A I D S
R E S E A R C H
M O N O G R A P H
C o m m i s s i o n e d b y t h e
S O C I A L A S P E C T S O F H I V / A I D S A N D
H E A LT H R E S E A R C H P R O G R A M M E
FA M I LY A N D
C O M M U N I T Y
I N T E RV E N T I O N S
F O R C H I L D R E N
A F F E C T E D B Y A I D S
L I N D A R I C H T E R , J U L I E M A N E G O L D
& R I A S H N E E PAT H E R
Funded by the WK Kellogg Foundation


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by the Child, Youth and Family Development Research Programme of the
Human Sciences Research Council (HSRC)
Funded by the WK Kellogg Foundation
Published by HSRC Publishers
Private Bag X9182, Cape Town, 8000, South Africa
www.hsrcpublishers.ac.za
© 2004 Human Sciences Research Council
First published 2004
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Preface v
Section one 1
1.
Introduction 3
1.1 Definitions of orphans and vulnerable children 3
1.2 Rights and development as the bases for interventions 4
1.3 The long-term nature and size of the problem 5
1.4 The status of evidence about family and community interventions for
orphans and vulnerable children 6
2.
The impact of HIV/AIDS on children, families
and communities 8
2.1 Impacts on children 8
2.2 Impacts on families and households 12
2.3 Impacts on communities 13
3.
Community-based approaches to caring for
children affected by HIV/AIDS 15
3.1 Needs of adult caregivers 18
3.2 Role of external agencies 19
4.
Orphan registration programmes 21
5.
Facilitating access to adequate nutrition and
healthcare 25
5.1 Nutritional assistance for preschool children 25
5.2 Assuring access to healthcare for affected children 26
6.
Facilitating access to education 28
6.1 Direct assistance 29
6.2 Provision of early childhood care and education (ECCE) 29
6.3 Community-based schools and schooling for working children 29
6.4 Assisting schools to provide psychosocial support for affected children 31
6.5 Government intervention to support the education of affected children 31
7.
Addressing childrens emotional needs 32
7.1 The provision of psychosocial support for children and families 32
7.2 Planning for the future and remembering the past 35
7.3 Substitute care for children 37
8.
Protecting children 41
8.1 Protecting children from abuse and exploitation 41
8.2 Protecting childrens assets and inheritance 41


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Community mobilisation and micro-finance 43
9.1 Community mobilisation 43
9.2 Livelihood support 47
9.3 Micro-credit and targeting of women 48
9.4 Vocational training and apprenticeships for young people 51
9.5 Factors contributing to the success of income-generating activities 51
9.6 Emergency relief 52
10.
The role of government 53
10.1 The role of the private sector 54
11.
Monitoring and evaluation of support
efforts 55
12.
Intervention-linked research 58
13.
General programme approach 60
Appendix 63
Responses developed by stakeholders to meet OVCs needs for OVC living in
family-like settings 63
Interventions to improve the financial situation of families fostering OVC 66
Risks and interventions to help families meet OVCs basic needs 67
References 69
Section two 71
Annotated bibliography 73


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In the operational framework to implement the strategy for the care of orphans and
vulnerable children (OVC) in Botswana, South Africa and Zimbabwe funded by the
WK Kellogg Foundation (WKKF), the goals of the project are to:

Improve the social conditions, health, development and quality of life of vulnerable
children and orphans; Support families and households coping with an increased burden of care for
affected and vulnerable children; Strengthen community-based support systems as an indirect means to assist
vulnerable children; and Build capacity in community-based systems for sustaining care and support to
vulnerable children and households over the long term.
The key deliverables of the project are to monitor and evaluate the impact of the
following programmes:

Home-based child-centred health, development, education and support programmes; Family and household support programmes; Strengthening community-support systems; and Programmes to build HIV/AIDS awareness, advocacy and policy to benefit orphans
and vulnerable children.
Steps in the process to achieve the deliverables include reviews of the available scientific,
programmatic and network information on the three key levels of the interventions
children, families and households and communities. Three reviews were articulated as
follows:

Evidence-based interventions for home-based child-centred development
programmes focusing on health and nutrition, psychosocial care, management of
inherited assets, among others; Evidence-based interventions directed at supporting families and households to cope
with the HIV/AIDS problem (an increased burden of care for affected and
vulnerable children); Evidence-based interventions directed at building capacities of communities to
provide long-term care and support for children and households.
The review of home-based child-centred development programmes was conducted
independently by a third party and has been reported separately.
1
That document
contains descriptions of the Community-based Options for Protection and Empowerment
Programs (COPE) programme in Malawi, the Strengthening Community Project for the
Empowerment of Orphans and Vulnerable Children (SCOPE) programme in Zambia,
Thandanani Association and the Children in Distress Network (CINDI) in South Africa,
and the Family AIDS Caring Trust (FACT), the Farm Orphan Support Trust (FOST) and the
Families, Orphans and Children Under Stress (FOCUS) programme in Zimbabwe, all of
which have been subjected to some form of evaluation. As information about these
programmes is widely available, they are not covered in further detail in this report.
There are several compendiums of programme examples in Africa and other parts of the
world, listed in the attached Annotated Bibliography, and further details about these
programmes are also not included in this review (see, for example, the Alliance 2003
v
©HSRC 2004
1 See A Strebel A (2004) The development, implementation and evaluation of interventions for the care of orphans and
vulnerable children in Botswana, South Africa and Zimbabwe: A literature review of evidence-based interventions for
home-based child-centred development. Cape Town: HSRC Publishers


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ublishers.ac.za Family and community interventions for children affected by AIDS
series; Cook 2002; the Displaced Children and Orphans Fund (DCOF) 2001; Family AIDS
Caring Trust (FACT) 2002; Lorey & Sussman 2001; WHO/UNICEF 1994; UNICEF 1999;
USAID 2001; USAID-PVO Steering Committee on Multisectoral Approaches to HIV/AIDS
2003).
This report focuses on interventions directed at supporting families and households, and
on building the capacities of communities. In the main, the emphasis is on intervention
principles rather than on actual programme implementation details, because it is widely
agreed that interventions need to be tailored for each particular situation. As Williamson
says, Interventions to mitigate the impacts of HIV/AIDS must be tailored to the particular
economic, social, cultural, and environmental contexts of the countries and communities
concerned. There is no one-size-fits-all approach (2000a:20). These intervention
principles, although not subjected to rigorous outcome evaluation, are derived from
reflection on practice and experience coming out of various forms of process evaluation.
Interventions to support children, families and communities run into each other with
inevitable overlaps. Where this occurs, the review ranges across children, families and
communities without artificial demarcation.
Method
As part of its work in the field of interventions for vulnerable children, the Child, Youth
and Family Development (CYFD) research programme maintains comprehensive
bibliographic databases and conducts ongoing document surveillance on topics related to
vulnerable children and policy and programmatic interventions.
Using these resources, documents for this review were sourced through electronic journal
systems, web-based searches, networks with bulletin boards, reports of meetings,
exchanges of documents between colleagues, and so on.
2
It shoul