ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS:

SUMMARY:

In partnership with the Department of Social Development (DOSD) PEPFAR funds will support the training

of caregivers of orphans and vulnerable children (OVC) and child protection activities. Planned interventions

include the development of the capacity of local community-based and faith-based organizations to provide

support to OVC, thereby addressing the burden of care experienced in particular by elderly females,

adolescents and male caregivers, each of whom has unique needs. As a result of training the quality of care

provided to OVC will improve. In particular, household approaches that create linkages between OVC

services and affected families will be prioritzed.

BACKGROUND:

The project supports the PEPFAR goal of supporting care for 12 million people infected with and affected by

HIV, including OVC. Among those most affected by the epidemic are children orphaned and made

vulnerable by its impact. They experience heightened susceptibility to isolation, stigma, malnutrition,

disrupted education, psychosocial issues and a generalized lack of physical and emotional care and

support.

Over 3.3 million South African children have lost one or both parents. Over 250,000 have lost both parents

and over 100,000 are estimated to be living in child-headed households. This translates into an increased

burden of care experienced by family members, caregivers, volunteers and community and faith-based

organizations. The personal needs of caregivers are often unmet. As a result their support to OVC is

compromised, leading to an increased risk of neglect and abuse. This PEPFAR activity will focus on

strengthening the capacity of caregivers by focusing on their own needs while simultaneously increasing the

knowledge base and skills they require to support OVC.

Implementing organizations:

PATH has partnered with its AIDSTAR Sector I Consortium partners, Health and Development Africa (HDA)

and The International HIV and AIDS Alliance (the Alliance) to deliver the Orphans and Vulnerable Children

Caregiver Support and Child Protection Training in the nine provinces of South Africa.

In terms of the project management structure, PATH as prime contractor and recipient of the award,

assumes accountability to USAID for project results, compliance and financial reporting. HDA takes the

technical lead for project implementation and day-to-day management and will house the project. The

Alliance leads the Caregiver support training component. Second tier partners will be added in FY 2008.

Gender:

The center of this activity will be child protection, and gender issues will be a major focus of this program.

The three gender priorities that will be addressed are: increasing gender equity in HIV and AIDS programs;

increasing women's legal rights; and reducing violence and coercion. All data will be segmented by gender.

The importance of life skills and HIV prevention information for highly vulnerable girls will be built into the

training program, thereby helping to educate youth and adults about the risks of cross-generational and

informal transactional sex.

ACTIVITIES AND EXPECTED RESULTS:

ACTIVITY 1: Training

Training will focus on the strengthening of the capacity of caregivers to provide adequate care to OVC.

Caregiver capacity development will address personal health issues; family strengthening including

relationship building, resource strengthening and resilience; psychosocial wellbeing; treatment literacy;

knowledge of and ability to access resource networks; coping with bereavement and grief; parenting skills

including household management, child nutrition, dealing with conflict, memory work, child development;

and communication skills. Addressing the human resource inadequacies of caregivers and supporting

organizations will enhance the quality of care provided to OVC.

The target of training is community-based caregivers active in the care and support of OVC. The caregiver

support training curriculum will be supported by manuals and toolkits. Toolkits will provide resource

information to raise awareness, build skills and strengthen problem-solving abilities. They will include a

resource pack containing for example low-literacy information sheets and read aloud story books to facilitate

child-caregiver communication about HIV/AIDS.

Training the Trainer (TOT) workshops will be offered to Master Trainers. Training of caregivers will take

place over five-days divided into two- and three-day sessions to allow participants to assimilate learning

over time.

Follow-up and support of trainees will take place through national and provincial convenings. Refresher

trainings will be offered to trainees who have completed training. A quarterly newsletter will promote

continuity of learning and enhanced networking between trainees. Training partners will conduct bi-annual

site visits to monitor training implementation and assess further needs. A reporting form will facilitate

collation of information. On-going training will be provided to trainee supervisors regarding their skills, roles

and responsibilities and to discuss changes to reporting and monitoring data.

Sector Education and Training Authority (SETA) accreditation of training curricula will be finalized. 500

manuals will be printed and available on the project website. 2500 caregiver toolkits will be printed and

disseminated.

Activity Narrative: Training sites will be identified in areas with highest prevalence of HIV and largest numbers of OVC in order

to facilitate sustainable scale-up, with attention given to creating linkages with other HIV-related programs.

Mapping processes will be employed to determine these greatest areas of need.

ACTIVITY 2: Improving collaboration and referral networks to promote sustainability

In order for caregivers to maintain a high standard of care, they must maintain their own health and

psychosocial wellbeing. Referral networks will be established in the communities where South African

PEPFAR OVC partners are working in to ensure that caregivers know where to access services for

themselves. Specific focus will be put on psychosocial and health services, including ARV treatment.

Project activities will seek to embed the training into communities by creating child champions and strong

referral and networking relationships between governmental and civil society organizations. In this way the

project seeks to promote community responses to OVC and caregiver needs. Community participation will

be encouraged in all project planning and implementation processes. For example caregiver and child

participation will be built into conferences and evaluation processes.

Through its close collaboration with DOSD the project promotes long-term scale up in order to increase the

number of OVC reached. The training program is replicable on a national level and takes into account the

varying needs of different populations such as elderly and adolescent caregivers, under five year olds and

persons with disabilities.

ACTIVITY 3: Dissemination of knowledge and better practices

This activity will focus on the identification and dissemination of better practices that strengthen households

and improve child protection. In the process, promising practices will be benchmarked against criteria for

"successful" practice. Ongoing discussions with PEPFAR partners and DOSD will provide information about

as yet undocumented approaches. Local partner capacity to document case studies will be developed with

a minimum of 30 individuals trained.

A targeted dissemination strategy will be developed. Promotional brochures will be distributed to 1000

organizations. Toolkits will be made available through public access networks and CD-Rom. Innovative

ways to disseminate better practices dissemination will be facilitated by the quarterly newsletter and other

ideas that will emerge in the strategy. At least three caregiver conferences will be held to share

documentation of better practices, discuss innovative approaches and common challenges.

ACTIVITY 4: Child Protection

Training will focus on the early identification, prevention, treatment and follow up of child abuse and neglect.

This continuum of care aims to create an effective and efficient response to high levels of child abuse

prevalent in South Africa and to address the increased vulnerability of OVC. Training will be developed for

NGOs, including FBOs, teachers, health professionals, mental health practitioners, social workers and

caregivers. Efforts will be directed at the development of referral networks, quality assurance and supportive

supervision to ensure follow up and mentoring of trained individuals.

Child champions will be identified in each geographical region where training takes place to provide

mentoring to trained individuals, advocate for child protection and promote sustainability of the project.

Meetings will be held locally and provincially to build awareness, increase networking and ensure

implementation of training practices.

Training will be offered to PEPFAR partners and child forums as established partners involved in support to

OVC. This will develop increased understanding of prevention, early intervention and treatment of child

abuse and neglect and the appropriate institutional and legal responses to child abuse. An understanding of

the roles, responsibilities and referral processes to and between child protection services, governmental

and civil society will prevent children falling through the continuum of care. In addition the project will focus

on the development of community-based safe spaces for children. This project will focus on introducing the

specials needs of OVC to the child protection professionals and also on introducing the child protection

identification skills and support options for OVC caregivers. Both sides need to be sensitized.

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

SUMMARY:

In collaboration with the South African Department of Social Development (DOSD), PEPFAR funds will be

used to support a caring for the caregivers intervention, with a major focus on the adolescent and female

caregivers of OVC. These will include elderly female household heads with young children, large families

with unrelated children (fostered or adopted), child-headed households, single parent/family member

households, and formal or informal cluster foster care.

Funding will be used primarily in the emphasis area of training specifically in-service training with additional

efforts in local organization capacity building. The primary target populations for the intervention is adults

over 25 years, people living with HIV and AIDS and orphans and vulnerable children (OVC). A service

provider to implement this activity will be selected in October 2007.

BACKGROUND:

Research has shown that families are absorbing the care of OVC but are doing so with great difficulty and

at great cost to the caregiver. Adult caregivers of OVC have needs of their own that must be addressed in

order to support and prolong their capacity to care for OVC. There are currently over 1 million OVC in South

Africa, and the number continues to rise. Support structures need to be built to ensure the current model of

community and family-based OVC care is able to be sustained. Issues and challenges that caregivers face

Activity Narrative: include burnout and personal health issues, depression, lack of adequate knowledge about HIV/AIDS,

stigma, the lack of resources or the knowledge of how to access them, the lack of parenting skills and grief

management. Trainings are needed that will increase the knowledge and skills of individuals providing care

and support to children who have been orphaned or made vulnerable by HIV/AIDS.

The South Africa PEPFAR OVC Partners are trying to address this issue, but due to the large demand,

have requested additional assistance in planning and implementing programs to address caring for the

caregiver.

ACTIVITIES AND EXPECTED RESULTS:

ACTIVITY 1: Training

This activity will focus on developing and sharing a caregiver support model for South Africa. Activities will

address the critical health needs of adult caregivers, including guardians, (grandmothers or aunts) and

adolescent heads of households. Activities will improve adult-to-child communication and provide

counseling on difficult issues including parental illness, death, how to deal with bereavement and grief, sex

education, parenting skills, gender sensitivity training and HIV prevention messages. These interventions

will prioritize the needs of the caregivers and will strengthen the caregivers parenting skills set to ensure

that they are able to keep the new family together as a family unit and support the OVC in a stable

environment. Workshops will be held and mentoring and support provided for caregivers to improve their

ability to care for vulnerable children and maintain the family unit.

ACTIVITY 2: Linkages and Referrals

In order for caregivers to maintain a high standard of care, they must maintain their own health. Referral

networks will be established in the communities that the South African PEPFAR OVC partners are working

in to ensure that caregivers know where to access services for themselves. Specific focus will be put on

psychosocial and health services, including ARV treatment. Issues around accessing these services will

also be examined including transportation costs and temporary child care to see how partners could best

address these issues.

ACTIVITY 3: Sharing Good Practices and Knowledge

This activity will focus on dissemination of valued practices for caregivers. The intervention will focus on

collection and sharing of information and best practices for caregiver support programs among OVC

organizations. Other interventions to reduce the burden of childcare on stressed caregivers will also be

explored. For example; aftercare programs offering sports and recreation, including weekends, holidays and

holiday camps. Better practices will be documented and then caregivers will be invited to workshop what

practices they could use in their communities, households and families. This intervention will focus on

supporting activities that avoid further destruction and degradation of the family unit. A caregiver tool kit will

be developed to provide organizations with sustained guidance for ongoing support of caregivers.

New/Continuing Activity: Continuing Activity

Continuing Activity: 21254

Continued Associated Activity Information

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

System ID System ID

21254 21254.08 U.S. Agency for PATH AIDSTAR 9224 9224.08 $900,000

International

Development

Emphasis Areas

Gender

* Increasing gender equity in HIV/AIDS programs

Human Capacity Development

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Table 3.3.13: