Problem Statement / needs assessment South Africa has a population of 42.8 million of which 12.8 million are children under the age of 18 years. Infant mortality in 2001 stood at 56 deaths per 1,000 live births and under-five mortality at 71 deaths per 1,000 live births. South Africa is one of the sub-Saharan African countries most severely affected by HIV/AIDS. UNAIDS estimates that there are 5.3 million South Africans living with HIV/AIDS, the largest number of infected people of any country in the world. To date, more than 1.7 million South Africans have died of HIV/AIDS, resulting in 1.1 million AIDS orphans. Statistics South Africa estimates that approximately 18 percent of the children living in Mpumalanga province are orphans and many more are vulnerable. Hands at Work aims to help restore and transform communities, facilitate the development of strong, community-based support systems for children affected by HIV and AIDS with the hope of assuring a secure and healthy future for the Orphaned and Vulnerable Children (OVC) living in the province.

Mpumalanga province, has a poverty rate of 57.3%, an antenatal HIV prevalence rate of 29.6% in the year 2000 and 61% of the population of the province living in rural areas, is very vulnerable to HIV/Aids. Hands at Work targeted two district areas in Mpumalanga which are Ehlanzeni and Bushbuckridge. In these two areas there are 13 Community Based Organization at Ehlanzeni District and five at Bushbuckridge areas while there are two major sub-partners in North West .

Hands at Work serves orphaned and vulnerable children (OVC) ages 0-17 years old, who are either orphaned or made more vulnerable because of HIV/AIDS. The child might have lost one or both parents to HIV/AIDS or made vulnerable due to the following factors:

Is HIV-positive;

Lives without adequate adult support (e.g., in a household with chronically ill parents, a household that has experienced a recent death from chronic illness, a household headed by a grandparent, and/or a household headed by a child);

Lives outside of family care (e.g., in residential care or on the streets); or

Is marginalized, stigmatized, or discriminated against.

Describe your response to the needs identified

The Hands at Work model came into being in 1998 when it began providing home-based care to the sick and dying in the Masoyi area. It began as an initiative under the Africa School of Missions, a Christian teaching college based in Masoyi. The school site remains the project headquarters for Hands at Work. Since then, it has expanded rapidly into a multi-layered and holistic project providing multiple services and activities.

Subsequent to the emergence of Masoyi Home-Based Care, the Hands at Work movement was established as a vehicle through which the Hands model could be replicated across the continent. Hands at Work is a South African NGO that provides comprehensive care and support services to OVC and their families through a network of associated community based organizations in eight countries in sub-Sahara Africa. The Hands at Work model lends itself towards mobilizing new community initiatives in extremely resource-poor settings. The model builds on the foundation of home based care and local community ownership by mobilizing the local church to accept the biblical mandate to look after the sick and dying in their communities and to care for the orphans. Hands at Work helps to establish, encourage and build capacity in CBOs that are formed out of local churches accepting the mandate and then assists in the implementation of the Hands Model by which to fulfil it.

The primary principle that guides the functions of the Orphan Care Programme is the belief that working with vulnerable children needs to begin with home-based care being provided to sick and dying family members. Home-based care provides the means through which staff and volunteers can enter people's homes, build trust, develop confidence, and render health care to the sick. Through the creation of the Community Care Centres, the Orphan Care Programme aims to uplift the quality of life of the most vulnerable OVC and their families through providing support structures, building resilience and cultivating coping mechanisms in the family.

11.2 Program Strategy / design

The CBO model used by Hands at Work seeks to help communities absorb the responsibility of caring for community members and children affected by HIV/AIDS. The model of intervention is based on strong community participation and extensive community involvement at multiple levels. Hands at Work does not initiate work in any communities but place a high value on community-ownership, identifying and empowering those in the community who are already doing something with the resources they have. Initial steps in a new community involve community mapping, needs assessment, and meetings with community leaders and pastors. Mentoring of pastors and care workers are critical activities in empowering communities, and often lead to the establishment (by the community, not by Hands at Work) of a Community Based Organization (CBO). Hands at Work provides ongoing support for CBOs through Service Centresnearby local offices typically staffed by 2-4 Hands at Work staff members who are in close relationship with each CBO, visiting weekly, organizing monthly workshops for CBO Coordinators, and mentoring and coaching care workers. Service Centre staff also mentor the CBOs in identifying areas of need in their communities, making plans for how to address the most critical needs, writing proposals and reports, governance of the organisation, and mobilization of resources.

Each CBO is unique in how they respond to the needs of OVC in their community, but they have much in common. Care workers (local community volunteers) visit OVC in their homes to care for the children in a parental role and to respond to the needs they find. The most important intervention by CBOs is through loving home visits, but other interventions are also made through these home visits counselling for OVC and mentoring/counselling of primary caregivers (PCG). Hands at Work supports CBO home visits through training and mentoring of care workers and through the PCG Program.

The PCG Coaching Team (part of Service Centre staff) focuses on helping care givers respond to grief and prepare to receive a new child into their families. These groups have helped to minimize the impact caused by grief, increase awareness of OVC issues to reduce stigma associated with OVC. A full training programme has been developed in preparing primary care givers for their new role as guardians. During 2009, 1800 primary care givers participated in the training programme. The programme focuses on self awareness, parenting skills, child development, responding to the emotional needs of OVC, bereavement and human rights. This Coaching programme is vital in developing the capacity of primary care givers and communities to absorb the burden of caring for OVC. It aims to help primary care givers understand how children deal with grief and the impact of bereavement on children if they do not receive support or assistance.

Community Care Centres are another critical component of OVC Care supported by Hands at Work. Care Centres are located at the centre of the community and act as a contact point for anyone infected or affected by HIV/AIDS to obtain care and support services with caregivers and families are directed at helping caregivers come to terms with the changes in their family environment and understanding the emotional needs and difficulties OVC experience. Care Centres provide daily feeding, orphan care, educational assistance, psychosocial support, ECD for young OVC, after-school care and tutoring support, leadership programmes, and community gardens.

Other services supported by Hands at Work in response to CBO needs include the delivery of school supplies, school uniforms and blankets, basic medical checkups, referrals to the clinic, deworming, and home building and renovations.

OVC Database / Spreadsheet

The development of a database that keeps a record of comprehensive information about each beneficiary has contributed to ensuring that the needs of each child or family are accurately identified and appropriately addressed. The measuring system is linked to the child care centres and the feeding list. This ensures that services are not duplicated. The database has also assisted with identifying extended family and support structures for the child. The system makes it easier to report on the services provided and to track the progress of each child. Training for volunteers and child care workers places considerable emphasis upon the importance of collecting information at each visit. When interacting with programme staff, it is clear that staff have a comprehensive understanding of the living situation of each child. This database is also recognized as the most comprehensive and accurate source of data available on OVC in the area.

Explain behaviour norms you are working to change and how you do it

Gender Issues The Single Young Mum's programs focus on prevention and protection of young teenage mothers that got pregnant either through rape, ignorant sexual behaviour or any other means. The Programme focuses on changing the behaviours of the young mothers toward the future by helping them to be a role model in the different communities they live in.

Youth Program The youth program focuses on the teenage boy and girl in our targeted communities. The programs have different interventions that focus mostly on HIV protection and risk behaviours e.g. Better Choices

Primary Care Givers Coaching Programs The Primary Care Givers coaching program focuses on mentoring caregivers and child headed household leaders. It takes them through step by step procedures on how to care for OVC properly. It also addresses behavioural issues on how caregivers relate with the children at home and also how the children relate with their families.

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