Community-Facility Linkages to Support the Scale Up of Lifelong Treatment for Pregnant and Breastfeeding Women

We are pleased to announce the release of Community-Facility Linkages to Support the Scale Up of Lifelong Treatment for Pregnant and Breastfeeding Women: A conceptual framework, compendium of promising practices and key operational considerations.
 
This work was commissioned by UNICEF, with the support of Sweden and Norad, through the Optimizing HIV Treatment Access (OHTA) for Pregnant and Breastfeeding Women Initiative to help strengthen community-facility linkages in support of lifelong antiretroviral therapy (ART) for pregnant and breastfeeding women living with HIV.
 
This package of materials includes a 3-page executive summary, full report and a programme manager’s summary. The report includes a conceptual framework and describes eleven promising practices associated with increased service uptake, adherence or retention along the continuum of care. Key operational considerations for country teams to define and roll out an effective, locally appropriate package of community-facility linkages are also recommended.
 
Please find the links to the report and related materials below:
 
Full Report: English, French
Executive Summary: English, French
Programme Manager’s Summary: English, French
Webinar: Recording and PPT slides  
 
For additional information about the OHTA Initiative, please visit: www.childrenandaids.org/352.htm

Policy Brief: Pathways from parental AIDS to psychological, educational and HIV risks for children

The questions:

• Evidence shows that parental AIDS-illness and death have severe negative impacts on children. However, we need to understand why AIDS hasthese effects.

• This study aims to identify these pathways, and thus identify important targets for interventions.

• Three key outcomes are examined: psychological, HIV-infection risks and educational.

The research:

• Cross-sectional survey of 6,002 children aged 10–17.

• Rural and urban sites in the Western Cape, Mpumalanga and KwaZulu-Natal, South Africa.

• Validated scales and symptom checklists were used. Structural equation modelling in AMOS 19 identified pathways of risk. AIDS-orphanhood and parental AIDS-illness raise risks of poverty and parental disability. Through these linkages, AIDS-affected children are more likely to be stigmatised outside the home, and exposed to physical, emotional and sexual abuse or rape. It is these ‘interlinking factors’ that cause psychological distress such as depression, anxiety and suicidal behaviour. And it is psychological distress that leads to higher rates of HIV infection risks (such as transactional sex and low condom use) amongst AIDS-affected adolescents.

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Now More than Ever! A need to reach the youngest children affected by HIV and AIDS

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Now More than Ever brochure - web version.pdf

This practical guide by the Coalition for Children Affected by AIDS helps implementers improve programming and/or program connections that support young children born into HIV-affected families. It provides information about early integrated interventions for health, nutrition, HIV, parenting, economic support, and early childhood development (ECD) for families affected by HIV. The resource offers practical examples and case studies from different contexts, including from Kenya, Malawi, Mozambique, Rwanda, and Zambia.

Care and Support for Teaching and Learning (CSTL) initiative: Regional scoping study report

Care and Support for Teaching and Learning (CSTL) initiative: Regional scoping study report

Care and Support for Teaching and Learning (CSTL) is a SADC initiative, which aims to assist SADC Member States to mainstream care and support into their education systems and ensure that schools in the SADC region become inclusive centres of learning, care and support where every learner, especially the most vulnerable, can learn.

One of the CSTL initiative’s strategic objectives is to increase learning and knowledge of care and support strategies across the region. To contribute to this, the SADC Secretariat will develop a regional research agenda on care and support for teaching and learning. This research agenda will provide guidance for coordinated, harmonized research that is relevant to issues of care and support for teaching and learning in the region and is driven by the Member States.

The scoping study

To contribute to the development of the regional research agenda, ascoping study was carried out in four of the five Member States engaged in CSTL Phase 1: Swaziland, Zambia, Mozambique and the Democratic Republic of Congo. The purpose of the scoping study was to identify relevant national research agendas, research gaps and priorities, good practices and lessons learnt, as well as potential research partners.South Africa, the fifth Member State, did not participate in the scoping study but will participate in a revised process. During the consultative meeting for the development of the regional research agenda, representatives of the South African MoE and a South African researcher will contribute information on research priorities from the South African perspective.

 A second objective of this scoping study was to analyse research challenges within and among Member States: that is, challenges which might need to be addressed through regional collaboration and mutual support, such as the development of the regional research agenda.

Within the context of this particular study,the termresearch gap is used to describe under-researched areas which lack information and data (qualitative or quantitative), while researchpriorities suggests in which areas it would be useful to conduct further research. Potential good practices in this study refers to programmes, projects or initiatives which went particularly well, and which would be suitable for case study research to be shared at a national and regional level. The term Lessons learnt, on the other hand, refers to any factors preventing the successful implementation of programmes or projects, to be researched and documented in order to avoid their replication.

Methodology

The scoping study is based entirely on qualitative research methods, using two complementary research tools: key informant interviews with research partners of the Ministry of Education (or other relevant government ministries), and focus group discussions with the CSTL National Coordination Units.This report aims at providing a balanced ‘snapshot’ overview of research needs related to care and support for teaching and learning in each of the four participating Member States, based on the input of a diverse range of interviewees.

Results per country

Swaziland  The scoping study in Swaziland was based on an ample and diverse range of partner organizations and researchers interviewed, and can be considered a success. A wealth of information was obtained from different sectors (public and non-governmental), different levels (national and school level), and from actors in different geographical locations within Swaziland.The following priority research areas were identified: 1. School feeding schemes, 2. Psycho-social support, 3. Multi-sectoral collaboration and school-community partnerships, 4. Leadership skills and training needs of headmasters.
Examples of potential good practices included the successful training of community carers, and neighbourhood care points (NCP) which provide food and recreational space for children, just to mention a few. An example of a lesson learnt was the inadequate referral system in cases of child abuse, highlighting children’s lack of direct access to existing referral systems.

Zambia  The in-depth interviews and group discussion in Zambia brought to light a particular concern around issues of child protection. This includes the following research areas: 1. Sexual abuse of children, including abuse of learners by teachers, 2. Teenage pregnancies, 3. Child abuse reporting channels, 4. Psycho-social support. From a national perspective, the quality of education was seen as a priority concern, with suggestions for research studies to investigate issues of educational and operational efficiency.

The discussions among Zambian programme implementers brought up a particularly rich array of potential good practices and practical recommendations. Some examples are: the inclusion of men in mother-support-groups to promote messages against child abuse; the success of community schools in providing education in otherwise neglected areas; and Interactive Radio Instruction (IRI) to reach children in rural areas who lack access to schools.

Mozambique  Due to exceptional circumstances in Mozambique at the time of the scoping study (a nationwide strike, as explained in section 8.2) the participation of NCU members and researchers was very limited. Consequently, the scoping study results regarding research priorities at a national level lack inferential value - it would be problematic to draw definite conclusions or recommendations from them.
Similar to other participating Member States, Mozambique reflects a lack of clarity on the concept of psycho-social support. Research on child protection issues was suggested, including the criteria for OVC identification and the underlying causes for child abuse.

Importantly, a need for a validation process for potential good practices became clear, in order to avoid one-sided and subjective evaluations of any practice or programme. A concrete example was the contradictory evaluations of the children’s parliament during the group discussion: while some stakeholders considered the parliament a successful practice, implementers at a provincial level voiced the impression that the parliament did not achieve a great impact. This further highlights the need for effective communication and an exchange of experiences among stakeholders working at different levels of research, programme planning and implementation.

DRC  A well-organized and well-attended NCU meeting contributed towards the successful execution of the scoping study in the DRC. However, in the context of a nation in a humanitarian crisis with violence still ravaging large parts of the country, there are many barriers to education. Faced with a multitude of challenges to the education system, the interviewees found it difficult to prioritize one research area clearly over another. A clear distinction was made between urgent programme needs andresearchneeds, as those two categories do not necessarily coincide. Research needs that were named with most frequency and given great importance by the scoping study participants included: 1. Sexual violence and gender inequality as a barrier to education, 2. PSS needs of traumatized children, 3. Documentation of innovative and efficient ways of meeting the multiple needs of OVC.

A potential good practice in the DRC is the Remedial Education Centres which allow OVC who have missed several years of schooling (such as former child soldiers, displaced children and children working in mines) to be reintegrated into the formal education system. Lessons learnt from the DRC include a lack of learner support resulting in drop-out, and the need for consultation between funding partners and local implementers, among others.

Conclusion and recommendations

Lack of overall collaboration and knowledge sharing between different stakeholders was mentioned as a cross-cutting area of concern in the four Member States. The scoping study brought to light that this deficit extends to the field of research. Limited dissemination and utilization of existing research studies became evident as some interviewees identified ‘research gaps’ in areas which other interviewees considered to be well-researched. This may be attributed to the lack of overarching national research bodies in all four countries. To maximize the utility of existing data and knowledge, a wider dissemination of research studies and stronger collaboration between different stakeholders is recommended, for example through the establishment of national research coordination bodies or central clearing houses, the development of knowledge management systems and the organization of research symposia.

The documentation of good practices and lessons learnt has the potential to be extremely useful to fellow CSTL Member States, if these practices and lessons are successfully shared with programme implementers and development practitioners in the region. To guarantee the accuracy of the information shared, the CSTL regional knowledge management strategy proposes discussing and validating potential good practices within the NCU before they are shared at a regional level with fellow CSTL Member States