SUMMARY:

Hands at Work in Africa (HAW) will use FY 2009 PEPFAR funds to provide a holistic care and support

package to people living with HIV (PLHIV) through community-based programs in four provinces.

BACKGROUND:

Established in 2002, HAW is a South African non-governmental organization (NGO) that provides

comprehensive care and support services to PLHIV through a network of associated community-based

organizations (CBOs). The Hands at Work model, and in particular, the Masoyi project, (described by

various independent organizations as a best practice model) lends itself towards mobilizing new community

initiatives in resource-poor settings. This 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

the 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 that agree to implement the Masoyi

Community Intervention Model. With PEPFAR funding, Hands at Work reaches patients and care givers

with an integrated service package that includes psychosocial and nutrition assistance. With FY 2009

funding, Hands at Work will continue to increase the program's reach and extend additional support to

established care centers. In addition, Hands at Work will continue to implement income-generating

initiatives, home-based care and resilience-building programs to further support improved security and

livelihoods for PLHIV.

ACTIVITIES AND EXPECTED RESULTS:

ACTIVITY 1: Local Organization Capacity Development

Hands At Work will partner with 17 local CBOs in Mpumalanga. Local organization capacity will be

developed through a CBO training and mentoring program. Partner CBOs will be trained and mentored for

an 18-month period in palliative care and support, and the provision of direct services to palliative care

which will develop and improve organizational capacity. As the number of CBOs capacitated increase

nationally, more sick adults can be reached in a cost-effective way, and brought into a safety net of care in a

way that ensures sustainable service delivery. Organizations will be taught how to access and implement

services within the frameworks provided by the departments of Health and Social Development. Part of the

outcome of the Local Organizational Capacity Development program is to make sure that the CBOs get

funding from other sources to be able to stand on their own after PEPFAR has stopped. For example, they

will be taught how to secure funding from other sources to be able to give better care to adults in their

various communities. Also, Hands at Work staff will be going for more training to capacitate themselves

more on recent trend in the industry and through that competent and capacitated CBOs will attract

government funding, thereby assisting government to reach their objectives.

As part of the Training and Mentoring program, CBOs will be trained in organizational matters such as

bookkeeping, proposal and report writing, conflict mediation, forming linkages and partnerships and

establishing relationships with local government departments and local service providers (HIV and AIDS

treatment sites etc.)

Hands at Work will strengthen referral networks and working relationships through the CBOs to other

services in the same locations. Strong and functional referral networks are essential to ensure that they

receive comprehensive care.

Additionally, care givers will receive basic counseling skills and HIV education training. All CBO and faith-

based organizations (FBOs) will receive monthly ongoing training and supervisory site visits.

Hands at Work makes use of combination of materials developed by Tearfund, DIFD-sponsored Barnabas

Trust Toolbox and Hands at Work which are structured accordingly to the national guidelines for home-

based care. CBOs will be trained to develop and/or strengthen referral networks and working relationships

to other services in the same locations. Strong and functional referral networks are essential for palliative

care to ensure that all clients receive comprehensive care.

Hands at Work will work with the Department of Health and will encourage caregivers from the 17 CBOs to

attend the 59-day home-based care training provided by the Department of Health. This will help ensure

that some of the care givers receive a government stipend. Hands at Work will also forge relationships with

the Department of Health and will negotiate with the department so that the care givers can get HBC kits

directly from government.

ACTIVITY 2: Palliative Care

Due to this being a new PEPFAR budget area with limited funds, Hands at Work will be supporting its

anchor partner, Masoyi Home-based Care (Masovi), with the majority of funds to support them as the model

and then some limited funding will go towards the other 17 CBOs organizations to assist them with a small

budget for their HBC activities which is similar to the services that are being rendered by Masoyi . Hands at

Work will extend the support of palliative care with the 17 CBOs organizations as the budget from PEPFAR

grows. And mainly they will be supported with budget in taking care some of their palliative care needs.

Through the bi-monthly workshop in the different CBOs. lessons will be given to the care givers to provide

a minimum standard of care focusing on clinical/physical, psychological, spiritual, social and prevention

interventions. In addition to sharing integrated HIV-related palliative care messages with HIV-infected

individuals and their families, the care workers will use a family-centered approach to client assessments.

The package of services includes basic pain and symptom management, support for adherence to

opportunistic infection (OI) medications (including cotrimoxazole prophylaxis and TB treatment) and

antiretroviral therapy (ART), and referral for family planning. Community and home-based psychological

Activity Narrative: support, stigma reduction strategies and adherence support for OI medications and ART will be provided.

Clients are also counseled on prevention with positives and family member are referred for counseling and

testing (CT). Outreach to the community and referral to health facilities for CT, Family Planning referrals will

be part of the palliative care activity. An additional key activity of care givers is monitoring of adherence to

TB and HIV treatment. Elements of the preventive care package for adults and children are also included

during interaction between the care worker and the client.

ACTIVITY 3: Masoyi HBC Support

Every aspect of the palliative care of Masoyi will be supported. Masoyi provides backup for people who

need extended care (not necessarily hospital care) or patients that are discharged early from hospital.

Services target terminally ill patients and people living with HIV. Masoyi has a strong referral support

structure with local clinics and ACTS clinic in Masoyi, which is then followed up by the designated care giver

for each patient referred.

The following areas will be supported:

--Cotrimoxazole Prophylaxis - support for transport for non-mobile patients and initial visits at ACTS clinic

and facilitating the handover to government clinics for continued support.

--Palliative Care - a support budget will be given to each of our CBOs for HBC kits (including napkins,

diapers, gloves and wound dressings), transport for the nursing staff, soya life porridge, individual garden

support, individual care plans to assist family members, adherence counseling refresher courses, care for

the care givers (minimal focus on incentives but rather on income generating activities).

--Early referral and retention in care and support - retraining of care givers in various aspects, including a

focus on reducing stigma, training of local churches to create a channel of early referral and addressing

stigma issues, transport support for patients.

--Basic Care Package - retraining of care givers, home visits, vitamins, counseling and nutrition training

--TB/HIV Services - monitoring through direct observing programs

--Quality of Care and Support Services - monthly workshops with nurses or a HBC specialist from each

CBO, bi-monthly workshops with care givers and continued training on reporting

Hands at Work and the CBOs plan to strengthen existing referral networks, working relationships with other

organizations, and development of other networking and referral partnerships within the same geographic

areas. This will aid in the provision of holistic service. CBO/FBOs will be trained on and encouraged to

refer clients for sexually transmitted infection screening and management, family planning, counseling and

testing substance/alcohol abuse and care for orphans and vulnerable children.

New/Continuing Activity: New Activity

Continuing Activity:

Emphasis Areas

Health-related Wraparound Programs

* Safe Motherhood

* TB

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $22,174

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 $5,538

Education

Water

Table 3.3.08:

ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS:

ACTIVITY 2: Human Capacity Development

Seventeen OVC Coordinators and 14 Youth Coordinators will be sponsored in the PEPFAR budget and

identified through the CBOs with a guideline on qualities and skill required for that position. They will meet

monthly for workshops to learn skills on dealing with children, in order to empower other care workers in

their different areas.

ACTIVITY 3: Psychosocial Support

The OVC Coordinators and Youth Coordinators in the CBOs will be trained by Hands at Work to provide the

psychosocial training for primary caregivers and child-headed households and in the development of

support groups. There will be a larger focus on the training of child-headed households in the primary

caregiver training.

This training was previously done by a training team within Hands at Work, but in line with sustainability and

community ownership this will now be done by the CBOs themselves.

Hands at Work was identified by the South African government (SAG) to be fast tracked in the registration

as an accredited training organization - however a breakdown between the SAG and the consultant has

stopped the process at a national level. Hands at Work will still be handing in accreditation documentation

for HBC training this year and will then work to extend this to other training areas.

ACTIVITY 4: Educational Support

Hands at Work will provide school stationary or school uniform packs to each of the schools serving OVC

through PEPFAR funding.

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

SUMMARY:

Hands at Work in Africa (hereafter Hands at Work) will use FY 2008 PEPFAR funds to provide a holistic

package of basic services to OVC, including increased access to educational support and social services

through community-based programs in four provinces. The specific target population is orphans and

vulnerable children and the major emphasis area is local organization capacity building.

BACKGROUND:

Established in 2002, Hands At Work (HAW) 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

(CBOs). Hands at Work has a vision to reach 100,000 OVC by 2010 in sub-Sahara Africa. The Hands at

Work model, and in particular, the Masoyi project, (described by various independent organizations as a

best practice model) lends itself towards mobilizing new community initiatives in resource-poor settings. It

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 the 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 that agree to implement the Masoyi Community Intervention Model. With PEPFAR

funding Hands at Work has reached 6500 OVC and over 1200 caregivers with an integrated service

package that includes education, psychosocial and nutrition assistance. With FY 2008 funding, Hands At

Work will continue to increase the program's reach and extend additional support to established care

centers to provide support groups for young mothers, facilitate reintegration of young mothers into schools;

ensure OVC access to counseling and testing and ARV treatment, when needed; train and mentor

Community Child Care Forums (CCCFs) and provide life skills and prevention education for all

beneficiaries. In addition, Hands At Work will also continue to implement income-generating initiatives,

home-based care and resilience-building programs to further support improved security and livelihoods for

children. The Hands at Work program is aligned with the South African National Action Plan for Orphans

and Other Children made vulnerable by HIV and AIDS and the Department of Social Development (DOSD)

Policy Framework and has a good relationship with both the national and provincial DOSDs.

ACTIVITIES AND EXPECTED RESULTS:

ACTIVITY 1: Local Organization Capacity Development

Local organization capacity will be developed through a CBO training and mentoring program. Partner

CBOs are trained and mentored for an 18 month period in OVC care and support, and the provision of

direct services to OVC; also developing and improving organizational capacity. Organizations are taught

how to access and implement services within the frameworks provided by the departments of education,

home affairs and DOSD. E.g., they are taught how to secure school fee exemption, rather than trying to

raise funds for fees; how to apply for and access legal documents and secure grants; rather than directly

paying monthly household expenses/needs. Hands at Work in Africa assists organizations with the

development and use of data collection tools, methods and processes; implementation plans and

subsequent monitoring, evaluation and reporting obligations. In the Training and Mentoring program, CBOs

will be trained in organizational matters such as bookkeeping, proposal and report writing, conflict

mediation, forming linkages and partnerships and establishing relationships with local government

departments and local service providers (treatment sites etc.). Local organization capacity will be developed

further with the training and mentoring of lead Child Care Workers in various organizations.

ACTIVITY 2: Human Capacity Development

Hands At Work will partner with 45 local CBOs to identify, train and mentor caregivers providing direct care

Activity Narrative: and support services to OVC and their families. Training topics will include basic child care, the role of the

childcare worker, OVC selection criteria and community care forums; minimizing discrimination and stigma,

HIV prevention, children issues, promoting gender equality, child rights and protection; and caregiver

participation in service delivery. Caregivers will also be trained to identify cases of vulnerability, abuse, ill

health and HIV and AIDS infection and referral mechanisms. In addition, caregivers will receive training and

support on family-centered care including basic parenting skills, nutrition counseling and food gardening

and health. Hands At Work will support local CBOs to develop caregiver support groups, led by senior

caregivers, to facilitate peer-to-peer support and information dissemination. Child care workers will also be

the first link to ensure M&E data capturing and integrity. Each child care workers will be mentored on

appropriate case management including documentation.

ACTIVITY 3: Psychosocial Support

Hands At Work will provide training and support to local CBO partners to provide a targeted psychosocial

support to OVC and their families. Psychosocial support activities will include the provision of one-on-one

counseling, group counseling (support groups), play therapy at care centers, and age-appropriate

development programs such as youth camps (based on Survive Your Life and Better Choice curricula) and

life-skills training. In addition, child-headed households (CHH) will receive training in grief managment,

sexuality and HIV prevention. Support groups will also be formed for members of these households to

provide ongoing counseling and support.

ACTIVITY 4: Educational Support

Hands At Work's community care centers are multi-purpose centers based in the community and used for

pre-school training for OVC and HIV-infected infants (0-5yrs), after-school care and homework tutoring, and

nutritional support for CHH. All the centers follow a set, pre-school curriculum to ensure that OVC are

adequately prepared for entry into primary school. Hands at Work works closely with the Department of

Education to ensure every OVC is enrolled in school and exempted from school fees. Academic assistance

and homework support will be facilitated at care centers by qualified teachers and volunteers, with a focus

on English and mathematics. Care centers are also places of safety for OVC. All school going CHH OVC

within the area of a care center will also receive nutritional counseling and a cooked meal (provided with

non-PEPFAR funding) at the care centers. Food parcels (sourced through public-private partnerships) will

also be provided to those children in need.

ACTIVITY 5: Health

Workshops on HIV and AIDS information and education will be held with all the OVC above 10 years. All

the OVC will be de-wormed at least once with assistance from the local health clinic. Health Care and home

visits are provided to the OVC by the Home-based Care staff funded by other Hands at Work donors. The

CBOs link OVC with health services including screening, immunizations and where needed home-based

care services (varying from adherence monitoring, basic wound care to cleaning) as well as pediatric testing

for infants and VCT for older OVC.

ACTIVITY 6: Legal Assistance and Economic Support

A birth certificate and identity document drive will enable social workers (who are employed to facilitate this

intervention) to apply for government social grants for OVC who qualify for them. This intervention will assist

government to fulfill their mandate as stipulated in the Department of Social Development's Strategic

Framework. Blankets will be distributed to all the new OVC registered after October 2008.

Hands at Work will support skills training for older OVC and income generating activities for caregivers, to

bring revenue and new skills that contribute to reducing the susceptibility of OVC and their caregivers to HIV

infection.

ACTIVITY 7: Nutritional Support

Active support will be given to ensure that food gardens provide fresh produce to supplement monthly food

parcels, and supply soup kitchens for daily meals provided to pre- and school going OVC at care centers.

Provision of monthly food parcels is a wrap around activity funded through national and local business

partnerships. Soya porridge is distributed to severely malnourished OVC as part of an emergency feeding

scheme funded from non-PEPFAR sources. Nutritional education training will be given to OVC-headed

households and caregivers to assist in improving OVC nutritional status by covering topics such as healthy

food choices, food preparation and storage.

ACTIVITY 8: Prevention Education

HIV Prevention and protection training will be provided to child-headed households, primary caregivers

(PCG), and OVC The training will focus on core themes such as life skills, gender equality, child protection

with the view to reduce violence and coercion, sexuality, HIV and AIDS and reproductive health. The youth

development programs, Survive Your Life, Better Choices and young moms focuses particularly on

abstinence and faithfulness. The young mom program is focused on integrating the girls back into the

education system while supporting them in caring for their babies.

New/Continuing Activity: Continuing Activity

Continuing Activity: 15934

Continued Associated Activity Information

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

System ID System ID

15934 15934.08 U.S. Agency for Hands at Work in 7296 7296.08 $1,000,000

International Africa

Development

Emphasis Areas

Gender

* Addressing male norms and behaviors

* Increasing women's access to income and productive resources

* Reducing violence and coercion

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $149,085

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Estimated amount of funding that is planned for Education $42,857

Water

Table 3.3.13: