Change package for Quality Improvement in Orphans … package for Quality Improvement in Orphans and...

Change package for Quality Improvement in

Orphans and Vulnerable Children Programmes in Kenya

SEPTEMBER 2013This change package was prepared by University Research Co., LLC (URC) for review by the United States Agency for International Development (USAID) and was authored by Roselyn Were, Stanley Masamo, and Jemimah Owande of USAID ASSIST and Emma Akinyi, Muhamed Akulima, Emily Murungi, Millicent Oluoko, and Stella Wachira of APHIA Plus. The work described was conducted under the USAID Health Care Improvement (HCI) and USAID Applying Science to Strengthen and Improve Systems (ASSIST) projects, which are made possible by the generous support of the American people through USAID, with funding from the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR).

Cover photo: Children under the Maua Methodist Hospital - Meru, KenyaPhoto credit: Allan Gichigi and Elijah Kanyi (Afroshok media)

Change package for Quality Improvement in

Orphans and Vulnerable Children Programmes in Kenya

DISCLAIMERThe contents of this change package are the sole responsibility of University Research Co., LLC (URC) and do not necessarily refl ect the views of the United States Agency for International Development or the United States Government.

By: Roselyn Were (USAID ASSIST), Stanley Masamo (USAID ASSIST), Jemimah Owande (USAID ASSIST),

Emma Akinyi (APHIA Plus Nuru ya Bonde), Muhamed Akulima (APHIA Plus Kamili), Emily Murungi (APHIA Plus Nairobi Coast), Millicent Oluoko (APHIA Plus Western Kenya), Stella Wachira (APHIA Plus Nairobi Coast)

September 2013

© September 2013 University Research Company., LLC (URC) / USAID ASSIST (Kenya)

Design and layout by Esther Kahinga

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Acknowledgement

We would like to acknowledge all the people who contributed to the development of this change package especially the Quality Improvement Teams and coaches who worked tirelessly to ensure improvement in service delivery for orphaned and vulnerable children (OVC) across the country. This work would not have been complete without the support of the Department of Children Services, APHIA and AMPATH PLUS and the Community Based Organizations whose work is disseminated through this document. The development and production of the OVC Change Package was supported by the USAID Applying Science to Strengthen and Improve Systems (ASSIST) Project.

The work of the USAID (ASSIST) Project is supported by the American people through the United States Agency for International Development (USAID) and its Bureau for Global Health, Offi ce of Health Systems. The project is managed by University Research Co., LLC (URC) under the terms of Cooperative Agreement Number AID-OAA-A-12-00101. The ASSIST Project team includes URC, Broad Branch Associates; EnCompass LLC; FHI 360; Harvard University School of Public Health; Health Research, Inc.; Institute for Healthcare Improvement; Initiatives Inc.; Johns Hopkins University Center for Communication Programs; Women Infl uencing Health Education and Rule of Law, LLC.

For more information on the work of the USAID ASSIST Project, please visit www.usaidassist.org.

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Table of Content

Background for Quality Improvement of Orphaned and Vulnerable Children Programs .........1Quality Improvement Process ................................................................................................3Change Ideas .......................................................................................................................15Annexes ...............................................................................................................................27

List of teams testing change in each service area ..........................................................28 List of participants .......................................................................................................31

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List of acronymsAACs Area Advisory CouncilsASSIST Applying Science to Strengthen and Improve SystemsAMPATH Academic Model Provinding Access to HealthcareAPHIA AIDS Population and Health Integrated AssistanceCBO Community Based OrganizationCHW Community Health WorkerCHV Community Health VolunteerCSI Child Status IndexCU Community UnitDCS Department of Children ServicesGOK Government of KenyaHCI Healthcare Improvement ProjectHIV / AIDS Human Immunodefi ceincy Virus / Aquired Immune Defi cinecy Syndrome.KCPE Kenya Certifi cate of Primary EducationKCSE Kenya Certifi cate of Secondary EducationLIP Local Implementing PartnerNSC National Steering CommitteeOVC Orphans and Vulnerable ChildrenPDSA Plan Do Study ActPSS Psychosocial SupportQI Quality ImprovementQIT Quality Improvement Teams URC University Research CompanyVSL Voluntary Saving and LoaningUSAID United States Agency for International Development

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Foreword

The term “orphans and vulnerable children” (OVC) includes not only children orphaned by their parents’ death, but also children considered vulnerable to psychological traumas endangering their health and well-being, including living with a chronically ill parent. In 2003, the launch of the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) called for interventions that met the needs of OVC aff ected by HIV and AIDS. The response to the PEPFAR call was the development of emergency humanitarian eff orts to address the plight of the large numbers of OVCs resulting from the HIV and AIDS epidemic. This means programs did not address integration or sustainability due to the emergency nature of the response. In recent years however the emergency response has not been appropriate and PEPFAR through the United States Agency for International Development (USAID) has emphasized on programs that address quality improvement as an integrated aspect of OVC programming. Moreover, lessons learned from OVC programs have revealed the need to improve service quality and to strengthen harmonization across partners.

But how do we defi ne quality? While there are many defi nitions of quality, one that is often used is the defi nition from the United States Institute of Medicine (IoM), that says quality is the “ degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge or evidence” .

Quality has six dimensions, • safety• eff ectiveness• patient centeredness• timeliness• effi ciency

With regard to quality improvement, this has been described as the systematic approach that uses specifi c

vi

techniques to improve quality and the most important ingredient in successful and sustained improvement being that way in which the change is introduced and implemented .

The University Research Company (URC), LLC notes that quality improvement (QI) uses quantitative and qualitative methods to improve the eff ectiveness, effi ciency, and safety of service delivery processes and systems, as well as the performance of human resources in delivering products and services. Using this defi nition and various quality improvement approaches and models such as the ‘Plan-Do-Study-Act’ (PDSA) model, a key focus for URC is addressing quality programming for OVC . This change packages draws on experiences from Kenya following a 2 year program that implemented change ideas in collaboration with 6 USAID implementing partners across the country.

This change package was developed following a harvest meeting where quality improvement teams shared the results of what they had successfully implemented over a period of two years since the fi rst improvement team was formed, though majority of the teams were formed much later. The package begins with some background information on the journey towards quality improvement for orphans and vulnerable children programming followed by a guide for changes that have proven to work. Case studies of some of the teams that implemented the change ideas presented here are shared in a seperate booklet Improving the lives of vulnerable children in Kenya: Experiences from implementing quality service standards

We invite you to study and utilize this package for all OVC programming.

Dr. Faith Mwangi-PowellCOP- URC Kenya.

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1BACKGROUND FOR QUALITY IMPROVEMENT

OF OVC PROGRAMS

The plight of Orphans and Vulnerable Children (OVC) is an issue of national concern in Kenya. It is estimated that there are over 2.6 million orphans in the country, 47% of whom are orphaned as a result of Human Immunodefi ciency Virus and Acquired Immune Defi ciency Syndrome (HIV and AIDS).

In response to an increasing number of OVC in Kenya, a National Steering Committee (NSC) on OVC was constituted in May 2004, to deliberate upon interventions tha would address the plight of OVC. A rapid assessment on the state of OVC was carried out in June 2004, with the support of various development partners. The assessment informed on the regrettable vulnerability of children that demanded immediate action. Consequently the NSC realized the need to come up with a national

policy on OVC to underpin intervention. In its commitment to improve the lives of OVCs in Kenya, the Government introduced the National Policy on Orphans and Vulnerable Children, which intendeds to ensure that every Kenyan child who is orphaned or vulnerable is protected and supported in order to achieve their full potential.

Eff orts to provide care and support to OVC have expanded rapidly both in terms of partners delivering services and resources allocated to meet the needs of these children. This has resulted in an increase in the number of children reached without equivalent focus on the quality and impact of services delivered.A situational analysis conducted in 2009 to assess the quality of services provided to OVC identifi ed

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various gaps including;1. Quality of services off ered by some

organizations has been inappropriate leading to stigmatization and discrimination of OVC by the rest of the community and wastage of resources

2. Existing interventions only support small proportion of OVC

3. Inadequate and inaccurate data on the needs of the children before intervention is launched

4. Lack of regulation on the duration a service provider should support a benefi ciary

5. Lack of social mapping of OVC service providers making it diffi cult for the Department of Children Services (DCS) to monitor and coordinate their operations.

To support and streamline the standards and quality of OVC care, the Department of Children Services and stakeholders initiated the process of developing service standards for quality improvement of service delivery.

The minimum service standards have eight service areas with specifi ed desired outcomes that guide improvement work as shown in table 1.

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Service area Desired outcome

Food & Nutrition OVC and other household members should have enough nutritiousfood to eat throughout the year and should not be anxious of where they will fi nd food for the next meal.

Education All orphans and vulnerable children have the right to education in a well-structured school with a proper teaching and learning system.

Health OVC and their households must have access to good health care services so as to promote and maintain a healthy lifestyle.It is important to ensure children aged 0-5 years go to the clinic, get immunization and are treated when sick.

Psychosocial support This is the emotional, social, spiritual, mental and physical support given to OVC and their households to promote all-round growth and development.

Shelter & Care OVC and their households must live in a structure that is safe,secure, habitable and with enough space for comfortable livingwith at least one responsible adult caregiver.

Child preotection Orphans and vulnerable children should be free from anyand all forms of abuse, neglect, discrimination and exploitation.

Household Economic Strengthening Households should be able to regularly and safely meet the basicneeds of the OVC on their own.

Coordination of care There should be a structured and well monitored system bringingtogether service providers who provide quality and essential servicesto OVC and their households.

Table 1: The eight service areas

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2.1 Dissemination of Standards

The dissemination of the standards over the year was an elaborate process that began even before the fi nalization and eventual launch of the Minimum Service Standards for Quality Improvement of Orphans and Vulnerable Children Programmes, Kenya (hereafter reff rered to as the Standards). Through partnership with the AIDS Population and Health Integrated Assistance (APHIA) implementers across the country, over 100 Quality Improvement Teams (QITs) were taken through the standards and have been using them to guide their work.

During the national launch, copies of the Standards in soft and hard copy were distributed

to key players in OVC programmes from across the country. The launch programme ensured participants were guided through the key

Offi cials from the Ministry, UNICEF, HCI and Child Geusts during the Minimum Standards launch

2QUALITY IMPROVEMENT PROCESS

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components of the standards and discussions were held on the application of these standards at the point of service delivery.

After the national launch, HCI together with the OVC Technical Working Group conducted dissemination workshops in 8 regions of Kenya. In total over 800 OVC service providers attended the meetings. District and county level dissemination work plans were developed for implementation under the coordination of the Ministry of Gender Children and Social Development through the Department of Children Services.

Besides the USAID funded Academic Model Providing Access to Healthcare (AMPATH) and APHIA plus implementers other service delivery teams that are linked to the government’s Area Advisory Councils (AAC) at grassroots level have also been supporting the dissemination exercise. A total of nine thousand copies of the standards were printed for distribution.

2.2 Capacity building of Department of Children Services on OVC QIFrom March - July 2012, HCI conducted trainings for 283 government personnel from the Department of Children Services and Nairobi City Council. The outcome of the trainings was the development of region-specifi c work plans that are being implemented jointly with HCI, the Department of Children Services and APHIA Plus the national USAID mechanism for service delivery for HIV/AIDS. The following activities have been ongoing since the training;

• Disseminating service standards to implementers at county, district, division and location levels

• Stakeholder mapping and development of directories of OVC service providers

• Harmonizing reporting and data management from the location level up to the province

• Building the capacity of point of service delivery providers in the standards and Quality Improvement

• Conducting county and district level learning sessions, documentation, reporting and consolidation of results

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The Department then conducted periodic stakeholder meetings and supportive supervision for the implementers.

The government’s capacity to provide leadership for Quality Improvement (QI) has been enhanced through training.

2.3 Institutionalizing QI at the Point of Service DeliveryHCI which was later replaced by the Applying Science to Strenthen and Improve Systems (ASSIST) in October 2012, continued to support the APHIA/AMPATH plus implementers in QI through coaching and mentorship and learning sessions at both national and project levels. HCI works with 6 projects one of which faced a close out in 2012. They include:

1. APHIA Plus Kamili - Central and Eastern provinces 2. APHIA Plus Nuru Ya Bonde - Rift Valley province 3. AMPATH plus - Uasin Gishu and Western Kenya 4. APHIA Plus Western Kenya – Western and Nyanza

Province 5. APHIA Plus Nairobi /Coast – Nairobi and Coast

Province 6. APHIA Plus North Arid Lands (closed in 2012 and

relaunched as Imarisha)- North Eastern region , Upper Eastern, Samburu and Turkana.

APHIA addresses various population and health issues including OVC. Under the OVC component, APHIA works with Local Implementing Patners (LIPs) usually Community Based Organizations (CBOs)and local Non-Governmental Organizations (NGOs) at grassroot / community level. The NGOs / CBOs then form QITs that work with the community to identify and assist OVC within that community. AMPATH directly implements their OVC component.

For QI to be implemented at the point of service delivery, representatives from CBOs that work with the above projects were trained as QI coaches. They then shared on the standards to their respective communities and later formed QITs.

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The QIT brings together about 15 members of the community who possess valuable skills in addressing the common challenges children face. The team generally consists of teachers, community health workers or volunteers, nurses, agricultural extension offi cers, district / volunteer children offi cers, a representative of the provincial administration like chief, spiritual leaders like pastors or imams, representatives of the area advisory council, guardians and OVC. A total of 150 QITs have been formed across the country.

To assess improvement on child outcomes, the Child Status Index tool is administered on children as baseline data collection with a repeat CSI administration six months later. This linked with the service tracking data that is collected monthly helps determine whether the changes instituted by the QI teams made a diff erence in the lives of the children. In problem identifi cation , the QI team compares the overall CSI data with the results of the self assessment based on the standards. This helped the teams agree on change ideas that have the highest probability of leading to improvement at both

systems and child levels. The changes at systems level will inform an improvement in the service delivery process as designed by the organization whereas the changes at child level will focus on addressing the felt needs of each individual child and their households.

2.4 Learning SessionsNational Learning Sessions were organised to provide an opportunity for QITs from across the country to share to learn from one another, and for HCI consolidate the results of the work done by QITs. Project specifi c learning sessions also took place at the APHIA level. Representatives of QI teams were brought together to share the successes and failures they had encountered in testing change ideas using the QI model for improvement (see fi gure 1). 2.6 Process of harvesting key changesFor over 2 years more than 100 QITs across the country with support from AMPATH and APHIA plus have innovated and tested many change ideas geared towards improving the quality of service

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delivery to OVC in Kenya. With support from HCI the QITs documented and shared these change ideas during project and national learning sessions. The sessions gave the teams an opportunity to share the change ideas that had had a clear demonstration to work in improving the well being of the OVC with QITs that were struggling with the

same challenges.

For a change to have worked, the teams had to share evidence (data) and experiences (qualitative data) with the others and demonstrate whether these change ideas lead to improvement or not.

A harvest meeting was held on 20 - 21 May 2013 with representatives (Champions) of the QITs, APHIA plus, AMPATH and HCI. The harvest involved the classifi cation of change ideas into service areas and then ranking them. The ranking was based on four parameters:• evidence - how many teams tested it• simplicity• scalability • relative importance - its contribution to the

results achieved. The teams members described in detail how each change idea was tested or implemented and the results of the implementation. Teams that tested the various changes are indicated in bold in the column ‘Notes on evidence.’

Figure 1: The Quality Improvement Model, adapted from Langely, P. et. al. (2009) The Quality Improvement Guide

USAID HEALTH CARE IMPROVEMENT PROJECTLangleyetal– TheImprovementGuide,JB,2009

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3. CHANGE IDEAS

10

Change Idea Steps to implement Notes on evidence

1 Improving food production through provision of certifi ed seeds

• Through support from the Ministry of Agriculture carry out assessment to identify the seeds required for each area, then conduct a community awareness meeting targeting caregivers with information on the new seeds.

• Ensure timely distribution of the seeds for increased yield.

• In collaboration with the Ministry of Agriculture carry out continuous follow up to ensure the caregivers are tending to the crops appropriately.

• Tested in 26 sites with moderate results• Good idea however the biggest challenge

is getting GOK staff to assist communities when no fi nancial support is available.

• Identifi cation of the correct seed and time for planting also requires agricultural professionals to support the caregivers.

• Adoption of irrigation technologies in case of insuffi cient rain fall increases yields.

Matunda Jua Kazi, ACK Embu

2 Nutrition education to caregivers

• With support from Ministry of health, carry out targeted awareness creation to caregivers on proper nutrition especially for children under the age of fi ve.

• Continuous growth monitoring by community health workers (CHWs) to assess nutrition status of children.

• Tested in 12 sites with high results showing it can easily be adopted and scaled up in other sites.

• The trainers need to adopt local language and use of pictorials for eff ective delivery, and understanding.

Shangia CU, Bukonoi

3 Ensure access to consistent supply of water

• Through collaboration with partners identify the source of water appropriate for the region.

• Seek resources from the community and partners and dig wells or dams to ensure continuous supply of water

• Formation of water management committee to ensure water is used appropriately e.g. household use and irrigation.

• Have systems to ensure the levies collected from sale of water are properly managed.

• Tested in 2 sites with high results. However for scale up there is need to adapt to specifi c environment. e.g. areas with a low water table need to adopt other methods.

• The water management committees need to have basic management and fi nancial skills for proper resource management.

Shangia

3.1 Service Area: Food and Nutrition

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3.2 Service Area: Education


1 Enhance parents/caregivers involvement in the education of their children

• Awareness creation through school management committee, chief meetings (barazas), CHW household visits and other forums on the importance of education.

• Initiate monthly meetings between the class teachers and caregivers where vital information regarding the child’s performance, challenges and strengths are shared and discussed

• Through the caregivers monthly meetings ensure importance of education is part of education sets received by the caregivers

• Continuous monitoring by the caregivers and the CHWs through the school register to ensure all children attend school as required.

• CHWs tracking parental involvement through the class teacher register.

• Tested in 17 sites with very high results

• Very viable and can be adopted in any environment.

• There is need for fl exibility to accommodate the busy schedule of the caregivers.

Shangia CU, Dago Dala Hera, YARD

2 Ensure timely payment of school levies and other educational materials including sanitary pads for girls

• Identify children whose caregivers cannot aff ord payment of school levies.

• Link to other partners including cooperates and government systems that support education.

• Link caregivers to alternative economic activities to improve household income

• In cases of delays in school fees payment discuss with the head teachers/principles early enough to ensure the children are not sent away from school

• Tested in 17 sites with moderate results. Very challenging because of the procedures within various organizations which the QIT may have no control over. However, with planning and submitting requests at the beginning of the school term most organizations are able to make payments in time

APHIA Plus Western Kenya , Nuru ya bonde

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3 Encourage students to initiate individual and joint study plans to improve their performance

• Create awareness targeting school going children on why it is important to have their parents involved in their education and performance

• Through the CHWs and the teachers ensure each child has developed a personal plan for improvement.

• Institute student-led tuition and coaching i.e. have those in higher classes coach those in lower classes

• Through the children clubs ensure education and performance are an integral part of their discussions

• Establish mentorship program in schools (academic clinics)

• Tested in 2 sites and showed high results. Can be adopted in any environment

• Academic clinics were adopted by Cheer up from other CBOs.

Cheer up, Dago Dala Hera

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3.3 Service Area: Health

Change idea Steps to implement Notes on evidence

1 Promote hand washing • Carry out advocacy and outreach campaigns in schools and households.

• With support from partners distribute leaky tins to schools with permanent sources of water.

• Encourage peer monitoring in schools where children monitor each other to ensure they wash their hands appropriately.

• Initiate health clubs in schools with a patron to ensure continuity

• De-worming primary school children and administering Vitamin A.

• Tested in 6 sites with high results. Can be scaled up but needs adapta-tion for specifi c sites i.e. areas with scarce water supply.

• The children are trained to make leaky tins using local resource like tins, buckets, jerry cans e.t.c.

LOCODEI, NOFI, Shangia, Kinani CU

2 Advocate for safe drinking water

• Carry out advocacy and outreach campaigns in schools and households on importance of ensuring water safety

• Encourage caregivers to treat water before use within the household

• Tested in 6 sites with moderate results, requires more advocacy and awareness creation.

• Challenges faced in areas with perennial water shortage

Shangia CU, NOFI, LOCODEI

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1 Renovation of dilapidated houses

• Identifi cation of most dilapidated houses.• Mobilized resource from local business

men and women• Worked with the caregiver to provide labor.

• Tested in 12 sites with moderate results. However, the renovation cost is expensive and may not be sustainable in the long run.

• A CBO in Eastern mentioned it is cheap because of local labour. WOFAK in Nuru Ya Bonde also used very minimal resources.

• Linking caregivers to household economic activities ensures they repair their houses with minimal external support e.g Hak-ishep in Kibera and Hope Worldwide Kenya in Eastern

Hakishep, WOFAK, Hope Worldwide Kenya

3.4 Service Area: Shelter and Care

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1 Enhance awareness to the community and children on importance of child protection

• Awareness creation targeting the community through churches, chief meeting (barazas) and school meetings on importance of child protection and referral processes

• Training CHWs on child rights and protection• Training children on child rights• Ensuring child protection during home visits by CHW• Formation of child rights clubs in school and ensuring they

learn to be each other’s keepers• Involve the community animators such as paralegals, parent

educators and CHVs in child protection through counseling, reporting and sharing information with the community members.

• Organize feedback sessions with the children in schools and churches to get information on what aff ects them through songs, exercises, skits, drama, talks and poems.

• Tested in 20 sites with good results. Can be easy adopted and scaled up.

AMPATH Port Victoria, AMPATH Kapsoya, Kagwa, Dabaso, Bukonoi

2 Identify areas with high prevalence of child abuse

• Map areas where children are likely to get exploited e.g. local brew dens, video shows and areas where truck drivers park

• Sensitize local brew sellers and identify hotspots where chil-dren are not allowed to access

• Monitor areas truck drivers park and ensure no children go there by involving the police children’s desk and children’s offi ce.

• Link with partners to provide OVC with basic needs to avoid them engaging in sexual exploitation.

• Tested in 12 sites with high results. Requires collaboration of the provincial administration and the AAC

AMPATH Budalangi,AMPATH Kapsoya, Dabaso

3.5 Service Area: Child Protection

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3 Identify and withdraw OVC from child labour

• Map out and identify the details of children involved in child labor i.e. their names, where they came from, local elders and caregivers during household visits.

• In partnership with provincial administration and the police child desk carry out a mop up of children involved in child labor.

• Hold awareness meetings with members of the community especially business community on the implication of child labor

• Tested in 6 sites with high results. There is however need for massive awareness creation and education to the caregivers if this is to be sustained.

• Households linked to house hold economic strengthening have minimal cases of child labour

Shangia, AMPATH Budalangi,

4 Establishment of children help desks within the police station

• Incorporating a representative of the police in the QIT• Discussions with the police offi cer in charge to set aside a

desk where children can report abuse cases• Collaboration with other partners including provincial

administration and AAC to speed up investigation and processing of the cases

• Tested in 5 sites with high results.

AMPATH Kapsoya, AMPATH Port Victoria, REEP

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5 Ensure legal registration of OVC and caregivers

• Awareness creation during meetings with area chief on importance of legal registration.

• Share with the provincial administration and the registrar • Mobilization of caregivers who don’t have national identity

cards or birth and death certifi cates. Awareness creation involving the registrar offi ce and provincial administration on importance of these documents is important.

• There is need to ensure the police clearly understand child rights and their role in ensuring children enjoy their rights if the desk is to be eff ective.

• There is also need for close monitoring by various partners to ensure no violation of child rights.

• There is need to empower children to be able to report in case they don’t receive the required service at the desk

• Tested in 20 sites. With very good results.

• Can be easily adopted and scaled up

Kagwa, Dago Dala Hera, Dabasu, Hakishep

6 Establishing legal clinics • Mapping local community members with expertise in legal matters

• Inviting them for a presentation on legal issues aff ecting OVC and their households and the impact on the entire community

• Identifying those willing to volunteer their time to support.• In collaboration with the legal volunteers, DCO and the area

chief convene legal clinics quarterly.

• One CBO implemented this change idea and had remarkable progress in child protection cases.

• Its adoption and scale up was a challenge because most legal practitioners are based in major cities and very few are willing to volunteer their time and resources to participate in legal clinics.

Cheer up

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3.6 Service Area: Household Economic Empowerment


1 Promote access to fi nancial services to the caregivers through Village Saving and Loaning (VSL) activities.

• Awareness creation through trained CHWs on the importance of VSL and how it operates to the caregivers. This will demystify the myths around loans.

• Carry out training on VSL to the caregivers.• Mobilize members to join and register.• Encourage saving and loaning by the caregivers

• Tested in 10 sites with good results, However at the start up stage awareness creation is important to clear the myths and beliefs around loans among the caregivers

KENWA, Msambweni CORPS, Shangia, Hakishep, AMPATH Budalangi

2 Diversifi cation of household income

• Awareness creation on diversifi ed sources of household income e.g. farming, energy saving jikos, solar driers etc

• Allow the caregivers to identify and select which source is most appropriate for them

• Link with relevant institutions and organizations for capacity building and monitoring

• Through caregiver support group track progress of each caregivers

• Through CHW monthly meetings track progress and identify challenges.

• Close monitoring by the caregiver or OVC support group is important for growth and development.

• Tested in 10 sites with fair results. Important lesson is to allow the OVC or caregiver to identify which income generating activity they want to pursue.

Kagwa, Dago Dala Hela, KENWA, Shangia, Msambweni CORPS

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3.7 Psychosocial Support


1 Strengthening community and household capacity for provision of psychosocial support to OVC and caregivers

• Training caregivers of psychosocial support with support from trained counselors

• There is need for clear guidance to the CHWs on what is defi ned as psychosocial support and how to measure results.

• Tested in 4 sites. • Diffi cult to measure results.

MOCASO, Redeemed Gospel Church

2 Conducting sensitization activities to create awareness on psychosocial support needs to caregivers and their households.

• Use practical and interesting methodologies e.g. drama and songs to pass the message

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3.8 Service Area: Coordination of Care


1 Harmonize OVC service delivery • Map out organizations providing OVC care and support in the region through the department of social services

• Hold meetings with representatives of the organization and map out their activities detailing activities, number of children, region covered and duration of project.

• Develop a database with the relevant details.

• In cases of duplication of work, hold meeting with the partners through the department of social services and department of children services for redistribution or adoption of diff erent service areas.

• Quarterly meeting through the department of children service to review progress of each organization.

• Develop a database of OVC to reduce cases of double support.

• Tested in 3 sites with improved results. • However, this is the core business of the

department of children services and they should take the lead or drive the process to ensure every actor adheres to the set standards.

Njukini CU

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4. ANNEXES

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ANNEX 1: LIST OF TEAMS TESTING CHANGE IN EACH SERVICE AREA

Partner Community based org/QI team

Food

sec

urity

Nut

rtio

n

Educ

atio

n

Econ

omic

em

pow

erm

ennt

Hea

lth

Psyc

hoso

cial

Su

ppor

t

Child

Pro

tect

ion

Shel

ter

Coor

dina

tion

of

care

AMAPATH AMPATH Port Victoria x

AMPATH Kapsoya x

APHIA Plus Kamili

Hope Worldwide Kenya - Makueni x x x

Twana Twitu x x x

Save the Children Meru x x x

Ruiru Baptist Church x x

Ngoliba x x x x

Makindu Children Centre x

Shephards of Life x x

Society of Women Aganist AIDS in Kenya (SWAK)

x x x

Cheers Up x

St. Joseph HIV Self Help Group x x

Food for the Hungry x x

Terry Child Support x x

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Food

sec

urity

Nut

rtio

n

Educ

atio

n

Econ

omic

em

pow

erm

ennt

Hea

lth

Psyc

hoso

cial

Su

ppor

t

Child

Pro

tect

ion

Shel

ter

Coor

dina

tion

of

care

Little Servants of the Sacred Heart

x

YARD x

Cheda x x

Catholic Diocese of Kitui x x

Anglican Church of Embu x x x

CARITAS Nyeri x x

APHIA Plus Nairobi Coast

HAKISHEP x x x x x

KICOSHEP x x x

MOCASO x x

Shangia Community Unit (CU) x x

Mkunumbi CU x x

Children Hope Foundation x x x

Redeemed Gospel Church x x

KENWA Korogocho x x

Progressive Care Coalition x x x

MOHAB x x

Msambweni CORPS x

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Food

sec

urity

Nut

rtio

n

Educ

atio

n

Econ

omic

em

pow

erm

ennt

Hea

lth

Psyc

hoso

cial

Su

ppor

t

Child

Pro

tect

ion

Shel

ter

Coor

dina

tion

of

care

LOCODEI x

Njiru Organic Farming Integrated x x x

St. Francis x

Njukini CU x

Dabasu CU x

APHIA Plus Nuru ya Bonde

Evangelising Sisters of Mary x

Catholic Diocese of Eldoret x x x x

Mother Francesca x x x

LIFA x

Catholic Diocese of Ngong x

Kenya National Organization of Peer Education and Training (KNOTE)

x x x

Beacon of Hope x x

Narok District Network Forum x

Deliverance Church Nakuru x

WOFAK x

25


Food

sec

urity

Nut

rtio

n

Educ

atio

n

Econ

omic

em

pow

erm

ennt

Hea

lth

Psyc

hoso

cial

Su

ppor

t

Child

Pro

tect

ion

Shel

ter

Coor

dina

tion

of

care

APHIA Plus Western

Dago Dala Hera Community Unit x x

Kagwa x x

REEP x x x

Matunda Jua Kazi x x x

Bukonoi x x x

Osiep Kiye x

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NAME LOCAL IMPLEMENTING PARTNER

PROJECT

1. James Kamau Hope Valley APHIA Plus Kamili2. Herbert Kahindi Shangia Community Unit APHIA Plus Nairobi Coast3. Mesaidi Mwarandu Shangia Community Unit APHIA Plus Nairobi Coast4. Lydia Simiyu Shangia Community Unit APHIA Plus Nairobi Coast5. Douglas Kariuki Cheer up APHIA Plus Kamili6. Javanson Njue ACK Embu APHIA Plus Kamili7. Christine Kalume Kinani APHIA Plus Nairobi Coast8. Millicent Akinyi Hakishep APHIA Plus Nairobi Coast9. Irene Masudi Dago Dala Hera APHIA Plus Western Kenya10. Susan Odero Dago Dala Hera APHIA Plus Western Kenya11. Joseph Makokha Bukonoi Sama Bungoma APHIA Plus Western Kenya12. Jackson Muge Bukonoi Sama Bungoma APHIA Plus Western Kenya13. Subira Kingi Dabaso CU APHIA Plus Nairobi Coast

14. Abdalla Mwatari Msambweni Corps APHIA Plus Nairobi Coast15. Omar Suya Locodei APHIA Plus Nairobi Coast16. Metrine Mudibo Redeemed Gospel Church APHIA Plus Nairobi Coast17. Emily Murungi Aphia plus Coast APHIA Plus Nairobi Coast18. Peter Odongo AMPATH Plus AMPATH Plus

ANNEX 2: LIST OF PARTICIPANTS

27

NAME LOCAL IMPLEMENTING PARTNER

PROJECT

19. Lilian Astiavula AMPATH Plus AMPATH Plus20. Emma Akinyi Aphia plus Rift Valley APHIA Plus Nuru ya Bonde21. Muhamed Akulima Aphia plus Kamili APHIA Plus Kamili22. Stella Wachira Aphia plus Nairobi/Coast APHIA Plus Nairobi Coast23. Millicent Oluoko Aphia plus Nyanza/Western APHIA Plus Western Kenya

24. Lukas Ndung’u YARD APHIA Plus Kamili

25. Joash Apollo REEP APHIA Plus Western Kenya

26. Scevar Swaro REEP APHIA Plus Western Kenya

27. Felix Miti NOFI APHIA Plus Nairobi Coast

28. Patrick Kinyae Njukini Community Unit APHIA Plus Nairobi Coast

29. Charles Mukabi MOCASO APHIA Plus Nairobi Coast

30. Lydiah Atieno MOCASO APHIA Plus Nairobi Coast

31. Stanley Masamo HCI USAID HCI32. Roselyn Were HCI USAID HCI33. Jemimah Owande HCI USAID HCI34. Irene Mutea HCI USAID HCI

Change package for Quality Improvement in Orphans … package for Quality Improvement in Orphans and...

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