SUMMARY:

World Vision (WV) is expanding OVC care activities by increasing the coverage, scope, and quality of

services to family members of HIV-infected individuals and older OVC. Emphasis areas are community

mobilization, training, and development of linkages and referral systems. The target populations are people

living with HIV and AIDS.

BACKGROUND:

World Vision is a non-profit organization established in 1967 working in 14 Area Development Programs

(ADPs) in six provinces of the country, reaching over 42,000 children with holistic development support.

World Vision has already identified and is providing community-led support to 4,439 OVC in these ADPs.

With PEPFAR funding this number will be increased to 17,500 children through the OVC project. For this

project, the target will be to address the needs of primary caregivers of OVC and older OVC which are not

covered by OVC funding. By working with community partnerships through their Community Care Coalitions

(CCC) model, World Vision enhances their ability to prevent, mitigate and alleviate the impact of HIV and

AIDS. Care at the home and community level is a strategy within the South African Government National

Strategic Plan.

World Vision will continue to strengthen access to integrated services as a part of a comprehensive care

package for PLHIV and their families in Free State, Limpopo and Eastern Cape provinces, with expansion

to at least 2 ADPs in Kwazulu-Natal province. The activities reinforce and expand services provided by

Community-based Organizations (CBOs) and government care programs, such as basic hygiene, wound

care, screening for pain and symptoms, nutrition assessment and support, spiritual care and support,

psychological care and promotion of the HIV preventive care package. With FY 2008 funding, World Vision

will further institutionalize the program within government and CBOs, while also expanding its reach. World

Vision will emphasize capacity building and local skills transfer, and assist HBC programs to develop

strategies to alleviate the care burden on girls. These strategies will specifically address gender sensitive

counseling, community outreach and couple counseling furthermore World Vision will ensure quality of

community-based services, and identify/apply lessons learned.

ACTIVITIES AND EXPECTED RESULTS:

ACTIVITY 1: Home-based care program

The majority (over 70%) of care workers (home visitors - HVs) in OVC programs are women (while two

thirds of the adult beneficiaries of the current home care programs are also women. In many cases, care

workers may also be recognized as traditional healers. World Vision will work to increase the involvement of

men in care giving. As part of psychosocial support trainings, care workers will engage men by focusing on

such topics as family violence, anger management, fathering and parenting skills. A stipend provided to

care workers and volunteers through the HBC program is an important source of household income.

Regular financial training seeks to improve the capacity and economic advancement of care workers in the

program. In addition to the psychosocial support training HVs will be trained on Palliative Community

Caregiving by Hospice.

Trained HVs provide a minimum standard of care focusing on physical, psychological, spiritual and social

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

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

on the need, clients will be referred to partner clinics and hospitals for pain management, treatment of OIs

including cotrimoxazole prophylaxis, family planning or other issues as observed. Home visitors will monitor

referrals to ensure appropriate follow-up and ongoing care and support. All clients will be counseled on

prevention with positives and family members will be referred for counseling and testing. Outreach to the

community and referrals are part of the HBC activities. An additional key activity of care workers 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. Special emphasis

during training will ensure HVs have a comprehensive understanding of referrals and linkages with other

services, including linkages with health and social welfare sectors for grants, legal aid, micro-finance,

spiritual support, CT, ARVs, and FP. With FY 2008 funding, World Vision will also seek to include bicycle

transport options for care workers to further improve coverage and support.

ACTIVITY 2: Psychosocial support training

In addition to home visitors, World Vision will also continue to identify and train supervisors and group

leaders to provide psychosocial support services. In districts where psychosocial support will be

established, community group leaders will be trained to reach family members of PLHIV and OVC, adults,

and their households through group counseling. At each site, qualified and trustworthy community members

to guide support group activities will be identified. These community-based group leaders will lead weekly

support sessions for the group members and conduct home visits to families of OVC. WV's Regional

Psychosocial Advisor will train supervisors as well as selected World Vision staff on a training curriculum

based on successful modules designed to address the particular needs of children and of adults. The

training will equip supervisors to assist and support others in care of the carer. At all levels, care of the carer

and care support training will focus on psychosocial interventions, including assessment, basic counseling,

group facilitation, and advocacy. Complementing health and nutrition lessons, training will ensure that all

trainees are able to recognize general physical as well as psychosocial health problems associated with

HIV and AIDS in children, and to make appropriate referrals to Child and Family Wellness clinics, Health

Centers and PHC Centers as needed.

Support group meetings led by trained group leaders using interactive and participatory techniques will be

held regularly with HVs. Working with churches/FBOs, and CBOs, World Vision will invite community

members to form psychosocial support groups. Group members will also be identified through assessment

interviews and information provided by relevant community members. During these support group sessions,

HVs and volunteers will learn to enhance coping skills to accomplish activities of daily living. Members will

carry out tasks designed to enhance relationships and build self-esteem. Positive living is reinforced as

group members develop emotional resilience. At the end of the project's first year, groups will be

Activity Narrative: encouraged to continue meeting, with ongoing guidance from World Vision's staff. The positive impacts of

psychosocial support will extend to group members' households, and family members will benefit indirectly

from the support group's second year of activities.

In all of the above activities, OVC will be counted only in the OVC program area. Palliative care to family

members of PLHIV or OVC will be provided in at least two or the five categories of palliative care services.

PLHIV will receive at least one clinical and one other category of palliative care service.

These activities will contribute to the PEPFAR goal of reaching 10 million HIV-infected and affected

individuals with care.

SUMMARY:

World Vision (WV), together with the Christian AIDS Bureau of South Africa (CABSA), will mobilize and

strengthen a community led response to protect and care for orphans and vulnerable children (OVC) and

their families. The program is active in the Free State, Limpopo and the Eastern Cape provinces and with

will expand to the KwaZulu-Natal province. The major emphasis area is human capacity development

(training). The target population is OVC.

BACKGROUND:

WV works in six provinces in South Africa (SA) in collaboration with CBOs, FBOs and government entities

to support over 42,000 sponsored children including 4,439 OVC registered at present. Currently, PEPFAR

supports Area Development Programs (ADPs in three and this will be expanded to four additional sites

within KwaZulu-Natal province. WV partners with CABSA to empower faith communities to develop projects

addressing HIV and AIDS. WV will use the CABSA curriculum (Channels of Hope (CoH)) to address

churches and FBOs to deal effectively with HIV and AIDS. The South African Government (SAG) Policy

Framework for OVC asserts that NGOs should assist in rolling out innovative and tested models to mobilize,

strengthen and support community led OVC efforts. With FY 2008 funding, WV will continue to assist

targeted communities to establish structures through which the community can care for and support OVC.

One element of an enabling environment for OVC support is the sustainability of community-based

organizations (CBO) such as Community Care Coalitions (CCC) which are equivalent to Child Care

Forums. WV will implement an organizational capacity building guide that includes self-assessment, training

based on the assessment and the follow-up support. WV will facilitate a process of sustainable community

involvement through this training to enable communities to develop and support their OVC. The WV

program will continue to work toward gender equity in service deliver by offering short gender courses to

NGOs and CBOs to improve their knowledge about child protection and how to address the factors that

keep girls out of school. FY 2008 additional funding, will expand activities under the Networks of Hope

program that they currently support expanding from 3 provinces to 4 with the addition of Kwazulu-Natal.

ACTIVITIES AND EXPECTED RESULTS:

ACTIVITY 1: Human Capacity Development

WV will conduct workshops, utilizing the CABSA CoH curriculum. A two-day Leaders Workshop will be held

with interested religious leaders The workshop will help religious leaders understand the urgency of the HIV

and AIDS crisis, to address negative and discriminatory attitudes and to work towards compassionate and

effective responses in congregations and communities. These leaders return to their congregations and to

FBOs to identify interested members who will in turn attend a four day workshop, which give attention to

best practice models for prevention, care for OVC, home-based care, voluntary counseling and testing and

advocacy. As a result of the four-day workshop, WV will work with each FBO to develop action plans to

address congregational and community, as well as confront gender discrimination, promoting gender equity

in communities. Trained congregation and FBO members will form Hope Teams which WV will support with

ongoing training and mentorship. In turn, these Hope teams will develop and carry out action plans relating

to the protection and care of OVC. The Hope Teams will work closely with the CCCs. 111 Hope Teams

have already been formed, training at this level will continue in FY 2008.

ACTIVITY 2: Community Mobilization

Through CCCs, WV will mobilize community stakeholders, including FBOs, CBOs, local government,

traditional leaders, school committees, health representatives, women groups, associations of people living

with HIV (PLHIV) and OVC. A two day stakeholder workshop will be held to identify gaps, and select the

CCC structure most appropriate to the local context. WV and CCCs will recruit new Home visitors (HV) to

visit OVC in their homes. CCCs will be encouraged to link and play an active role within the District Action

Committee for Children affected by HIV and AIDS (DACCA). Together with the CCC the HV will receive

training on Child Rights and Protection, access to education, health and nutrition, HIV prevention, Life Skills,

psychosocial support (PSS) and succession planning over five days. As a result, each identified OVC will

receive support from HV ranging from direct material provision to greater livelihood security.

ACTIVITY 3: Care and Support

After the workshops for CCCs and HVs, each OVC will receive a basic minimum package of services and

support. The services will include child monitoring and protection, PSS, agricultural inputs, facilitating

access to education, health care, basic nutrition training, HIV prevention, home-based care for chronically ill

adults and children, succession planning and supervised recreation. Direct support will include school fees,

vocational training, school uniforms, books and supplies, facilitation with transport for primary health care

checkups, improved diets/livelihoods through, clothing shoes, bedding and blankets.

ACIVITY 4: Local Organizational Capacity Development

WV developed an Organizational Capacity Building (OCB) guide to build organizational capacity. The OCB

process begins with an organizational self-assessment, training based on the result of the assessment and

follow-up support. The training may include Organizational Purpose, Planning, Procedures, Group

dynamics, Monitoring, Evaluation and Reporting, Finance, Resource Mobilization and external relations.

Through this activity WV will build the capacity of local organizations to operate effectively in providing

adequate protection and care to OVC and their families. WV will partner with CABSA to establish resource

centers in each ADP; stocked with relevant HIV and AIDS materials. The resource centers will be used by

the CCCs and community assisting them in the development of an adequate response to the OVC issues

facing their community.

ACIVITY 5: Referrals and linkages

WV works in collaboration with the DOSD, the Departments of Health, Education, Agriculture, private

companies, FBOs and CBOs. These partnerships will be expanded to ensure that all OVC are provided with

a full package of care and referred for appropriate treatment and care services. In addition to establishing a

program of 'community conversations', the project will integrate a gender component and advocacy into all

activities. The aim of these activities is to build stronger, more gender-equitable relationships with better

communication between partners utilizing participatory learning to improve the health, well-being and

resilience of adolescent OVC (Boys and Girls). Emphasis is place on options to delay sexual activity.

In FY 2008 the following activities will be added:

Activity Narrative: ACTIVITY 6: Community conversations

Facilitated community conversations will focus on raising awareness of social-economic and cultural

inequalities that put women at a disadvantage and how this contributes to the spread of HIV and AIDS.

Specifically, discussions will focus on how to strengthen the negotiating powers of women and girls in

sexual relationships and on raising the awareness of men about the role they play in sexual relationships.

This gender equality dialogue will emphasize the positive aspects of changing the behaviors that increase

the risk of becoming HIV-infected and using best practices. WV will benefit from participatory research

conducted demonstrating that these open and frank but sensitive "community conversations" help cement

new positive attitudes among youth and reduce gender-biased stereotypes. The majority of care workers

(Home visitors/HV) in OVC programs are women (over 70%). WV will work to increase the involvement of

men in care-giving of OVC. As part of the CCC (Community Care Coalition) trainings, HV's will engage men

by focusing on such topics as family violence, anger management, fathering and parenting skills. Training

materials will include discussion of power relations between girls and boys, women and men, and will give

girls skills in refusal and negotiation. CoH training will also emphasize addressing gender from a standpoint

of context and attitudes. WV will focus on men and boys as agents of change in this process of awareness

building, mobilizing and spreading HIV prevention messages.

ACTIVITY 7: Peer-support groups and Youth AIDS clubs

Peer support groups and Youth AIDS clubs will be targeted toward adolescents. WV will connect with these

adolescent OVC through schools and churches. Training in Youth prevention strategies will target boys and

girls. Using a participatory process, OVC will identify role models (including positive deviants) to serve as

the peer support leaders. The adolescents will form peer-education groups and these groups will form the

critical catalysts for the community social discourse on healthy norms and avoidance of risk behavior. The

anticipated outcome of this process is a re-emergence of AB as a community norm and a reduction in the

practice of cross-generational sex, transactional sex and multiple casual sex partnerships, etc.

In all WVSA ADP PEPFAR-funded sites there are sponsored children, funded by donors from different

countries, many of whom are OVC. WV requires at least quarterly visits to each of these children by

Development Workers. Through this process WVSA identifies the education, health, spiritual and other

needs of the children and their families. WV field staff provides a proactive role in identifying the needs of

OVC and the subsequent delivery of services, justifying the allocation of WV Matching funding to the budget

allocated by PEPFAR.

The WV OVC activities will contribute to the PEPFAR 2-7-10 goal by improving access to quality care to 10

million people including OVC.