PEPFAR's annual planning process is done either at the country (COP) or regional level (ROP).
PEPFAR's programs are implemented through implementing partners who apply for funding based on PEPFAR's published Requests for Applications.
Since 2010, PEPFAR COPs have grouped implementing partners according to an organizational type. We have retroactively applied these classifications to earlier years in the database as well.
Also called "Strategic Areas", these are general areas of HIV programming. Each program area has several corresponding budget codes.
Specific areas of HIV programming. Budget Codes are the lowest level of spending data available.
Expenditure Program Areas track general areas of PEPFAR expenditure.
Expenditure Sub-Program Areas track more specific PEPFAR expenditures.
Object classes provide highly specific ways that implementing partners are spending PEPFAR funds on programming.
Cross-cutting attributions are areas of PEPFAR programming that contribute across several program areas. They contain limited indicative information related to aspects such as human resources, health infrastructure, or key populations programming. However, they represent only a small proportion of the total funds that PEPFAR allocates through the COP process. Additionally, they have changed significantly over the years. As such, analysis and interpretation of these data should be approached carefully. Learn more
Beneficiary Expenditure data identify how PEPFAR programming is targeted at reaching different populations.
Sub-Beneficiary Expenditure data highlight more specific populations targeted for HIV prevention and treatment interventions.
PEPFAR sets targets using the Monitoring, Evaluation, and Reporting (MER) System - documentation for which can be found on PEPFAR's website at https://www.pepfar.gov/reports/guidance/. As with most data on this website, the targets here have been extracted from the COP documents. Targets are for the fiscal year following each COP year, such that selecting 2016 will access targets for FY2017. This feature is currently experimental and should be used for exploratory purposes only at present.
Years of mechanism: 2007 2008 2009
ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS
ACTIVITY 1: This has linkages to the orphans and vulnerable children (OVC) and palliative care
components of Ingwavuma Orphan Care (IOC). Clients will be targeted for prevention and care. The
conceptual framework for this is that providing regular advice from knowledgeable adults and ongoing one
to one or group counseling will provide an environment in which the OVC are more likely to abstain from sex
or delay onset of sexual intercourse. Children in the OVC program will be educated about the benefits of
abstaining from sex, dangers of indulging in sex for money, risks of concurrent partners, alcohol and drug
abuse leading to inhibition, Teaching will be on a one to one basis or at group meetings. This intervention
will be of particular benefit in reaching out-of-school youth.
Adults in the palliative care program will be taught about the risks of re-infection and the benefits of
abstaining or remaining faithful to one partner while using condoms. Alcohol use and its effect on HIV
spread will be discussed. This education will take place when caregivers visit clients at home and at support
groups. As the educators have ongoing contact with their clients, there will be many opportunities to
reinforce messages and discuss how the client can practice positive prevention in his/her context.
ACTIVITY 2: The conceptual framework for this activity is that by strengthening the churches and
developing a church culture of promoting abstinence and faithfulness (AB), HIV will be reduced in church
attendees. Church leaders (120) will continue to be taught and supported to talk about AB with their
congregations. A review of available material will be made in order to find an appropriate curriculum to
follow. The aim is to find a program that will allow for ongoing prevention messages coupled with activities
that will produce an enabling environment. This should make such activities become part of the norm of
church culture, thus promoting sustainability of the prevention program. The church leaders will target their
programs at youth and also at adults both married and single. The voluntary counseling and testing (VCT)
program will be available to provide services to churches whose congregations request it.
ACTIVITY 3: The conceptual framework of this activity is that strengthening families will lead to increased
faithfulness in the marriages and so reduce the risk of HIV. Secondly, good family values will be passed on
to the children in the family also reducing their risk of HIV infection. Family counseling will continue. The
counseling provided will aim to challenge male and female norms, stressing the need for faithfulness by the
husband and empowering the wife or wives in the relationship. This activity will be linked to the VCT
program so that couples can easily access VCT and know their status.
ACTIVITY 4: Staff trained in giving prevention messages will be assessed in how the training has improved
their work. Additional training needs will be identified and the training provided.
NEW ACTIVITY: The conceptual framework for this is to strengthen abstinence among youth attending
school Christian unions. The youth who attend Christian unions follow a faith that believes in abstinence
until marriage then faithfulness within marriage. However the youth lack skills and knowledge in how to put
this into practice. School abstinence clubs will be set up. Selection criteria will be developed to screen
potential Youth Club Facilitators and a review of available curricula and training materials will be made
before the program starts. The facilitators will then be trained to use the chosen material and receive regular
supervision during the program's duration. This activity uses a risk avoidance approach to sexual prevention
that is appropriate for IOC's target group of youth 10 to 14 years of age. It uses peer groups to reinforce
abstinence messages, geared at promoting abstinence and delaying sexual initiation. The involvement of
schools help to expand the reach and scale of HIV and AIDS education programs, as young people spend a
considerable amount of time in this setting.
It is envisioned that as part of the program, club members will wear "abstinence rings", which are steel rings
earned by youth club members after they have nurtured a seedling into a small tree. The ring then reminds
them of their promises and obligations to the group to remain abstinent. Youth Club Facilitators will start
abstinence clubs in fifteen schools every four months. The schools will be chosen to be close to active
community groups that are already working with us so that they will be able to help publicize and support
the program. The youth club facilitators will continue to encourage each group, ensure its constitution is
adhered to, ensure that its members are taking initiative to encourage and support one another, and to help
solve problems that will arise among members of the clubs.
--------------------
SUMMARY:Ingwavuma Orphan Care will continue to strengthen and, in some cases, formalize new
prevention work, training its staff and volunteers to effectively advocate for and promote prevention,
abstinence and faithfulness among all its beneficiaries. The emphasis areas include gender and human
capacity building. The church congregations and families of clients in our programs for home-based care
will be the entry point to access the target populations which are adolescents, adults, religious leaders and
orphans and vulnerable children.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. 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 were
new to PEPFAR in FY 2007, and are registered as welfare organizations with the South African Department
of Social Development (DOSD). IOC and LK work closely with the Department of Health, which refers
orphans and vulnerable children (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 Memorandum of Understanding
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. These youth clubs
will be actively involved with prevention messaging and counseling as well as all the other programs of IOC
Activity Narrative: and LK. Prevention has always been a part of the activities of IOC and LK and the need has been identified
to further ensure its quality and scope through direct project management, support and monitoring; and also
through new specific prevention programs.ACTIVITIES AND EXPECTED RESULTS: ACTIVITY 1: Behavior
Change OutreachFamily Support Teams, comprised of volunteers recruited from local churches, provide
intensive care to OVC living in their immediate vicinity. The teams are supervised by Orphan Care
Coordinators and both conduct regular home visits to OVC. Home-based carers visit the homes of people
living with HIV and nurses, chaplains, youth pastors, social workers, and paralegals, facilitators of youth
clubs and support groups for HIV-infected people all have a strong opportunity to educate on behavior
change which includes encouraging youth aged 10-14 to abstain or delay sexual debut whenever they visit.
For older youth aged 15-24, secondary abstinence is encouraged while information on correct and
consistent condom use is provided for youth at risk and those who are sexually active. Education and
counseling is done with both HIV negative and positive people, through support groups for HIVinfected
people and counseling home-based care patients. IOC and LK will ensure all staff and volunteers are
trained to do this effectively through their normal process of line-management supervision and will
document and monitor the interventions using an innovative intervention monitoring database, described
below. ACTIVITY 2: Mobilizing Pastors to Counsel for HIV prevention: In FY 2007 Ingwavuma Orphan Care
meticulously built up relationships with many of the 800 pastors in the area, and a group of pastors, of all
denominations, requested that Ingwavuma Orphan Care provide them with training on HIV and AIDS and
prevention. IOC leadership training for pastors will be conducted in FY 2007/8, using Zulu source material
from Dr. John C. Maxwell. Training will be conducted over 5 months in 20 sessions and will be followed up
by the training of pastors to give prevention messages to their congregations along traditionally faith-based
lines, including fidelity and mutual monogamy. This messaging will encourage reduction of the number of
sexual partners and discouraging cross generational and multiple concurrent partnerships. Pastors, as
trusted members of the community, will also conduct abstinence workshops for youth. The pastors have
built a good relationship with the community members. They will first participate in HIV awareness
workshops and then prevention and abstinence workshops. Pastors will then in turn conduct these
workshops; targeting youth aged 10-14 before they initiate sexual activity. The workshops will be held at
churches, and will include health presentations from the IOC nurse. Using FY 2008 funding, this activity will
be scaled up significantly beyond the scope of the small pilot project that was implemented in FY
2007.ACTIVITY 3: Family Counseling: Ingwavuma Orphan Care holds workshops for couples once a month
for a period of six months, rotating around the different IOC areas, to strengthen marriages and families. A
program of oral and video presentations is given by locally-respected men and pastors, followed up by
individual family counseling initially with the parents and then with the whole family. Counselors will receive
additional training in marriage counseling and counseling in general by an external training provider. The
training includes a series on "How to Have a Successful Marriage" and opportunities will be sought to reach
mobile populations, specifically when husbands are home from the mines. Because its ethos is like a
traditional community meeting profile, with respected elders sharing the secrets of having strong marriages
and individual counseling to individual circumstances, this program has been highly popular since May
2007. Using FY 2008 funding, IOC will expand the couple's workshops throughout the municipal district,
reaching larger numbers of people with a very high quality and personalized intervention. The workshops
and counseling promote reduction of number of sexual partners and HIV testing with referrals to IOC's
testing program. The expected behavioral changes are strong and monogamous marriages; giving children
the family security they need to be successful and abstinent. The workshops specifically address male
norms and behaviors and address discrimination, abuse and coercion amongst women and girl
children.ACTIVITY 4: Training of Staff and Volunteers:An inter-disciplinary team of nurses, social workers,
chaplains, and orphan care coordinators, as well as a consultant with proven motivational skills will train
Family Support Teams. Training of IOC staff to provide prevention messages will occur every month at one
of the three staff team days. Training for pastors, including prevention messages for AB and methods of
disseminating this information to the community will occur once per month over three months.ACTIVITY 5:
Monitoring and Evaluation:IOC's sophisticated M&E system operates on a MySQL/ PHP/ Javascript
platform covering both home-based care and orphan care beneficiaries and field workers. Every contact
with a beneficiary by a field worker and every intervention are recorded by timesheet. Each intervention is
categorized according to the PEPFAR SASI indicators so that reporting is extremely simple. A Data Quality
Officer audits the data and verifies the interventions with home-visits on a rolling three-month audit program.
The Quality Improvement Manager and staff undertake regular client satisfaction interviews on visits to the
clients' homes after three or four months subsequent to the intervention and establish what IOC staff and
volunteers have done in practice and whether the client feels their behavior has changed.This activity will
enable IOC to reach hundreds of youth and adults with the abstinence and faithfulness messages. This
activity will contribute to the PEPFAR 2-7-10 goals of averting seven million infections by helping adults and
youth reduce risky sexual behaviors.
New/Continuing Activity: Continuing Activity
Continuing Activity: 13987
Continued Associated Activity Information
Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds
System ID System ID
13987 13987.08 U.S. Agency for Ingwavuma 6676 4749.08 $125,000
International Orphan Care
Development
Emphasis Areas
Gender
* Addressing male norms and behaviors
* Reducing violence and coercion
Health-related Wraparound Programs
* Family Planning
Human Capacity Development
Estimated amount of funding that is planned for Human Capacity Development $9,543
Public Health Evaluation
Food and Nutrition: Policy, Tools, and Service Delivery
Food and Nutrition: Commodities
Economic Strengthening
Education
Water
Table 3.3.02:
ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS:
ACTIVITY 1- Ingwavuma Orphan Care (IOC)'s linkages with OVC will be strengthened to allow earlier
referrals of children identified by the palliative care staff. At admission to the program, the caregivers
compile a genogram of the family. They therefore identify children in the household who might be made
vulnerable by the sickness and death of the patient. These children are referred to the OVC staff, who can
then assist with accessing documents, psychological support and planning who will care for the children in
future.
Prevention of HIV will be improved through counseling and testing sexual partners and children of HIV
clients, counseling discordant couples, diagnosis and management of sexually transmitted infections (STIs),
condom distribution, and encouraging adherence to antiretroviral therapy (ART).
Caregivers are supported by regular supervision sessions, monthly in-service training, access to a trained
counselor and end of year social functions. Caregivers are also provided with an occupational health
service which includes counseling and testing (CT) and ioniazid prophylaxis, where needed. This is run by
the doctor and professional nurses.
The doctor has a dispensing license and is responsible for the dispensary. Nurses are allowed to prescribe
up to Schedule 4 drugs. Senior caregivers will be trained and supplied with Schedule 0 medications which
are available to the general public without prescription. This is in line with task shifting.
ACTIVITY 2-Caregivers are trained in DOTS and TB and will provide support to patients on TB treatment.
There will be regular screening of HIV patients for TB and TB patients for HIV. IOC is receiving USAID
funding for TB work and so there are additional activities around TB, such as formation of TB support
groups, holding community awareness campaigns and workshops for TB patients.
ACTIVITY 3- Funding will be used to complete a 28-bed in-patient unit to provide care for patients who do
not have adequate support at home. The unit is being built with great attention paid to infection control as it
is anticipated that it will be used by terminally ill patients with multi-drug resistant (MDR) and extremely drug
resistant (XDR) TB.
ACTIVITY 4- Clients in support groups will be assisted with economic strengthening through income
generating projects. The comprehensive care and treatment package is implemented through the support
groups which IOC runs. Adherence support is achieved through support groups and also through home
visits by caregivers to clients who are taking ART. The caregivers provide ongoing counseling, education
and encouragement to clients taking ART and report any problems which occur to the nursing staff. Clients
who are taking TB treatment are offered home testing for HIV by the nursing staff. Clients who are HIV-
infected will be screened regularly for signs of TB by their caregivers. Caregivers will check that CD4 counts
are being checked six-monthly for all HIV-infected patients. Those who are unable to access testing at
government clinics due to illness, social or geographical reasons will be offered CD4 counts by IOC using
their own testing facility, All nurses and caregivers have been trained in palliative care provision. In addition
to the palliative care provided at home, IOC will open an in-patient unit for adults and children who cannot
be adequately cared for at home due to social, medical or other reasons.
--------------------------
SUMMARY:
Ingwavuma Orphan Care (IOC) 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 provision of medical supplies.
BACKGROUND:
This project started in 2002 and was expanded in 2003 to include additional patients and caregivers. IOC is
a member of the Hospice and Palliative Care Association (HPCA) and has benefited indirectly from
PEPFAR through mentoring and support of the HPCA medical director and professional nurse. IOC became
a PEPFAR partner in FY 2007. 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
IOC will use PEPFAR funding to continue to improve and expand its health services. IOC employs three
nurses, a chaplain to offer spiritual support and 25 paid caregivers. All staff are paid adequately and care is
taken to provide good working conditions in order to retain staff in this remote rural area This project offers
pre-employment and in service 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 that includes: 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
Activity Narrative: 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 men and women. The teams of caregivers are visited by the nurses and chaplain 1-4
times a month ensuring the delivery of elements of the basic 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 samples to the nearest clinic for analysis. If the
results are positive, the clients are 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 have enough food. 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 from the United States to assist with ongoing supervision and in-service
training of the lay caregivers. FY 2008 activities will be expanded to ensure that the entire catchment area
of Mosvold Hospital is provided with palliative care. Quality of care will be further improved to provide the
basic care package to encompass clients who are HIV-infected but asymptomatic.
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 center, 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. FY 2008 activities will be expanded to include training of all staff in the basic care
package. New caregivers will be recruited and trained to provide services in areas which are currently
uncovered. PLHIV will be trained to implement the basic care package.
ACTIVITY 3: Renovation of training center and expanded office facility
The purpose of this activity is to renovate buildings at a new office complex which will allow the integration
of all the activities of Ingwavuma Orphan Care at the geographical center of the area in which it works. A
run down building requires extensive renovation to convert it into some offices and storage area for
PEPFAR-funded staff. Current offices were built to accommodate 7 staff while by 2008 there will be around
30. The current offices will be converted to a full time training center, providing much needed infrastructure
and services in the area. The training center will be used by the organization to train staff, volunteers and
community members for many of the PEPFAR-related activities. Changes to the building will include
landscaping the grounds and purchasing appropriate furniture. Funding for renovation is expected to cost
no more than 10% of funding for this program area.
ACITVITY 4: Support Groups
Support groups will be formed to better provide the basic care package. Support groups will be
strengthened throughout the health district. Support groups are aimed at mixed groups of men and women
who are HIV-infected. There are separate groups which target children and their caregivers. Groups meet
once a month. Groups are led by caregivers, especially those who are HIV-infected themselves, but
members of the groups are encouraged to take the lead over time. This will be a place where the basic care
package is implemented as well as integrated prevention strategies. Addressing prevention with HIV-
infected individuals is an important part of a comprehensive care strategy. Through healthy living and
reduction of risk behaviors, these prevention with positives interventions can substantially improve quality of
life and reduce rates of HIV transmission. The goal of these interventions is to prevent the spread of HIV to
sex partners and infants born to HIV-infected mothers and protect the health of infected individuals.
In the above activities, PLHIV will receive at least one clinical and one other category of palliative care
service. Palliative care to family members of PLHIV or OVC will be provided in at least two or the five
categories of palliative care services.
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.
Continuing Activity: 13983
13983 8244.08 U.S. Agency for Ingwavuma 6676 4749.08 $300,000
8244 8244.07 U.S. Agency for Ingwavuma 4749 4749.07 New APS 2006 $125,000
Construction/Renovation
* Increasing gender equity in HIV/AIDS programs
* TB
Estimated amount of funding that is planned for Human Capacity Development $156,802
Estimated amount of funding that is planned for Food and Nutrition: Commodities $5,625
Table 3.3.08:
FY 2008 COP activities will be expanded to include:
-Expanding the availability of pediatric services in the target area and increase human resources devoted to
pediatric HIV care and treatment.
Ingwavuma Orphan Care (IOC) activities are carried out to improve the current pediatric home-based care
project through training of lay caregivers and to provide medical support in the way training nurses and
provision of medical supplies. An in-patient unit with 10 residential beds and day care facilities will be
established.
IOC will use PEPFAR funding to continue to improve and expand its health services. IOC employs four
positive are then referred to the nearby local Department of Health (DOH) clinics and hospital for
supply of drugs, including cotrimoxazole, pain medication and treatment for opportunistic infections. The
doctor oversees the dispensary. Nurses collect sputum samples if TB is suspected and deliver the samples
to the nearest clinic for analysis. If the results are positive, the clients are 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 have enough food. 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 contribute to the support of the clients through medical
DOH, which contributes to some of the existing caregivers' salaries and project running costs. Quality of
care will be further improved to provide the basic care package to encompass clients who are HIV-infected
but asymptomatic.
pediatric palliative care. 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 in children and methods
of encouraging clients to start and continue taking ARVs or TB medication properly.
The purpose of this activity is to renovate buildings at a new center which will allow the integration of all the
activities of Ingwavuma Orphan Care at the geographical center of the area in which it works. Current
offices were built to accommodate 7 staff while by 2009 there will be around 50. The current offices will be
converted to a full time training center, providing much needed infrastructure and services in the area. The
training center will be used by the organization to train staff, volunteers and community members for many
of the PEPFAR-related activities. Changes to the building will include landscaping the grounds and
purchasing appropriate furniture. Funding for renovation is expected to cost no more than 10% of funding
for this program area.
Much of this year will be devoted to development of an in-patient and day care pediatric unit. The capital
Activity Narrative: costs are being paid for by other funders. The pediatric section will have 10 beds. Children with all palliative
care needs will be assisted but it is expected that the majority will have AIDS and/or TB. This is the only
such unit in KwaZulu-Natal. The District DOH is fully in support of this project and has promised to send a
representative to the strategic planning meeting with an aim to contribute to resource mobilization. The
building will be completed and equipped. This is a continuation of the capital project which is due to start in
2008. Policies and procedures will be developed in accordance with South African government policies, and
staff will be recruited and trained in pediatric palliative care, childhood development, infection control,
bereavement support and other relevant topics. The unit will accept referrals from Department of Health
institutions and also from the community palliative care program.
The unit will be used to provide palliative care to terminally ill children and their families. It may provide end
of life care and also respite care to the families. ART will be provided by the DOH.
Support groups will be continued to provide the basic care package. Support groups are aimed at children
and their caregivers. Groups meet once a month. Groups are led by a support group facilitator, but
package is implemented as well as integrated prevention strategies. A curriculum has been developed
which assists the children to understand HIV and to accept their status. Children are provided with health
care and nutritional support as well as psychological support at the groups. The nutritional status of the
children is monitored and the children are provided with nutritional and micro nutrient supplements if
required. The children attending will be screened every six months for TB and referred for further
investigation if needed to the government hospital.
In the above activities, People Living with HIV/AIDS (PLHIV) will receive at least one clinical and one other
category of palliative care service. Palliative care to family members will be provided in at least two of the
five categories of palliative care services.
The support groups teach the caregivers and the children about ARVs and give them adherence support
through constantly reminding them to take their pills, peer support and monitoring whether the children are
attending the clinic regularly. The children are screened for TB and caregivers are taught about the
symptoms of TB in children. Those who are taking treatment are monitored to ensure that they adhere to
treatment until it is completed. The in patient unit will provide palliative care for children who are reaching
the end of their life and cannot be cared for adequately at home due to social, financial or medical reasons.
The unit will provide good quality care with adequate symptom relief as well as spiritual, social and
psychological support.
New/Continuing Activity: New Activity
Continuing Activity:
Estimated amount of funding that is planned for Human Capacity Development $27,671
Estimated amount of funding that is planned for Food and Nutrition: Commodities $993
Table 3.3.10:
ACTIVITY 1:
In addition to the continuation of all of the activities listed above for FY 2008, in FY 2009 Ingwavuma
Orphan Care (IOC) will be improving the quality of its services through further staff training, developing and
documenting training material with clear learning outcomes for staff, volunteers and caregivers. It will
strengthen the monitoring and evaluation of its programs. It will consult the community on what services
they require through focus group discussion and this information will feedback into strategic plans. Having
excellent community links, the strategy is highly community and beneficiary directed and at this stage. IOC's
strategy involves working closely with local churches so that the congregations are actively involved with
caring for their own community and that pastors are working together providing education and support for
4000 OVC. Although the particular ways that this will happen depend upon the community. IOC has 120
churches that are on board and are willing to participate in OVC support. A church liaison officer will be
appointed to work with these churches. This is in addition to the orphan coordinators who work directly with
about 20 volunteers each, supporting them with training and referral pathways.
ACTIVITY 2:
The database will be used by all sub-grantees for data collection. Sub-grantees will be mentored and
training needs identified and met where possible. Training curricula developed for caregivers will be shared
and disseminated.
ACTIVITY 3:
A foster care supervisor (a trained auxiliary social worker) will provide follow-up supervision of families
receiving foster care grants. She will hold support groups for foster parents where she can provide
additional information e.g. on money management as well as facilitating sharing between the foster parents.
She will also do home visits and spot checks to make sure that the children are being cared for adequately.
Families are encouraged to aim for self-sustainability rather than becoming dependent on the foster care
grants, which will in any case cease when the children reach 18. They are taught about income generating
projects as well as how to save money.
ACTIVITIES 4-6:
These activities will continue with a focus on improving the quality of services through better monitoring and
evaluation, implementing quality improvement systems, further training of caregivers and staff and
improving support for primary caregivers. Coordination of care with other service providers will be improved
through the local Child Care Forum.
-------------------------
Ingwavuma Orphan Care (IOC), in partnership with Lulisandla Kumntwana (LK), provides psychosocial,
educational and nutritional support to OVC and facilitates access to government social grants and other
social services. Activities aim to extend the reach of OVC projects in Ingwavuma and Mseleni areas of
Northern KwaZulu-Natal. FY 2008 funding will be used to double the numbers of OVC reached. The primary
emphasis area for this project is human capacity development 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.
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 due to poverty and the
severe impact of HIV and AIDS in the community. 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 were new to PEPFAR in
2007, 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. IOC's OVC
services are closely linked to its palliative care services, ensuring that children of terminally ill clients are
referred early for support. 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 KwaZulu-Natal Department of Welfare to ensure that there is no
duplication of services and to facilitate sharing of information, skills, and resources.
ACTIVITY 1: Service Delivery Improvement and Expansion
In FY 2008 with PEPFAR support, IOC and its partner LK will continue to expand their current OVC services
by establishing more staff and family support teams in areas that are currently not being served.
Infrastructure will be improved with the establishment of further satellite resource centers and upgrading the
central offices and care center. The orphan coordinators will continue to 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
Activity Narrative: 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 coordinators will continue to distribute food and clothes to those in need from
the resource centers, 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 officers will assist families in getting the documents they need to apply for the
grants. School support officers, memory box workers and a youth pastor, who are funded by other grants,
provide psychosocial, bereavement and spiritual support to the children. The team will ensure that OVC are
attending school and will provide uniforms if needed. A housing project is also ongoing, funded by other
grants such as Greater Good South Africa and school groups, which rebuilds houses for some orphan
families whose houses have collapsed.
ACTIVITY 2: Capacity Building
The organizational capacity of both IOC and LK will continue to be enhanced. This will include in-service
training of existing staff and employing and training new staff to improve sustainability. Training provided to
the IOC and LK staff includes driving lessons, computer literacy, project management skills and advocacy
skills. Another key feature is the 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 2008 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 recruits foster parents, who attend parenting workshops run by the organizations. IOC will
duplicate this service. The social workers 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 and Ingwavuma 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. IOC and LK 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.
ACTIVITY 4: Memory Boxes
IOC and LK will continue to help HIV-affected families create Memory Boxes for OVC. Memory boxes are
created by the family, 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. This is a valuable
psychosocial intervention which helps the OVC to cope with what is happening in their lives. IOC and LK
each employ a Memory Box worker. Community team members are also trained in Memory Box work.
Support groups for HIV-affected and infected children are established which will provide psychosocial
support and information for the caregivers and the children.
ACTIVITY 5: Youth Clubs
FY 2008 PEPFAR funding will support 25 after-school youth clubs in 25 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 (aged 5 to 24 years), 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. 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.
ACTIVITY 6: Renovation of Training Center and Expanded Office Facility
IOC will renovate a building at a new office complex which will allow for the integration of all IOC activities at
the geographical center of the area in which it works. A run-down building requires extensive renovation to
convert it into some offices and storage area for PEPFAR-funded staff. Current offices were built to
accommodate 7 staff while by 2008 there will be around 30. The current offices will be converted to a full
time training center, providing much needed infrastructure and services in the area. The training center will
be used by the organization to train staff, volunteers and community members for many of the PEPFAR
related activities. PEPFAR funding will be used to do the landscaping of the grounds and equipment and
furniture purchases.
Continuing Activity: 13984
13984 8245.08 U.S. Agency for Ingwavuma 6676 4749.08 $600,000
8245 8245.07 U.S. Agency for Ingwavuma 4749 4749.07 New APS 2006 $375,000
* Child Survival Activities
Estimated amount of funding that is planned for Human Capacity Development $123,871
Table 3.3.13:
ACTIVITY 2: A greater emphasis will be placed on tuberculosis (TB) education and screening. A local
drama group will be hired to provide entertainment and education at the testing site. One play will be about
HIV and the other about TB. Anyone who tests positive for HIV will be screened for TB. Those who are
suspected of having TB will be referred to government clinics for follow-up. A quality assurance program will
include site inspections by the supervisor and batches of blood will be sent to a reference laboratory for
cross-checking of results. Counselors will receive debriefing and support one day a week.
Expansion of Ingwavuma Orphan Care's current counseling and testing (CT) project consists of recruiting
and training a dedicated mobile team to provide counseling and testing, specifically targeting youth. The
home-based care staff will continue to provide CT to their clients and clients' families, with task shifting from
nursing staff to lay counselors.
Ingwavuma Orphan Care (IOC) started to offer counseling and testing to its palliative care clients and their
families in April 2007. The National Department of Health and nursing staff train lay caregivers to provide
pre- and post-test counseling to their clients in their homes, while the nurses and doctors carry out the test
at the clients' homes when they next visit. The project has found that many male clients are reluctant to go
to local clinics or the hospital for HIV testing, but are willing to be tested in their own home, so this program
helps to address gender equality in HIV programs. Home testing also increases the uptake of couple testing
and testing children of HIV-infected clients.
ACTIVITY 1: Home-based Counseling and Testing Services for Home-Based Care Clients
Counseling and testing services will be integrated with the home-based care project. The lay caregivers will
counsel clients and their families and recommend testing for anyone who has not yet been tested. They will
then offer testing and post-test counseling at the clients' homes. The IOC will train caregivers to administer
the HIV tests as part of a task-shifting strategy. Nurses will supervise and monitor their activities. HIV-
infected clients can immediately be referred into IOC's home care service and support groups that are run
by the organization. The nurses can then take blood to check CD4 counts, which will be transported to the
local hospital. The nurses will undertake quality assurance monitoring. High-risk negative clients will be
referred to existing programs such as loveLife. This activity also works to increase the local organization
capacity through training of staff and employment of skilled personnel.
ACTIVITY 2: Mobile Counseling and Testing Unit Targeting Youth
IOC will set up a CT mobile team consisting of two trained HIV counselors and an assistant. The team will
work from a vehicle with a trailer. The counselors will provide CT, and the IOC medical staff will monitor
their work. These services will be publicized through the extensive existing community links IOC has with
high schools and areas where youth congregate, such as near water points and outside informal drinking
dens. Many of the targeted girls are involved in transactional sex for food or other favors. The emphasis is
on targeting adolescents in a youth-friendly way. However, anyone who wishes to be tested will be welcome
to use the service.
The team will set up three tents with chairs and tables at a selected site such as a high school. The team is
equipped with a music system and DVD projector with which to play music and show DVDs relating to HIV
and abstinence. One tent will house leaflets, information about HIV and other youth-relevant material. The
HIV counselors will work in the other two tents.
Once a group has gathered, people will be encouraged to go for free testing to know their status. In the
tents the counselors will perform confidential pre-test counseling, testing and post-test counseling. Finger
prick tests are used. As per government protocol, the serial testing algorithm should be used, as opposed to
parallel testing. Those who test positive are encouraged to go to the clinic or hospital for CD4 counts. Those
who test negative are provided post-test counseling and referred to youth programs such as loveLife.
Continuing Activity: 13988
13988 13988.08 U.S. Agency for Ingwavuma 6676 4749.08 $100,000
Estimated amount of funding that is planned for Human Capacity Development $42,619
Table 3.3.14:
