INTEGRATED ACTIVITY FLAG:

This activity relates to Ingwavuma Orphan Care activities in OVC (#8245). This partner may benefit from the Partnership for Supply Chain Management ARV Drugs activity (#7935), which will explore current pain and symptom management practices, drug availability and cost, and provide recommendations.

SUMMARY:

Activities are carried out to expand the current home-based care project through recruiting and training of lay caregivers and to provide medical support in the way of hiring and training nurses and medical supplies. The primary emphasis is on human resources, with additional emphasis on local organization capacity development, development of network/linkages/referral systems and training. Specific target populations are people living with HIV and AIDS, HIV-affected families, and caregivers of people living with HIV and AIDS.

BACKGROUND:

This project started in 2002 and was expanded in 2003 to include additional patients and caregivers. It has not previously received any U.S. Government or PEPFAR funding, but is a member of the Hospice and Palliative Care Association (HPCA) and thus has benefited indirectly from PEPFAR through mentoring and support of the HPCA medical director and professional nurse. The project works closely with Mosvold Hospital and its clinics in KwaZulu-Natal, with referrals in both directions. The hospital supplies the project with drugs, food and nursing supplies. The project is also partially funded by the provincial Department of Health/European Union Partnership. Most of the caregivers are women and the project provides them with education and a regular income. Male caregivers provide good role models to show that men can also be caring and look after the sick.

ACTIVITIES AND EXPECTED RESULTS:

ACTIVITY 1: Improving/Expanding Health Services

Ingwavuma Orphan Care (IOC) will use PEPFAR funding to improve and expand its health services. IOC currently has one nurse trained in palliative care, a chaplain to offer spiritual support, 28 paid caregivers, and is in the process of recruiting a second nurse. This project offers training and employment for volunteers, all of whom are affected by HIV, as home-based caregivers.

The home-based caregivers live in their own communities spread across 2,100 square kilometers of the health district. They work in teams of 1-4 caregivers plus several local untrained volunteers. They visit people who are ill, providing basic nursing care and ensuring delivery of the elements of the preventive care package, psychological, social and spiritual care. Family members are taught basic nursing techniques and about hygiene and nutrition. The caregivers distribute items such as gloves to promote infection control. If they suspect that a patient is HIV-infected, they will counsel them about the need for testing and encourage disclosure and testing of the whole family. Clients who test positive are then referred to the nearby local Department of Health (DOH) clinics and hospital for administration of ARVs. Caregivers follow up on referrals to ensure that patients have received the necessary care and understand medication instructions. Effort will be made to ensure equitable access to care services for both males and females (key legislative area).

The teams of caregivers are visited by the nurses and chaplain 1-2 times a month ensuring the delivery of elements of the preventive care package. The nurses and chaplain, together with the caregivers, then visit the clients needing specialized care. The nurse carries a basic supply of drugs, including cotrimoxazole, pain medication and treatment for opportunistic infections. Nurses collect sputum samples if TB is suspected and deliver the sample to the nearest clinic for analysis. If the results are positive, the client is referred to the DOH clinic for DOTS. The chaplain visits clients who request spiritual support.

The project also advocates to government sources for HIV-affected families who do not get enough food from. The open and caring attitude of the caregivers helps to reduce

discrimination and stigma against those who are HIV-infected. The caregivers counsel relatives and neighbors who exhibit discriminatory behavior against the clients. Vulnerable children in the families are identified and referred to the OVC branch of the project. Bereavement support is provided, if necessary.

PEPFAR funding will allow the project to employ nearly twice as many trained home-based caregivers, which will result in nearly twice as many patients receiving care. It will also contribute to the support of the clients through medical personnel and medical supplies. This funding enhances the support already given to the project through the DOH, which contributes to some of the existing caregivers' salaries and project running costs. The project will aim to recruit volunteer nurses (key legislative area) from the United States to assist with ongoing supervision and in-service training of the lay caregivers.

ACTIVITY 2: Caregiver Training

The main objective of the training is to increase skills in delivery of quality palliative care services including elements of the preventive care package. Lay caregivers are trained by a former home-based caregiver, who is assisted by the nursing staff, paralegals, a social worker, and other staff. Subjects covered in the training include HIV counseling, basic nursing, TB and ARV support, screening for pain and symptoms and methods of encouraging clients to start and continue taking ARVs or TB medication properly. Volunteer caregivers will be trained at IOC's training centre, doing their practical training at Mosvold Hospital. This 56-day training is in line with the South African DOH guidelines for home-based caregivers. At the end of the training these caregivers could be employed by the project to further extend the reach of home-based care support, funds permitting.

These results contribute to the overall PEPFAR objectives of 2-7-10 by increasing the number of people trained as home-based caregivers, increasing the number of people receiving palliative care, and increasing the quality of palliative care services.

INTEGRATED ACTIVITY FLAG: This activity also relates to Ingwavuma Orphan Care's Basic Health Care and Support activities (#8244).

SUMMARY: Ingwavuma Orphan Care (IOC), in partnership with Lulisandla Kumntwana (LK), provides psychosocial, educational and nutritional support to OVC and facilitates access to government grants and other social services. Activities aim to extend the reach of OVC projects in Ingwavuma and Mseleni areas of Northern KwaZulu-Natal. The primary emphasis area for this project is human resources, with additional emphasis on local organization capacity development, development of network/linkages/referral systems and training. The primary target populations are OVC, HIV-infected children, and caregivers of OVC.

BACKGROUND: This project is part of the work of two organizations, Ingwavuma Orphan Care (IOC) and their partner Lulisandla Kumntwana (LK), which began their work in 2000 and 2002, respectively. The organizations work in adjacent districts in Northern KwaZulu-Natal, covering an area of around 4,000 square kilometers between them. There are thought to be about 10,000 orphans (both parents deceased) in this area. Most of the other 100,000 children under 18 in the region could be said to be vulnerable. The organizations have been networking with each other since 2002 and benefit from this partnership through sharing ideas, information and resources, and occasionally loaning each other staff with particular expertise. Both organizations are new to PEPFAR and are registered as Welfare Organizations with the South African Department of Social Development (DoSD). Three of their social workers are funded by the DoSD. IOC also has strong links with the Department of Home Affairs and its paralegal officers assist clients with getting their applications in order to secure birth certificates, death certificates and identity documents from this department. LK works closely with the Department of Health, which refers OVC to LK and helps facilitate psychosocial workshops that train boys and girls in life skills, gender issues, and sexual education. LK also has an MOU with the local Department of Welfare to ensure that there is no duplication of services and to facilitate sharing of information, skills, and resources. These projects address gender by reducing the burden on girls and women of caring for OVC and reducing the need for teenage girls and young women to use sex to get food. The youth clubs and psychosocial workshops described below provide a forum for young people to discuss gender issues and for young girls to boost self-esteem and build self-confidence.

ACTIVITIES AND EXPECTED RESULTS:

ACTIVITY 1: Service Delivery Improvement and Expansion In FY2007 with PEPFAR support, IOC and its partner LK will expand their current OVC services. A satellite office will be established in Manyiseni, a village 60 kilometers from Ingwavuma. A paralegal officer and an orphan coordinator will be based at this office to assist families to access appropriate services. LK will also increase its staff to include a paralegal officer and another orphan coordinator. The orphan coordinator will mobilize, train and support teams of people from local churches who will regularly visit OVC and their caregivers and assist them practically, spiritually, emotionally and socially. This will lessen the burden of OVC care on women and girls, as many of the caregivers for OVC are elderly grandmothers and female OVC. Training of the team members includes child abuse awareness, how to refer children to other services, and addresses the area of reducing violence and coercion. The coordinator will distribute food and clothes to those in need, refer families to the social worker to access foster care grants and deal with cases of child abuse, and refer children in need of health care to the home-based care teams, HIV support groups or local clinics. The paralegal officer will assist families in getting the documents they need to apply for the grants. A housing project is also ongoing, rebuilding houses for some orphan families whose houses have collapsed. The team will ensure that OVC are attending school and will provide uniforms if needed.

ACTIVITY 2: Capacity Building The organizational capacity of both IOC and LK will be enhanced. This will include training of existing staff and employing and training additional management staff to improve sustainability. Training provide to the IOC and LK staff will include driving lessons,

computer literacy, project management skills and advocacy skills. Another key feature will be the development and implementation of a database to provide clear information on the work done by the field staff and volunteers and show how many children are receiving at least three of the nine key OVC interventions. This will allow managers to monitor activities and develop quality improvement plans.

ACTIVITY 3: Foster Care Facilitation With FY 2007 PEPFAR funding, LK will continue to run a fostering agency to identify children in need of care and place them with qualified community families. LK employs two social workers to facilitate this process. LK will recruit foster parents, who will attend parenting workshops run by the organizations. IOC will set up an MOU with the DoSD at Ingwavuma to avoid duplication of services. DoSD will assist with advice and overseeing IOC's work. The social workers will investigate home circumstances, screen the foster parent, and assist the children in accessing birth and death certificates. The social workers take the family to the Children's Court at Ubombo (60km away) where the children are officially placed in foster care. The family is then able to apply for the government foster care grant. The social workers continue to supervise the placement to ensure quality of care and timely application for foster care renewal.

ACTIVITY 4: Memory Boxes IOC and LK will help HIV-affected families create Memory Boxes for OVC. Memory boxes are created by the parents, and consist of a collection of important documents, photos, meaningful items, and stories about themselves. This then serves as a memento for the children once the parent has died and the documents make it easier to sort out a government foster care grant for the children. IOC and LK will each employ a Memory Box worker. Community team members will also be trained in Memory Box work. Support groups for HIV-affected and infected children will be established and implemented.

ACTIVITY 5: Youth Clubs FY 2007 PEPFAR funding will support 10 after-school youth clubs that IOC currently runs in 10 primary schools, in addition to youth clubs that both IOC and LK will establish and run at their centers. These youth clubs will develop the life skills and spiritual growth of youth in general, and orphans and vulnerable children in particular. The life skills program in the youth clubs and the psychosocial support workshops will include training for youth on male norms and behaviors and violence avoidance. The support offered to OVC through these clubs also enables young girls, who are especially vulnerable to abuse, teenage pregnancy, and HIV-infection, to develop self-respect and self-esteem and to develop strategies to protect themselves. Training for both girls and boys will include discussion on the challenges of early sexual activity, the benefits of abstinence, and the importance of faithfulness for life with one partner. Youth clubs and workshops encourage OVC to remain in school and offer help with homework supervision and support.

These activities contribute to the overall PEPFAR 2-7-10 goals by contributing to the 10 million people provided with care, including OVC so that OVC are able to grow up in their own communities with their basic needs and rights fulfilled.