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Live your life. Create your destiny.

Empowerment Programme toSupport Children in Child Headed

Households in Resource PoorCommunities in Soshanguve, South

Africa: Phase 1 of an InterventionStudy

J E Ibebuike (D-Tech Nursing Student)

1. BACKGROUND

2. RESEARCH BACKGROUND TO THE PROBLEM

3. OBJECTIVES OF THE STUDY

4. THEORETICAL FRAMEWORK

5. RESEARCH METHODS AND DESIGN

6. TRUSTWORTHINESS

7. ETHICAL CONSIDERATIONS

8. FINDINGS OF THE STUDY

9. JUSTIFICATION OF THE STUDY

10. LIMITATIONS

11. RECOMMENDATIONS

12. CONCLUSION

Faculty of Science: Adelaide Tambo School of Nursing Science

OVERVIEW OF THE PRESENTATION


• The Nelson Mandela children’s Fund in their 2001 report noted that SouthAfrica has the fastest growing rate of people living with HIV and AIDS

• This has led to an alarming increase in the number of children orphaned byAIDS and

• The attendant care of the orphaned children by their siblings leading to theterm child headed households (CHHs).

• The child takes on decision making and responsibilities usually carried outby parents, including the provision of care to other children.

1. BACKGROUND


Child headed household has been defined as:

= a household which is headed by a person under 18 years old and who is:

• taking care of the household with other younger siblings, as they have lostboth parents to HIV/AIDS or other causes; or

• providing the household income and taking care of the household with otheryounger siblings, whose parents or primary caregivers are chronically ill withHIV/AIDS or with other causes; or

• living alone and taking care of him/herself as no other siblings are present inthe household and as either one of his or her parents are deceased, orwhere the parents cannot be found or are unknown. This third category ofchildren includes street children and child soldiers as noted in some studies.

1. BACKGROUND (cont.)


However, a child headed household has also been defined as:

= a household where:

• both parents or alternative adult caregiver are permanently absent and theresponsibility for the day-to-day management of the entire household ispresided by any person who is less than 20 years of age.

For the purpose of this study

• children above 18 years but not exceeding 19 years will be included asa “child”

• The child in this context is a child who has been identified living in achild headed household



Types of child headed households (CHHs)

• Unaccompanied CHHs: no adults more than 18 years-old are found

• Accompanied CHHs: households with dependant adults who are notresponsible for the household such as

- ailing parents

- old grandparents

- disabled uncles/aunts

- some other old relatives


Major causes of orphan hood: Leading to the emergence of child headed households

• HIV and AIDS• Armed conflicts• Poverty-driven family disintegration• Others, e.g., natural disasters

Why the study: To develop an empowerment programme to support children in CHHs

in the resource poor communities of Soshanguve Ext 12 and 13• Could be refined, replicated or serve as a baseline for further

intervention studies when completed• Research result will assist health planners in closing the gap to ensure

children in CHHs in resource poor communities are empowered


2. RESEARCH BACKGROUND TO THE PROBLEM

The objectives of the study were to:

• identify children in CHHs in the resource poor communities of

Soshanguve

• determine the lived experiences and needs of children in CHHs

• determine the knowledge and perceptions of the resource poor

communities about children in CHHs


3. OBJECTIVES OF THE STUDY

6-Step Model for Community Empowerment

Designed to address specific physiological, social, financial, psychological,

spiritual, environmental and physical needs

Intervention Theory

An explanatory theory which combines the characteristics of descriptive and

prescriptive theories

- descriptive theory describes the problem of children in CHHs

- prescriptive theory specifies what needs doing to achieve anoutcome.


4. THEORETICAL FRAMEWORK


4. THEORETICAL FRAMEWORK (cont.)

Step 1: Gaining entrance into thecommunity

Step 2: Identifying issues of interest orconcern

to the community

Step 3: Prioritizingidentified issues

Step 4: Formulating a strategy to addressa priority issue

Step 5: Developing andimplementing an action plan to

resolveprioritized issues

Step 6: Transitioning to new issues

The 6 steps of the model are:

The nature of the Intervention Theory: involves 2 broad phases

• Phase 1: assisted to guide the conduct of the research in Phase 1

• Phase 2: guided in

- the implementation and evaluation of the effectiveness of thedeveloped empowerment programme in Phase 2


4. THEORETICAL FRAMEWORK (cont.)


5. RESEARCH METHODS AND DESIGNResearch Methods and

Design

Phase 1

Design Qualitative intervention

Quantitative component for demographic data

Population

Target

Sampling method

Sampling size

Children in CHHs and adults within the resource poor

communities

Purposive sampling method

Saturation of data

Data gathering

Data gathering

method

Data gathering

instrument

In-depth interviews using unstructured interview, focus

group discussion, self-report, field notes and voice

recording

Unstructured interview schedule, field notes and voice

recorder

Data analysis Tesch’s approach

Descriptive statistics

Research outcome Children in CHHs identified, their lived experiences and

needs determined

Summary of researchmethods and design forPhase 1 of the Study

Contextual study– results cannot begeneralized

The study was conducted in SoshanguveExt.12 and 13:

• Soshanguve forms part of the greaterTshwane Metropolitan Municipality.

• It is a semi formal settlement 45km Northof Pretoria.

• The total number of people living in theseextensions is unknown as informal houses areconstantly erected.

• No healthcare facilities available within aradius of 5km

• Resource poor community

• 56% unemployment rate, and

• 75% of the population lived below the internationalpoverty level of $2.


5. 1 Context of the Study

C

Ext 12 A

Ext 12 B

Ext 13 B

Ext 13 A

N

N = new site

Informal Settlement


5. 1 Context of the Study (cont.)

Identification, lived experiences and needs of children in child headedhouseholds in resource poor communities and knowledge and perceptionsof the resource poor communities about these children.

Research design: Qualitative contextual intervention design andQuantitative component for the demographic data

Inclusion criteria:

• Children from 8-19 years of age resident in the child headedhouseholds in Soshanguve Extension 12 and 13

• Community members resident in Soshanguve Extension 12 and 13

• Willingness to participate in the research


5.2 Research Methods

Sampling method: Purposive sampling

Sampling size: n• Children from CHHs – saturation of data: (17) n=17• Focus group

Data gathering method: In-depth interviews with the children

Data gathering instrument:

- unstructured interview schedule

- field notes and

- voice recorder

• Period: 2 months


5.2 Research Methods (cont.)

Data gathering: In-depth interviews using unstructured interview, focusgroup discussions, self-report, field notes and voice recording

• Formation of a project team: consists of

- the researcher

- community leaders

- advisory committee (consists of some adult members of thecommunities as well as some of the community leaders)

- the language translator, who is a registered community healthnurse working at the mobile clinic (also served as a field worker)


5.2 Phase 1 Research Methods (cont.)

Data gathering (cont.):

• Pre-test: was done to test the research instrument and feasibility of thestudy



Data analysis:

• Open coding using Tesch’s approach, and• Descriptive statistics for the qualitative component



Trustworthiness was ensured through:

• Credibility• Transferability• Dependability• Confirmability• Authenticity


6. TRUSTWORTHINESS


7. ETHICAL CONSIDERATIONS

• Informed assent/consent from participants

• Permission from the NCoP programme manager

• Numbering of transcribed interviews – anonymity and confidentiality

• No harm intended – emotional discomfort experienced – timeallowed to give support and counselling

• Privacy

• Respondents who meet criteria will be purposively sampled

• Approved by the ethics committee


8. FINDINGS OF THE STUDY (NOT RESULTS)

Results will be discussed according to the following:

8.1 General and demographic data:

8.1.1 Gender and age

8.1.2 Cultural group distribution

8.1.3 Education level and source of income

8.1.4 Age of participants in relation to educational level and type of CHHs

8.2 Research findings:

8.2.1 Themes, categories and sub-categories from in-depth interviews fromparticipants from CHHs

8.2.2 Themes, categories and sub-categories from in-depth interviews fromparticipants from focus group discussions


8.1 General and demographic data:

8.1.1 Gender and ageGENDER FREQUENCY PERCENTAGE

Male 9 52.9%

Female 8 47.1%

Total 17 100.0%

AGE FREQUENCY PERCENTAGE

8-9 years 4 23.5%

10-11 years 3 17.6%

12-13 years 2 11.8%

14-15 years 2 11.8%

16-17 years 3 17.6%

18-19 years 3 17.6%

Total 30 100.0%


8.1 General and demographic data (cont.):

8.1.2 Cultural group distribution

Sepedi8

47%

IsiZulu4

23%

Xitsonga2

12%

Tshivenda2

12%

Sesotho1

6%

Frequency

Sepedi

IsiZulu

Xitsonga

Tshivenda

Sesotho


8.1 General and demographic data (cont.):

8.1.3 Education level and source of incomeLevel of education Frequency Results

Grade 1 – 7 12 70.6%

Grade 8 - 10 3 17.6%

Drop out 2 11.8%

Total 17 100.0%

Conclusion:• Majority of participants’ education level were between grade 1 – 7 (primary level)• 17.6% were in secondary level and 11.8% dropped out of school

Source of income Frequency (n=17) Percentage

Grants 9 52.9%

Unspecified 7 41.2%

Menial job 1 5.9%

Total 30 100.0%


8.1 General and demographic data (cont.):8.1.4 Age of participants in relation to

educational level and type of CHHsParticipants

number

Age Educational level in grade Type of household

01 11 years 1-7 Accompanied



04 9 years 1-7 Unaccompanied

05 19 years Dropped out of school Unaccompanied


07 17 years Dropped out of school Unaccompanied











Conclusion:• 5 out of the 12 participants in

grades 1-7 were above 12 yearsof age (the expected age for asmooth academic progression inschool) and this may be indicativeof poor progress in school.

• The participants’ distribution withrespect to the type of CHHsshowed that 10 (58.8%) were fromunaccompanied CHHs while 7(41.2%) were from accompaniedCHHs.


8.2 Research findings:8.2.1 Themes, categories and sub-categories from in-depth interviews from

participants from CHHsThemes Categories Sub-categoriesKnowledge about existence ofCHHs

Awareness of CHHs Acquainted with CHHs Unaccompanied CHHs Accompanied CHHs

Identification of children of CHHs Ease of identification ofchildren of CHHs

Method of identification ofchildren of CHHs

Reasons for the formation ofCHHs

Parental death Cause of parental deathDeath of a single parent and propertypreservation

Single parentage by motherand mother’s last wishes

Death of a parent and abandonment bythe surviving parent

Death of mother andabandonment by father

Parental preparation Request for a relativeLived experiences of children inCHHs

Personal experiences Emotional disturbance Sadness

Experiences in the community Stigmatization anddiscrimination

Child labour Sexual exploitation Negative influence of friends

Academic experiences Academic performanceAccess to grant Receiving grant

Not receiving grantNeeds of children in CHHs Basic life needs Food, clothes, shoes and

money for subsistenceEducational needs School fees, money for

transport fare to school,scholastic materials andfurthering of education

Health issues Psychological trauma Physical injury

Empowerment Aspirations Empowerment for basic life needs Provision of grants Physical support for basic life

needsEmpowerment for educational needs Physical provision for

educational needs Re-enrolment in school Support for home work

Empowerment for health issues Psychological counsel General household

supervision


8.2 Researchfindings (cont.):8.2.2 Themes,categories and sub-categories from in-depth interviewsfrom participantsfrom focus groupdiscussions

Themes Categories Sub-categories

Resource poor

communities’ knowledge

about child headed

households

Awareness of existence of

child headed households

Acquainted with CHHs

Accompanied CHHs

Unaccompanied CHHs

Identification of children of

CHHs

Ease of identification

of children of CHHs

Methods of

identification of

children of CHHs

Reasons for the formation of

CHHs

Death of parents

Alcoholic parents

HIV and AIDS

Parental illness

Parental abandonment

Lack of care and

maltreatment by

relatives

Resource poor

communities’ perceptions

about CHHs

Resource poor communities’

views about child headed

households

Views about

unaccompanied CHHs

Views about education

of children in CHHs

Views about needs of

children in CHHs

Risky behaviours of

children in CHHs

Poverty and child

labour

Resource poor communities’

views on grants for children

in CHHs

Awareness of

government provision

of grants

Awareness of lack of

required documents for

grant

Collection of and

personal use of the

children’s grant by a

third party


8.2 Researchfindings (cont.):8.2.2 Themes,categories andsub-categoriesfrom in-depthinterviews fromparticipants fromfocus groupdiscussions (cont.)

Resource poor

communities’ challenges

towards assisting the

CHHs

Resource poor

communities’ support for

children of child headed

households

Collaboration of the

resource poor

communities with NGOs

or government

Areas of resource poor

communities’ support

for the children in CHHs

Obstacles to resource

poor communities’

support for children of

CHHs

Resource poor

communities’

knowledge of

implementation of

government legislations

for child headed

households


9. JUSTIFICATION OF THE STUDY

• The study is justified because:

- the purpose and the objectives were accomplished


10. LIMITATIONS• Communication:

- participants words when translated to English may not carry theweight intended as in the local language

- probability for amendment is always present during translationsdue to misinterpretation or partial oversight, though this may havebeen unintentional

• Contextual study:

- findings cannot be generalized for Province or country


11. RECOMMENDATIONS OF THE STUDY

11.1 Nursing ProfessionProfessional nurses: should be involved in:

Respect and confidentiality to the orphaned children



11.2 Nursing EducationProfessional nurses and student nurses: should be involved in:

professional nurses in school health system should form HIV and AIDSawareness club that can help create positive attitude through drama, quiz,songs

Health professionals:

should encourage and organize peer group clubs called ‘SPEAK-OUT’ whereorphaned children encourage themselves to be strong



11.3 Nursing ResearchTo empower the results to be generalised for the province or countryrespectively:

similar study should be conducted on empowerment programme to supportchild headed households in other resource poor communities in the provinceor provinces

Evidence should be gathered on the actual demographic data of child headedhouseholds in all communities and provinces:

to ensure new CHHs are not missed, and are therefore captured in thedatabase for empowerment programmes, preferably yearly



11.4 Policy MakersProfessional nurses: should be involved in:

Provision of grants for children of parents diagnosed with HIV/AIDS till 18years of age, or

or adopted by the government depending on the financial state of their parents

Support and provision for CHHs by policy makers, non-governmentalorganisations, companies, churches, community members, well-to-doindividuals

Provision of Drop-in Centres and school transport by government

Monitoring and report on school performance at end of every school term

Policy makers should improve more in ensuring that these children in CHHsfurther their education.

- This will result in a reliable, trusted and sustainable future for them

The study provided evidence that:

• Child headed households remain societal issues in our environment

• Though the empowerment programme was not meant as a permanentsolution to the needs of the children, of significance is the fact that it drewthe attention of the communities on the need to support these childrenand assist them to live normal lives within their communities

• It is hoped that the study assists with information in any plan to identifyCHHs in resource poor communities in HIV/AIDS endemic areas.

• The findings showed that the households face serious socioeconomic challenges and aPhase 2 of the study which will develop, implement and evaluate the effectiveness of anempowerment programme to support children in child headed households in the resourcepoor communities is recommended.


12. CONCLUSION

empowerment programme to support children in … programme...live your life. create your destiny....

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