Health Care, Education, Hygiene and Social Support for Orphans and Vulnerable

Children of Piave, KenyaA Sustainable, community-based joint initiative between the Society for Women and AIDS in Kenya, Sanofi-Aventis

and ROTH – Reach Out To Humanity

Illustrations & Graphic Design – anniestamant.com

ccording to the World Health Organization,

47.5 million children in sub-Saharan Africa

have experienced the loss of one or both parents.

More than a quarter of these children have been

orphaned as a direct result of HIV and AIDS. It is well

established that orphaned and vulnerable children

(OVC) have trouble accessing essential health care

services, experience greater food insecurity and are

less likely to complete their secondary education.

OVC are also at a greater risk of contracting HIV.

One interesting response to the growing number

of orphaned and vulnerable children has been the

coalescing of concerned community members to

form support groups and to attempt to address some

of the physical, emotional, and educational needs

of children. The Society for Women and AIDS in Kenya

(SWAK) is one such example. Comprised entirely of

women over the age of 50, the Piave Chapter of SWAK

has been working to improve the lives of 424 OVC in

their community by providing essential health care,

education and indispensable social support for some

of Kenya’s most vulnerable children.

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Reach Out to Humanity (ROTH) is a non-profit, secular organization

that is founded on the principle that every human being has the

right to proper health care, clean water, education, nutrition, and

shelter regardless of race, gender, or religion. ROTH aims to uphold

these ideals through various ongoing initiatives in disadvantaged

areas throughout the world. From May until July 2010, SWAK

partnered with Sanofi-Aventis and ROTH to deliver one of its most

successful projects to date. The objectives of this project were:

To increase SWAK’s community based team by educating new

volunteers; screen 150 children to know their HIV status; educate

200 children on disease prevention, sexual and reproductive

health and hygiene; distribute 200 mosquito nets to vulnerable

populations and distribute 300 sanitary napkins to girls.

Objective 1Increase SWAK’s community based response team by educating an additional 100 community based volunteers on how to care for OVCs. The training of the additional community based

volunteers took place during May and June. During this

time 120 caregivers went through rigorous training in

partnership with staff from the Ministry of Public Health.

Topics covered during training included defining what

makes a child vulnerable; the impact of HIV and AIDS

on children including psychological stress, loss of

inheritance and malnutrition; the current status and

statistics on OVC in Kenya; water and sanitation, TB,

malaria and other disease prevention; child abuse and

children’s rights. Caregivers were also trained on how

to fight stigmatisation and were trained as psychosocial

support people in order to provide important physical

and emotional support to the 424 children in the

programme. Caregivers were also asked to identify

stakeholders involved in the OVC programme in the

community and were introduced to local groups of

People Living with HIV and AIDS (PLWHAs).

Lessons Learned and Recommendations for Future Projects:

•Those selected to be trained as community caregivers were very eager and excited to participate in the

programme.

•Participants expressed a need to work with discordant couples since this has emerged as an important

issue within the community.

•Caregivers also expressed a desire to follow a bereavement training course in order to better be able to

respond to cases of recent death in a family.

•One of the biggest challenges we faced during the training was mainly due to many of the caregivers

never having received a formal education. Many of the health related topics took longer to explain as a

result. We strongly recommend that these caregivers undergo continuous education in order for them

to fully grasp the topics covered.

•Ongoing training in psycho-social support and bereavement counselling would be beneficial to the

caregivers.

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Objective 2Bring a total of 150 children for VCT (Voluntary Counselling and Testing) to know their HIV status.

Knowing the status of the 424 OVC under SWAK’s care

is vital in order to ensure that HIV positive children are

receiving adequate nutrition and are adhering to anti-

retroviral treatment. Thanks to the efforts of this project,

the status of an additional 176 OVC in the programme

is now known. A total of 382 children have now been

tested for HIV and know their status. Out of these 382

children 27 (7%) of them are HIV positive and need

AIDS care service. Counseling for those children who

tested positive for HIV began immediately. SWAK will

continue to deliver important care to these children.

This includes making sure these children are enrolled in

ARV programmes and that they regularly attend visits

to the local dispensary. They will also work closely with

them as they learn to live positively with HIV. Making

sure these children receive adequate nutritional intake

will be a continuous priority for the caregivers.

Lessons Learned and Recommendations for Future Projects:

•The stigma associated with HIV is still a very prevalent obstacle in getting primary guardians to consent

to their child being tested for HIV.

•Some of the older children tested also act as primary caregivers to their younger siblings (i.e. child

headed households). These children need additional support since they are both primary caregivers

and people living with HIV.

•Due to the cost of traveling to the voluntary counseling and testing site many of the guardians who

came to get their children tested requested a travel subsidy.

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Objective 3Educate 200 children on TB, malaria and disease prevention, sexual and reproductive health and hygiene through guidance and counselling sessions204 OVC attended weekend sessions focusing on communicable and non-communicable disease prevention. The

training took place over four days at Ngano Primary School. The children were split into four different streams

according to their age group and level of understanding of the topics covered. A total of eight facilitators were

recruited for the training. Most of these facilitators came from the Ministry of Health or the Children Social Welfare

Department. Topics covered included coping with life as an OVC, fighting stigma and discrimination; water and

sanitation and personal hygiene practices; HIV and AIDS including the stages of disease progression, modes of

transmission and signs and symptoms; drug and substance abuse; sexual and reproductive health; TB modes of

transmission and infection, signs and symptoms, prevention and control; malaria modes of transmission, signs and

symptoms, prevention and control.

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Lessons Learned and Recommendations for Future Projects:

•A more simplified and demonstrative approach is necessary for some of the younger children.

•Older children showed great enthusiasm to learn and many of them had a number of questions when

it came to the topics of sexual and reproductive health.

•Many children were getting their information from unreliable sources emphasising a need to concentrate

on dispelling many of the myths surrounding the topics covered.

•Children reported being sexually active as young as 10-14 years of age. Future projects need to provide

additional resources on sexual and reproductive health.

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Objective 4Distribute 200 mosquito nets and 300 sanitary napkins to girlsBy tightly adhering to the proposed budget, SWAK and project managers were able to secure an excess of funds

following the completion of the previous three aspects of the project. As a result, we were able to purchase an

extra 150 mosquito nets to be delivered to vulnerable and immunologically naive populations. Project managers

visited local primary schools in partnership with a Public Health Officer in order to teach children about malaria

transmission and the importance of sleeping under a net. Demonstrations were given in class about how to use a

mosquito net and children engaged in educational puzzles provided by sanofi-aventis’ Impact Malaria programme.

Along with health staff, project managers travelled to various homes in the village to properly hang nets and to

show families how to stow nets during the day. Sexual and reproductive health sessions were held exclusively with

some of the female OVC. During this time sanitary napkins were distributed and girls were encouraged to come

back to SWAK offices regularly in order to receive additional supplies.

Lessons Learned and Recommendations for Future Projects:

•There were not enough mosquito nets to distribute one to every student in the 1-5 year age group in

primary schools.

•Despite children knowing the causes of malaria transmission, many of their families could not afford to

have a net in the home. In cases were nets were present in the home, there was often not enough for

everyone.

•Poor road conditions and the neglect of many households to cover open containers acted as frequent

mosquito breeding sites in this community. Future efforts need to emphasise the importance of

covering stagnant water.

•Menstruation was a frequent reason why girls reported missing school.

•In addition to sanitary napkins, many of the girls reported not having under garments which they could

use. Future projects should include the provision of both under garments and sanitary napkins.