Written by Wossen Aman, Tesfaye Deksisa and Wendwesen Endale from the Mekdim Ethiopia National Association (MENA)
Tarikwa Tibebe, a 17-year-old girl living in Addis Ababa, Ethiopia, was diagnosed with HIV four years after she lost her mother to the same disease. After her mother's death, Tarikwa’s only living relative, her grandmother, began to care for her but did not make enough money to cover their daily living expenses or transportation fees to get Tarikwa to school. The psychological toll of her mother’s death and limited access to other support caused Tarikwa to lose hope and give up on her education.
Emebet, a social service worker from the USAID-funded Family-Focused HIV Prevention, Care, and Treatment Services Activity and the Common Vision Development Association (CVDA), a local implementing partner under the Mekdim Ethiopia National Association, met Tarikwa while providing care and support to other HIV-affected children in the community. After speaking with Tarikwa to better understand her situation, Emebet came up with some viable ways Tarikwa could improve her life. Through Emebet’s help, Tarikwa got a part-time job as a waiter at a local café, allowing her to earn enough money to pay for sanitary supplies, food and other necessities. Emebet also supported Tarikwa in her health, ensuring that she took her medication regularily and worked with her local health facility to optain a letter to allow her to return to school. Emebet then found a volunteer to pay for Tarikwa's transportation and other school-related costs, ultimately allowing Tarikwa to return to school.
Emebet has continued to support Tarikwa in her health and schooling and has seen tremendous improvements in her psychological wellbeing as well as in her grades. Tarikwa has started to shine, always getting remarkable grades and impressing her teachers. She desires to be a clothes designer.
“I am very happy now…thanks to the social service worker and health facility staff,” Tarikwa says. “[Emebet] is a warm-hearted, dedicated hope for me to see the unseen corner of life where I envision myself as the best fashion designer. I need to thank her and others who are helping me through continued blessings and support.”
Written by Dr Poppy Masinga, President of the Association of South African Social Work Education Institutions (ASASWEI)
South Africa continues to experience unprecedented weather patterns that place members of society at more risk than they already are due to unabating historical inequalities and injustices linked with colonisation and apartheid. Moreover, the global community is also grappling with complex socio-economic, political, religious, and environmental challenges, which directly and indirectly impact South Africa negatively. Hence, the role of the social work profession cannot be overstated. When faced with complex national, regional, and global challenges, social service professionals serve as beacons of hope. With their vast research expertise, social work practice knowledge and skills, they inspire transformation, resilience, empowerment, and hope. Notably, the role of social service professionals in advocating for the rights of the most vulnerable members of society cannot be underestimated.
The current economic decline, including the aftermath of the KwaZulu-Natal 2022 disasters and political insurgency, persistent inequality, injustice, unemployment, poverty, violent crime, and other devastating disasters presents significant challenges to social work and other social service practitioners. Social service professionals face immense pressure, not only related to dealing with the above-mentioned adversities and traumas, but they also have to endure working under challenging conditions and resource constraints. Thus, creating a sustainable future and fostering social, economic, and environmental justice requires collaboration, networking, and partnership across various sectors. These sectors include Government Departments, Non-Governmental and Community Based Organizations, research and academic institutions, civil society, and business sectors.
Moreover, the role of the Association of South African Social Work Education Institutions (ASASWEI) is crucial in ensuring the country can withstand some of the adversities with a supply of the needed human resources who have relevant skills and competencies. To effectively intervene and address the complex intersecting socio-economic and environmental challenges, social work practitioners need to be well equipped with relevant knowledge, skills and practice techniques to become competent to intervene effectively with these myriads of complex intersecting national, regional and global socio-economic, environmental, political, cultural scourges that continue to place many individuals, families and communities at risk.
They need to graduate with the degree in social work feeling empowered to face the harsh realities of modern-day society. Hence, as ASASWEI, we endeavour to strengthen social work education, research, and practice, by ensuring that social work academics and practice placement supervisors are well equipped to train students and empower them with the knowledge, skills, and techniques to not only serve individuals, families, groups, and communities; but to also challenge unjust and ineffective policies. Moreover, social work training and practice need to emphasize empowering individuals, families, groups, and communities to be self-reliant and self-sustainable.
One way of enhancing social work training and education, research, and practice, is through knowledge production and sharing and networking platforms such as conferences, symposia, and webinars. ASASWEI is proud to be hosting the Bi-annual ASASWEI International Social Work Conference. The conference's theme, "Advancing Social Work Praxis through Strengthened Multi-Sectoral Responses to Adversity, Vulnerability, and Trauma," is a timely and relevant topic. The 2023 ASASWEI International Social Work Conference aims to provide a platform for networking and building meaningful partnerships for change. This hybrid conference will offer engagement opportunities and shared learning to enhance knowledge and skills related to multi-sectoral responses needed to address the root causes of adversity, vulnerability, and trauma linked to immense socio-economic hardships, environmental disasters, and political instabilities. Our goal is to protect human lives and promote justice and sustainable change.
Mark the Conference dates 27-29 September on your calendar and secure your spot by registering on the ASASWEI. We promise to inspire, enlighten, and transform the field of social work and other related social sciences.
Dr Poppy Masinga is the current President of Association of South African Social Work Education Institutions (ASASWEI) and is the Head of the Social Work and Community Development faculty at the South African College of Applied Psychology (SACAP).
From 30th June to 7th July, Alliance director, Hugh Salmon, was privileged to be able to join other national and international colleagues in London in supporting a side event, titled "Care Reform: a Ukraine Reconstruction Priority", with a senior delegation from the government of Ukraine, led by the Minister of Social Policy, Oksana Zholnovych. The focus of the event—hosted by the UK Foreign, Commonwealth and Development Office (FCDO)—was on good practice and innovative approaches to care system reform, and the development of community-based services to support children and families, including children and adults with disabilities and their families, so as to prevent the need for residential care. The conference was followed by a Ukrainian government study visit to London, hosted by FCDO, to meet central and local government colleagues, and to see a range of services for children and families. Other organisations involved in supporting the side event and study visit included UNICEF, Maestral International, Hope and Homes for Children and Lumos. The programme of visits and meetings included meetings with ministerial counterparts, the body responsible for inspecting social services (OFSTED), leading children’s NGOs and two London local authorities. A particular highlight was the session on the role of the social service workforce, hosted by the NGO Coram, which included presentations from the two Chief Social Workers for England. Valuable insights were also shared by young people with lived experience on the UK care system.
The side event and study visit were organised to immediately follow the Ukraine Recovery Conference (URC), co-hosted by the UK Government and the Government of Ukraine, a high-level event dedicated to supporting Ukraine's recovery, which took place from 21– 22 June, also in London. Ahead of the conference, the Alliance worked with a coalition of NGOs and private sector organisations to develop joint recommendations on the reform of Ukraine’s child protection and care system, which included:
- Asking the Government of Ukraine to develop a national care reform strategy that prioritizes the prevention of family separation through direct financial assistance to families, reform of the family court system in line with international child rights frameworks, the development of support services to help children live well in families, and a strong social service workforce to deliver these services.
- Asking Ukraine's international partners to prioritise funding to support families to care for their own children, to develop inclusive, family and community-based care services, and to strengthen the social service workforce required to deliver these services.
Photo: European Commission Vice-President for Democracy and Demography Dubravka Šuica's gives speech at Ukraine Recovery Conference Side Event
Submitted by: Michael Byamukama Ntanda and John Mary Ssekate, National Association of Social Workers of Uganda (NASWU).
Over the last two decades, demand for higher education in East Africa has resulted in an exponential increase in the number of public and private universities. Currently, 140 universities are part of the Inter-University Council for East Africa (IUCEA) – an East African Community (EAC) institution focused on ensuring coordination and collaboration of academic activities within all accredited universities in the region. The majority of such universities offer social work courses.
In 2006, IUCEA initiated a process aimed at harmonising regional quality assurance by establishing a common East African Quality Assurance Framework and a regional quality assurance office at the IUCEA Secretariat, and by setting regional higher education benchmarks and quality standards based on internationally recognised frameworks.
On May 5, 2023, the IUCEA met with representatives from the seven partner states (Burundi, Kenya, Rwanda, South Sudan, United Republic of Tanzania, Uganda and Democratic Republic of Congo) to discuss standardizing social work education within the EAC. The benchmarks will:
- serve as minimum standards for social work education;
- be used as a point of reference for evaluating performance and level of quality; and
- provide a means for the academic community to better articulate the programmes in a specific subject or subject area. The benchmarks will also provide standards for the skills and knowledge students should be able to demonstrate upon graduation.
The benchmarking process will first involve a review of the social studies curriculum in the region in general, as well as the social work and social administration curriculum more specifically. The team will then discuss and agree upon a framework for the benchmarks, identify key stakeholders and define their roles, and establish a road map to design a Bachelor of Social Work and Social Administration programme for East African Higher Learning Institutions. The benchmarks will also consider existing member country social work standards and the Global Standards for Social Work Education and Training, as approved by the International Federation of Social Workers (IFSW) and the International Association of Schools of Social Work.
The benchmarking and standardization process will answer the following questions:
- What is the current status of Social Work and Social Administration programmes in East Africa?
- Which constitutes quality in the design and delivery of Social Work and Social Administration programmes within each partner State?
- How can the design and delivery of Social Work and Social Administration programme in East Africa be harmonized so as to ascertain the quality, comparability and mobility of the university students across the region?
- How can university lecturers be empowered to cope with the challenges in delivery of Social Work and Social Administration programmes in East African universities?
- How can the key stakeholders in Social Work and Social Administration higher learning programmes be involved in improving quality of social service delivery in East African?
- What will be the areas of focus/specialization and the courses in the Social Work and Social Administration programme?
The process will lead to a common understanding on the framework and the roadmap for the development of the benchmarks for the Bachelor for Social Work and Social Administration and the implementation plan according to Proffesor Michael Mawa and Proffesor Ndabarushimana the Head of Quality Assurance and Qualifications Framework Unit at the IUCEA and Senior Quality Assurance and Standards officer respectively.On his side, Mr. Michael Byamukama Ntanda, the president of the National Association of Social Workers of Uganda-(NASWU) shared with stakeholders the need to engage and make wider consultations with other key stakeholders at regional and international level like the Global Social Service Workforce Alliance, and the IFSW for quality and sustainable standards.
Stay tuned for more information as this process continues.
Submitted by: Michael Byamukama Ntanda and John Mary Ssekate, National Association of Social Workers of Uganda (NASWU)
From May 8th to May 15th, a team of 26 Israeli social work professionals took part in a weeklong learning exchange with Ugandan social workers in order to share best practices and listen to inspiring and promising field stories in different domains of social work practice and along the continuum of social protection and care. The visit was led by Inbal Harmoni, President of the Israel Union of Social Workers; Reut Cohen, Union Director for the Jerusalem District; Dr. Ella, the Head of Quality Supervision at the Israel Ministry of Welfare; and Tami Morez, a senior Israel-East Africa Social Worker.
The learning exchange symbolizes a long-term working relationship and friendship between Israel and Uganda and encompasses themes emphasized in the 2020 to 2030 Global Agenda for Social Work and Social Development framework, namely: valuing social work as an essential service; transforming social protection systems; Ubuntu: strengthening social solidarity and global connectedness; promoting diversity and the power of joint social action; and co-building an inclusive social transformation.
While in Uganda, the Israeli social workers interfaced with frontline social workers employed at the Butabika National Mental Health Referral Hospital, social worker students participating in social work education and research at Makerere University, policy makers at the parliament of Uganda, and social workers involved in mental health programing with the Regional Psychosocial Support Initiative (REPSSI).
The social workers also visited REHORE, an urban refugee agency; Africa Renewal Ministries, a faith-based organization, and home to both Loving Hearts and Bethany children transitional homes, focused on taking care of abandoned minors and other at-risk children; Project-Ten; Days for Girls Uganda; and the National Association of Social Workers of Uganda.
Throughout the visit, social workers in Uganda and their counterparts from Israel shared their unique interventions, experiences, guidelines, policies and social work frameworks along different practice domains. Social workers from both countries compared similarities and differences with a view to strengthening and re-enforcing individual social workers, social work agencies and sister professional bodies.
“I love Uganda - the climate, her welcoming people with Ubuntu values, green environment, organic food and fruits and unique animals and birds,” said Tami Morez, one of the Israel social work trip coordinators.
This Israel-Uganda social work learning experience presents a unique opportunity for the social work community to continue working and thinking about strengthening international professional networks, sharing social work models, innovative tools, frameworks and field experiences in different practice domains of social work practice for a well-planned, trained and supported social workforce. The Israel-Uganda social work engagement also opened new discussions around joint research and publications, sharing innovations, and networking in respect to 2020 to 2030 Global Agenda for Social Work and Social Development framework.
by Tomoo Okubo, Social Protection Specialist, UNICEF and Aniruddha Kulkarni, Global Technical Lead, Child Protection Systems, UNICEF (originally developed as a discussion paper by UNICEF and Global Social Service Workforce Alliance based on research by Julie Drolet, Professor of Social Work, University of Calgary)
- Children and families, particularly the most vulnerable, including girls, children with disabilities, children on the move, and children without parental care, face multiple risks and deprivations across the life course. Social protection responses such as social transfers and social insurance programmes, as well as social care and support services for those with additional or complex needs, are key to addressing poverty and vulnerabilities.
- The social service workforce plays an important role within social protection systems by connecting children, individuals, and families with a range of social services across sectors.
- Despite the increasing challenge of poverty and vulnerability exacerbated by the COVID-19 pandemic, conflict and climate change, as well as the increasing recognition of the role of social service workers, investments in strengthening the workforce remain low across most countries.
- Building on country experiences and lessons learnt over the past years, this blog aims to clarify the role of the social service workforce in the social protection system. It also outlines key considerations for strengthening the social service workforce in their integral role in delivering effective and efficient social protection programmes and services.
Important commitments have been made under the 2030 agenda for Sustainable Development, ranging from ending poverty, reducing inequality, promoting health, developing education and skills, as well strengthening access to justice and ending violence. Central to this transformative agenda is the guiding principle of making sure that no one is left behind. This can only be achieved by combatting the structural causes which cause individuals, families and communities to face a range of risks and threats, and which leave many marginalized and socially excluded.
While major progress has been made towards some of the goals in the 2030 agenda, multiple risks, including the COVID-19 pandemic, armed conflict in many countries, and the widening effects of climate change, are now threatening the progress made over many decades. The people and groups ‘left behind’ by social and economic development are disproportionally affected by these risks, leading them to experience higher levels of multidimensional poverty and social vulnerability. The need for connecting those in greatest need to timely, adequate and comprehensive social protection, including social transfers and targeted and integrated social services and support, is an urgent priority in achieving the SDGs and ensuring no one is left behind.
Social protection has become a key pillar of response to poverty and vulnerabilities facing children, individuals and families across the globe. Social protection is defined as ‘a set of policies and programmes aimed at preventing and protecting all people against poverty, vulnerability and social exclusion, throughout their life cycle placing a particular emphasis on vulnerable groups.’ Under this broad definition, the specific programmes offered are defined under each country’s strategies, policies or frameworks, and they commonly include:
- Social transfers (such as cash transfers, tax credits, in-kind transfers)
- Social insurance (such as health insurance, unemployment insurance)
- Labour and jobs programmes (such as family friendly policies and livelihood programmes)
This note focuses on the integral role of the social service workforce in social protection systems, and in particular, in ensuring access to social protection programmes such as those outlined above, combined with services of support, care or protection for people with additional needs.
The social service workforce has a unique and critical role in addressing poverty, vulnerability, gender inequality and social exclusion at a systemic level. Social service workers do so by developing a comprehensive understanding of the needs of children and families, carrying out assessments, developing case plans and connecting them with necessary support and services across sectors. However, for the social service workforce to effectively perform these functions, they require adequate investment and support. To help inform the investment required, the following sections explore who comprises the social service workforce, their key functions – especially in social protection programmes and services, and the important considerations in strengthening the workforce.
2. Understanding the workforce: who are they and what roles do they play?
The social service workforce is defined by the Global Social Service Workforce Alliance as including both paid and unpaid, governmental and non-governmental, professionals and para-professionals, working to ensure the healthy development and well-being of children and families. Concretely, the workforce is composed of people with a range of job titles, including (but not limited to) social workers, social educators, social pedagogues, child-care workers, youth workers, child and youth care workers, community development workers, community liaison officers, community workers, welfare officers, social or cultural animators and case managers.
While social work as a profession has developed over a long period of time, and in many countries is the dominant profession in the social service workforce, this brief takes into account the wider workforce, as other categories of professionals and para professionals have evolved over time and also make invaluable contributions to care, protection and support for people in need, and to achieving social justice.
A dedicated and qualified social service workforce is essential to coordinate efforts and resources and to provide a system of support for children and families that coordinates inputs across all sectors. While the most commonly understood role of social service workers may be related to their role in delivery of response services – in directly reaching the families and children in need, it is important to recognize the role of social service workers as extending beyond response, and covering a wide range of promotive, preventive and rehabilitative functions, provided at macro, mezzo and micro levels, across all sectors.The three main categories of services can be understood as follows:
At the micro level, the social service workforce respond to identified needs by:
- Offering the first point of contact for children, families and other individuals in need of support, care or protection;
- Assessing and determining the needs and best interests of children and families, and others in need, across the life course;
- Assisting people in need with accessing social protection programmes, and coordinating those programmes with other social services, including social care, child protection, protection from gender-based violence, mental health services and psychosocial support;
- Connecting people with, and ensuring their access to, other sources of help, including relevant health, education, protection, legal and livelihood services.
While responding to address immediate needs and risks is critical, intervening early to prevent or mitigate those needs or risk factors and vulnerabilities, has more potential for achieving long-term benefits, and is therefore also the most cost-effective approach. Prevention work by the social service workforce is undertaken at both mezzo (for a whole community) and micro levels (for individuals and families). Preventive services include:
- Community outreach to identify families and children with additional needs and vulnerabilities (including living in poverty or at risk of poverty).
- Providing them with access to relevant social protection schemes, including social transfers, social insurances, employment support, and social services to prevent them from falling into poverty and destitution, to reduce vulnerability, to build resilience and life skills (e.g., parenting) and to address additional needs (e.g., for children with disabilities and their families, young people leaving alternative care etc.).
- Through community outreach and awareness raising, identifying and addressing social norms and harmful behaviours that would otherwise contribute to social problems.
Social service workers who work at the macro level oversee the functioning of overall systems of social protection and social services, including planning, delivery, monitoring and evaluation. Specifically, they work to secure and manage budget allocations; advocate for and develop policies and programmes; oversee human resources and social service institutions, manage reviews and evaluations of the system; and steer strategic shifts in the way the system is managed. Social service workers can also undertake a range of promotive functions at the mezzo level, such as mobilizing entire communities to protect children and facilitating dialogue with community leaders. As poverty and vulnerability are often rooted in structural inequities and discrimination, the social service workforce can also play a transformative role in changing the power imbalances that create and sustain poverty in all its dimensions, vulnerability, discrimination and social exclusion.
Finally, in understanding the wide range of functions that the social service workforce can perform, it is important to acknowledge that these functions should be offered through a coordinated network of interventions and support. For example, a community worker or volunteer may identify families at risk of poverty and link the families with a local officer who administers cash transfer programmes. Likewise, a social worker can identify children and individuals who may already be included in social protection programmes but are also at risk of violence, and refer them to protection services. Building such an integrated network of services allows families to access a range of types of support, and ensures quality services are available when and where they are most needed. Within such a network, it is important that the social service workforce across sectors have a clear understanding of their individual functions, that other professions recognize and respect their roles, and that effective coordination and case management mechanisms, that reach across sectors, are available to ensure seamless referral, support and follow-up.
3. Ways forward – key considerations in strengthening the SSW in the social protection systems
While the importance of social services workforce is clear in building comprehensive social protection systems, too often the investment and support to strengthen the social service workforce are limited. While acknowledging that challenges vary significantly across different contexts, we focus on three key considerations for policymakers in strengthening the social service workforce within the social protection systems.
Is there a clear vision of individual functions, coordination, referrals, as well as a clear set of coordination and referral systems across sectors?
It needs to be clear who does what and when, in a given case. This requires ministries and implementing agencies to come together to develop and improve joint standard operating procedures, that cover assessment, decision making, referral, follow-up and review. Strong referral and coordination systems also require professionals, para professionals and community volunteers across sectors - not only in the SSW but also in allied sectors such as health, education and justice - to be regularly trained together. This helps building cross-sectoral working relationships based on trust and mutual recognition.
Are governments investing enough in the social service workforce for them to be able to fulfill these functions?
Despite the urgent needs, the number of social service workers is often limited, and inadequate for them to perform all their essential functions, at different levels. This leads to families and individuals not having access to the right level and type of quality services of social care support and protection, when most needed. It also leads to overload among the social service workforce. Building a social service workforce takes high-level commitment and resource allocation, particularly at national levels.
Human resource needs should be met to enable the workforce to effectively administer and implement integrated support, including for integrated/cash plus programs. Sufficient human resources will also ensure that social service workers and social protection administrators are not overwhelmed with excessively high caseloads, which could in turn lead to prolonged stress, burnout, high turnover and reduced service quality.
Is the arrangement of functions and services designed to be accessible and coordinated from the perspective of families, children and individuals?
A common experience of people seeking help to address complex social needs is that, even if they can access one type of help, e.g. a cash transfer for parents of a young child or child with disability, they struggle to access help to address other needs or risks, e.g. poor or insecure housing, a suitable school for a child with special needs. Excessive time and effort spent seeking different forms of help can have a range of adverse effects, from loss of confidence and motivation, to heightened risk. Even when help is accessed, it is often not coordinated or incompatible. Accessing one type of help, such as employment or housing, might result in the applicant losing their ability or entitlement to access equally important services such as suitable child care, schooling or protective services. Furthermore, inquiries into the reasons why services to protect children or women from violence often fail have found one of the most common reasons to be lack of information sharing, risk assessment and referral systems that cross agency and district boundaries. Investment, planning and capacity building is therefore needed to develop and sustain a workforce that can apply a ‘no wrong door’ approach to ensure all key types of help are accessed by those in need, and a coordinated, inter-agency approach to protect those at risk. To provide such services requires a needs-led, rights-based, and person-centred approach, which focuses on ensuring that support, care and protection is responsive and tailored to individuals and families’ needs. This should be the approach taken by social service workers, including those involved in administering and providing social assistance including cash transfers and other programmes, characterised by a determination to stay with the individual or family till their problem is fully resolved, while helping build their coping strategies and resilience in the long-term.
 UNICEF (2019) Guidelines to Strengthen the Social Service Workforce for Child Protection
 Although there is no single recommended ratio of number of social service workers to a given population, and one would be hard to define as local contexts and definitions of the workforce vary widely, GSSWA reviews (2017-2019) covering close to 50 low and middle income countries reveal mostly very low ratios, ranging from 0.3 per 100,000 children in West Bengal, India, to 781.2 per 100,000 children in the Maldives, but averaging about 50 per 100,000 child population. By contrast, WHO recommends a minimum ratio of 445 doctors, nurses and midwives per 100,000 total population. However, the definition of SSW used in many of these national estimates does not include the full range of community volunteers and para professionals often involved at the most local level.
 The Victoria Climbie Inquiry: report of an inquiry by Lord Laming (2003) and Every Child Matters (2003) HM Treasury, UK. https://www.gov.uk/government/publications/every-child-matters
 No Wrong Door: A Holistic Approach to Human Services (undated). Developed and written by the Governing Institute (USA) custom media division, with information and input from RSM.
BASW and CWIP. (2019). Anti-poverty Practice Guide for Social Work. Birmingham. British Association of Social Workers. https://www.basw.co.uk/system/files/resources/Anti%20Poverty%20Guide%20A...
Global Social Service Workforce Alliance (GSSWA) Resources, including regional mapping reports: https://www.socialserviceworkforce.org/alliance-developed-resources
GSSWA (2015). Para Professionals in the Social Service Workforce: Guiding Principles, Functions and Competencies. 2nd edition
GSSWA (2017). Global Advocacy Toolkit for the Social Service Workforce
GSSWA (2019). Guidance Note on Defining the Social Service Workforce.
Martorano and Sanfilippo (2012) Innovative Features In Conditional Cash Transfers: An Impact Evaluation Of Chile Solidario On Households And Children. UNICEF Innocenti Working Paper. https://www.unicef-irc.org/publications/pdf/iwp_2012_03.pdf
UNICEF ECA (2018) Strengthening the Social Work and Social Service workforce in Europe and Central Asia as an Investment in Our Children ’ s Future: A Call to Action. https://www.unicef.org/eca/media/6621/file/Call-to-action-Monitoring-Fra...
by Rebecca Smith, Head of Child Protection Programmes, Save the Children International
In honour of World Mental Health Day on the 10th of October, I attended a Global Ministerial Mental Health Summit in Rome where senior leaders from around the world were placing a spotlight on issues related to mental health. As we celebrate the Social Service Workforce this week, a workforce absolutely critical for supporting the mental health of individuals and communities, it is vital that we also address their own mental health and the systems and structure that help them succeed.
At Save the Children, our staff and partners provide services in some of the most sensitive and insecure locations you can imagine. On a daily basis they face devastating, highly stressful, and sometimes life-threatening situations which directly affect their own psychosocial wellbeing.
Suzan Akwii, our Child Protection Specialist in the Syria response, stated that staff working in camps in AlHol North East Syria, commonly report sleep disturbances, anxiety and panic, nightmares, and mood disturbances which if unattended could result in chronic mental health issues. This is not unique. According to a new report by the WHO at least a quarter of health and care workers surveyed reported anxiety, depression and symptoms of burnout.
Globally there is a need to reduce the stigma around mental health and to promote and scale up approaches to improve the care of the global social service workforce. As Rasha al Hosain, a mental health and psychosocial support youth advocate stated so eloquently, “It’s okay not to be okay. It’s okay to seek help. It’s okay to heal.”
Save the Children has been developing a global competency framework on what it means to be a child protection professional and a key component of this is how to support their own staff with the challenges they face. Supportive supervision is a vital component to helping workers to reflect on what is both inside and outside of their own control. Supervisors can help staff to think through complex cases and also reflect on how they are coping and when they may need time off or additional support.
According to Lo Leang, the Head of Child Protection in Save the Children Cambodia, “Just by talking about the challenges, it is a relief – because some of the challenges are structural. It can help the case workers make sense of the complexity and remember why they are doing what they do – instead of internalising the challenges.” In a video created by the Better Care Network, Lo reflected that despite the importance of supervision, it is often overlooked, particularly where social work is a new or emerging profession. This learning helped to inform and develop a structured social work supervision training programme in Cambodia and fed into the Global Social Service Workforce Alliance (2020) Guidance Manual on Strengthening Supervision for the Social Service Workforce.
Supporting the mental health of staff also means looking at the structural challenges they are facing, ensuring that there are adequate staff to client ratios and that we continue to advocate for legislative and policy changes that are needed.
Empowering the social service workforce with power and agency to help be advocates not only encourages much needed change, but also supports their own ability to take action and feel like they are making a difference.
Global spotlights, like World Mental Health Day and the Social Service Workforce week provide the opportunity to champion our unsung social service workforce and make sure the resources and capacity is there to support the mental health of those supporting children, families and communities.
 Qatar Foundation, World Innovation Summit for Health (WISH), in collaboration with the World Health Organisation (WHO). 2022. Our duty of care: A global call to action to protect the mental health of health and care workers.
By Rory Truell, IFSW Secretary-General
Elina showed me how they seal the plastic bags. Just before placing the open ends in the heat machine, she places a small piece of paper inside, with a few words written on it. “The Ukrainian people are strong” she translates.
Elina is one of many women who founded and work in the local kitchen at the Community Social Work Centre. It is one of the first projects supported by a partnership between the Kamenets Podisk District Council, local communities and the International Federation of Social Workers. Together the partners have developed an approach which transforms the idea of ‘humanitarian aid’, (which too often strips peoples of their capabilities) into resourceful and confident communities with a hope for a strong future.
Elina explains to me that the contents of the bag are mixed grains and herbs to form dehydrated barley soup. Three hundred grams make five liters of thick nutritious food. The next bag has a more reddish substance and I ask if it is Borshch. “You know Borshch?” she asks with some surprise.
The dehydrated packets are easily distributed to displaced people, those at the front lines and anyone who has lost their normal food supply as a consequence of the war. Everything in the package has been shrunk through hydration and all the necessary herbs and spices added. All that is required is for clean water to be added and bought to a boil for about 40 minutes. The women in this Community Kitchen produce about 1,200 meals a day, making a significant contribution to food security in their distribution network. It is one of many projects that brings the community together, recognizing their strengths, creating opportunities for mutual support and ensuring people have an active role in their own futures.
Another example of such projects is focused on making bed frames and furniture, as more people are arriving in the district with nothing but the clothes on their backs. With the coming months of winter and dampness, the challenge for finding beds, cupboards and wardrobes has become urgent. Under such pressing conditions, finding the material and machinery to manufacture mattresses has not been possible. Thanks to the Romanian Social Work Association, these are being donated and bought in by trucks from across the border. The frames and side cupboards will be produced locally in an initiative supported by the Kamenets Podisk / IFSW partnership.
With each of these examples, the approach is to support the local communities to, where possible, develop their own enterprises, as the economy has ground to a halt. This comes at a time when people have not been paid since the start of the invasion and industries crashed when men were drafted into the army. This approach is built from social work experiences from other countries experiencing war or natural disasters as well as from successful examples of transforming poverty into thriving communities and societies. It is an approach that prioritizes local-led development over relief-aid and transforms the concept of aid into support for self-sustaining social and economic development.
The partnership between the Kamenets Podisk District and IFSW has worked carefully to consider these dynamics. The partnership has supported, encouraged and facilitated community enterprises and, in the case of the above examples, supplied the dehydration machines and an industrial dough machine in the Community Kitchen. But these examples only represent the beginning aim of this approach and its overarching vision. Further down in this article we will explore other examples. Before that, however, it may be important for some readers to hear more about why the traditional aid model is not the preferred option.
The challenges of traditional aid approaches
Globally, social workers have witnessed unintended long-term consequences and prolonged devastation bought about from traditional aid approaches. International aid in many situations of war and extreme crisis is often blind and deaf to local strengths and does not have the necessary principles and processes to form partnerships with local communities. Consequently, when food or clothing is provided free, any chance of local communities maintaining or adapting their local economy is immediately broken. No one can cost-effectively produce products when the same products are being distributed by aid agencies for free. Therefore, manufacturing machinery lies dormant, workers are displaced without income, and an environment of dependency emerges. We know from situations of crisis that when people are dormant, waiting for their water, their meals or their small cash payments, they often report feeling powerless, worthless and frustrated. Such situations often prolong or exacerbate their emotional and psychological challenges. Yet when people are active in their own recovery or a part of rebuilding their community’s future, their trauma symptoms are significantly reduced.
“At the Community Social Work Centre, we use the social work model,” Yana Melnychuk the Centre’s coordinator explained to me. “We have many resources and ideas here in Kamenets Podisk District. Yes, we are under attack and war. Yes, many of our loved ones are at the battlefields and we are so scared for them every moment. But we are still strong people. We know what to do, we know our community and how everyone must be supported and involved for our survival now, and for our future. We welcome every donation, and we will make sure that each cent goes to supporting our sustainable survival via our interdependency, and not by the dependency aid model. By working together, we will not just survive we will thrive,” she said.
The partnership and other IFSW projects do not reject all aid, and financial aid is always welcomed, providing the people who need it can collectively (as much as possible) be involved with how it should be spent. Examples of the healthy use of outside financial support can be seen in money used to purchase mattresses and dehydration machines for this partnership (funded by donations from international social work associations). Examples can also be seen in the IFSW’s work supporting Ukrainian refugees as they move from the war zone through bordering countries.
Social workers who set up information points during the refugees’ journeys on many occasions called for external financial support and the donation of clothes, sleeping bags, and medicine, and for members of the public to host or drive refugees to their next point. As people were on the move, it was simply not possible to support the development of their local economy, nor did the refugees request this. They were more interested in which countries would give them and their children the best opportunities and where they could have somewhere safe to rest for a while and have something to eat.
Having learned from other refugees’ journeys, the social workers involved in the Ukraine situation focused on not having temporary camps or tent cities. In those environments, people can get trapped for months or years in frustrating, almost institutionalized conditions: ‘Breakfast is at 7:00, lunch is at 12:00. Never leave the camp without permission. A doctor comes on Wednesdays and an immigration expert on Fridays’, and so on. Instead, the social workers have worked alongside communities in receiving countries to open their homes to refugees and for the public schools to integrate refugee children. They have utilized donated funds to support refugees in converting buildings into medium-term accommodations with community kitchens and support systems. They have sought funding for the development of small businesses that utilize the refugees’ skills or negotiated with employers in other parts of Europe that had shortages of workers and sought funding to support the refugees’ transportation to these areas.
The success of this work, like that in the Kamenets Podisk district, requires the social workers to have their eyes and ears open to what the refugees want and recognize refugee capabilities and strengths in leading their own development. The approach does not reject donations, which are still needed, but it does reject the aid mentality, which is the dominant approach to social development in crisis situations, as it cannot translate the circumstances of crisis to situations of opportunity.
The Approach of the Kamenets Podisk / IFSW partnership
Kamenets Podisk / IFSW partnership has listened to people that have worked through change and are consequently using an ‘inside out’ model of development. The decisions are made on the inside by the people struggling but are informed by experiences in other places. This has shown the wisdom to think long-term, to create a local vision that sets a new course of life, beyond this war, a vision for a life even better than before this crisis.
Therefore, in addition to finding ways to accommodate and feed the 50,000 plus displaced people newly arrived in the district, a social diagnosis and skills audit is being undertaken to evaluate the resources sitting in the community. Teachers, manufacturers, trades people, community organizers, carers, scientists and others are being identified and supported to apply their skills in restarting or creating new enterprises for everyone’s good.
Simultaneously the Community Social Work Centre provides a drop-in service where everyone will be greeted and given an opportunity to sit, talk and participate. Programmes are offered including childcare and schooling for children to enable parents, mostly women, to enter the workforce or join community projects. Respite care progammes have also been developed, giving overburdened moms or dads time when needed. Support groups have been created so that no one feels isolated and newly arrived displaced people are welcomed. There are no barriers to participation and community members are also encouraged to play a role in the organization and delivery of the programmes. To assist with the challenges of traumatized soldiers coming home while on a few days leave, groups have been established to provide information and care. They also provide social education so that all in the district can understand the symptoms of war-related trauma and can act upon them.
And the Centre does not stop there…
In a relatively cashless society (due to the economy breaking down), the Community Social Work Centre staff and volunteers are transforming an old warehouse into a community social exchange supermarket. When possible, this supermarket will buy and provide local products, only importing essential items that cannot be made locally. Each item will have a price which can be purchased in cash or in exchange for points that people have acquired while working within the community. People like Elina in the Community Kitchen, Kayta who teaches math to children, or Aliona who photographs families to send to their loved ones at the frontline.
Conversations for the community to provide its own social exchange supermarket in the longer-term are already taking place, as there have been discussion around the need for a permanent food and accommodation social security strategy for refugees who return after the war.
‘What will happen when a bus load of institutionalized children return after the invasion ends,’ one person asks. This question refers to pre-war social service systems that were based on former Soviet systems. Under such systems many children with disabilities were placed in large institutions away for their families and communities. ‘We will need to rebuild our communities to include them,’ came a reply.
These conversations bounce through the Community Social Work Centre, across the tables and cups of coffee, the stacked boxes of winter jackets waiting to be distributed, the emergency food kits, the teaching whiteboards and the children’s toys. Conversations focused on making food today but thinking ahead to after the war. They each speak of hope, mutual support and recognition of each person’s role in fulfilling that vision.
A Learning Experience
The Kamenets Podisk / IFSW partnership is not approaching their response with any strict criteria. It is a practical approach, adapted from learning of other people in crisis situations. The key to the success of this approach and others, in different cultures and with different challenges, has been one very clear factor: locally led development.
Social workers have been critical to the outcomes: using their skills to bring people together in recognizing their combined strengths and finding outside support and funding focused on people and sustainability, not just immediate relief. Finding international solidarity and support is an essential pillar to making these projects move forward. IFSW, therefore, invites international funding agencies and all policy makers concerned with the journey from crisis to prosperity, to come, observe and participate in this transformational approach to international development.
I asked Elina, working in the Community Kitchen, if she would mind officials coming to see what they are achieving in the Kamenets Podisk District. She replied, “This work, this place, these people, give me hope [and] I want everyone to have hope. I want them to come from every country to learn how to make this food, to see how we do it. I want them to learn that their people are strong, like ours are. When we respect each other at home and in other countries, maybe then we will stop having wars.”
Acknowledgements: I would like to thank and acknowledge the leadership team involved with all of these developments. From the Ukraine Kamenets Podisk District, Mykhailo Simashkevych, District Mayor, and Yana Melnychuk, Coordinator of the Community Social Work Programme. From IFSW, Ana Radulescu (IFSW European Regional President) with the support of Herbert Paulischin and Alexandra Zoituc and the team from AsProAs (The Romanian Association of Social Workers).
The social service workforce can play a unique and powerful role in supporting individuals and communities in addressing social determinants of health. However, for health systems to gain the most from the unique skills and competencies of social service workers, care must be taken in determining how these workers are deployed. The Global Social Service Workforce Alliance’s recent technical report, Social Service Workers in Health Facilities: Their Role in Addressing Social and Other Determinants of Health Among Children and Families, finds the most common models for deployment to include the roving or liaison model, the permanent on-site support model and the interprofessional team model. In lower-resource settings or where integration of social services into health is developing, a roving or liaison model with substantial time spent doing home visits may be the most appropriate. It has also been applied with support from donors seeking to strengthen linkages between clinics and communities within an existing health system but without making significant changes to staffing or infrastructure.
People-centered care has long been practiced within the U.S. President’s Emergency Plan for AIDS Relief’s (PEPFAR) Orphans and Vulnerable Children (OVC) programming. With an emphasis on wraparound services and close collaboration with partners operating in health facilities, PEPFAR OVC implementing partners have shown promising results integrating health and social services, and the workforces providing them, particularly using the roving/community liaison model.
In Eswatini, the Insika Project, led by Pact, leveraged existing cadres of home visitors already engaged in comprehensive case management for OVC to disseminate information on the COVID-19 vaccination, then liaise with vaccine mobilizers to register and follow up with children and caregivers over the two-dose series. Administered either at home by a visiting nurse or at a community site, 74 per cent of project beneficiaries offered the vaccine have now been vaccinated compared to 60 per cent of non-project beneficiaries in the same geographic areas. The highest-performing areas are where vaccine mobilizers are paired with nurses in roving teams. This success is attributed to stronger relationships, regular engagement, and the resulting rapport and trust between project beneficiaries and the home visitor connecting them to the health facility, creating increased demand for vaccines.
In Zambia, the Empowered Children and Adolescent Program 1, led by the Center for Infectious Disease Research in Zambia, and the SAFE Project, led by John Snow, Inc., developed an intensified approach to community viral load sample collection. Community case workers identify young people who have missed or are having difficulties making their appointments as part of their routine case management home visits. The community case workers are paired with facility case workers who verify the patients’ viral load status and facilitate access to testing provided on the weekends in nearby sites. This schedule is often preferred by adolescents who are either in school or uncomfortable waiting in long lines at health facilities. Viral load coverage at Nchanga North Referral Hospital, in the catchment area where this intensified approach has been deployed, has improved from 72 per cent in January 2021 to 97 per cent in March 2022.
In Zimbabwe, the Catholic Relief Services-led Pathways Project, in conjunction with the Ministry of Health and Child Care, trained 86 points of contact from among para professional social service cadres, like lead childcare workers, and stationed them at health facilities.
“Traditionally, in health facilities and for clinical workers, there has not been much space for social worker contributions…Slowly and progressively, we see some appreciation and acknowledgement of their role…People are beginning to find each other and appreciate that nobody is coming to intrude in each other’s space but to complement each other,” observed Richard Savo, Deputy Chief of Party for the project.
With agreements in place between the clinical and OVC implementing partners, and using a case management approach, these points of contact help children and families affected by HIV navigate needed services. They track them at the household level and monitor their risk of dropping out of treatment through close coordination with village health workers and community and childcare workers engaged by local implementing partners in nine districts. During COVID-19 shutdowns, the points of contact ensured multi-month supplies of medications were dispensed to HIV-positive patients to support adherence to treatment while regular health services were disrupted. Overall, the project has achieved a success rate of 95 per cent of HIV positive people who previously stopped taking their medication return to care.
For more information on the different models for deployment of social service workers in health facilities, read the full technical report: Social Service Workers in Health Facilities: Their Role in Addressing Social and Other Determinants of Health Among Children and Families.
The Global Social Service Workforce Alliance’s recent technical report, Social Service Workers in Health Facilities: Their Role in Addressing Social and Other Determinants of Health Among Children and Families, finds that with a social service workforce working in and linked to health facilities, there is much more potential for health systems to not only address clinical needs effectively and efficiently, but to tackle the inequities present in health care provision itself. Integrating social service workers in health facilities also allows countries to work towards more just, people-centered health systems and universal health coverage, in line with Sustainable Development Goal 3.
Five cross-cutting advantages or benefits of having social service workers deployed in health facilities include:
- Enabling a holistic approach to health care: The involvement of the social service workforce in health facilities can expand the traditional medical model, which focuses on diagnosing and treating disease with medical interventions, with a recognition of and support for the social and other factors that enable more effective and lasting treatment. Incorporating this “social work” lens can result in fewer periods of ill health and increased access to advice and support to make changes in certain at-risk populations’ behaviour, social situation and environment, resulting in reduced hospital readmission rates, reduced length of patient stays in hospital, and reduced costs for health providers and/or patients.
- Addressing the social determinants of health: A significant proportion of the underlying factors contributing to poor health are social and behavioural, as much as physiological. In identifying, preventing and ameliorating these factors—including poverty, social exclusion, poor nutrition and housing, hazardous living conditions, abuse and violence—the social service workforce can play a key role in preventing or reducing illness and a range of health conditions. The preventive role can involve primary prevention (preventing initial onset of health conditions in the whole population) as well as secondary prevention (preventing or reducing ill health amongst the most at-risk populations or preventing its recurrence).
- Coordinating integrated care and support by working across sectors and disciplines: The social service workforce is trained and ideally placed to assess, plan, and coordinate complex packages of care and support. This care may involve input from medical practitioners and therapists, the support of community volunteers and civil society groups, and coordination with local social welfare departments, early childhood services and schools, labour services, housing departments and police.
- Early identification and coordinated intervention in cases of violence against children, women or elders: Deployment in health settings can enable social workers with statutory child protection roles, as well as those involved in the assessment and intervention in cases of intimate partner violence, sexual violence and elder abuse, an opportunity for early identification of risk factors and signs of abuse as presented in injuries, behaviour or concerns expressed by patients or their family member on admission to hospital or when arriving for emergency treatment. Once risks and concerns are identified, social workers in health settings are well placed to carry out multi-disciplinary assessment, and lead coordination with police and other statutory colleagues in child protection agencies, in the process of holding multidisciplinary case conferences, planning joint interventions and carrying out multi-agency reviews of such cases.
- Supporting patients across the life course: Since the role of social workers, supported by the wider social service workforce, is to help support people through all the major challenges and transitions they face in life, their deployment alongside health colleagues enables them to provide timely and tailored support to patients, to help them navigate these life challenges and transitions. Prominent examples include supporting older people to return home through organising the care and support they need following a fall or stroke and supporting the most vulnerable mothers and their infants—including adolescents, those without the support of a partner or family, or those experiencing intimate partner violence—through pregnancy, childbirth and early childhood.
Read more about the important role of social service workers in health facilities and how they can most effectively be deployed in the the full technical report: Social Service Workers in Health Facilities: Their Role in Addressing Social and Other Determinants of Health Among Children and Families.