Qualitative research report on orphans and vulnerable children in Palapye, Botswana Free download from www.hsrcpress.ac.za Edited by GN Tsheko W Published by HSRC Press Private Bag X9182, Cape Town, 8000, South Africa www.hsrcpress.ac.za First published 2007 Free download from www.hsrcpress.ac.za ISBN 978-0-7969-2187-1 © 2007 Human Sciences Research Council Copyedited by Vaun Cornell Typeset by Janco Yspeert Cover design by Oryx Media Cover photo: ©Eric Miller/iAfrika Photos Print management by Compress Distributed in Africa by Blue Weaver Tel: +27 (0) 21 701 4477; Fax: +27 (0) 21 701 7302 www.oneworldbooks.com Distributed in Europe and the United Kingdom by Eurospan Distribution Services (EDS) Tel: +44 (0) 20 7240 0856; Fax: +44 (0) 20 7379 0609 www.eurospangroup.com/bookstore Distributed in North America by Independent Publishers Group (IPG) Call toll-free: (800) 888 4741; Fax: +1 (312) 337 5985 www.ipgbook.com Acknowledgements iv Acronyms and abbreviations Definition of terms vi Executive summary vii v 1.1 Defining orphans and vulnerable children 1.2 Background to situation of OVC in Botswana Free download from www.hsrcpress.ac.za 2.1 Aims of the qualitative research 3.1 3.2 3.3 3.4 3.5 Research design Research participants and sampling procedures Data collection instruments Ethical considerations Data analysis 4.1 4.2 4.3 4.4 4.5 4.6 4.7 4.8 Description of site 10 The situation of OVC 12 Household situation 14 Institutional care of children 17 Child abuse 18 Community members’ and leaders’ perceptions of OVC Support structures for OVC in community 20 Context of HIV/AIDS 25 19 5.1 Recommendations on care of OVC 27 5.2 Recommendations on support of households and communities caring for OVC 27 5.3 Recommendations on service providers for OVC 28 Appendix Appendix Appendix Appendix Appendix References Interview Interview Interview Interview Interview 40 schedule schedule schedule schedule schedule for for for for for OVC 29 immediate caregivers of OVC 31 members of NGOs, CBOs and FBOs 34 members of state services or government background for BSS component 38 36 This study was supported by the WK Kellogg Foundation and undertaken by Masiela Trust Fund OVC Research-Botswana under the umbrella of the Human Sciences Research Council in South Africa Masiela Trust Fund OVC Research-Botswana is indebted to the field assistants, respondents and community leaders who participated in this study We are also grateful to our research team which has worked tirelessly in the preparation of instruments and collection of data We also thank all those who helped at various stages in the writing of this report, especially Dr Dudu Jankie who analysed some of the data Thank you Free download from www.hsrcpress.ac.za Masiela Trust Fund Research Project Director iv acquired immune deficiency syndrome ARV anti-retroviral therapy BSS behavioural risks and sero-status CBO community-based organisation CHBC community home-based care FBO faith-based organisation HIV human immuno-deficiency virus HSRC Human Sciences Research Council MTF Masiela Trust Fund MTP medium-term plan NGO non-governmental organisation OVC orphans and vulnerable children PLWA people living with HIV and AIDS PMTCT Free download from www.hsrcpress.ac.za AIDS prevention of mother to child transmission of HIV STPA short-term plan of action TCM total community mobilisation VCT voluntary counselling and testing v Basic human rights These are rights held to be common to all people, such as education, health, protection from abuse and neglect, food, shelter, non-discrimination, preservation of identity, etc Street children These are children who have run away from home and live in the streets Many are believed to be orphans while the rest have run away from home due to lack of parental love and care An orphan The most accepted definition of an orphan is a child who has lost both parents through death In Botswana an orphan is a child below 18 years who has lost both adoptive or biological parents, or the one single parent if unmarried (Skinner et al 2004) Free download from www.hsrcpress.ac.za A vulnerable child A child who has no or very restricted access to basic needs The child may have both parents but his/her rights might be denied (Skinner et al 2004) vi Free download from www.hsrcpress.ac.za In 2002 the Human Sciences Research Council (HSRC) received funding from the WK Kellogg Foundation to develop and implement a five-year intervention project on the care of orphans and vulnerable children (OVC), as well as households and communities coping with the care of affected children in Botswana, South Africa and Zimbabwe The project comprises two components: firstly funding and technical assistance directed at interventions to assist OVC; and secondly research to develop a better understanding of the situation of OVC and towards the development of best practice approaches for interventions The HSRC is collaborating with research institutions in Zimbabwe and Botswana, and with non-governmental organisations (NGOs) that would act as implementing partners for the interventions In Botswana, the Masiela Trust Fund (MTF) was chosen to work with the University of Botswana Research Team as an implementing partner MTF’s mission is to mobilise resources to address the needs of orphans in order to minimise the phenomenon of street children, juvenile delinquency, and to help divert a culture of destitution, as well as forge a threat-free environment in the interest of a better tomorrow MTF works with community-based organisations (CBOs) and faith-based organisations (FBOs), and funds their projects in the intervention sites to ensure delivery of necessary services to those who need them In Botswana, Palapye was chosen as an intervention site for this project, in addition to the already existing sites where MTF has interventions This study used qualitative techniques to enable in-depth understanding of the situation of OVC in Palapye Different approaches were used in data collection, including structured and semi-structured interviews and focus group discussions These helped the researchers understand issues related to behaviour, attitudes, opinions, beliefs, feelings, knowledge and values about OVC A total of 32 key informant interviews and eight focus group discussions were conducted Purposive sampling was used to make sure that all significant sectors of the communities were systematically covered Interviews were held with OVC, immediate carers of OVC, NGO/CBO/FBO representatives, community leaders and government officials Palapye is a semi-urban locality and Setswana is the predominant language used in the area It also has advanced infrastructure The community has access to different shops (food, furniture, and clothing), public phones, public transport, electricity, water, tarred roads and others It is a typical village where some families still reside in one-roomed traditional houses constructed of mud with a thatched roof Most of the households not have running water and proper sewerage Palapye has some urban dwellings, where families reside in modern multi-roomed houses that have running water, proper sewage and electricity The Department of Water Affairs has provided community standpipes in the village for use by villagers who not have running water in their homes There are an increasing number of OVC in Palapye, and the situation is compounded by HIV/AIDS resulting in the death of able-bodied parents This leaves the children in the care of old and poor grandparents Poverty levels seem quite high, as many reported shortages of basic needs including housing Poverty alleviation initiatives are crucial for this community Though the government has programmes to cater for orphaned children and the destitute, there are challenges in registering those who qualify for these services, which results in programmes not being accessible Another complicating factor is the reluctance of families to register such children with appropriate authorities The community needs to be educated on available programmes and their benefits vii Further, due to shortages of transport, finance and manpower in delivery of services, accessing services remains a challenge On the other hand, NGO/CBO/FBO efforts to address the issues are frustrated by the great lack of funds This calls for a stronger partnership in caring for OVC In some poorer households even the support from social welfare services of providing food rations does not benefit OVC, as it is said that some caregivers steal these supplies and use them for their own gain This calls for education on caring for children and home management Free download from www.hsrcpress.ac.za Stigma continues to be a major challenge regardless of how long HIV/AIDS has been in existence and how much education has been done A general lack of knowledge on HIV/AIDS is apparent in the myths surrounding transmission, prevention and cure Communities need more education on issues of HIV/AIDS, especially to try and decrease the extent to which people are subject to stigma viii Introduction Free download from www.hsrcpress.ac.za The AIDS epidemic has left behind an estimated 15 million orphans worldwide Around 80 per cent of these AIDS orphans live in sub-Saharan Africa (Fredriksson-Bass & Kanabus 2004) Tragically, the number of orphans in sub-Saharan Africa will continue to rise in the years ahead, due to the high proportion of adults in the region already living with HIV/AIDS, and the continuing difficulties in expanding access to life-prolonging anti-retroviral treatment (UNICEF 2003) In sub-Saharan Africa, even more catastrophically than elsewhere, the HIV/AIDS epidemic has deepened poverty and exacerbated myriad deprivations The responsibility of caring for orphaned children is a major factor in pushing many extended families beyond their ability to cope (UNICEF 2003) Many countries are experiencing large increases in the number of families headed by women and grandparents, and these households are often progressively unable to provide adequately for the children in their care Children orphaned by HIV/AIDS are disadvantaged in numerous and often devastating ways For instance, in addition to the trauma of witnessing the sickness and death of one or both parents, they are likely to be poorer and less healthy than non-orphans (UNICEF 2003) They are more likely to suffer damage to their cognitive and emotional development, to have less access to education, and to be subjected to the worst forms of child labour (UNICEF 2003) Young people who have lost one or both parent are among the most exposed in the society This is particularly true in sub-Saharan Africa where few social support systems exist outside of families and where basic social services are largely inadequate (Fredriksson-Bass & Kanabus 2004) Furthermore, orphans may grow up without basic material resources and may lack the love and support that emotionally-invested caregivers usually provide They may be discriminated against because of the sero-status of their parents, or be forced to discontinue their education because of lack of money or the need to take care of their siblings (Skinner et al 2004) There is general consensus in the literature that help for orphans should be targeted at supporting families and communities and improving their capacity to cope, rather than setting up institutions for the children, as orphanages are not a sustainable long-term solution (UNAIDS 2002) In addition, institutional care is known to have deleterious effects on children Children sent away from their villages may lose their rights to their parents’ land and other property, as well as their sense of belonging to a family and a community 1.1 Defining orphans and vulnerable children Skinner et al (2004) define an orphan as a child who has lost one or both parents through death, desertion or if the parents are unable or unwilling to provide care They further define a child as someone who is aged 18 and below The Botswana Short Term Plan of Action (STPA) (Ministry of Local Government Lands and Housing 1999: 9) on the care of orphans defines an orphan as a ‘child below 18 years who has lost one [single parent] or two [married couples] biological or adoptive parents’ The plan of action goes on to categorise another group of orphans as social orphans and defines them as ‘abandoned or dumped children whose parents cannot be traced’ For the purposes of this report, both definitions cited above will be used Defining a vulnerable child can be complex but focuses around three core areas (Skinner et al 2004): Material problems, including insufficient access to money, food, clothing, shelter, health care and education; Emotional problems, including lack of caring, love, support, space to grieve and containment of emotions; and Social problems, including lack of a supportive peer group, of role models to follow, stigma or of guidance in difficult situations, and risks in the immediate environment 1.2 Background to situation of OVC in Botswana The number of orphans in Botswana has increased tremendously in recent years due to high and increasing prevalence of HIV and AIDS In 1999, the number of registered orphans was 21 109 and this number doubled to 42 000 by 2003 (Ministry of Local Government 2004) This trend is shown in Figure Thousands Free download from www.hsrcpress.ac.za Figure 1: Number of registered orphans, Botswana, 1999–2003 45 40 35 30 25 20 15 10 37 850 42 000 2002 2003 30 855 24 341 21 109 1999 2000 2001 Source: Ministry of Local Government (2003), Department of Social Services 1999–2003 The number of registered orphans has been increasing, and findings from the rapid assessment on the situation of orphans in Botswana (Ministry of Health 1998) indicated that many orphans not have access to basic necessities such as food, clothing, shelter and toiletries The assessment also established that their basic fundamental human rights were violated by society and caregivers, including relatives in some cases – for example, their food rations being sold and being used as cheap labour by the business community What further aggravates the problem is that many caregivers are aged grandparents, who live in abject poverty, and in many cases are supported through the destitute programme or old age pension (Ministry of Local Government Lands and Housing 1999) The advent of HIV and AIDS has not only increased the problem of orphans but also compounded the phenomenon of vulnerable children The long-term sickness and eventual death of a parent or both parents to HIV and AIDS exposes OVC to all kinds of abuse For instance, it was frequently mentioned that many vulnerable children end up leaving their homes to join the ranks of street children while some remain in poverty in their homes According to a Situation Analysis of Street Children in Botswana (Dynah Conclusion and recommendations Free download from www.hsrcpress.ac.za It is apparent from the discussions in this report that the situation of orphans and vulnerable children is escalating The community is concerned about this Furthermore, the community suspects that large numbers of people are infected with HIV/AIDS This is a serious situation in that it indicates an increasing number of orphans due to HIV/AIDS Poverty is also reported by many of the households This raises concern as it directly exacerbates the vulnerability of children in such households What is disheartening is the reluctance of families to register orphans and vulnerable children with the government programmes designed to address the OVC situation Reasons given for this reluctance range from the shame of being known to be poor to complaints about what the programmes offer These complaints are offered by carers and not the immediate beneficiaries of the programmes The very carers who claim they are overwhelmed by caring for these children are the same people who deny or refuse assistance The issues of pride and stigma, as expressed by some respondents, also compound the accessibility of services and programmes for OVC Stigma is still a big problem in that when one goes to register an orphaned or vulnerable child, they tend to attract unwanted attention It is these suspicious looks from others that deter some people from registering children who need the offered services Further, with this inability of most families to care for the children, those who receive assistance have a tendency to misuse the service Both children and adults who participated in this study related how some carers used their supplies from the government for their own gain In some cases they probably this out of ignorance and cultural practices; for example, food supplies include items such as eggs, and in traditional Setswana culture children are not allowed to eat eggs It is evident from the study that orphans not always receive good care and support from their guardians and relatives Many of them are living in absolute poverty and poor housing Lack of parental care and guidance leads many of them to leave home to become street children There is also an indication that OVC are sexually abused while some boys are used as cheap labour It is clear from the study that the extended family system is disintegrating and households are becoming ‘nuclear family centred’, caring only for carers’ children and not other relatives Property grabbing from orphans is another area of concern This calls for greater collaboration and partnerships in orphan care at national, district and community levels Services to OVC are mainly provided by government through public assistance programmes such as the Short-Term Plan of Action on Orphan Care and the destitute persons programme The destitute persons programme does not seem to be understood, especially regarding how it can benefit vulnerable children An educational campaign on the matter is seriously needed Current implementation of the Short-Term Plan of Action on Orphan Care has a strong bias toward providing material assistance such as clothing and food baskets, as compared to emotional or psycho-social counselling, which is an equally important component of child development and protection Furthermore, at present children’s needs that require emotional or therapeutic counselling are mostly provided as part of family counselling 26 rather than for children in their own right, except in schools where guidance and counselling units are being set up increasingly for children attending school This is because the main national child protection legislation, the Children’s Act, provides no means of emotional and rehabilitative support for children and their families Free download from www.hsrcpress.ac.za The study noted the importance of the contribution of NGOs to orphan care, but these NGOs have financial constraints and cannot adequately cover or expand to other areas Constraints include shortages of manpower, transport and finances They are also unable to cover some aspects of their core mandate Since government cannot sufficiently provide services for OVC across the length and breadth of the country it is important to support these NGOs These organisations already exist at the community level and if their funding is increased there would be no need for government to establish new structures and employ new staff The study also highlighted another important factor in the care of OVC In Palapye there was strong community involvement in the care of OVC, with individuals and community organisations, including the commercial sector, contributing to the care of OVC Government should use this model to sensitise other communities to take care of orphans in their localities This would contribute to making OVC care sustainable 5.1 • • • • • • 5.2 • • • • • Recommendations on care of OVC The reluctance of parents/guardians to register OVC needs to be addressed urgently There is a need for community education campaigns to address the matter A clear understanding of who OVC are is needed so that people can assist in identifying all children needing support in their communities There is a need for psycho-social support in the case of orphans, and to cope with their situation in the case of other vulnerable children Education of caregivers in providing love and support for the children under their care is needed Strict punishment on perpetrators who abuse children is needed The laws have to be reviewed to ensure that this happens Education campaigns must be strengthened to eliminate stigma associated with orphanhood and poverty Recommendations on support of households and communities caring for OVC Poverty reduction strategies need to be built into communities so that they can care for themselves and their children better Education in better parenting skills and home management skills is needed so that parents can refrain from abusing and stealing supplies meant for children Alcohol and other substance abuse by parents needs to be addressed Educational campaigns and strengthening of community support structures are needed It is evident from the study that group counselling and guidance for OVC and guardians is lacking Counselling and guidance for OVC and their guardians should be provided in order to assist them to cope with their situations Empowerment of communities to take care of OVC is crucial for sustainability of orphan care programmes The community should be encouraged to participate in the provision of orphan care services such as fundraising, sponsor-a-child, adopting a child and foster parenting 27 • 5.3 • • • Free download from www.hsrcpress.ac.za • 28 • General knowledge about HIV and AIDS is limited Strategies on HIV and AIDS education must be strengthened to effectively reach household and ward levels to address misconceptions that perpetuate HIV transmission Recommendations on service providers for OVC Government’s commitment to problem of OVC is commendable but there is a need for monitoring and evaluation to improve service provision The shortage of manpower needs to be a priority in the delivery of service especially for government NGOs, FBOs and CBOs are limited/constrained due to lack of funds to expand their services Government and its collaborating partners should increase their financial support to NGOs, FBOs, and CBOs providing orphan care services in order to expand their services The conditions under which many orphans live are appalling and cannot be ignored There is a need to look into the possibility of the establishment of orphan care centres (orphanages) and day-care centres for OVC nationwide Government should encourage NGOs to establish such centres, and government and its collaborating partners should provide the necessary support There need to be precautions taken not to distance children from their communities of origin Government and other development partners should up-scale education on HIV/ AIDS towards a behavioural-change mode Interview schedule for OVC The key areas to be covered in the interview are in bold Below these are prompts that may be used to elicit discussion, plus the particular areas that need to be covered in the interview For each interview different sections of the interview schedule will have to be prioritised, and some of the areas of discussion may fall away Do not use the prompts unless the respondent is finding it difficult to talk about the area Responses are sought beyond the immediate prompts as long as the discussion stays within the broad subject Background of person being interviewed Why the person is being interviewed Position in community and how they came to be in this position We have asked you to be interviewed as we want to know and understand your experiences since (insert appropriate context here, for example, one or more parent died, became ill, or if your situation has changed)? Free download from www.hsrcpress.ac.za What are your major needs and concerns? Care of OVC Personal history of the OVC OVC’s own reflection on situation Housing, access to facilities, resources Loss of personal possessions Level of emotional and physical care Coping methods Support structures Attitudes to carers, key influencing figures in their communities Attitudes of the community towards OVC, especially incidents of stigma Perceptions of OVC by the community Stigma against OVC Anger at OVC Positive attitudes to OVC Policy and legislation for the protection of OVC Knowledge of law, policy or pre-established practices to protect OVC Attitudes towards such regulations Implementation and support of these regulations Suggestions of how to help OVC in the community Role of individuals, CBOs, NGOs, FBOs and state structures What is needed to facilitate these contributions Assessment of the commitment on the part of their structures to assist Actions the government should take to assist OVC 29 Secondary set of questions What you know and understand about HIV and AIDS? Is there anything that puts you particularly at risk for contracting HIV? Risks of HIV as a result of violence Child abuse Rape and sexual assault Caring for victims of violence Taking payment for sexual services Free download from www.hsrcpress.ac.za Suggestions of how to limit the spread of HIV/AIDS in the community Educational and information needs Infrastructural needs – PMTCT, VCT and condom distribution Interventions at the social level – stigma, gender discrimination, promiscuity Checks on the health service 30 Personal knowledge, beliefs and behaviour in relation to HIV Knowledge and beliefs about HIV Attitudes towards safer sexual practices and PLWHA Past behaviour and commitments to future behaviour Complications in protecting themselves from HIV Access to resources Confusion in information Social pressures, risks of judgment and stigma Skills and capacity in caring for OVC Care and treatment of PLWHA in the community Availability of services for PLWHA Impact of services Views on VCT, PMTCT and ARVs Advantages and disadvantages for the PLWHA and community of being open about status Interview schedule for immediate carers of OVC The key areas to be covered in the interview are in bold Below these are prompts that may be used to elicit discussion, plus the particular areas that need to be covered in the interview For each interview, different sections of the interview schedule will have to be prioritized, and some of the areas of discussion may fall away Do not use the prompts unless the respondent is finding it difficult to talk about the area Responses are sought beyond the immediate prompts as long as the discussion stays within the broad subject Background of person being interviewed Why the person is being interviewed Position in community and how they came to be in this position Free download from www.hsrcpress.ac.za We have asked you to be interviewed as we want to know and understand your experiences as a carer for orphaned and vulnerable children? What are your major challenges, needs and concerns? The living situation of OVC, ranging from the best off to those in the worst situations, including the number of them in the community Awareness of OVC Estimates of the number of OVC Housing conditions, examples of good and bad Access to facilities by OVC, particularly educational, health and social services Financial and social resources available for OVC Community resources available for the care of OVC Major threats for OVC at the levels of physical, emotional and quality of life Attitudes of the community towards OVC, especially incidents of stigma Perceptions of OVC by the community Stigma against OVC Anger at OVC Positive attitudes to OVC Care and support structures for OVC Indications of who is providing this care and support Include examination of systems at the level of the family, community, organisational, state and others that may exist Impact of services Check sustainability of these systems of care Desirability and effectiveness of the different structures for care and support Requirements of these structures to be able to provide a better service Indicators of success for systems of care 31 Challenges for the community in providing care and support Providing the basics of shelter, food, education and care Dealing with emotional impact of orphanhood or vulnerability, such as mourning, post-traumatic stress disorder Interactions of the OVC with others in the household/institution Dealing with stigma Policy and legislation for the protection of OVC Knowledge of law, policy or pre-established practices to protect OVC Attitudes towards such regulations Implementation and support of these regulations Free download from www.hsrcpress.ac.za Complications in caring for OVC Attitudes of carers to OVC Impact of caring for OVC on lifestyle Experiences of stigma as a result of providing care to OVC Impact on rest of household of the entrance of the OVC Suggestions of how to help OVC in the community Role of individuals, CBOs, NGOs, FBOs and state structures What is needed to facilitate these contributions? Assessment of the commitment on the part of their structures to assist What you know and understand about HIV and AIDS? What you believe are the key interventions to prevent or limit the spread of HIV? Personal knowledge, beliefs and behaviour in relation to HIV Knowledge and beliefs about HIV Attitudes towards safer sexual practices and PLWHA Past behaviour and commitments to future behaviour Suggestions of how to limit the spread of HIV/AIDS in the community Educational and information needs Infrastructural needs – PMTCT, VCT and condom distribution Interventions at the social level – stigma, gender discrimination or promiscuity Checks on the health service Risks of HIV as a result of violence Child abuse Rape and sexual assault Caring for victims of violence Taking payment for sexual services Challenges to protecting themselves from HIV Access to resources Confusion in information Social pressures, risks of judgment and stigma Skills and capacity in caring for OVC 32 Extent of HIV/AIDS as a problem in the community Awareness and knowledge of HIV/AIDS Estimates of the number of people with HIV/AIDS Impact of HIV/AIDS on state and organisational resources available Impact of HIV/AIDS on community resources available Impact of HIV/AIDS on the social functioning of the community Free download from www.hsrcpress.ac.za Care and treatment of PLWHA in the community Availability of services for PLWHA Impact of services Views on VCT, PMTCT and ARVs Advantages and disadvantages for the PLWHA and community of being open about status 33 Interview schedule for members of NGOs, CBOs and FBOs The key areas to be covered in the interview are in bold Below these are prompts that may be used to elicit discussion, plus the particular areas that need to be covered in the interview For each interview, different sections of the interview schedule will have to be prioritised, and some of the areas of discussion may fall away Do not use the prompts unless the respondent is finding it difficult to talk about the area Responses are sought beyond the immediate prompts as long as the discussion stays within the broad subject Free download from www.hsrcpress.ac.za Background of person being interviewed Why the person is being interviewed Position in community and how they came to be in this position What is your or your organisation’s role in relation to OVC? What is your or your organisation’s source of knowledge about OVC? What work does your organisation and how you assist OVC? What you think is the size of the problem and what impact is it having on this community? What are your major challenges, needs and concerns? How these relate to your own resources? The living situation of OVC, ranging from the best off to those in the worst situations, including the number of them in the community Awareness of OVC Estimates of the number of OVC Housing conditions, examples of good and bad Access to facilities by OVC, particularly educational, health and social services Financial and social resources available for OVC Community resources available for the care of OVC Major threats for OVC at the levels of physical, emotional and quality of life Extent of HIV/AIDS as a problem in the community Awareness and knowledge of HIV/AIDS Estimates of the number of people with HIV/AIDS Impact of HIV/AIDS on state and organisational resources available Impact of HIV/AIDS on community resources available Impact of HIV/AIDS on the social functioning of the community Attitudes of the community towards OVC, especially incidents of stigma Perceptions of OVC by the community Stigma against OVC Anger at OVC Positive attitudes to OVC Care and support structures for OVC Indications of who is providing this care and support Include examination of systems at the level of the family, community, organisational, state and others that may exist 34 Impact of services Check sustainability of these systems of care Desirability and effectiveness of the different structures for care and support Requirements for these structures to be able to provide a better service Indicators of success for systems of care Free download from www.hsrcpress.ac.za Profile and evaluation questions of implementing intervention organisation Knowledge of the intervention organisation, structure and past activities Perceptions of the organisation and their capacity to the work Ideas of how to facilitate the organisation’s work Indicators of success for the implementing organisation Challenges for the community in providing care and support Providing the basics of shelter, food, education and care Dealing with the emotional impact of orphanhood or vulnerability, such as mourning, post-traumatic stress disorder Interactions of the OVC with others in the household/institution Access to resources to facilitate care Attitudes of carers to OVC Assisting the OVC to deal with stigma Experiences of stigma as a result of providing care to OVC Policy and legislation for the protection of OVC Knowledge of law, policy or pre-established practices to protect OVC Attitudes towards such regulations Implementation and support of these regulations Suggestions of how to help OVC in the community Role of individuals, CBOs, NGOs, FBOs and state structures What is needed to facilitate these contributions? Assessment of the commitment on the part of their structures to assist What you believe are the key interventions to prevent or limit the spread of HIV? Suggestions of how to limit the spread of HIV/AIDS in the community Educational and information needs Infrastructural needs – PMTCT, VCT and condom distribution Interventions at the social level – stigma, gender discrimination, promiscuity Checks on the health service Care and treatment of PLWHA in the community Availability of services for PLWHA Impact of services Views on VCT, PMTCT and ARVs Advantages and disadvantages for the PLWHA and community of being open about status Risks of HIV as a result of violence Child abuse Rape and sexual assault Caring for victims of violence Taking payment for sexual services 35 Interview schedule for members of state services or government The key areas to be covered in the interview are in bold Below these are prompts that may be used to elicit discussion, plus the particular areas that need to be covered in the interview For each interview, different sections of the interview schedule will have to be prioritised, and some of the areas of discussion may fall away Do not use the prompts unless the respondent is finding it difficult to talk about the area Responses are sought beyond the immediate prompts as long as the discussion stays within the broad subject Free download from www.hsrcpress.ac.za Background of person being interviewed Why the person is being interviewed Position in community and how they came to be in this position What is your or your organisation’s role in relation to OVC? What is your or your organisation’s source of knowledge about OVC? What work does your organisation and how you assist OVC? What you think is the size of the problem and what impact is it having on this community? What are your major challenges, needs and concerns? How these relate to your own resources? The living situation of OVC, ranging from the best off to those in the worst situations, including the number of them in the community Awareness of OVC Estimates of the number of OVC Housing conditions, examples of good and bad Access to facilities by OVC, particularly educational, health and social services Financial and social resources available for OVC Community resources available for the care of OVC Major threats for OVC at the levels of physical, emotional and quality of life Extent of HIV/AIDS as a problem in the community Awareness and knowledge of HIV/AIDS Estimates of the number of people with HIV/AIDS Impact of HIV/AIDS on state and organisational resources available Impact of HIV/AIDS on community resources available Impact of HIV/AIDS on the social functioning of the community Attitudes of the community towards OVC, especially incidents of stigma Perceptions of OVC by the community Stigma against OVC Anger at OVC Positive attitudes to OVC Care and support structures for OVC Indications of who is providing this care and support Include examination of systems at the level of the family, community, organisational, state and others that may exist 36 Impact of services Check sustainability of these systems of care Desirability and effectiveness of the different structures for care and support Requirements of these structures to be able to provide a better service Indicators of success for systems of care Free download from www.hsrcpress.ac.za Profile and evaluation questions of implementing intervention organisation Knowledge of the intervention organisation, structure and past activities Perceptions of the organisation and their capacity to the work Ideas of how to facilitate the organisation’s work Indicators of success for the implementing organisation Challenges for the community in providing care and support Providing the basics of shelter, food, education and care Dealing with emotional impact of orphanhood or vulnerability – mourning, post-traumatic stress disorder Interactions of the OVC with others in the household/institution Access to resources to facilitate care Attitudes of carers to OVC Assisting the OVC to deal with stigma Experiences of stigma as a result of providing care to OVC Policy and legislation for the protection of OVC Knowledge of law, policy or pre-established practices to protect OVC Attitudes towards such regulations Implementation and support of these regulations Suggestions of how to help OVC in the community Role of individuals, CBOs, NGOs, FBOs and state structures What is needed to facilitate these contributions? Assessment of the commitment on the part of their structures to assist What you believe are the key interventions to prevent or limit the spread of HIV? Suggestions of how to limit the spread of HIV/AIDS in the community Educational and information needs Infrastructural needs – PMTCT, VCT and condom distribution Interventions at the social level – stigma, gender discrimination, promiscuity Checks on the health service Care and treatment of PLWHA in the community Availability of services for PLWHA Impact of services Views on VCT, PMTCT and ARVs Advantages and disadvantages for the PLWHA and community of being open about status Risks of HIV as a result of violence Child abuse Rape and sexual assault Caring for victims of violence Taking payment for sexual services 37 Interview schedule as background for BSS component The key areas to be covered in the interview are in bold Below these are prompts that may be used to elicit discussion, plus the particular areas that need to be covered in the interview For each interview, different sections of the interview schedule will have to be prioritised, and some of the areas of discussion may fall away Do not use the prompts unless the respondent is finding it difficult to talk about the area Responses are sought beyond the immediate prompts as long as the discussion stays within the broad subject Background of person being interviewed Why the person is being interviewed Position in community Free download from www.hsrcpress.ac.za What you know and understand about HIV and AIDS? Is there anything that puts you particularly at risk for contracting HIV? Personal knowledge, beliefs and behaviour in relation to HIV Knowledge and beliefs about HIV Attitudes towards safer sexual practices and PLWHA Past behaviour and commitments to future behaviour Extent of HIV/AIDS as a problem in the community Awareness and knowledge of HIV/AIDS Estimates of the number of people with HIV/AIDS Impact of HIV/AIDS on state and organisational resources available Impact of HIV/AIDS on community resources available Impact of HIV/AIDS on the social functioning of the community Suggestions of how to limit the spread of HIV/AIDS in the community Educational and information needs Infrastructural needs – PMTCT, VCT and condom distribution Interventions at the social level – stigma, gender discrimination, promiscuity Checks on the health service Complications in protecting themselves from HIV Access to resources Confusion in information Social pressures, risks of judgment and stigma Skills and capacity in caring for OVC Care and treatment of PLWHA in the community Availability of services for PLWHA Impact of services Views on VCT, PMTCT and ARVs Advantages and disadvantages for the PLWHA and community of being open about status 38 Attitudes of the community towards OVC, especially incidents of stigma Perceptions of OVC by the community Stigma against OVC Anger at OVC Positive attitudes to OVC Risks of HIV as a result of violence Child abuse Rape and sexual assault Caring for victims of violence Taking payment for sexual services Free download from www.hsrcpress.ac.za Major sources of information on HIV and AIDS Media sources Organisational and state services information Peers and colleagues 39 CSO (Central Statistics Office) (2001) Populations and housing census population of towns, villages and associated localities Gaborone, Botswana: Government Printer Dynah S (2002) Situation of analysis of street children in Botswana Gaborone, Botswana: Ministry of Local Government Eisner EW (1991) The enlightened eye: Qualitative inquiry and the enhancement of educational practice New York: Macmillan Fredricksson-Bass J & Kanabus A (2004) HIV and AIDS in Botswana Avert Organisation Simbayi LC, Jooste S & Zungu-Dirwayi N (2003) The development, implementation, and evaluation of interventions for the care of orphans and vulnerable children in Botswana, South Africa and Zimbabwe: An operational handbook for fieldworkers Cape Town: HSRC Maykut P & Morehouse R (1994) Beginning qualitative research: A philosophic and practical guide London and New York: Routledge Falmer Free download from www.hsrcpress.ac.za Ministry of Health (1998) The rapid assessment of the situation of orphans in Botswana Consultancy Report Gaborone, Botswana: AIDS/STD Unit Ministry of Local Government (2003) Department of Social Services Quarterly Report Unpublished Ministry of Local Government (2004) Social Welfare division database Gaborone, Botswana: Government Printer Ministry of Local Government Lands and Housing, Social Welfare Division (1999) Short term plan of action on care of orphans in Botswana 1999–2001 Gaborone, Botswana: Government Printer Skinner D, Tsheko N, Mtero-Munyatsi Segwabe M, Chibatamoto P, Mfecane S, Chindiwana B, Nkomo N, Tlou S & Chitiyo G (2004) Defining orphaned and vulnerable children Cape Town: HSRC Press UN (United Nations) (2000) Population, reproductive health and the millennium development goals New York: UN UNAIDS (2002) Report on the Global HIV/AIDS epidemic New York: UNAIDS UNICEF (United Nations Children’s Fund) (2003) Africa’s orphaned generations New York: UNICEF 40 ... person with information, counselling and mobilisation to take control of HIV and AIDS in his or her life TCM field officers make home visits to give lessons and provide information on HIV and. .. Gaborone, Botswana: Government Printer Ministry of Local Government Lands and Housing, Social Welfare Division (1999) Short term plan of action on care of orphans in Botswana 1999–2001 Gaborone, Botswana: ... food, clothing, shelter, health care and education; Emotional problems, including lack of caring, love, support, space to grieve and containment of emotions; and Social problems, including lack