Guide to Mobilising and Strengthening Community-Led Care for Orphans and Vulnerable Children HIV/AIDS Hope Initiative This guide is intended to provide useful tools for individuals and organisations seeking to mobilise and strengthen community-led care for orphans and vulnerable children (OVC). It is based on an OVC programming strategy developed by World Vision, an international Christian relief and development organisation. In line with global best practice, World Vision’s OVC programming strategy focuses on strengthening family and community care for OVC, primarily through support of community care coalitions (CCCs) that bring together churches and other faith-based organisations, government, local business, traditional structures, and other NGOs. Building on efforts already underway in the community, these coalitions support home visitors: women and men who volunteer to take responsibility for identifying, monitoring, assisting, and protecting OVC. CCCs facilitate both co-ordination and expansion of OVC responses within the community. The guide is composed of two units. Unit 1 is a resource for mobilisers of community-led OVC care using the CCC strategy. Unit 2 is a resource for facilitators who lead training to equip CCCs and their home visitors to provide effective, sustainable care for OVC. The guide was developed through World Vision’s HIV/AIDS Hope Initiative, working to expand and enhance responses to HIV/AIDS in the nearly 100 countries where World Vision works around the world. Guide to Mobilising and Strengthening Community-Led Care for Orphans and Vulnerable Children HIV/AIDS Hope Initiative Copyright © World Vision International, 2005 All contents of this toolkit are copyright © World Vision International, 2005. All rights reserved. Portions of the toolkit may be reproduced with written permission from World Vision International. For more information, email [email protected]. Acknowledgements The Guide to Mobilising and Strengthening Community-Led Care for Orphans and Vulnerable Children has been developed by the Models of Learning programme, the research and development arm of World Vision’s global HIV/AIDS Hope Initiative. This document has evolved through more than a year of field-testing and review, beginning in late 2003. Special thanks is due to the OVC specialists on the Models of Learning team, Grace Mayanja and Faith Ngoma, who authored the initial version of the guide in response to the need expressed by World Vision field staff and community partners. Sincere gratitude is also owed to the World Vision staff and community care coalition members in Mozambique, Uganda, and Zambia with whom the Models of Learning team worked to pilot the guide. We are grateful to consultants Deborah Forbes and Michele Gaudrault, who revised the guide based on the learnings of this pilot process and produced a review draft for the Bangkok International AIDS Conference in July 2004. We very much appreciate the input of the more than forty World Vision national HIV/AIDS co-ordinators and regional HIV/AIDS staff from across Africa who reviewed the guide in September 2004 and made excellent recommendations for further refinement. We also wish to thank the participants in the World Vision Africa regional OVC training of trainers workshop in November 2004 for their guidance on additional improvements needed. We are indebted to the South Africa-based team of consultants managed by Neil Verlaque-Napper for their excellent work on a tight production schedule to finalise the guide for publication. Sincere thanks to team member Alastair Findlay for his illustrations throughout the guide and on the cover, as well as to team member Gill McDowell for her work to design, format, and edit this version of the guide. We gratefully acknowledge the following Models of Learning staff for their contributions to the development of the guide: Namposya Chitanika, Angela Mubangizi, Kennedy Nkwemu, Maurice Sepiso, David Serukka, and Richard Wamimbi. Models of Learning director Mark Lorey’s leadership of the overall compilation, refinement, and production of this guide is appreciated. Finally, we offer thanks to World Vision Africa HIV/AIDS director Martha Newsome and World Vision Africa communications director Nigel Marsh for their ongoing support and wise counsel. This guide will continually evolve as additional experience is gained and new lessons are learned. Input is welcomed and appreciated. Please send comments and suggestions to the Models of Learning programme: [email protected]. Ken Casey Special Representative to the World Vision International President HIV/AIDS Hope Initiative 2005 Acronyms ADP Area Development Programme AIDS Acquired Immune Deficiency Syndrome BCC Behavioural Change Communication CA Correspondence Analyst CBO Community-Based Organisation CCC Community Care Coalition CCF Community Care Facilitator CDF Community Development Facilitator CRS Customer Relations Services FBO Faith-Based Organisation FGD Focus Group Discussion GIK Gift in Kind HIV Human Immunodeficiency Virus IEC Information, Education and Communication IGAs Income Generating Activities LC Local Council NGO Non-Governmental Organisation OVC Orphans and Vulnerable Children PLWHA People Living with HIV/AIDS PMTCT Prevention of Mother To Child Transmission PSS Psychosocial Support PTA Parents and Teachers Association SMART Specific Measurable Attainable Relevant Time-Bound STI Sexually Transmitted Infection SWOT Strength Weaknesses Opportunities Threats TB Tuberculosis ToT Training of Trainers UNAIDS Joint United Nations Programme on HIV/AIDS UNICEF United Nations Children’s Fund UPE Universal Primary Education WV World Vision CONTENTS INTRODUCTION UNIT I - Mobilising Community-Led Care for OVC: A Guide for Mobilisers Module 1: Overview of the Mobilisation Process Introduction 5 Stage 1: Preliminary Institutional Mapping 6 Stage 2: Community Stakeholders’ Meeting 8 Stage 3: Forming a Community Care Coalition (CCC) 10 Stage 4: Action Planning 11 Stage 5: Training Community Care CoalitionMembers 13 Stage 6: Identifying OVC 14 Stage 7: Identifying Home Visitors 15 Stage 8: Training Home Visitors 16 Stage 9: Supporting Home Visitors 17 Stage 10: Monitoring and Reporting 18 Stage 11: Mobilising Resources 20 Module 2: Detailed Instructions for the Mobiliser Introduction 21 Step 1: Preliminary Institutional Mapping 22 Step 2: First Community Stakeholders’ Meeting: Assessing the OVC Situation 27 Step 3: Second Community Stakeholders’ Meeting: Forming a Community Care Coalition (CCC) 35 Step 4: Action Planning 40 Step 5: Monitoring and Reporting 45 UNIT 2 - Strengthening Community-Led Care for OVC: A Guide for Facilitators Facilitator’s Guidelines Background Information 51 Part 1: The Key Issues of Training 53 Part 2: The Seven Steps of Planning 59 Part 3: Running the Training Programme 71 Part 3: Sample Training Agenda 83 Module 1: HIV/AIDS and the Situation of OVC Topic 1: Basic Information on HIV/AIDS 87 - Activity 1: What are HIV and AIDS? 89 - Activity 2: Modes of HIV Transmission - Facts and Misconceptions 90 - Activity 3: Preventing HIV Infection 92 - Activity 4: HIV Self-Risk Assessment Quiz 93 - Activity 5: General Trends in HIV/AIDS Infection 94 - Activity 6: Preparing for Home Visits: Information on HIV/AIDS 95 Topic 2: The Impact of HIV/AIDS 97 - Activity 1: The Definition of Psychological and Socio-Economic 99 - Activity 2: The Psychological and Socio-Economic Impact of HIV/AIDS on Children, Families and Communities 100 Topic 3: National Frameworks for Supporting OVC 103 - Activity 1: National OVC Policy 105 - Activity 2: Government Strategies and Responsibilities 106 - Activity 3: Other Stakeholder Responsibilities 108 - Activity 4: The Seven Components of OVC Support 111 - Activity 5: CCCs and OVC Support 113 - Activity 6: Preparing for Home Visits: Elements of OVC Support 114 Topic 4: Children’s Rights and How They Apply to the Care of OVC 115 - Activity 1: What are Children’s Rights? 116 - Activity 2: Categories of Children’s Rights 118 - Activity 3: Abuse of Children’s Rights: Forms, Causes and Consequences 120 - Activity 4: The Sexual Abuse of Children 123 - Activity 5: Protecting Children 125 - Activity 6: Preparing for Home Visits: Monitoring for Signs of Child Abuse 126 Topic 5: The Implications of Gender-Based Roles for OVC 127 - Activity 1: The Gender Roles of Girls and Boys 129 - Activity 2: The Advantages and Disadvantages of Gender-Based Roles 131 - Activity 3: Strategies to Overcome Gender-Based Discrimination 133 - Activity 4: Preparing for Home Visits: Gender Awareness 135 - Activity 5: Review of the Home Visitor’s Handbook 136 Module 2: Addressing the Psychosocial and Spiritual Needs of OVC and Their Caregivers Topic 1: The Different Needs of OVC 137 - Activity 1: The Different Needs of Children 139 - Activity 2: How Children React to Unmet Needs 141 - Activity 3: Problems Experienced by OVC in the Community 142 - Activity 4: Preparing for Home Visits: OVC Needs 144 Topic 2: Psychosocial Support for OVC 145 - Activity 1: What is Psychosocial Support? 147 - Activity 2: What Psychosocial Support is Being Provided to OVC? 148 Topic 3: The Stages of Development and Understanding in Children 149 - Activity 1: Growth, Development and Change in Children 151 - Activity 2: Indicators of Development in Children 153 - Activity 3: Theories of Age and Understanding in Children 155 - Activity 4: Environmental Factors in Children’s Development 157 - Activity 5: The Community’s Role in Children’s Development 159 - Activity 6: Preparing for Home Visits: Child Development 160 Topic 4: Counselling and Communicating with OVC 163 - Activity 1: The Characteristics of a Children 165 - Activity 2: How Children Communicate 166 - Activity 3: Effective Methods for Communicating with Children 168 - Activity 4: The Do’s and Don’ts of Communicating with Children 171 - Activity 5: Practising Effective Communication 173 Topic 5: Accompanying OVC through Grief and Bereavement 175 - Activity 1: Grief and Loss 177 - Activity 2: The Signs and Symptoms of Grief 179 - Activity 3: The Understanding of Death at Different Ages 180 - Activity 4: Preparing Children for Death in the Family 181 - Activity 5: Support Strategies to help Grieving Children 183 Topic 6: Using Play in Counselling Children 185 - Activity 1: Why is Play Important for Children? 187 - Activity 2: Play as an Indicator of a Child’s Well-Being 188 - Activity 3: Methods for Using Play in Counselling Children 190 Topic 7: Spiritual Care for Orphans and Vulnerable Children 191 - Activity 1: Signs of Spiritual Problems in Children 193 - Activity 2: Signs of Spiritual Health in Children 194 - Activity 3: Strategies for the Spiritual Care of OVC 195 Topic 8: Support for Caregivers 197 - Activity 1: Enhancing Self-Awareness in Caregivers 199 - Activity 2: The Tree of Life 200 - Activity 3: Me Drawings 201 - Activity 4: Me Boxes 202 - Activity 5: Support Groups 203 - Activity 6: Review of the Home Visitor’s Handbook 204 Module 3: Addressing the Physical Needs of OVC Topic 1: Food Security for OVC 205 - Activity 1: The Meaning of Food Security 207 - Activity 2: Threats to the Food Security of OVC 208 - Activity 3: Community Initiatives to Enhance Food Security for OVC 209 - Activity 4: Preparing for Home Visits: Food Security and OVC 210 Topic 2: Improving the Nutrition of OVC and Those Affected by HIV/AIDS 213 - Activity 1: The Meaning of Nutrition 215 - Activity 2: Identifying Important Foods 216 - Activity 3: Nutritional Support for Children with HIV or Those Born to HIV Positive Mothers 218 - Activity 4: Nutritional Support for HIV Positive Pregnant Women and Breastfeeding Mothers 221 - Activity 5: Nutritional Support for Adults Living with HIV/AIDS 222 - Activity 6: The Causes and Effects of Poor Nutrition 223 - Activity 7: Steps to Help Malnourished OVC 224 - Activity 8: Preparing for Home Visits: Nutritional Information 225 Topic 3: Monitoring the Health of Orphans and Vulnerable Children 227 - Activity 1: Basic Healthcare and the Needs of OVC 229 - Activity 2: Immunisation 231 - Activity 3: Common Diseases that Affect Children 233 - Activity 4: Barriers to Healthcare and Ways to Ensure Access 235 - Activity 5: Basic Hygiene Practices 236 - Activity 6: Access to Sanitation and Safe Water 239 - Activity 7: Sexual and Reproductive Health 240 - Activity 8: Preparing for Home Visits: Monitoring the Health of OVC 241 - Activity 9: Review of the Home Visitor’s Handbook 242