N/A

New/Continuing Activity: New Activity

Continuing Activity:

Program Budget Code: 13 - HKID Care: OVC

Total Planned Funding for Program Budget Code: $1,903,698

Total Planned Funding for Program Budget Code: $0

Program Area Narrative:

With relatively limited funding and extreme staffing constraints, PEPFAR Swaziland made a difficult, but strategic decision to

consolidate and phase out support for the OVC program area during FY08. PEPFAR programming in this area had been very

limited and dwarfed by the resources and national efforts of the Global Fund, NERCHA and UNICEF. Without expertise on the

team and only nominal financial input, PEPFAR's national contribution to OVC services and support was inconsequential.

Instead, PEPFAR Swaziland accelerated its already notable efforts to expand access to care and treatment for parents, other

caregivers and children living with HIV. PEPFAR also continued to be a key player in promoting family-centered, holistic PMTCT

services and primary prevention.

Sadly however, the number of children made more vulnerable by AIDS in Swaziland continues to increase while their life

circumstances worsen due to the combined effects of HIV/AIDS, increasing poverty, recurrent drought and an extreme care

deficit. As the nation with the world's highest HIV prevalence, Swaziland is in the midst of a serious crisis for children. Nearly all

children have been touched by the AIDS epidemic in some way. The 2007 SDHS estimates that 31% of children are orphaned

and/or vulnerable (i.e., living in a household where a parent or adult is too ill to work or perform normal activities). This number is

expected to grow to 200,000 by 2010. Only 22% of children in Swaziland live with both parents and one third of all children are

not living with either parent. Most children in Swaziland grow up in impoverished households. Approximately 70% of all

households live below the poverty line and 40% of the population is in need of external food assistance. Under these

circumstances, the rights of children are increasingly unprotected. As a stark example, a recent national survey supported by

UNICEF and CDC revealed that one third of girls aged 13-24 had experienced sexual violence.

National level interventions for OVC include the establishment of a National Children's Coordinating Unit (NCCU) and the

introduction of several policies and bills including the Children's Policy and Bill and the Children's Justice Act among others. All of

these key documents currently rest in draft form awaiting government approval. To protect and deliver services to OVC, the Child

Protection Committee and Neighborhood Care Point (NCP) initiatives were developed, but have yet to be fully and consistently

implemented. In addition, hundreds of very small scale efforts are undertaken by faith and community based organizations in

Swaziland to try and meet the immediate needs of OVC. As there are no national standards for these efforts, they are fragmented

and widely varied in terms of quality and types of support.

With greatly increased resources available in FY09 and beyond, PEPFAR will reverse its decision to phase out of the OVC

program area and work rapidly to become a significant partner in the OVC response. An urgent priority will be to establish and fill

an OVC specialist position on the PEPFAR team. This person will lead the development and implementation of the PEPFAR

OVC portfolio and will join various OVC forums at the national level (including the Child Protection Network, NCP Interagency

Coordinating meetings and ad hoc working groups established by NERCHA, the NCCU and the Global Fund).

All activities are being developed in line with the National Plan of Action for Orphans and Vulnerable Children 2006-2010 and the

National HIV/AIDS Strategic Framework 2009-2013 that is currently under development. Six priority areas have been identified

for support in the emerging OVC portfolio:

1) Policy and legislation - Several key bills and policies related to children and their rights are currently awaiting adoption by

government. Through the OVC program area, PEPFAR will become an important advocate in ensuring that the draft Children's

Policy and Bill, the Child Justice Act, the Domestic Violence and Sexual Offences Bill and Social Welfare Policy are all approved.

In implementing the activities described below, PEPFAR will assist in paving the way for full implementation of these key policies

and bills once they are enacted.

2) Development of national OVC standards - OVC services and support in Swaziland are fragmented, sporadic and varied in

terms of both quality and impact. PEPFAR intends to develop an activity to address the need for national standards and quality

improvement of OVC programs. Key host country institutions including the NCCU, the Department of Social Welfare (DSW) and

NERCHA have expressed interest in this activity. PEPFAR will play a leadership role in partnership with the NCCU and UNICEF

to conduct a national consultation on setting standards for OVC programs and services. PEPFAR will support the coordination of

this consultation through an existing implementing partner. Prior to the consultation, representatives from the NCCU and DSW

will attend a regional conference on OVC standards with the intent of increasing the local knowledge base and momentum for this

activity. Following the national consultation, various activities will be pursued to finalize and implement national standards. This

will include the provision of TA to strengthen the evolving monitoring database for OVC.

3) Community based services and support - A key strategy in the national plan of action for OVC in Swaziland is the

establishment of NCPs as community-based centers where children eat at least one daily meal, play, participate in early

education activities and receive basic services. A 2006 assessment found that NCPs are serving a critical role in OVC care, but

coverage is limited, services are uneven and standards are lacking. Government and partners have agreed to greatly expand and

improve the quality of NCPs as centers of care for OVCs. The most recent Global Fund proposal includes support to increase the

number of NCPs, from 660 to 2000 in five years. PEPFAR intends to complement this construction work by channeling funds to

200 NCPs for improved and increased provision of services and support, including health care services, early childhood

development, psychosocial support and water and sanitation. Strategies to strengthen referrals to other needed services,

including HIV testing, will also be developed. Up to 20 per cent of the funding will be allowed for use on infrastructure renovations

(e.g., covering kitchens that are currently unusable when it rains and improving water and sanitation). This activity will be carried

out in close collaboration with NERCHA and UNICEF.

Through the PACT umbrella, PEPFAR will support World Vision to provide holistic community-based support to OVCs through

NCPs and their surrounding communities. World Vision has a long track record of working in communities for children and

PEPFAR funding will be used to expand this work in Shiselweni, an underserved, rural region of Swaziland. Interventions will

include educational, nutritional and psychosocial support. Home gardens will be promoted to supplement household nutrition and

home visitor systems will be established for monitoring and support. World Vision will be funded through the PACT umbrella,

sharing expertise and experience with local NGOs working in other underserved communities. In particular, World Vision will

model community-based OVC support for Cabrini Ministries, another PACT sub-partner that runs a high volume ART clinic and

has great potential for outreach OVC work through its established relationship with the surrounding communities.

In addition to their ongoing work in AB prevention, Peace Corps will expand the work of the volunteers to include participation in

the OVC program area. With COP 09 funding, PEPFAR will fully fund seven volunteers as well as small community-based grants

for which all volunteers can apply. All volunteers, including the seven PEPFAR-funded volunteers, will work in both AB prevention

and the OVC program area and will be encouraged to link with NCPs and other indigenous structures supporting OVCs in their

communities.

4) Expanding the protection of children from violence and abuse - The national "Lihlombe Lekukhalela" (shoulder to cry on)

initiative, supported by UNICEF and NGO partners, works to protect children from violence and abuse. Save the Children

Swaziland coordinates the work of several NGOs implementing this project. Child protectors and child protection committees are

trained to identify and assist victims of child abuse in both rural and urban communities. The police service is engaged and

trained to effectively deal with child abuse cases. Parliamentarians have also received training through this initiative. With COP

09 funding, PEPFAR intends to pursue a PPP involving Save the Children Sweden, UK and Swaziland to expand this activity.

5) Increasing access to secondary education for OVCs - The U.S. Ambassador's Girls Scholarship Program currently provides

disadvantaged girls with primary school tuition, uniforms, other fees and psychosocial support. When these girls reach secondary

school (age 12-14), the support is discontinued as no secondary school scholarships are currently available. To promote the

continuum of care and further protect these primary school graduates through the vulnerable teen years, PEPFAR intends to

provide additional funding. Caritas (an NGO body of the Roman Catholic Church) currently implements the primary school

scholarship program and will be funded through PACT to extend this support to secondary school. To be eligible, beneficiaries

will need to successfully complete their final year of primary school education in 2008, or have successfully completed it in 2007,

and not have other means of paying for school fees such as through household income or other bursary programmes offered by

government or by other NGOs. To provide a safety net and ensure their success, beneficiaries will also be provided with

psychosocial support through periodic mentoring workshops.

6) Economic strengthening for vulnerable households - With initial support from USAID through Technoserve, Caritas is

implementing an income generating activity focused on beekeeping and honey production. The activity is well-structured and

closely monitored. Market analysis reveals tremendous unmet demand. PEPFAR will fund Caritas through PACT to extend this

activity to child and grandparent headed households. To be eligible, beneficiaries will need to be from a child or grandparent

headed household within a high productivity beekeeping area, have no other source of income and a demonstrated interest in

beekeeping. Priority of participation will be given to out of school youth. Training delivered to grandparents will also include

modules on caring for OVCs.

Products/Outputs: Approved Children's Policy and Bill, Child Justice Act, Domestic Violence and Sexual Offences Bill and Social

Welfare Policy; Established PPP for child protection.

In an effort to consolidate the program under pre-Compact funding levels, PEPFAR phased out of OVC programming in

Swaziland. Additional funding offered through a Compact would provide PEPFAR with the important opportunity to re-engage and

become a key national partner in the OVC program area. Without Compact funding, an OVC Program Specialist will not be

recruited and new OVC activities will not be pursued. Support for additional Peace Corps Volunteers to serve in expanded

community-based OVC and prevention activities are not included in the pre-Compact program budget.

Table 3.3.13: