already caring for orphan children) who were interviewed at baseline were female. This suggests that the people appointed as standby guardians are not necessarily the individuals who ultimately care for the children once the parents die.

Succession planning is an attractive and effective program for HIV-positive parents who wish to ensure a better future for their children, but it is challenging to implement.


Overall, the SP program met with a high degree of acceptability and enthusiasm among HIVpositive parents, who generally welcomed the support to ensure a better future for their children. Indeed, as word spread about the program, there was demand for it in neighboring areas. However, SP is a complex program made up of many components, including counseling and support to parents as they disclose their HIV-status to children and others, legal training and assistance with wills, and income-generation activities. As such, it must be implemented by an organisation or a group of organizations with a wide range of technical proficiencies.

More research is needed to explore the long-term impact of succession planning on children
once their parents have died.


Succession planning did not appear to have a pronounced effect on children whose parents were still living. This is not surprising, given that several of the program components focused on the long-term well-being of children. Steps taken by parents in the program (disclosing serostatus, appointing guardians, and writing wills) are promising, and suggest that SP does contribute to helping parents plan for a better future for their children. But more research is needed to document longer-term program impact."