ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS:

Economic Development

AMREF's women's association project will be piloted as a strategy of alleviating the plight of rural women.

Under this initiative, women from the communities where the project is operating will be encouraged to

group themselves and will be advanced a small loan from PEPFAR funding that will belong to the group.

The model being followed here is the Care Voluntary Savings and Loan project currently being implemented

with PEPFAR. Each group then develops a code of conduct on how the group will function, including the

interest that will be charged on borrowed funds and defaulters. Individual members from the group will then

borrow from the group at a nominal interest. At the end of the year, the profits will then be shared amongst

the group members with the initial seed money being returned to the pot for use again the following year. It

is envisaged that these associations will present opportunities for income generation for community health

workers and children from disadvantaged families to participate. These income generating activities will be

developed following locally focused operational research on niches in the local market conditions that could

be exploited. Also leveraged will be the experience generated by other PEPFAR partners. The main

outcome of this activity is that women's access to income and productive resources will be increased.

Human Capacity Development

For human capacity development, the focus will be on partner training and incentives for care workers.

Partners will be trained on activities that enhance service delivery such as home-based care (HBC), first

aid, counseling, monitoring and evaluation. Other areas that will be supported include management and

leadership development for staff to reduce staff turnover. Support for staff salaries will be a key priority area

as currently there is a high volunteer turnover due to unfavorable work conditions and low morale. Some of

the strategies that will be introduced include experience related remuneration systems, incentives for staff,

team building exercises as well as procurement of materials and equipment to enhance how work is done.

The trainings will focus on HBC-specific training support certified by the South African Government (SAG).

Additional training for HBC care workers is to be leveraged through creating synergies with the OVC aspect

of this project. For example, joint trainings can be conducted in basic first aid and counseling where children

will be the primary beneficiaries, with HBC clients also benefiting from the skills. Meanwhile, incentives,

such as stipends for 200 care workers, will be subsumed under partners contractual costs

Gender

AMREF will seek to address the gender imbalances that currently exist within the community. This will be

done through promoting the participation of men in the provision of care at the community level. It is

projected that the inclusion of men in the provision of care will challenge the gender stereotypes that

currently exist. Males will be trained on identifying cultural practices that promote inequality and then

identifying cultural practices to replace the harmful ones that currently exist.

Particular emphasis will be placed on the involvement of male volunteers in care provision as the presence

and participation of men compliments unity in the real family setting. Secondly, male volunteer presence will

be a clear message that men also care about the impact of disease and death on the family and community.

This will also challenge the notion that salaried jobs are for men whilst the lesser paying and often voluntary

jobs are for women since men will now also be working as volunteers. Both of these interventions will

address male norms and behaviors, related to the PEPFAR emphasis areas.

Alignment with the National Strategic Plan (NSP) or other SAG policies or plans

At the organizational level, the project develops the capacity of community-based organizations to

strengthen financial, project management and governance systems. This is done through the development

of systems that are then used within these organizations to ensure effective and efficient implementation of

activities that are in line with the NSP's objective of increasing the number of organizations accessing

organizational and program support.

The program's reliance on community home-based care workers also ensures that capacity at the local

level is developed and community care workers develop career paths that they are comfortable with. In

addition the project also provides training to community health workers to ensure that their capacity is

developed. Currently, AMREF's training unit is working with the health and welfare services sectoral training

authority (HWSETA) on the accreditation of the training that AMREF is providing to CHWs. This program

approach is aligned to the NSP's goal of expanding community home-based care as part of the expanded

public works program.

-------------------------

SUMMARY:

The African Medical and Research Foundation (AMREF) will strengthen the capacity of South African

district government departments, Child Care Forums (CCFs), NGOs and CBOs, and service providers to

provide quality and accessible care and support for family members and caregivers through training,

mentoring, awareness raising and advocacy. Emphasis areas for this program are local organization

training and capacity building. Target groups for the program include family members and children older

than 18 years, caregivers of OVC, community and public sector health and social service workers.

BACKGROUND:

AMREF is an international health and development NGO working in East and Southern Africa. In South

Africa, AMREF previously worked in Mpumalanga from 2001 to 2004. This work focused on strengthening

Activity Narrative: community caregiving infrastructures for OVC, including the improvement of capacity and integration of

service providers and government departments. Building on the OVC initiative in Kwazulu-Natal and

Limpopo province, AMREF has formed partnerships with key government and civil society stakeholders in

both Limpopo (Sekhukhune district) and KwaZulu-Natal (Umkhanyakude district). In these two particular

districts, in which 55% and 57% respectively of the population are under the age of 18. According to the

2006 antenatal survey, KZN has the highest HIV prevalence rate in the country at 20.6% whilst Limpopo

has a prevalence rate of 11.7%. AMREF has identified the need to develop a comprehensive program to

address the needs of other family members of HIV-infected individuals and OVC who are in need of

palliative care services. The project will be implemented in Kwazulu-Natal where the OVC project is being

implemented. AMREF's work is closely aligned to the aims of the Department of Social Development's

National Action Plan for OVC and the HIV and AIDS and STI National strategic plan 2007-2011.

ACTIVITY 1: Comprehensive Care for Family Members

The project will seek to facilitate access to health services to address needs of children and adults over 18

who are no longer classified as OVC under the South African constitution as well as PEPFAR guidelines.

The palliative care project recognizes that, while formal health services may provide episodic advice and

medical and material supplies, only community supporters/carers provide continuous patient care.

Currently, partners that AMREF is working with already have volunteers who are already offering home-

based care services, these volunteers will be trained to assess family members in need of palliative care

services since there are already dealing with and have experience in the provision of palliative care. These

services include assistance on how to manage common conditions associated with HIV and AIDS

opportunistic infections e.g. dealing with pressure sores, wound dressing etc. In addition, assistance will be

provided on how to deal with stigma and emotional trauma, grief management, assisting family members to

prepare for death psychologically, spiritually and physically. In addition, any households with family

members in need of palliative care that will have been identified by the OVC supporters will be given to the

home-based care volunteers for them to be entered into the palliative care program. The same will apply to

any OVC who will have been identified by home-based care supporters. Particular attention will be given to

child headed households and elderly headed households that may have a limited capacity to respond to the

needs of the sick family member. OVC will be counted in the OVC program area and eligible family

members will receive at least two categories of service from clinical/physical, psychological, spiritual, social

and preventive care.

1.1 Recruitment and Training of Volunteers

The project will not recruit new volunteers to implement the palliative care intervention but will utilize the

already existing volunteers who are already working on the home-based care intervention. Volunteers will

be encouraged to work within the neighborhoods where they reside in order for them to cover the area

adequately as well as minimize traveling time and concentrate on service provision. Training of volunteers

will be aimed at strengthening the services that they are already delivering under the department of health's

community home-based care program. This training will cover areas such as general health, common

diseases, health and hygiene as well as nutrition and wellness. In addition, AMREF will use its home-based

care manual to train volunteers in the delivery of home-based care services. Furthermore, volunteers will be

trained in the delivery of non-clinical services such as psychosocial support, health education as well as

basic HIV and AIDS prevention education for the family members. Care workers and providers will be

trained to conduct basic health care needs assessments, provide first aid and refer for clinical services that

include screening for pain and symptoms, diagnosis, doctor consultations and treatment. Carers will link

with local clinics and hospitals to ensure the provision of quality follow-up support for sick family members.

AMREF will link with established service providers in the area to provide clinical care for patients and family

members in need. One provider that AMREF intend collaborate with is Mpilonhle which is based in

Mtubatuba and operate a mobile medical unit and thus are best placed to conduct clinical assessments of

patients identified by AMREF's trained care supporters. The Africa Center will also be a potential AMREF

partner on the palliative care project.

1.2 Non Clinical Services Provided

Some of the services that AMREF's partner will provide include psychosocial support and counseling

services to clients identified within the home. Family members will also be taught on how to deliver home-

based care services to build their capacity to give palliative care to family members in the absence of the

community care supporters. Some of the services that they will be trained to deliver include medicine

administration, providing social and psychological support as well as how to deal with common conditions

such as skin conditions, bed sores, diarrhea, nausea and mouth infections as well as pain management.

Family members will also be provided with HIV prevention education to reduce the likelihood of infection

during the process of giving care to the sick family member. Other services that will also be provided include

home cleaning and washing services and food preparation. AMREF's role on the program will be to provide

technical assistance to partners in the implementation of the program. Technical support will be focused on

training of the partners' volunteers in the delivery of palliative care services. The training will focus on

monitoring and evaluation of their activities concerning the services that clients receive including training in

supervisory techniques aimed at ensuring that volunteers work and deliver the appropriate services to

clients as well as ensuring that services are of an exceptionally high standard.

ACTIVITY 2: Wellness Programs for Caregivers

The wellness model that AMREF will implement for caregivers will empower caregivers and help them

develop healthier lifestyles and enhance wellness in both the individual caregivers as well as their families.

AMREF will also use PEPFAR funding to conduct wellness programs, in collaboration with sub-partners, for

volunteer caregivers through facilitating linkage with the health care centers and Counseling and Testing

centers (clinics/hospitals) to ensure that carers receive the non-clinical (psychosocial support, spiritual

counseling, nutritional counseling) and clinical care (screening, diagnosis, doctor consultations, treatment,

and follow-up care) required. Volunteers will seek to transfer the knowledge and the skills that they will have

received from AMREF so that family members are able to provide care and support to family carers.

AMREF will also work with the CBO partners and the health care centers to develop support groups to

Activity Narrative: share coping skills and provide a support system for caregivers. Community care supporters will be

encouraged to form community carers forums aimed at building solidarity among care supporters, reduce

burn out and improve service delivery to clients. The community care forums will also present opportunities

for care supporters to socialize; provide each other with literacy training; health education; coping advice;

counseling and social support.

ACTIVITY 3: Capacity Building for Community partners

AMREF will continue to develop the capacity of community-based organizations by strengthening training

and systems development, support and follow-up for CBOs/NGOs engaged in palliative care and OVC

service delivery, including financial management, program and management skills, leadership and

governance and resource mobilization training. AMREF will train the selected partner organization selected

NGO workers and community care workers in psychosocial support and counseling for family members of

HIV-infected and OVC.

These activities will contribute to the PEPFAR goal by providing care to 10 million people who are HIV-

infected and family members of HIV-infected and OVC.

New/Continuing Activity: Continuing Activity

Continuing Activity: 13372

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

13372 12360.08 U.S. Agency for African Medical 6454 4626.08 $194,000

International and Research

Development Foundation

12360 12360.07 U.S. Agency for African Medical 4626 4626.07 $200,000

International and Research

Development Foundation

Emphasis Areas

Gender

* Addressing male norms and behaviors

* Increasing gender equity in HIV/AIDS programs

* Increasing women's access to income and productive resources

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $100,000

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Estimated amount of funding that is planned for Economic Strengthening $48,000

Education

Water

Table 3.3.08:

ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS:

Gender Programming:

The program will seek to increase women's access to income and productive resources through the

formation of women's associations. Women from the project areas will group themselves and be advanced

a loan that will belong to the group. Each group will develop a code of conduct on how the group will

function including the interest that will be charged on borrowed funds and defaulters. Individual members

from the group will then borrow from the group at a nominal interest. At the year end profits are shared

among the group members with the initial seed money being returned to the pot for use again the following

year. It is envisaged that these associations will present opportunities for income generation for community

health workers and children from disadvantaged families. These income generating activities will be

developed following locally focused operational research on niches in the local market conditions that could

be exploited. Also leveraged will be the experience generated by other PEPFAR partners. The African

Medical and Research Foundation (AMREF) will seek to replicate the voluntary savings and loan scheme

being implemented by Care.

Economic Strengthening:

In addition, AMREF will pilot an income generating initiative for OVC, partnering with Project Concern

International; a US-based NGO with experience in the implementation of income generating activities. The

primary aim is to develop agricultural income generating activities including food production and animal

husbandry. Children who have graduated will form associations who will then be provided entrepreneurial

training and skills on how to implement and manage an income generation activity. Each group will then be

asked to develop a proposal and then access funds from the project. It is anticipated that such initiatives

would lead to economic development of the area as it creates employment opportunities for children and

their families. It is planned that the income generation is targeted at OVC who have graduated. The initial

pilot seeks to benefit 50 children (25 per district).

Human Capacity Development:

Human capacity development activities will focus on training of community health workers (CHWs), and

project and management staff. For CHWs training will aim at equipping them with skills to enhance service

delivery. CHWs will be trained on how to identify, refer, support and monitor children. The scope of training

includes basic home-based care, counseling, support to home-based care, tuberculosis and ART clients, as

well as providision of nutritional support.

AMREF will focus on training of CHWs to improve service delivery. The use of job aids in rural communities

will be promoted. Job aids are materials that help a CHW perform the required tasks while providing a

sense of affiliation and enhancing the CHW's authority. Appropriate job aids also strengthen skills and are

invaluable in increasing confidence. Job aids that AMREF will pilot among community health workers are on

health education for children and community members:

Alignment with the NSP or other SAG policies:

AMREF's OVC project seeks to improve children's access to comprehensive services being provided by

civil society and government through the identification of children at the local level and referring them to the

relevant service providers that include Health, Education, Department of Social Development (DOSD) and

the South African Social Security Agency (SASSA). In situations where services cannot be obtained from

government, children are referred to other CBOs and NGOs for the relevant service. This is in line with the

National Strategic Plans (NSP) goal of developing and operationalizing mechanisms to identify, track and

link child-headed households to grants and other social services.

The project promotes the development of community structures that enhance the communities' response to

the plight of OVC. This is done through the creation of child care forums at the district and ward levels to

ensure that each ward in which the project is being implemented has a platform to identify children and

address their needs.

The project also seeks to increase the number of children accessing services from government

departments. Through activities with the different agencies above,,the project is working towards the NSP's

objectives of increasing the number of children accessing grants and essential registration. Referrals by

service providers will also increase children's access.

In addition, the program's reliance on community home-based care workers also ensures that capacity at

the local level is developed and community care workers develop career paths. This program approach is

aligned to the NSP's goal of expanding community home-based care as part of the expanded public works

program.

-------------------------

SUMMARY:

The African Medical and Research Foundation (AMREF) will strengthen capacity of South African district

government departments, Child Care Forums (CCFs), NGOs and CBOs, and service providers to provide

quality and accessible care and support for OVC, through training, mentoring, awareness-raising and

advocacy for children's rights. Emphasis areas for this program are training, gender (addressing male

norms and behaviors and reducing violence and coercion and local organization capacity development.

Target groups include OVC (0-18yrs) and their caregivers.

BACKGROUND:

AMREF is an international health and development NGO working in East and Southern Africa. In South

Activity Narrative: Africa, AMREF previously worked in Mpumalanga (from 2001 to 2004) strengthening community care-giving

infrastructure for OVC, including the improvement of capacity and integration of service providers and

government departments. Building on this initiative, AMREF has formed partnerships with key government

and civil society stakeholders in both Limpopo province (Sekhukhune district) and KwaZulu-Natal (KZN)

province (Umkhanyakude district). In these two particular districts, in which 55% and 57% respectively of

the population are under the age of 18, AMREF has identified the need to develop a comprehensive

program to address the needs of OVC by strengthening collaboration between, and capacity of, local

service providers, government and civil society groups. The districts are presidential rural nodal points

recognized by the SAG as the poorest and most under-resourced districts in South Africa. The NDOH

(2006) survey reported that KZN and Limpopo have high HIV prevalence rates (20.6% and 11.7%,

respectively) and a high number of OVC (57% and 55% respectively). Currently, AMREF has seven local

partners providing services to OVC located in sites in Sekhukhune and Umkhanyakude districts of KwaZulu-

Natal and Limpopo provinces, respectively where intervention will continue with FY 2007 PEPFAR funding.

Each of these partners, in turn, work with an average of three second line partners who spearhead

identification of children and servicing of these children within their locality. In FY 2008, AMREF is

proposing to add a new partner (Ndumo Drop-In Center) to be contracted as one of AMREF's first line

partners to increase reach and improve access to services in Umkhanyakude. AMREF work is closely

aligned to the aims of the Department of Social Development's (DOSD) National Action Plan for OVC as

well as the National HIV and AIDS Strategic Plan (2007-2011).

ACTIVITIES AND EXPECTED RESULTS:

ACTIVITY 1: Human Capacity Development

With FY 2008 PEPFAR funding AMREF will provide training, mentoring and on-site support to its eight

established CBO partners (first line partners) and their individual networks of emerging community groups

(second line partners) to strengthen care and support systems for OVC in the two districts. AMREF's first

line partners are those partners who have signed contracts with AMREF and receive sub grants from

AMREF and have been registered as community-based organizations (CBOs). Second line partners on the

other hand are community groups that have been formed to address needs that will have been identified in

their communities such as home-based care and orphans and vulnerable children. AMREF will focus on

system development at community level for first line level and service delivery at second line partner level.

For AMREF's first-line partners, capacity development activities will include training in financial, project,

organizational and human resource management. In addition, they will be trained in supportive supervision

to ensure that volunteers do the work they are supposed to do and that the quality is of a high standard.

AMREF will also provide capacity building support for second line partners from where most of the children

are identified and serviced. Particular attention will be on the identification, referral and support mechanisms

to ensure that children who will have been identified receive a comprehensive package of services. Second

line partners will receive essential training in the identification, servicing and referral system that has been

developed.

ACTIVITY 2: Care and Support Services

AMREF-trained community care workers and service providers will provide a comprehensive care and

support package for children requiring psychosocial, nutritional, educational and health care support.

Trained service providers will identify OVC and conduct needs assessments, home-visits, and psychosocial

support, provide nutritional support and counseling, and life skills training and homework supervision. In

addition, AMREF and its partners will also provide assistance with SAG social security grant applications,

succession planning and birth registration as well as on-going monitoring and follow-up for other essential

services including access to primary health care protection services, and information on HIV prevention and

interventions to reduce gender-based violence (GBV). AMREF will also continue to ensure that OVC under

five years access health care through integrated management of childhood infections (IMCI) and the

expanded immunization program (EIP) supported by UNICEF. This service package is provided directly to

OVC by the Children's Drop in Centers, CCFs, CBOs and NGOs including home-based care organizations.

Health practitioner capacity has often been cited as presenting a barrier for children and adolescents to

access health services. AMREF will strengthen the skills base of health care professionals in the delivery of

child friendly health services. AMREF also will work with the local clinics and health service providers to

promote provision of reproductive health service, counseling and testing, management of sexual violence as

well as information and counseling on development including nutrition, hygiene, and substance abuse. This

will be a major focus aimed at reducing death and disease, deliver on the rights of the children and

adolescents to health care

ACTIVITY 3: Strengthening district and civil society capacity and coordination

To ensure sustainability of support for OVC, AMREF will provide training in program design, planning and

implementation, monitoring and evaluation as well as technical support for government at district and

municipality levels (including District AIDS Council). AMREF will facilitate improved collaboration between

departments and integration of services by organizing and facilitating regular inter-agency/ departmental

meetings and forums. AMREF will provide organizational strengthening training and systems development,

support and follow-up for CBOs/NGOs engaged in OVC service delivery, including financial and program

management skills, leadership and resource mobilization training. AMREF will train selected NGO workers

and community care workers in psychosocial support and counseling for OVC. To cope with the number of

children in need of care, the establishment of community care structures is essential. AMREF will build on

the childcare forums that will have been established and strengthen these structures. CCFs will be key in

the identification and support of orphans through community-based care and support program. CCFs will

continue to be established in every ward and strengthened.

ACTIVITY 4: Community-level Advocacy

In FY 2008 AMREF will conduct consultations with civil society and government stakeholders to determine

Activity Narrative: community level advocacy issues. In response, AMREF will train youth, caregivers, service providers on

advocacy skills and planning and assist to develop strategies to advocate for changes to SAG policy and

practice concerning OVC, identify and work to eliminate bottlenecks in service provision and mobilize

resources. AMREF will facilitate and support advocacy meetings with traditional leaders, local and district

government. AMREF will also continue to support CCFs in their advocacy role at community level on behalf

of OVC. Specifically, AMREF will provide CCF members with training to support advocacy against GBV,

especially against female OVC. Some of the major challenges that orphans face include lack of access to

adequate treatment and care services, loss of property and lack of protection from abuse and exploitation.

AMREF will partner with organizations such as Legal AID, mobile clinical service providers as well as other

civil society and community-based organizations to ensure that there is synergy in the implementation of

program and that children get a comprehensive package of services.

ACTIVITY 5: Gender Mainstreaming

This component will build on the peer education initiative pilot that was started in 2007. Male OVC will be a

key group of focus under this initiative. The gender-mainstreaming component seeks to increase the

participation of male OVC in the provision of care to other children as well as address the gender

stereotypes that tend to predispose female OVC to abuse. Male OVC will be educated on the norms and

behaviors that promote equality of the sexes. AMREF will use PEPFAR funds to continue training and

supporting community care workers, partners and other stakeholders (e.g. traditional leaders, teachers,

health workers, social workers) to mainstream gender into the delivery of a comprehensive service package

for OVC. AMREF will work with OVC service providers and stakeholders to develop and implement gender-

based violence awareness campaigns with specific focus on vulnerable populations such as female OVC

and the disabled. In addition, AMREF will work to sensitize parents and teachers to mainstream gender

issues in life skills training. Gender mainstreaming will include training on gender roles, gender-based

violence recognition and prevention, male/female norms and behaviors in OVC identification, referral, care

and support.

New/Continuing Activity: Continuing Activity

Continuing Activity: 13373

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

13373 6562.08 U.S. Agency for African Medical 6454 4626.08 $2,231,000

International and Research

Development Foundation

7915 6562.07 U.S. Agency for African Medical 4626 4626.07 $1,750,000

International and Research

Development Foundation

6562 6562.06 U.S. Agency for African Medical 4104 4104.06 AMREF $1,000,000

International and Research

Development Foundation

Emphasis Areas

Gender

* Addressing male norms and behaviors

* Increasing gender equity in HIV/AIDS programs

* Increasing women's access to income and productive resources

Health-related Wraparound Programs

* Child Survival Activities

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $400,000

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Estimated amount of funding that is planned for Food and Nutrition: Commodities $50,000

Economic Strengthening

Estimated amount of funding that is planned for Economic Strengthening $100,000

Education

Estimated amount of funding that is planned for Education $50,000

Water

Table 3.3.13: