From Surviving to Thriving

By Dr. Tessie San Martin
April 3, 2018

Orphans and Vulnerable Children (OVC)—it is not just a description or a state of being. It is an important group that the U.S. government prioritizes to tackle the most devastating effects of the HIV epidemic—the children who are left fatherless and motherless. This includes children who are being cared for by a sick parent, at times living with HIV themselves or living with the stigma of the disease, and merely surviving in households that are living on the edge of total collapse. These living environments further expose children to other risks, like trafficking. Kenya is estimated to have more than 3.5 million children in this state. 

I traveled with several Plan International USA board members to see the OVC program that Plan is implementing in Kenya, in partnership with the United States Agency for International Development (USAID). The project is called Nilinde, which means “protect me” in Swahili. We went to Kilifi, a county on the Kenyan Indian Ocean coast. Resources are scarce there, with almost half of the population living under the poverty line.

The U.S. government spends more than $6 billion a year to control the spread of the HIV epidemic globally. What gets the lion’s share of the funding and attention is the treatment; anti-retrovirals have been life-saving. But surviving through treatment is not enough. As important as that work is to contain the epidemic, OVC programs are an essential element of a country’s effort to move beyond epidemic control to sustainably managing its recovery and preventing further spread of HIV.

OVC programs succeed because they work at the grassroots level. The Plan approach is family-centered and child-focused, increasing the resilience of children, caregivers, and households so they are able to graduate from the program by meeting key markers over time related to health, economic standing, school enrollment and progression, and protection. This type of one-family, one-household, one-village-at-a-time work leverages Plan’s grassroots relationships and experience from years of working in Kilifi, and the resulting community trust is essential to working through the social and cultural barriers that surround HIV and AIDS. Without this trust it would be difficult, if not impossible, to identify affected children and families, to link them to the medical and psychosocial support they need, and, most importantly, to get the family, community, and caregiver buy-in essential to ensuring this work continues long after Plan’s OVC project is over.

The breadth of the integrated activities that form the OVC project is impressive. The program seeks to tackle the complex set of circumstances that are creating and perpetuating vulnerability at the personal, household, and community levels so the devastating cycle of poverty, exacerbated by a cruel disease, can be broken. 

Improved Access to Health Services

A central element to ensuring children and families are supported is the community health volunteer (CHV). CHVs, as the name implies, are not paid, though they receive a small allowance to cover transportation costs. CHVs are from the community and have volunteered to help link individuals from the community to health providers, as well as to social and child protection services, education, and economic strengthening opportunities. Yet, the CHVs we met with in Kilifi are quite vulnerable themselves—so the project design includes economic strengthening activities to support their ability to continue volunteering. In the village we visited, small grants were awarded to help the CHVs buy chicks and start small poultry farms to complement their livelihood activities.

Saving for Education

The project also works with targeted schools in high-prevalence areas. To ensure that children affected by the disease are not left behind it is essential to get them to go to—and stay in—the school system. There are many barriers to education, from teacher attitudes to lack of money for school fees. To assist with school fees, Plan helps establish village savings and loans associations that encourage caregivers to save money and allow them to borrow cash. Training and technical assistance to these associations enables members to manage their funds and to plan for the use and repayment of loans. The project also includes working with and motivating the teachers in the Early Childhood Centers to stop HIV stigma.

Social, Emotional, and Economic Support

Among the more powerful elements of the project are community mentor mothers—women who are HIV-positive themselves. They share their experiences and work with the mothers and the CHVs to ensure that HIV-positive project participants stay healthy, while also further strengthening the web of support for children living with HIV and their families. And because households cannot take care of the children if they themselves are in economic free fall, Plan includes household economic strengthening activities (similar to the poultry farms for CHVs mentioned above), and even small asset transfers for the most vulnerable. 

This comprehensive, integrated approach is challenging to implement but it is yielding results. Plan has already transitioned out of one county in the program with lower HIV prevalence and stronger capacity for OVC care, and we are evaluating the sustainability of the programming post-transition. The lessons learned will be used to further refine programs in Kilifi and the four other remaining counties where Plan continues to implement this project. 

Of course, none of this would work without a close and effective working relationship with the government and local authorities. We met with Kenyan officials from the Department of Children Services (DCS), whose job it is to ensure the children affected by HIV, particularly those from the most vulnerable households, are linked to and receiving services on a timely and regular basis. The relationship between Plan and DCS (as well as other service providers within the Government of Kenya) is symbiotic. Without the government’s involvement there is no long-term sustainability. Without Plan the most marginalized and vulnerable might not be reached or reached as quickly.  

A country’s hope is in its children. OVC programs like the one we saw in Kenya—bringing communities, NGOs, and local authorities together to tackle many of the root causes perpetuating vulnerability and exclusion—help improve children’s prospects for healthy and productive lives. This brightens not only their future, but the future of Kenya.