Training and Motivating Volunteer Caregivers Enables HIV/AIDS Affected Children in Zambia to Access High Quality Care and Support

Authors: Wezi Kaira, James Mateyo, & Shelby Benson

“Before STEPS OVC came, as a member of the League of Mercy, my friends and I visited the sick in their homes where we helped them with household chores, bathed bed ridden patients and cooked in certain instances. Little did we know that we were in fact risking our lives and that of patients, especially in the transmission of HIV!”

*This was shared by a STEPS OVC caregiver who was exposed to HIV and possibly exposing others to HIV through serving households prior to receiving training and capacity building in managing and mitigating the impact of HIV in her community in Zambia.

Through a network of over 52,000 volunteer home visitors (called “caregivers”) and working through 621 local subgrantees (community- and faith-based organizations) and Rural Health Centers (RHCs), STEPS OVC (Sustainability through Economic Strengthening, Prevention and Support for vulnerable youths and Orphans and Vulnerable Children) has strengthened communities in rural Zambia to mitigate the impact of HIV on households living with HIV-positive individuals and orphans. In collaboration with the Ministry of Health, the USAID-funded STEPS OVC program (2010-2016) capitalized on the zeal from community volunteers and groups by building their capacity in providing evidence-based home based care, support and referrals for households affected by HIV/AIDS. This has improved not only the management of HIV in households but also the prevention of further spread of HIV in communities of Zambia.

Because the project is closing out, STEPS OVC has phased out operations in 58 districts and now only works directly with 15,479 caregivers in 15 districts. But the caregivers in phased-out districts and communities have continued to provide services to households in their communities affected by HIV, stigma has reduced, and HIV prevalence rates continue to drop owing to the great work provided by the community caregivers who are now supervised by the local RHC or the district medical centers. This is a clear demonstration that the thorough capacity built in community caregivers is in the community to stay, and HIV affected people will continue to receive services from the caregivers.

Community-based Approach & Trainings
The strength in the approach taken by STEPS OVC is that it is community-based. It involves local leadership and stakeholders in the identification and selection of caregivers. Caregiver training was done in the local language and in local setup in villages. In addition, household members caring for vulnerable populations were also often involved in these trainings so they could support the work of the volunteer home visitor/caregiver when they were not present.  

Caregivers who were unable to read and write were paired with those with advanced educational levels during training, visitation periods, and reporting. For specialized training like finger pricking for HIV and malaria testing, caregivers with advanced education (grade 12 or higher) were selected and trained. Most of them have now been employed by many rural health centers or other NGOs implementing health programs.

All the trained caregivers were given certificates of attendance in recognition for their skills attained from the specialized trainings. All caregivers were equipped with tools for work such as identity cards, HBC kits (with contents such as gloves, pain killers, oil, lotion, petroleum jelly, torches, etc.), protective clothing, bags to carry supplies, Chtenge wrappers (a printed/branded cotton cloth popularly worn by women in Zambia), and bicycles to aid their work. Many of these items were received as Gifts-In-Kind and also served to incentivize caregivers.

Home Visits
With a ratio of 1 caregiver to 5 households and a maximum number of 30 beneficiaries in total, caregivers provided services to HIV-affected households during their bi-weekly visits. Evidence-based interventions and services were provided to project beneficiaries during these visits, such as counseling and testing for HIV and malaria, psychosocial support to HIV infected children, economic strengthening support to adults and youth, HIV prevention interventions, parenting skills building, nutrition and education support, linkages and referrals for clinical needs, child and gender protection interventions, and others based on need.

Government Coordination
At project inception, STEPS OVC ensured identified caregivers were linked to permanent structures in their communities like churches, RHCs and the Department of Social Welfare, to ensure sustainability. As such, caregivers reported to Site Coordinators, and Site Coordinators reported to RHCs and/or to partner CBOs or FBOs. This reporting system and structure also supported sustainability to ensure continued provision of services. All the caregivers are fully linked and report to the government reporting system through their CBOs or FBOs participation in the District AIDS Task Force (DATF) for coordination.

STEPS OVC also supported the caregivers to create a forum to meet and discuss issues affecting them across projects and districts. This is the National Caregiver Alliance that has received support from government and other NGOs.

Motivation
The golden question is: what motivates these caregivers? As previously stated, the STEPS OVC project capitalized on the existing platform of volunteers striving to make a difference in their communities by vocation, or for some volunteers who had the passion to serve, but were unable to be professional medical practitioners for various reasons. STEPS OVC offered such individuals training in areas they knew were needed in their community and were passionate about and equipped them with not only the knowledge but also strengthened their linkages to CBOs, FBOs and Government community structures. It is a lasting and sustainable solution, indeed. 

About World Vision
This blog was contributed by World Vision staff from the STEPS OVC program. World Vision is a Christian humanitarian organization dedicated to working with children, families and their communities worldwide to reach their full potential by tackling the causes of poverty and injustice. World Vision’s Health programming includes a large and diverse portfolio of ongoing US government, private foundation and individual private donor funded projects located in over 100 countries across Africa, Latin America, Eastern Europe, the Middle East and South Asia addressing HIV/AIDS (prevention, OVC, HBC/palliative care, treatment adherence) and community health (maternal and child health, child survival, malaria, polio eradication, neglected tropical diseases, healthy timing and spacing of births, and local mobilization for primary health care delivery). 

World Vision Zambia has been registered and working in Zambia since 1981. World Vision Zambia provides support to approximately 400,000 children through grants and in child sponsorship within the 40 Area Development Programs. It impacts more than 2 million people countrywide in areas of health, education, livelihood security and HIV and AIDS support. For more information on World Vision’s Health programming or the STEPS OVC program, please contact Shelby Benson.