Coordinating Comprehensive Care for Children (4Children)

For Children in South Sudan, Managing HIV and its Treatment Is Complicated

kseaton — Tue, 29 Oct 2019 16:33:14 +0000

For Children in South Sudan, Managing HIV and its Treatment Is Complicated kseaton October 29, 2019

October 29, 2019

Civil war makes it hard to get health services and medications, especially for kids like Abdu.

Abdu* is five years old and lives with his mother in South Sudan’s capital city of Juba. He is HIV-positive and must remain vigilant about adhering to his antiretroviral treatment (ART) plan.

But war and displacement make this kind of adherence difficult, or even impossible for some families. The months went by as Abdu’s family navigated life in a conflict zone. He missed important monitoring visits to the Juba Military Referral Hospital, where they would have replenished his drugs, measured his growth, and changed his dosage as needed.

This kind of thing happens frequently in South Sudan, which has one of the largest displacement crises in Africa. Since 2013, civil war has killed nearly 400,000 people and displaced more than 4.3 million. And 1.9 million people are internally displaced.

The 4Children project in South Sudan is trying to make sure this doesn’t happen again to Abdu or to other children living with HIV. The project strives to improve the lives of orphans and vulnerable children affected by HIV and other adversities by ensuring regular access to treatment, especially during conflict or in the face of other obstacles.

Conflict makes accessing health care very hard, especially for children, who face unique challenges when it comes to HIV treatment. Some do not have immediate caregivers, or their caregivers are reluctant to take them to health facilities. Unreliable communication networks—combined with the often sudden need to travel—make it difficult to get in touch with health workers and adjust treatment plans. This has resulted in more children missing their follow-up care, which often leads to very high viral loads, low weight, and poor health outcomes.

By the time Abdu was able to return to the health facility, he was emaciated. He weighed only 9 kilograms—under 20 pounds—had facial swelling, and a much higher viral load.

“I almost lost my son,” Abdu’s mother says. “Today he is healthy and able to play with other children.”

The 4Children Project aims to decrease such instances by “tracing” children to make sure they are attending appointments and receiving treatment. The clinic staff, case care workers, and social workers met to discuss what had gone wrong in Abdu’s care. They pinpointed referral barriers, lack of medical records, and changes in the family’s contact information. Then they came up with a plan tailored for Abdu and his mother.

Health workers began meeting with Abdu and his mother regularly to monitor his treatment adherence. Through a combination of regular home visits, reminders, and adherence counseling, they’ve gotten the family back on track with their treatment.

Today, Abdu has a 100% attendance rate. His viral load has gone down, and his weight has more than doubled.

“I almost lost my son while in the village,” Abdu’s mother said during a follow-up home visit. “Today he is healthy and able to play with other children.”

*Name has been changed for anonymity.

4Children is led by Catholic Relief Services (CRS) with partners IntraHealth, Maestral, Pact, Plan International USA, and Westat. Funding is through the United States President’s Emergency Plan for AIDS Relief (PEPFAR) and the United States Agency for International Development (USAID).

By Peter Musa Sereru

Adolescent/youth HIV officer, IntraHealth International

Coordinating Comprehensive Care for Children (4Children) HIV & AIDS Education & Performance Youth Engagement Community Health Workers South Sudan

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In Botswana, a Stronger Workforce Means Better Care for Orphans and Vulnerable Children

mnathe — Mon, 12 Nov 2018 18:32:37 +0000

In Botswana, a Stronger Workforce Means Better Care for Orphans and Vulnerable Children mnathe November 12, 2018

November 12, 2018

Social service workers face heavy caseloads, big expectations, and even suspicion from their communities.

IntraHealth International has joined the Call to Action: Strengthening the Social Service Workforce to Better Protect Children and Achieve the SDGs.

This call is close to our hearts, because our mission—which is to improve the performance of health workers and strengthen the systems in which they work—includes social service workers, from government-employed social workers to trained community case workers or volunteers on child-protection committees. They play a key role in connecting vulnerable children and families to services, including health services, and work hand-in-hand with health workers to achieve a world in which everyone everywhere has the health care they need to thrive.

This inclusive commitment is what motivated our choice to sign on to the call and its specific recommended actions align with much of our work in health and social welfare systems and workforce strengthening.

One professional covers several villages. It's difficult for them to meet expectations.

For example, in Botswana, we’re a partner on two USAID-funded projects that are improving the lives of orphans and vulnerable children and their families. One is the Catholic Relief Services (CRS)-led Coordinating Comprehensive Care for Children (4Children) project, where IntraHealth worked alongside the government of Botswana and USAID on the qualitative portion of a national situational analysis of orphans and vulnerable children (OVC).

The analysis revealed the high caseloads district social workers experience (especially given that one professional covers several villages), and how difficult it is for them to meet expectations. They face the heavy burden of administering assessments for households that need government cash transfers / OVC grants, and suspicion from community members, some of whom accuse them of corruption when their households are deemed ineligible for assistance.

“We know the community does not like us,” one respondent told us. “They think we are corrupt, when we are following the policy. They think we have bad attitudes, when we are overworked and overburdened.”

A motivated, well-equipped workforce is essential for providing high-quality services—and to providing a safety net for the families most at risk. The results show us some of the challenges to making that workforce a reality in Botswana.

Under the Project Concern International (PCI)-led Botswana Comprehensive Care and Support for Orphans and Vulnerable Children project—which empowers communities to seek, support, and provide HIV/AIDS-related services to OVC and their parents/caregivers—we’ve used what we learned from the situational analysis to support government systems and workforce strengthening efforts at the national level.

The results will inform a new national framework to deliver better services to orphans and vulnerable children.

We’re doing this mainly by seconding a senior technical advisor to the Ministry of Local Government and Rural Development, which is the primary custodian of OVC, particularly the Department of Social Protection and the Department of Community Development.

So far, we’ve helped:

Form a technical working group to assume ownership of the national-level efforts.
Complete an assessment of the existing system of enrolling children in social protection/welfare services (like OVC grants and other forms of assistance such as birth registration, emergency food and clothing, and psychosocial support).
Determine which gaps to address within structures, systems, and procedures.

Findings from the assessment point to a need for more effective policy dissemination, so that across sectors and down to the civil society organization (CSO) level, all those who are involved in delivering services to OVC are clear on their roles, responsibilities, and reporting requirements, as well as joint planning at the district level with CSOs, since they are one of the major partners in OVC programming in Botswana.

“OVC problems require a multisectoral approach,” one government policymaker shared during the assessment, “and that calls for information-sharing, joint planning, and partnership in program implementation. If there is poor coordination, the management of the programs will be compromised, hence negatively affecting the quality of service provision.”

According to Ms. Boipelo Seitlhamo, senior social service workforce advisor with the project, internal consultative meetings on the report results “created dialogue with the Department of Social Protection and paved the way for developing an action plan that prioritizes response to gaps in knowledge and implementation of policies, reporting and referrals, including a mechanism for tracking and documenting OVC interventions.”

After the report results and recommendations are widely disseminated, the project plans to work with the Department of Social Projection, the lead agency in rolling out a revised enrollment system that will ensure all eligible children are assessed, registered, and receive benefits in line with the Children’s Act. The results will also inform a new national framework for forging effective working relationships between government and CSOs to deliver better services for OVC.

For decades, IntraHealth has worked to improve health and social systems around the world, partnering with countries to better plan, develop, and support their frontline workforces. And as the HIV epidemic continues and other threats—such as Ebola and Zika outbreaks and global refugee crises—grow, so will the needs of vulnerable children and their families. Our work is far from done.

IntraHealth International was the host and a fiscal sponsor of the Global Social Service Workforce Alliance from 2012 to 2016 under the USAID-funded global CapacityPlus Project.

This post originally appeared on the Social Service Workforce Alliance blog under the headline Improving Care for OVC through Systems Strengthening in Botswana.

By Alex Collins

Former health workforce technical advisor, IntraHealth International

Coordinating Comprehensive Care for Children (4Children) HIV & AIDS Policy & Advocacy Social Services Youth Engagement Social Service Workers Botswana

Boipelo Seitlhamo (center) presents findings from an assessment of Botswana's existing system for accessing social protection services for orphans and vulnerable children. Photo courtesy of IntraHealth International.

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Tool Helps Prioritize Vulnerable Households in Uganda, Lesotho, and South Sudan

Anonymous — Tue, 27 Sep 2016 13:42:51 +0000

Tool Helps Prioritize Vulnerable Households in Uganda, Lesotho, and South Sudan Anonymous (not verified) September 27, 2016

June 17, 2016

Today, the Day of the African Child, we focus on the needs of vulnerable children on the continent and a success taking place right now, through adaptation of a tool built for one country being applied in two more to help children.

The success began when the Ministry of Gender, Labour and Social Development (MGLSD) in Uganda, with support from MEASURE Evaluation, funded by the United States Agency for International Development (USAID), redesigned a tool that intended to identify the most vulnerable children.

The original tool took hours to administer and still didn’t capture which households were most in need of program services.

The new tool in Uganda, the Household Vulnerability Prioritization Tool (HVPT), is now being adapted and applied in South Sudan and Lesotho to inform programs for vulnerable children (also called orphans and vulnerable children [OVC] programs).

It was incredibly helpful to have such a solid springboard of training materials.

A chief difficulty of OVC programs is that there are more families who need services than there are funds to provide for them and it is difficult to assess how to allocate limited slots. For example, in a conflict area like South Sudan, a family’s vulnerability is different from that experienced by families in an area of high HIV prevalence.

Each country and program must have some level of confidence that the neediest households will be the ones identified, but there is no global standardized approach to determine need.

Now, the Uganda tool—16 yes/no questions that take less than a half hour to administer—is showing the way.

In Lesotho, “it was very important to bring district government and civil society together to define vulnerability and to develop and implement a tool,” said Diana Chamrad, PhD, the technical improvement director working with University Research Co., LLC, Center for Human Services, based in Maryland.

She works with the USAID-funded ASSIST project in Lesotho.

“This is also a shift (for us) to households rather than (a focus on) individual children,” she says. Their top priorities for vulnerability are child-headed households, followed by children not enrolled in school, those who don’t have at least one meal a day, if a child in the household is infected with HIV, and households where children are experiencing abuse.

Chamrad says the Lesotho program heard about the work in Uganda and, in April, contacted Molly Cannon, senior monitoring and evaluation (M&E) specialist at Palladium, a MEASURE Evaluation partner. By May, district and national government and community-based organizations (CBOs) working as partners on ASSIST met for a week to lay out a case management model. The prioritization tool was the first step and implementing partners are now piloting the adapted tool.

In South Sudan, the team working on 4Children, a global PEPFAR-funded project, implemented through a consortium led by Catholic Relief Services (CRS) with partners IntraHealth International, Pact, Plan International USA, Maestral International, and Westat, is adapting the tool to the local context, says Alex Collins, program officer with IntraHealth.

“USAID in Washington recommended the tool to the 4Children project team. We presented the Uganda tool as part of a review of vulnerability assessment tools to our South Sudan team, then conducted a validation and training of trainers workshop in order to adapt the tool to the Juba context and equip project staff for training facility- and community-based agents in its use for project enrollment,” she says.

The adapted tool has been shared with the Ministry of Health for review and approval and Collins expects the tool to be used for project enrollment within the next month.

The priorities for the 4Children project and the State Directorate for Gender and Social Development in Juba, the capital city of South Sudan, were taken into account in the adaptation, prioritizing enrollment for households where a child protection issue was noted, as well as those with high vulnerability indicators including a child out of school, a person in the household who is HIV-positive, and a child going a whole day without eating.“

Given the anticipated high numbers of households in Juba made vulnerable as a result of the current conflict, plus economic and political realities in South Sudan, the project is supportive of this approach that will target the most vulnerable households first,” says Collins. “It was incredibly helpful to have such a solid springboard of training materials, as well as the tool and database, to introduce it to our project staff and stakeholders.”

Cannon says the Uganda “fix” for the tool was conceived from the ground up, incorporating the information needed for Uganda’s purpose and the tool then designed to fit.“

That’s an important aspect,” she says. “We don’t want people to take the tool off the shelf and apply it in their context. It needs to be tailored for them, in partnership with the government and its stakeholders.”

For more information on the tool developed in Uganda and other information about programs for vulnerable households, see:

This post was originally published by the MEASURE Evaluation.

By Kathy Doherty

Senior research writer, MEASURE Evaluation

Coordinating Comprehensive Care for Children (4Children) Child Health South Sudan Uganda

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Groundbreaking Report Shows Strong Social Services Improve Wellbeing of Vulnerable Children and Families

Anonymous — Tue, 13 Sep 2016 12:26:11 +0000

Groundbreaking Report Shows Strong Social Services Improve Wellbeing of Vulnerable Children and Families Anonymous (not verified) September 13, 2016 June 16, 2015

The State of the Social Service Workforce 2015 Report, released last week by the Global Social Service Workforce Alliance, demonstrates how gaps in workforce support and funding negatively affect the quality and effectiveness of social services, leading to missed opportunities for improving the wellbeing of the world’s most vulnerable populations. The report is a review of the social service workforce in 15 countries.

Social service workers reunite families, provide critical psychosocial support, alleviate economic hardship, and address larger social concerns, such as poverty, discrimination, and injustice. They often connect families to the health services they need, and health workers rely on them to refer clients who may need additional support services.

Highlights from the report include:

Low ratios of social service workers to population reduce access to and quality of care (Nepal ratio = 1:115,800)
Lack of up-to-date data on this workforce negatively affects allocations of resources, resulting in decreased quality and availability of services
Many countries currently lack a registration and licensing system but have committed to implementing a system to increase standards for care
All countries in the report offer bachelor’s degrees in social work, yet only six have doctorate programs.

“This report aims to establish a baseline for collecting and sharing data in order for the right number of workers to be in the right positions and locations,” says Dr. James McCaffery, Chairperson of the Steering Committee of the Global Social Service Workforce Alliance. “Strengthening this workforce will ensure vulnerable populations have access to the care and support they need.”

The report was launched at the 2nd Annual Global Social Service Workforce Alliance Symposium held last week in Washington, DC. More than 360 participants from 20 countries joined the event including participants from UNICEF, USAID, PEPFAR, governments, professional associations, non-profit organizations, and universities.

The report profiles workers in different countries and their varying roles, including Daw Khin Htwe Kyi in the Department of Social Welfare in Myanmar. The country is developing a case management system to train and deploy case managers throughout the country. “The system will not only bring together different service providers, but importantly link these service providers with families who need the support,” she said.

The Global Social Service Workforce Alliance is hosted by IntraHealth International. The report was made possible by generous support of GHR Foundation and the United States Agency for International Development (USAID) through the President’s Emergency Plan for AIDS Relief (PEPFAR) program to CapacityPlus (led by IntraHealth International) and 4Children (led by CRS). The Alliance’s mission is to promote the knowledge and evidence, resources and tools, and political will and action needed to address key social service workforce challenges, especially within low- to middle-income countries. The Alliance acts as a convener to share good practices, advance knowledge and advocate for workforce improvements to lead to better outcomes for children and families. Members of the Alliance span 66 countries.

Coordinating Comprehensive Care for Children (4Children)

Global Social Service Workforce Alliance Takes Steps toward Growth, Independence

Anonymous — Tue, 13 Sep 2016 12:26:11 +0000

Global Social Service Workforce Alliance Takes Steps toward Growth, Independence Anonymous (not verified) September 13, 2016 July 05, 2016

IntraHealth International and the Global Social Service Workforce Alliance are proud to announce that the Tides Center will become the new host and fiscal sponsor of the alliance effective July 15, 2016.

The alliance is an influential and effective advocate for social service workers and systems around the world. It strives for a world where a well-planned, trained, and supported social service workforce helps those in need improve their lives. The alliance works with individuals and organizations at the local, regional, and international levels to strengthen the social service workforce.

With participation and support from a broad range of participating organizations and a strong and diverse steering committee, the alliance has grown to include more than 900 members representing 87 countries. IntraHealth has acted as host and fiscal sponsor to the alliance since its launch three years ago. Both entities are committed to improving the health and well-being of vulnerable populations through stronger workforces.

The new host represents a shift toward greater independence for the alliance. The Tides Center is specifically designed to act as a fiscal sponsor to networks and start-up groups similar to the alliance. It has experience supporting global networks, works with a vast array of donors, and has highly developed fiscal sponsorship support structures. The Tides Center is positioned to help the alliance achieve its goals of continued growth and organizational independence. The alliance looks forward to increased partnerships, new members and expanding projects.

Social service workers are critical to creating protective environments for healthy development and well-being by alleviating poverty; reducing discrimination; facilitating access to essential services; promoting social justice; and preventing and responding to violence, abuse, exploitation, neglect, and family separation.

Collaboration between IntraHealth and the alliance will continue to be important. Both entities will continue to work together to build the capacity of social service workers and systematically link social and health services. IntraHealth and the alliance will continue to work together under the 4Children Project, led by Catholic Relief Services and funded by the United Stated Agency for International Development through the President’s Emergency Plan for AIDS Relief (PEPFAR) to improve the health and well-being of orphans and vulnerable children affected by HIV, AIDS, and other adversities.

Coordinating Comprehensive Care for Children (4Children)