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  1. 1. OVC programme overview SOURCE: South Africa HIV/AIDS response stakeholder interviews; Project team analysis <ul><ul><ul><li>OVC policy in South Africa is amongst the best in the world </li></ul></ul></ul><ul><ul><ul><li>OVC care is a growing problem in South Africa due as the number of HIV/AIDS OVCs continues to increase </li></ul></ul></ul><ul><ul><ul><li>Complex programme with a large number of implementers </li></ul></ul></ul><ul><ul><ul><li>Poor evaluation and data collection due to lack of integration across sectors and poor data collection capabilities </li></ul></ul></ul><ul><ul><ul><li>Strong policy drives action (i.e., the Child Care Act) however front line staff lack training/understanding of all elements to properly implement </li></ul></ul></ul><ul><ul><ul><li>Coordination is poor as although t here are a number of forums at all levels, however provincial and lower forums are not adequately funded or staffed, leading to poor functionality </li></ul></ul></ul><ul><ul><ul><li>Civil society leads implementation but lack capabilities and capacity </li></ul></ul></ul><ul><ul><ul><li>Government and development partners both fund implementers to deliver core programmes </li></ul></ul></ul><ul><ul><ul><li>Government provides child care and foster care grants though financial resources are not sufficient to care for the actually numbers of OVCs and donor funding is levelling off </li></ul></ul></ul><ul><ul><ul><li>Government lacks an overview of the real number of OVCs </li></ul></ul></ul>Overview Structure Implemen-tation model Financing
  2. 2. Coordination complexity archetypes – South Africa (province) 1 Includes provider-initiated VCT SOURCE: South Africa HIV/ AIDS stakeholder interviews Medium High Low Extreme Intervention type (primary) <ul><ul><li>Clinical </li></ul></ul><ul><ul><li>Clinical </li></ul></ul><ul><ul><li>Clinical/ Behavioural </li></ul></ul><ul><ul><li>Behavioural </li></ul></ul>Number of funders <ul><ul><li>0-2 </li></ul></ul><ul><ul><li>3-5 </li></ul></ul><ul><ul><li>>10 </li></ul></ul><ul><ul><li>3-5 </li></ul></ul>Number of implementers <ul><ul><li>1 </li></ul></ul><ul><ul><li>2-10 </li></ul></ul><ul><ul><li>11-25 </li></ul></ul><ul><ul><li>>25 </li></ul></ul>Examples of programs in archetype <ul><ul><li>N/A </li></ul></ul><ul><ul><li>N/A </li></ul></ul><ul><ul><li>PMTCT </li></ul></ul><ul><ul><li>ART </li></ul></ul><ul><ul><li>MMC </li></ul></ul><ul><ul><li>VCT </li></ul></ul><ul><ul><li>OVC </li></ul></ul><ul><ul><li>BCC </li></ul></ul>
  3. 3. OVC programme is highly complex (1/2) SOURCE: South Africa HIV/AIDS response stakeholder interviews 1 National Action Committee for Children Affected by AIDS; 2 Provincial Action Committee; 3 District Action Committee 4 Minister of Social Development Provincial National District NGOs NGOs NGOs National NGOs Implementers PACCA 2 DACCA 3 NACCA 1 HIV Coordinator Children’s Provincial Coordinator Combined in some provinces e.g., Northern Province District Coordinator Multi-sectoral coordi-nation of OVC services (chair is HIV Director – also sits on SANAC) HIV Directorate Children’s Directorate MSD 4 =>DG Premier=>DG=> Head of Department Child protection services Community-based, early intervention District tenders out services to CBOs PRELIMINARY ILLUSTRATIVE NGOs NGOs NGOs Social workers & residential institutions NGOs NGOs NGOs Donors/ foundations NGOs NGOs NGOs OVC leads NGOs NGOs NGOs NGOs/COSs provide community services NGOs NGOs NGOs Provincial NGOs NGOs NGOs NGOs Private sector
  4. 4. OVC programme is highly complex (2/2) Low Medium High Extreme Funders <ul><ul><li>DSD provides majority of funding </li></ul></ul><ul><ul><li>10% of USAID funding goes towards OVC, funding mainly community-based services and health systems strengthening (e.g., M&R systems, evaluation, training programmes). Funding goes to NGOs (e.g., NACCW/ Isibindi) or DSD via Pact SA (umbrella grant management organisation) </li></ul></ul><ul><ul><li>Some private foundations provide funding as well (e.g., DG Murry) </li></ul></ul>Implementers <ul><ul><li>Government employs social workers in each district, and manages child and youth care centres (i.e., residential care) </li></ul></ul><ul><ul><li>All community-based care is done by NGOs/ small CBOs: funding is from international donors/ foundations (e.g., PEPFAR) or via district tenders </li></ul></ul>Size <ul><ul><li>~500,000 – 600,000 children currently in statutory foster care </li></ul></ul><ul><ul><li>90,000 social workers, each with enormous case loads of ~400 – 500 children each </li></ul></ul><ul><ul><li>Approximately 3.8 million children have lost one or both parents to HIV </li></ul></ul><ul><ul><li>Ability to provide care in the community (i.e., community-based child and youth care workers working in the ‘life space’ of the child) is required </li></ul></ul><ul><ul><li>This has resulted in hundreds of small CBOs providing care in each province, often starting out as volunteer organisations/ child care forums & evolving into service delivery as gaps are identified </li></ul></ul><ul><ul><li>Coordination and community-level integration is critical – certain provinces are better organised than others (e.g., in KZN there are well organised networks such as the Cindi network, while in others there is virtually no coordination) </li></ul></ul>Capabilities required SOURCE: USAID, stakeholder interviews, DSD reports PRELIMINARY
  5. 5. Key programme players and roles SOURCE: South Africa HIV/AIDS response stakeholder interviews <ul><ul><li>DSD developed Child Care Act </li></ul></ul><ul><ul><li>NACCA led on development of OVC policy (in line with Child Care Act) </li></ul></ul><ul><ul><li>DSD allocates resources ac-ross provinces </li></ul></ul><ul><ul><li>PEPFAR provides funding to DSD through Pact SA </li></ul></ul><ul><ul><li>Target set centrally and disaggregated to district level </li></ul></ul><ul><ul><li>Provincial DoH develop operational plans </li></ul></ul><ul><ul><li>Social workers provide statutory services </li></ul></ul><ul><ul><li>No community-based youth and child care workers </li></ul></ul><ul><ul><li>National and provincial databases (poorly integrated) </li></ul></ul><ul><ul><li>HSRC – annual household survey </li></ul></ul>Government <ul><ul><li>PEPFAR and some private foundations (e.g., DG Murry) provide OVC funding </li></ul></ul><ul><ul><li>Limited involvement at provincial level </li></ul></ul><ul><ul><li>Largely fund innovative models (e.g., Isibindi) which can then be scaled up </li></ul></ul><ul><ul><li>All partners monitor & report to donors (and are required to supply data to district gvt) </li></ul></ul><ul><ul><li>Fund ad-hoc independent evaluation (largely prog-rammatic, not comparative) </li></ul></ul><ul><ul><li>Local University provided TA for development </li></ul></ul>Donors <ul><ul><li>NGOs receive funding directly from donors (e.g., Isibindi) or via district gvt tenders </li></ul></ul><ul><ul><li>N/A </li></ul></ul><ul><ul><li>Child care forums are volunteer-led </li></ul></ul><ul><ul><li>Community services pro-vided by NGOs and CBOs </li></ul></ul><ul><ul><li>RCFF, Child Welfare, RFM are child protection agencies (NGOs with a mandate to do statutory work) </li></ul></ul><ul><ul><li>All partners monitor & report to donors (and are required to supply data to district gvt) </li></ul></ul><ul><ul><li>N/A </li></ul></ul><ul><ul><li>Very active input/ challenge policies/ strategies (highly consultative) 1 </li></ul></ul>Civil Society organisations/ NGOs PRELIMINARY Strategy/ Policy Resource allocation (budgeting) Planning Implementation Monitoring and reporting Evaluation
  6. 6. Programme landscape 1 National Information System for Welfare 2 Provincial Information Management System for Welfare SOURCE: South Africa HIV/AIDS response stakeholder interviews <ul><ul><li>Social workers delivering statutory services </li></ul></ul><ul><ul><li>Community development workers do prevention and early intervention </li></ul></ul><ul><ul><li>Child and youth care workers – employed by gvt in institutions, in community programmes they are employed by NGOs (PEPFAR partners care for ~500,000 orphans) </li></ul></ul><ul><ul><li>Children’s Act was developed by DSD, with extensive, lengthy consultation with multiple stakeholders </li></ul></ul><ul><ul><li>Main change was the focus on family preservation, prevention and early intervention </li></ul></ul><ul><ul><li>Development started in ~1995, with the first part accepted by parliament in 2005, and amended in 2007 </li></ul></ul><ul><ul><li>Norms and standards only established in 2008/09 – this is when the Act came into force </li></ul></ul><ul><ul><li>DSD costed the Child Care Act – focused on social workers/ statutory services, not C hild and Youth Care workers, prevention or early intervention </li></ul></ul><ul><ul><li>DSD tends to play a very active role in allocating donor resources/ choosing partners (e.g., represented on all PEPFAR tech eval committees, full transparency over donor resources) </li></ul></ul><ul><ul><li>Planning is done at a provincial level, who decide on targets and disaggregate them to the districts </li></ul></ul><ul><ul><li>Very weak </li></ul></ul><ul><ul><li>Only donor funded programmes really do robust M&R </li></ul></ul><ul><ul><li>DSD has two systems at a national (NISWEL) & provincial (PIMWEL) level which are comp-letely unintegrated </li></ul></ul><ul><ul><li>Poor quality data collection at a district level </li></ul></ul><ul><ul><li>This data is fed into provincial offices, which lack the capacity to consoli-date/analyse the data properly due to high turnover/ vacancies </li></ul></ul><ul><ul><li>Data that is collected is not incorporated into planning (e.g., maternal orphans database) </li></ul></ul><ul><ul><li>Very weak </li></ul></ul><ul><ul><li>Very limited internal research capabilities </li></ul></ul><ul><ul><li>Ad hoc studies are commissioned (paid for by donors/ PACT), e.g., evaluation of Isibindi currently underway – PEPFAR funded </li></ul></ul><ul><ul><li>Mix of local and oversees organisations do the evaluation </li></ul></ul><ul><ul><li>Programme evaluation rather than comparative evaluation </li></ul></ul>PRELIMINARY Strategy/ Policy Resource allocation (budgeting) Planning Implementation Monitoring and reporting Evaluation
  7. 7. Key forums in OVC SOURCE: South Africa HIV/AIDS response stakeholder interviews PRELIMINARY SANAC Programme Implementation Committee <ul><ul><li>Who : Lead by DoH, Provincial AIDS Councils, District / Local, AIDS Councils/ Multi-Sectoral Action Teams </li></ul></ul><ul><ul><li>How often : Every 2 months </li></ul></ul><ul><ul><li>Objectives : highest body providing strategic and political guidance to government on HIV and AIDS and STIs </li></ul></ul><ul><ul><li>The forum is considered to be well functioning </li></ul></ul><ul><ul><li>Who : national level government, large CSOs, development agencies and donors </li></ul></ul><ul><ul><li>How often : Steering committee: every 6 weeks; general reference teams: 2 times a year </li></ul></ul><ul><ul><li>Objectives: provide input to a national coordinated response to OVCs </li></ul></ul>NACCA <ul><ul><li>Functional arena for discussion and planning </li></ul></ul><ul><ul><li>Strength of lobbyist stems from independent funding and resulting freedom of speech </li></ul></ul><ul><ul><li>Who : District Action Committee for Children Affected by HIV and AIDS (DACCA) </li></ul></ul><ul><ul><li>How often : Varies </li></ul></ul><ul><ul><li>Objectives : coordinate area Forums/ Committees/Community Fora were proposed </li></ul></ul>DACCA <ul><ul><li>Generally underperforming </li></ul></ul><ul><ul><li>High level of government control (chooses attendees, sets agenda), as DACCAs have no independent funding sources </li></ul></ul><ul><ul><li>Political infighting amongst NGOs discourages involvement </li></ul></ul><ul><ul><li>Who : provincial level government, large CSOs, development agencies and donors </li></ul></ul><ul><ul><li>How often : Once a month </li></ul></ul><ul><ul><li>Objectives : provide input to a provincial coordinated response to OVCs </li></ul></ul>PACCA <ul><ul><li>PACCA is able to convene a representative group across sectors </li></ul></ul><ul><ul><li>Integrity is challenged by government control and limited civil society input </li></ul></ul>Forum Description Strengths and challenges
  8. 8. Key forums in OVC (2/2) SOURCE: South Africa HIV/AIDS response stakeholder interviews LACCA <ul><ul><li>Who: Local Action Committee for Children Affected by HIV and AIDS </li></ul></ul><ul><ul><li>How often: Varies </li></ul></ul><ul><ul><li>Objectives: coordinate local Forums, Committees, and Community Fora </li></ul></ul><ul><ul><li>Generally ineffective and often nonexistent </li></ul></ul><ul><ul><li>Not adequately funded or staffed </li></ul></ul><ul><ul><li>Who: Led by DSD </li></ul></ul><ul><ul><li>How often: </li></ul></ul><ul><ul><li>Objectives: promote coordination between all stakeholders at all levels </li></ul></ul><ul><ul><li>TBD </li></ul></ul>Provincial/District Action Committees <ul><ul><li>Who: Led by DSD </li></ul></ul><ul><ul><li>How often: </li></ul></ul><ul><ul><li>Objectives: facilitate co-operation, co-ordination and integration of all government spheres/ departments and CSOs </li></ul></ul><ul><ul><li>Provincial equivalent: Provincial Child Care and Protection Forums </li></ul></ul><ul><ul><li>Child protection/care forums are functional at the national level but failing at the provincial level </li></ul></ul>National child care and protection Forum <ul><ul><li>Who: Led by DSD, Provincial Action Committees, District Action Committees /Child Care Forums </li></ul></ul><ul><ul><li>How often: </li></ul></ul><ul><ul><li>Objectives: promote coordination between all stakeholders at all levels </li></ul></ul><ul><ul><li>TBD </li></ul></ul>National Action Committee for Children Affected by HIV and AIDS Forum Description Strengths and challenges PRELIMINARY
  9. 9. The Isibindi programme offers a new model of donor funding SOURCE: South Africa HIV/AIDS response stakeholder interviews ; NACCA <ul><ul><li>Designed by the National Association of Child Care Workers </li></ul></ul><ul><ul><li>Implemented in over 55 sites in 8 provinces by over 40 partner organizations </li></ul></ul><ul><ul><li>Run on a ‘social franchise’ basis </li></ul></ul><ul><ul><li>Five-way partnerships link the DSD at provincial level, the donor, the community, implementing organisations and the NACCW </li></ul></ul><ul><ul><li>Standardised monitoring and evaluation system collates data and maintains accountability </li></ul></ul>PEPFAR <ul><ul><li>Funded Isibindi when it was an innovative new community model </li></ul></ul><ul><ul><li>Tested and evaluated it over the course of a few years </li></ul></ul><ul><ul><li>Now government plans to take ownership and roll it out across the country as a standard model of care </li></ul></ul>NACCA PRELIMINARY
  10. 10. Isibindi’s integrated community model is highly effective will a number of positive spillover effects SOURCE: South Africa HIV/AIDS response stakeholder interviews ; NACCA PRELIMINARY <ul><ul><li>Operating Model </li></ul></ul><ul><ul><li>Unemployed community members are screened, selected, trained and deployed as child and youth care workers </li></ul></ul><ul><ul><li>Mentorship is provided by experienced social service professionals </li></ul></ul><ul><ul><li>Workers blend household support with care and development </li></ul></ul><ul><ul><li>Main beneficiaries are children and families </li></ul></ul><ul><ul><li>Organizations are assisted to grow and access further resources </li></ul></ul><ul><ul><li>Communities are strengthened through the injection of skills and resources </li></ul></ul><ul><ul><li>Workers are set on a career path in a recognized profession </li></ul></ul><ul><ul><li>Safe Park Model </li></ul></ul><ul><ul><li>Currently being replicated across South Africa by over 20 organisations </li></ul></ul><ul><ul><li>Provides places for children to play safely under adult supervision </li></ul></ul><ul><ul><li>Girl Child Program </li></ul></ul><ul><ul><li>Female children and household heads are offered an intensive program of self-development and career information and planning </li></ul></ul><ul><ul><li>Care for Caregivers </li></ul></ul><ul><ul><li>Provides group and individual counselling to child and youth care workers </li></ul></ul><ul><ul><li>Child Protection Program </li></ul></ul><ul><ul><li>Vulnerable victims of sexual abuse are provided therapeutic support </li></ul></ul><ul><ul><li>Disability Program </li></ul></ul><ul><ul><li>Screening and assessment program providing access to remedial therapy and (where possible) assistive devices </li></ul></ul>“ No one is born a good citizen; no nation is born a democracy. Rather, both are processes that continue to evolve over a lifetime. Young people must be included from birth. A society that cuts off from its youth severs its lifeline.” - Kofi Annan