Children First (CF) is USG's lead mechanism to improve the lives of orphans and other vulnerable children (OVC) affected by and infected with HIV/AIDS in Zimbabwe. The aim is to increase OVC access to a range of comprehensive care services and build the capacity of communities to provide these services. In addition to PEPFAR funding, USG provides annual wraparound Population funding for training, referrals to care and establishment of service networks for OVC reproductive health.

Since 2008, CF has worked to mitigate the impact of HIV/AIDS on children in Zimbabwe by improving OVC access to quality care and support services through 3 main objectives: 1) increased access to and quality of OVC services through community initiatives; 2) strengthened human capacity and performance of local communities to meet needs of OVCs; 3) improved community and national-level advocacy for the social protection of OVCs. CF is identifying new models, undertaking advocacy, and targeting highly vulnerable children such as those in child-headed households, abused children, disabled children, and children outside of family care. CF works closely with public and private sector providers to promote networking and complementarity of services to assure that OVC services are as cost-efficient as possible.

During the past year CF has successfully undertaken activities that have helped partners transition from emergency humanitarian service focus which characterised much of FY09 to again focus on traditional sustainable development services. To achieve this, the project focused on rebuilding the capacity of larger NGOs and helping them re-engage with the public service delivery systems. For many NGOs this required a changed mind-set as it called for engaging more pro-actively with a struggling system that lacked many of the amenities of the past. Significant progress was also made in helping partners develop alternative models of care and support in the areas of; paediatric ART, school based primary health care, child rights CD listener programs for schools and communities, integrated school based programs, community based child legislation; and alternative education for out of school youth. This has brought the private and public service delivery systems together and in that way supported the country's slowly resuscitating social service delivery systems. Through these activities partners were able to bring more services to children in the areas of health, education and social protection. As of June 2010, CF partners had reached 65,417 OVC (49% male, 51% female) with 36,422 of these children reached with 3 or more services.

CF implemented its activities through direct grants to 17 local NGO partners who in turn sub-granted to 38 CBOs (24 FBOs) that work with OVC, and also provide referrals and linkages with other programs and service providers. CF also works with Child Protection Committees, its Child Advisory Board and volunteers in Harare and Umzingwane to improve its ability to monitor and respond to the needs of OVC in their communities, thus improving linkages between communities and the district and national AIDS response.

In terms of Human Resources for Health, by the third quarter FY09, CF had trained 582 community based providers/caregivers from 4 partner organizations. CF continued to provide mentoring support to its NGO/CBOs mainly in finance and M & E. Two CF partners conducted training of trainers on Child Protection and HIV in the Workplace policies to 12 partner organizations; and Stigma and Discrimination Reduction training to 4 partners.

In terms of Child Survival activities, CF helped develop two alternative models of care and support for HIV positive children. The Integrated Model for Pediatric Aids Care and Treatment works with home based care programs and the Child Adherence Support Program with trained adolescents to provide adherence support to HIV positive children in clinics. Both programs have increased the number of HIV positive children receiving pediatric care and treatment. CF partners also worked with city council clinics to provide primary health care assessments in schools. For Advocacy and Child Protection, CF jointly with Population Services International (PSI) implemented a 26 episode national radio drama on child rights issues which was transferred into a CD education package introduced in 72 CF supported schools. CF also started to produce advocacy briefs from school health assessments to raise awareness on disease trends such as measles and lack of medicines in clinics for diseases such as bilharzias and fungal diseases. The advocacy briefs were shared with relevant stakeholders such as UNICEF, JSI and the district local councils.

CF works with partners to integrate child sexual protection into their programs through community advocacy against child sexual abuse and life skills training of OVC. CF facilitates clinical counseling for post exposure prophylaxis (PEP) and follow up support through community volunteers. The community based response program established by CF in 2009 which involves communities and children reporting child abuse cases through an established network of volunteers, has increased the response rate of child abuse e.g. PEP cases increased by about 40% between 2009-2010.

In terms of family planning and reproductive health (FP/RH) services, CF contracted Island Hospice as a technical partner to help build the capacity of CF's 8 youth friendly centers (YFCs) in RH service provision to youth. A baseline was conducted which established the need to create a more integrated youth program that combines RH with livelihoods and lifelong education. This is the model that CF is now implementing in its YFCs. In addition, 7 of CF's NGO partners offered services to their beneficiaries this year in information-education-communications (IEC); referrals; stigma reduction and sanitary hygiene packs.

To support children living with disabilities, CF gave specific grants to 2 partners, one focusing on; helping disabled children access specialized care; facilitating caregiver trainings for care and support of children living with disabilities at community level through outreach programs; and creating awareness against stigma and discrimination of disabled children at community level. The other partner worked with CF to translate child rights CD based material into Braille for the benefit of blind children in schools as well as repair books and equipment in special needs schools.

Education support through school block grants ensured that children were retained in school. NGOs providing education support worked with CF to develop a more integrated school based program which will be run by parent associations in FY11 and complements the Government of Zimbabwe's education, health and social protection initiatives at the school level.

CF will continue to implement its M & E capacity building program with partners through the database, with the plan to quickly transition to the GoZ's newly introduced village/area registers. These registers will keep the names of OVCs at a local level and act as a local database. Quarterly monitoring and beneficiary verification visits will continue so as to ensure that activities are streamlined and quality of care improved. Periodic evaluations will help inform the impact that the project is having on the lives of children. To track the quality of OVC service provision, CF and partners developed and started tracking Desired Performance Standards for the 3 sector areas of education, health and social protection. Additionally, partners began to monitor the quality of services received at the child level using the Child Status Index. These activities will continue in FY11.

With FY2011 funding CF will bring significant resources to the community level, working with the most cost effective of the current partners and community groups. CF will build the capacity of NGOs in grant making and supporting community initiatives with technical assistance in quality OVC care and support. In FY11, the project will work with partners and community groups to adapt and replicate program designs and tools, identify and strengthen local solutions for OVC service provision that are linked to and support public sector service delivery, build upon identified effective practices, and strengthen partner community outreach and volunteer programs. CF will expand services at the community level in three ways; (i) strengthening linkages between community based programs and the public delivery system; (ii) replicating adapted and refined CF and other emerging community-based innovations; and (iii) ensuring that resources reach community-level initiatives working with OVC through strengthening partner outreach (iv) building livelihoods and food security into programs for sustainability and (v) continuing to support NGOs with interventions which serve the specific needs of highly vulnerable children.

Specifically:

Once a year CF and NGOs will refine and expand the school-based primary health care package so that OVC will have access to PHC screening, school-based care, and referral for more complicated cases.

School-based Child Rights CD listener groups packages which include PSS boxes will be mainstreamed in all CF- supported grants to standardize PSS support;

CF will work closely with SDAs and SDCs to expand its integrated school based program in all CF block grant schools. This program will include a livelihood component and where possible will be expanded to satellite schools .

CF and NGOs in partnership with Ministry of Education Sports and Culture (MOESC) and Adult Functional Literacy Organization of Zimbabwe (ALOZ) will scale up Non formal programs for out of school youths and expand this program to include a reproductive health and livelihood component.

The reproductive health component implemented through the youth friendly corners will be expanded into a holistic integrated youth program to include livelihoods, Sports and lifelong education .

CF will work with legal based NGOs in its project areas to increase access to legal education and assistance through the Child Legislation Modules which will be implemented through community paralegals.

Community initiatives will receive challenge grants that will enable them to provide services to children, but will also receive technical assistance that will enable them to increase the number of services provided or develop linkages that will enable OVC to receive a more comprehensive package of services.

Community initiatives will be helped to develop targeted economic strengthening programs that will bring income into the home while aiming to redress the social and economic inequalities that increase the vulnerability of OVC households. The programs will focus on female and youth headed households as studies have shown that they are often the ones who are left caring for large numbers of orphans and are unable to access the support they need. Economic strengthening programmes will include; micro enterprise and vocational skills training as well as agricultural based income generating activities. Activities will look at sustainability issues and target youth who are graduating out of traditional OVC support programs as well as those who are out of school.

CF will partner with the Department of Social Services (DSS) in the Ministry of Labour and Social Services to strengthen the M&E system for DSS and POS2 using evaluation outcomes and recommendations from the POS1. In addition to addressing the challenges faced in POS1, CF will also look at the proposed focus for POS2 in order to help strengthen the system. In light of this, CF will build DSS and POS2 M&E capacity through the following: (i) Secondment of an M&E Expert to DSS (ii) Adoption of CF strategy for: (i) verification of partner activities, beneficiary selection, service provision and quality of services provided. Ward Child Protection Committees (WCPC), Ward Aids Action Committees (WAAC), District Child Protection Committees (DCPCs) and District Aids Action Committees (DAAC) members supported by the M&E expert and CF's Community Based Trainers will be trained to do the verification exercises; and (ii) conducting periodic data quality assessments to establish accuracy and reliability of data reported. (iii) CF will help customize the PoS2 database to track children against services received. (iv) CF will translate the recently introduced manual village/area registers into electronic registers at district level to track OVC assisted (v) CF will build DSS and POS 2 capacity in tracking quality of services using the CSI and the DPS.

To achieve the FY11 goals and still maintain efficiency and cost effectiveness, CF will use a 3-pronged approach for funding NGOs and CBOs while concurrently refining CF systems and management:

1. Small/Challenge Grants: These in-kind and cash grants will provide small amounts starting from $300 - $5,000 to enable community groups to accomplish narrowly-defined, small-scale activities. This mechanism will deliver on CF's mandate for down-streaming support and services directly to the most vulnerable children and their caregivers. CF has leveraged its main NGO Partners to disburse 90 such grants and concomitant technical support; the balance of 60 which are outside the reach of CF's partners, will be supported directly by the project.

2. Task Orders: This new mechanism will be issued against specific time-bound deliverables for the Technical Support Partners referred to in the Cooperative Agreement. Given that these NGOs have specific technical capabilities but are not themselves currently reaching large numbers of beneficiaries, this mechanism will ensure the greatest return on CF's investment of money and staff time.

3. Sub grants/contracts: Some NGO Partners will continue to receive subcontracts from CF. These contracts will target those implementing integrated programs, and specialized services for highly vulnerable children.

With additional resources, CF will select additional partners who are able to scale up activities in the following areas: youth out of school study groups, mainstreaming of disability in formal schools and integrated Early Childhood Development programs.