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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.

Caregiver outdoor meetingCommunity-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.

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.

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Thank You and Happy New Year to Our Members

Looking back on 2015, the Global Social Service Alliance is deeply grateful for people like you who make the world a better place. A strong social service workforce is needed now more than ever to help create protective environments for healthy development, tackle poverty, and promote social justice. Countless lives were made better through the efforts of the social service workforce.   
The past year has been one of great growth and accomplishment for this field in general and for the Global Social Service Workforce Alliance. Your support and that of nearly 800 other members in 73 countries has contributed to this success and we look forward to your engagement in 2016.
We invite you to take a look below as we reflect on the past year and look ahead to the many exciting events and opportunities awaiting your involvement in the coming year.

Achievements in 2015

The Alliance serves as a convener for an inclusive, representative network for discourse and collective learning. In 2015, the Alliance participated in a number of leading learning events worldwide, including:

Knowledge Development
The Alliance aims to advance knowledge by deriving, organizing and disseminating critical evidence-based research, resources, tools, models and best practices. The following are a few examples from this past year:

The network of members in the Alliance helps to advocate for workforce-supportive reforms, including through the following activities in 2015:

Building on Our Success in 2016

In 2016, the Alliance will continue its commitment to being a convener of people and ideas by organizing events and webinars, launching a new website that will allow members to more easily interact with one another, and helping to advance knowledge of effective ways to address workforce challenges by building a body of evidence to support workforce strengthening efforts. And we will continue to support and facilitate efforts to advocate for this important work.

More information on these upcoming events and programs and many more initiatives planned for 2016 will be shared in upcoming e-updates. We also invite you to visit our website, like us on our Facebook page and follow us on Twitter for the latest updates.

Together we can achieve a world where a well-planned, well-trained and well-developed workforce is fully able to provide needed services to care for and support those who need it most. We look forward to your continued input and involvement in the coming year.

The Global Social Service Workforce Alliance
Amy Bess, Nicole Brown & the Alliance Steering Committee

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World AIDS Day 2015: On the Fast-Track to End AIDS

World AIDS Day aims to raise awareness about AIDS and the global spread of the HIV virus. It is also dedicated to commemorating those who have passed on or been affected by AIDS.

Ending the AIDS Epidemic as part of the SDGsRemarkable progress has been made in the fight against AIDS. But now, as this year’s theme states, it is time to fast-track efforts to end AIDS. Bold action to address the new targets laid out in the Sustainable Development Goals can end the epidemic by 2030. Rapid scale up of programs will lead to 21 million AIDS-related deaths averted and 5.9 million infections among children averted by 2030.

Today, too many children are still affected by the disease. Those who are living with HIV/AIDS still don’t have enough access to the testing, treatment and care they need. Children living with or affected by HIV/AIDS face unique protection risks and stigma. At the same time, children facing other vulnerabilities have an especially high risk of acquiring HIV/AIDS as they move into adolescence and adulthood.

To realize the future of an AIDS-free Generation, it is imperative to put in place the protection, care and support services that are so critical to ensuring the healthy development and well-being of all children.

Globally, social service workers are at the forefront of providing critical support and services to children and families affected by HIV/AIDS. They provide case management services and referrals, psychosocial support, child protection services, economic strengthening and social protection services, family strengthening services and early childhood development services. By providing these services and acting as a critical link between community and clinic service provision, social service workers have been proven to positively impact levels of testing, adherence and retention. They also help communities combat stigma, lead advocacy campaigns and ensure that effective policies and legislation are in place.  

This year, World AIDS Day acts as a reminder to all of us to step up our efforts to raise awareness, ensure access to quality prevention, care, treatment and comprehensive support services to families affected by HIV and AIDS.

Get Involved!

  • Learn the facts
  • Spread awareness by wearing a red ribbon
  • Download World AIDS Day campaign materials
  • Put your knowledge into action and plan an event
  • Let us know how you’ll be celebrating on our Facebook page
  • Join the conversation on Twitter by using the hashtag #WAD2015
  • Read resources related to HIV/AIDS and the social service workforce
  • View a webinar featuring ways that the social service workforce is combatting AIDS in Ethiopia, Mozambique, and Zimbabwe
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Celebrating Rights of the Child: Social service workforce helps all children realize their rights

A group of childrenAuthored by Thomas Fenn, Senior Adviser, HIV/AIDS; Peter Gross, Child Protection Specialist (Alternative Care); and Jennifer Yablonski, Social Protection Specialist, at UNICEF.

Today we celebrate the 26th anniversary of the UN Convention on the Rights of the Child. This presents a timely occasion to consider the increasingly important role the social service workforce has in helping all children realize their rights. The social service workforce globally includes community volunteers, care workers in child care facilities, paraprofessional social workers and specialized social workers employed by governments.   

The Sustainable Development Goals (SDGs) adopted by world leaders gathered at the UN in New York in September 2015 present a major opportunity to strengthen child protection – and for this the social service workforce is a critical component. For the first time ever a number of clear child protection-related targets are part of the global development agenda. And, as will be discussed, a well-resourced and accessible social service workforce is well-placed to help meet the global goals and targets.

SDG 16 ‘Promote peaceful and inclusive societies for sustainable development’ includes target 16.2 ‘End abuse, exploitation, trafficking and all forms of violence against, and torture of, children’. SDG 8 ‘Promote inclusive and sustainable economic growth, employment and decent work for all’ includes target 8.7 which focuses on ending child labour, including child recruitment and use of child soldiers. In SDG 1 ‘Ending poverty in all its forms everywhere’, target 1.3 is particularly relevant to the social service workforce. This target aims to ‘implement nationally appropriate social protection systems and measures for all, including floors, and to achieve substantial coverage of the poor and the vulnerable by 2030.’

UNICEF works worldwide to protect and promote the rights of children and their families, providing critical support to national and sub-national programs and civil society efforts, including to reduce the vulnerability of children across multiple sectors. UNICEF’s #ENDviolence initiative, launched in 2013, connects well to the SDGs. It aims to end one of the most universal child protection experiences, and which can have a devastating impact on current and future lives, that of violence. For example, 85% of all children have experienced violent discipline. As part of UNICEF’s efforts to strengthen the evidence base on what works to prevent and respond to violence against children, the ‘Ending Violence Against Children: Six Strategies for Action’ was developed. The six strategies include 1) supporting parents, families and caregivers, 2) helping children and adolescents manage risks and challenges, 3) changing attitudes and social norms that encourage violence and discrimination, 4) promoting and providing support services for children, 5) implementing laws and policies that protect children, and 6) carrying out data collection and research.  As will be explored below, community volunteers, care workers in child care facilities, paraprofessional social workers and specialized social workers –all those who comprise the social service workforce - play an important role in implementing many of these strategies.

Child protection is not about violence alone. There are other areas for which the social service workforce is required. Children may be separated from their parents (placed in alternative care) for various reasons including becoming orphaned, or they may interact with the justice system. In 2014, UNICEF data showed that 58 countries have an Alternative Care Policy in line with the Guidelines for the Alternative Care of Children; in 61 countries UNICEF supported improved service provision in relation to justice for children, including psychological support, legal aid and assistance, and child-friendly institutional and community-based capacities.

For these and other child protection issues, the social service workforce plays a critical role in protecting children from violence, exploitation and abuse. For example, they support parents, families and caregivers by strengthening parenting skills, their ability to solve problems and their ability to cope. Social service providers also help children and their families access essential services such as education, health care, HIV-related services, protection services, legal assistance, and government benefits, which in many countries are also administered by social workers. Collaboration between the services is essential because integrated efforts help reduce childhood and family vulnerability.

Thus there are considerable demands on the social service workforce. These demands are compounded by the need for effective social services in both development and humanitarian settings, where providers may face huge pressures in very difficult circumstances. In addition, the proportion of children to social service workers can be challenging – in some countries there may be tens of thousands of children per government social worker. This is why community members and community groups can, and need to, play a crucial role in enabling vulnerable children and their families to access support services, at least until increased investments are made into the social service workforce. 

Developing a stronger social service workforce is a major component of strengthening child protection systems to enable society to prevent violence, exploitation and abuse, and to respond appropriately where these occur. Professionals working on the frontlines protecting the most vulnerable children who might otherwise fall through safety nets, and helping them and their families thrive in their communities, deserve our utmost recognition, appreciation and support. The work of the social service workforce helps to directly connect children’s enjoyment of their rights with the achievement of the Sustainable Development Goals.

Photo courtesy of UNICEF.

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A CYCW Gives Back: A New Hope & Determination

This is Part 2 in the Series "Once an At-Risk Youth, Thembi Becomes a Child & Youth Care Worker," contributed by the National Association of Child Care Workers (NACCW) in South Africa.

Thembi Helps Other Girls At-Risk

One of the first families Thembi helped in her new role was of three orphaned girls. Eighteen-year-old Asanda and her two siblings were in Johannesburg when their mother passed away. They moved across the country to live with a maternal aunt. With three children herself and unemployed, the aunt was overwhelmed.

Thembi helped the family secure a foster care grant and budget to make ends meet each month. She taught them how to establish and maintain a vegetable garden to improve their diets and extend their resources. She also helped them work on grief and relationship issues. The children and their aunt participated in grief work sessions, learned to express their feelings of loss and share memories. They created a memory box to honor their mother and found individual and joint healing.

The Powerful Combination of Professional and Caring Relationships

Asanda was a bright student and her CYCW took every opportunity to talk to her about the importance of education. She encouraged her to join the study group at the Isibindi Safe Park and made it her own priority to help her with her schoolwork.

When Thembi learned that Asanda wanted to become a doctor, she helped her with college applications. She was accepted into the medical program at the University of KwaZulu Natal, yet funding was a problem. Though her aunt had saved some money from the foster care grant, it was not enough.  Knowing the sincerity of her dream, her CYCW advocated for support from the National Association of Child Care Workers, and so Asanda was indeed able to register for university.  She is now happily involved in her first year of medical studies.

“My childhood life was similar to Asanda’s. I relate to the aspect of growing up without parents, which is why I felt it was important to help,” said Thembi. The two formed a close bond.

Asanda is now one of the youth role models of the Isibindi program. She was a leadership voice at the NACCW’s Biennial Conference in July. She talked to a reporter about her experiences.

Both Asanda and Thembi demonstrate great courage, hope and determination as they evolve into their chosen careers. Through professional life-space focused care dedicated to addressing the unique needs and circumstances of vulnerable children and youth, change truly is possible.

*Names changed to protect identity

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Together, we can! Strengthening the capacity of multi-disciplinary teams within the Guatemalan child protection workforce

Contributed by Kelley Bunkers, formerly a child protection consultant and currently Child Protection and Welfare Systems Technical Director at 4Children and member of the Global Social Service Workforce Alliance

Group photo of training participantsI joined with Jini Roby (Professor of Social Work at Brigham Young University) to develop two training modules for Buckner Guatemala. The trainings were launched in June 2015 with two sessions of two-day trainings to highlight the important role of multi-disciplinary teams, such as social workers, psychologists and pedagogues, within the Guatemalan child protection system in general and the court system specifically. We traveled to Guatemala City, Guatemala, to hold these trainings from June 8-12, 2015, which were hosted by Buckner Guatemala, with support from the Displaced Children and Orphans Fund (DCOF) and the Guatemalan Court System.  

The two modules, jointly developed by Buckner Guatemala’s “Semillas de Esperanza” (Fostering Hope Guatemala) project and the Guatemalan School of Judicial Studies were titled: Values, Knowledge and Interpersonal Skills for Child Protection and Alternative Care. Jini and I contributed to the development of the modules in a participatory process that was informed and reviewed by a multi-disciplinary team of experts representing Guatemalan child welfare government bodies, academic institutions and representatives from child-focused organizations.

The June training was officially launched by Fostering Hope Guatemala a Project of Buckner and the Guatemalan Judicial System and included key note speeches from the Chilean Ambassador to Guatemala, Ambassador Domingo Namuncura. The participation of Ambassador Namuncura was particularly relevant given that he is a trained social worker and he has contributed significant work in human rights related efforts within Chile. The presentations by guest speakers and the content of the two training modules we presented focused on the values and skills of the multi-disciplinary team including the important role of coordination between the legal and the psychosocial sectors in providing a holistic response to children.  Participants shared interesting real life examples from Chile and Guatemala, which illustrated how the child protection system continues to be strengthened in these countries. We also divided participants into small groups to interact and raise questions. Participants agreed that these sessions provided useful opportunities for them to reflect and discuss the training content. 

The module on alternative care proved to be especially interesting to participants given the important role that multi-disciplinary teams have in the assessment, referral, case management and follow up procedures involved in the decision making process of alternative care. Participants were particularly interested in learning more about the evidence base related to both residential and family based care. Very few participants were familiar with the Guidelines on Alternative Care of Children so the information provided was especially relevant. Participants also suggested that Guatemala develop its own National Guidelines for Alternative Care to ensure that they were contextually appropriate and informed by real life experiences of children and families. 

I engaged with participants in lively discussions around this issue. They developed concrete ideas about how they could take the information learned in the training and incorporate it into their daily work. Examples included sharing information on the detrimental effects of residential care on children’s development with judges to help influence and inform their decisions related to alternative care. Participants also stressed the need to improve linkages with local service providers to strengthen community based family strengthening services that aim to prevent separation and eventual placement in residential care.

Pre-service and in-service trainings remain an important aspect of the training multi-disciplinary teams receive, including social workers. UNESCO data from 2013 shows that 293,721 students in Guatemala are engaged in higher education; approximately 5,000 of those are studying social work.

Abigail Alvarez Och, a Professor of Social Work at a university in Guatemala City, shared with me that many of her students have chosen their career path because they come from very humble backgrounds and can easily relate to the personal experiences of many of their clients. She has spent the past 24 years working in the social service sector. Now the Director of Gender and Ethnic Equality within the Presidential Secretariat for Planning and Programming, she was involved in the recent drafting of the National Plan of Action for Development K’atun Nuestra Guatemala 2032.  The plan is centered on human development and finding the means to guarantee the participation and fulfillment of rights of Guatemalan citizens, including children. “I utilized a lot of my social work background and theory to inform the drafting of this important document,” she said.

The training modules we developed were officially endorsed by the Guatemala School of Judicial Studies (GSJS) in a formal ceremony attended by government representatives from both Guatemala and the United States. I was excited to learn that the training will also be mandatory pre-service training for all new social workers, pedagogues and psychologists and required in-service training for existing staff of multi-disciplinary teams. The GSJS will offer the training utilizing the trainer’s guide that we developed together with the student manual. Both manuals, Manual del Docente and Manual del Estudiante, are now available publicly, in Spanish. As Guatemala continues to strengthen its social service workforce across all sectors, the skills developed through these trainings will be invaluable toward advancing child protection, alternative care and psychosocial support.

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Once an At-Risk Youth, Thembi Becomes a Child & Youth Care Worker

Contributed by the National Association of Child Care Workers, South Africa

After Thembi’s* parents passed away from an illness when she was in Grade 11, she and her brother, in Grade 8 at the time, moved in with their grandmother. It was not an easy transition for any of them.

The grandmother did not work; in fact, she was old enough to be dependent upon government grants for the elderly. The money was not adequate for her to cope with the sudden growth in the household and with the needs of two growing school-aged children. She was not able to afford the children’s school uniforms and other material needs. They were struggling, with no means to access what was needed to steer them out of their bleak reality. The highly stressful situation impacted the grandmother’s health; she developed a high-blood pressure condition. 

Unfortunately, the story is not uncommon in the many granny-headed families in South Africa. If the parents pass away, there is oftentimes no financial, material or psychosocial support for the children. Sometimes proper identification is not available. Who helps vulnerable children to respond to these crises?

A Child and Youth Care Worker Intervenes

In 2010, Lungi, an Isibindi Child and Youth Care Worker (CYCW) intervened. She explained the program, its purpose and services to the grandmother. Developed and implemented by the National Association of Child Care Workers (NACCW), the Isibindi program is serving more than 180,000 orphans, at-risk or vulnerable children throughout South Africa. Each worker aids up to 48 children, monitoring a child’s progress, acting as their confident and providing support in any areas as needed in a child’s life. CYCWs build relationships with children through interaction in typical daily routines- cooking together, reading, household chores and life skills.

The grandmother was both pleased and relieved to be immediately registered in the program and receive additional support for herself as well as the children. The CYCW assisted the family in applying to the Department of Social Development for a foster grant. She also helped with Christmas gifts during that first, difficult year. Over time, this new, blended family was able to begin saving money toward future schooling.

Lungi saw the need for grief counseling to help the family cope with their losses. In addition, life-space counselling played a big role in teaching the family to communicate and develop routines for sharing responsibility for household chores and they were taught effective behavior management skills to strengthen their family. Lungi also encouraged and supported the family to grow a food garden; this project was a great success and was even formally approved by the Department of Agriculture.

The CYCW also arranged for the children to participate in the city’s soup kitchen breakfasts and lunches. With a full belly, the children were better able to concentrate on their school work. She also participated in regular school visits and helped with homework.

Thembi Joins the Isibindi TeamThembi graduates from a local college

Thembi completed her schooling in 2011; then her CYCW advocated successfully for funds to enable her to further her education. She was accepted into the Human Resources program at at local college in 2012. Following graduation, in 2014, Lungi further encouraged Thembi to apply for a CYCW post. She was selected for the job in this exciting new initiative – once an at-risk youth herself, she had now graduated to become a service provider to others facing difficult situations.

“The skills that are important to me as a CYCW are observation, communication, listening and facilitation,” said Thembi. “My relationship with Lungi means a lot. She taught me the importance of education and loving life. She is an important role model to me.”

Meaning “courage” in IsiZulu, the Isibindi program is in the second year of a five-year scale up and is being funded by PEPFAR through USAID. With a goal of training 10,000 CYCWs, to date 4,402 CYCWs have been trained.

Read Part 2 of Thembi's story next month. Her story will be posted as a blog and included in the December member e-update.

*Names changed to protect identity

Anonymous's picture

The Alliance Joins 53 Signatories Calling on Global Action for Children

The Global Social Service Workforce Alliance (the Alliance) is proud to join 52 leading children’s and disability rights organizations in calling on the UN Statistical Commission and Inter-Agency Expert Group on the Sustainable Development Goal Indicators to ensure children living outside of families are a part of the SDGs. NGOs and other civil society bodies have been encouraged to give their views on the Indicators, which will make up the monitoring framework and allow progress against the goals to be assessed.

While all children count, not all children are counted. The document “Transforming Our World: the 2030 Agenda for Global Action” calls for children’s holistic needs to be fully addressed, including health care, education, and protection from violence, exploitation and abuse. The Alliance supports efforts to ensure that we ‘leave no one behind’ in the post-2015 global development agenda.

As one of the signatories, the Alliance joins in the following recommendations:

  • Ensure that children living outside of household and/or without parental care are represented in disaggregated data. If the Post-2015 agenda is to leave no one behind, it is essential that the global monitoring framework includes methodologies to ensure that children living outside of households and/or without parental care are represented and that data is used to inform targeted, appropriate, and accessible interventions.
  • Improve and expand data collection methodologies to ensure all children are represented. The post‐2015 global monitoring framework offers an opportunity to do more and better on behalf of the world’s most vulnerable children – ensuring, first and foremost, that they are no longer invisible.

It is estimated that anywhere from 2-8 million children live outside of family care. Most of these children are not orphans and have family members who could provide care with the right support. Given the importance of a strong workforce to provide this support, the Alliance feels it is important to ensure that any enumeration of children outside of family care include collection of workforce data to assist with adequate workforce planning and development to best support family-based care.

The letter to UN Expert Group states: “All children count, but not all children are counted. As a result, some of the world’s most vulnerable children – those without parental care or at risk of being so; in institutions or on the street; trafficked; separated from their families as a result of conflict or disaster; or recruited into armed groups – have largely fallen off the UN’s statistical map. There are only limited data about how many children live in such precarious circumstances, except for scattered estimates from some specific countries.”

The Inter-Agency Expert Group will next meet again in Bangkok from October 26-28, and a final set of indicators is expected to be completed by early 2016. The Alliance joins the voices of support in calling for all children to be counted in these final indicators.

Nicole Brown's picture

Improving Access to Services for Children and Families Through Collaboration Among Health Workers and Social Service Workers

When health workers and social service workers collaborate to enhance community capacity to care for children and adolescents, vulnerable children and families reap the benefits. Last month, I witnessed first-hand some of those benefits.

Global evidence shows that children orphaned by AIDS or living with HIV-positive caregivers face an increased risk of physical and emotional abuse as compared to other children in sub-Saharan Africa, including other orphans. They also face stigma, neglect and many other issues that negatively impact their psychosocial wellbeing.

To strengthen linkages and referral systems between community and government service providers, the Bantwana Initiative was developed by World Education Initiative (WEI) and is an initiative of WEI and John Snow, Inc. The program prides itself on “innovative models of care that are based on existing community structures and address children’s comprehensive needs.” The program is supporting vulnerable children and families in Swaziland, Tanzania, Uganda, and in Zimbabwe, which I recently visited.

In Zimbabwe, nearly one in four children has lost one or both parents, most due to HIV/AIDS, and 1 in 11 children die before age five due to HIV-related illnesses.[1] Additionally, there were an estimated 1.2 million Zimbabweans living with HIV/AIDS in 2011, 200,615 were children under age 15.[2] Many of these children acquired HIV from their HIV-infected mothers during pregnancy, birth, or breastfeeding, with mother-to-child transmission accounting for virtually all new HIV infections among infants in Zimbabwe. There are also a total of 1.2 million children of school going age, between 3-16 years, who were out of school in 2012 and 843,266 people (ages 5-24 years) had never been to school[3]. Overall, more than one quarter of children between 3 to 16 years were out of school. To combat these staggering statistics, Bantwana developed an integrated pediatric HIV/AIDS care and treatment program and is working closely with the government to strengthen the social service system.

I had the opportunity to meet Shelton Tshuna, one of the 9,765 community-level child care workers trained across 65 districts throughout Zimbabwe. The neighborhood where he works is familiar and convenient to him because it’s in his backyard. We drove less than 10 minutes from the tourist town of Victoria Falls to his community in the Chinotimba area. Only an SUV would be able to travel the paths of this village, for when we stepped out of the car, golden dust half covered our shoes.

Meeting of CCWsI attended a meeting of 21 child care workers (CCWs) as they discussed some of the issues facing their community and how they can best address them. They’re easily recognizable, as each wears a t-shirt and hat that announce them as a child care worker within the community. They’ve received training to be sensitive to the needs of children living with HIV, case management procedures, and some psychosocial support. They’ve also attended a course on basic counselling and communication, receiving a certificate upon completion. The CCWs have come to gain the trust of their neighbors and are viewed as a formal role within the community, leading to community participation in identifying children in need of the CCW’s help. The CCWs work with the Child Protection Committee and Village Health Worker to implement an integrated approach to addressing the children's overall well-being.

Shelton meets with the family“Working with the community is important,” Shelton told me. As a CCW for the last 1.5 years, he’s spent months getting to know 13-year-old Khethiwe* and gaining the trust of his grandfather. The boy moved from another area of Zimbabwe last year after his mother, father and younger brother all died from HIV. His grandfather and a maternal aunt are now his caregivers. Out-of-school for a period, Shelton helped Khethiwe re-enroll in school. He told me that social studies is his favorite class. He’s also begun making new friends. In fact, he was playing soccer with them when we arrived. The transition hasn’t been easy, though. Shelton visits Khethiwe and his caregivers frequently, which is apparent from their casual, friendly interaction.

Prior to Shelton’s help, the grandfather told me their “situation was pathetic, and we couldn’t afford much.” Shelton is helping enroll the family in World Vision’s food program, to ensure Khethiwe receives adequate, nutritious meals to help with his own HIV status. He’s also now receiving ARV treatments and paperwork is underway to obtain his birth certificate, which will help the family to access additional benefits and services from the government and volunteer organizations.

Bantwana is also collaborating with UNICEF and Zimbabwe’s Department of Social Services (DSS) on a three-year case management project. As part of the scale-up, CCWs receive training to work with vulnerable children until they no longer need their services. Through the program, DSS social work staff will be deployed to 30,000 vulnerable households by 2017, Yvonne Mandikutse, a child welfare officer with the government told me.

To-date, the program is having great results, some of these I witnessed first-hand. In Shelton’s ward, in the last year, community members have increased their sensitization to neglect and sexual abuse, leading to increased reporting of these issues; two children were reunited with their families; 34 students were re-enrolled in school; and CCWs helped 34 children/families to obtain birth certificates, necessary to help the families qualify for additional aid and support.

“How to handle children in distress is critical to training of para professionals. We’ve trained close to 1,500 para social workers. Strengthening of formal and informal systems to increase the wellbeing of children begins at the community level,” said Edton Babu Ndyabahika, Deputy Country Director, Bantwana Initiative, Uganda.

The need for more and better integrated services is beginning to receive more attention. I joined more than 400 attendees from 27 countries, largely within sub-Saharan Africa, at the Regional Psychosocial Support Initiative Forum (REPSSI Forum) in Zimbabwe for three days in September to discuss the importance and challenges of integrating child protection, HIV programming and psychosocial support by strengthening community level linkages. There, I met Edton and several others from Bantwana’s other country programs, who all shared examples of why this is important and how it’s making a difference in their countries.

“Strengthening the framework of psychosocial support must remain embedded in social services. Exposure to best practices and the exchange of knowledge adds quality to psychosocial support,” said Priscah Mupfumira, Minister of Public Service, Labour and Social Welfare, Zimbabwe, in her address to Forum attendees.

Initiatives like Bantwana in Zimbabwe are making this case on the ground, effectively integrating a case management model into existing government social services and extending the government’s reach to the children and families who need support most.

Ashenafi presents during an Alliance Forum sessionAs a co-sponsor of the REPSSI Forum, the Global Social Service Workforce Alliance, the organization where I work, held three sessions on the importance of supporting community-level workers (or para professional workers), including increased training and recognition, so that they can be best utilized toward strengthening these community linkages. Community-level workers play critical roles in linking programs to health facilities, reinforcing promising practices, uniting organizations and government, and promoting a referral system. Largely community volunteers, these workers oftentimes lack the training and recognition to work hand-in-hand with health workers and others providing and advocating for children’s well-being. To help address these gaps, the Alliance’s Interest Group on Para Professionals, comprised of dedicated members of the Alliance, developed a competency framework. This new resource outlines functions and competencies of para professional social service workers. It is our hope it will be used to provide program guidance, accountability and ultimately inform training and supervision of para professionals.

It takes a strong social service workforce to provide the best care for vulnerable populations. The Alliance celebrates people like Shelton who are committed to making this dream a reality and supports these linkages through conferences, tools and resources.


*Child's name has been changed to protect his identity.

[1] The National Strategic Plan for Eliminating New HIV Infections in Children and Keeping Mothers and Families Alive (2011-2015)

[2] MOHCW AIDS & TB Unit Annual Report 2011

[3] UNICEF Commissioned a 'National Assessment of Out of School Children,' Dr Jeanette Manjengwa, June 2015

Additional resource:
Protection and resilience: A simple checklist for why, where and how to coordinate HIV and child protection policy and programming, introduced at the REPSSI Forum during a session presented by

Jim McCaffery's picture

A Competency Framework for Para Professional Social Service Workers

by Jim McCaffery, Chair, Global Social Service Workforce Alliance Steering Committee

Welcome to Day Five of Social Service Workforce Week! This week, as you probably know, we have been celebrating the work of community level social ervice workers. Given the critical role these community workers play every day in providing care and support to children and families, it has been our premise that they form the backbone of a strong social service system.

We hope that through the various methods and communication channels this week – blogs, worker profiles, web visits, tweets, and so on – we have all gained a better understanding of what they do and how they do it. And that we would appreciate both the individual stories as well as the overall perspectives and tools that have been highlighted.

As we look at the bigger picture of community level social service workers, one cannot help but be impressed by the great diversity of roles and services that they provide. While this is a real strength in that community level work must fit different contexts, it also poses a challenge -- the functions and activities of these workers are not well described or delineated within or across countries. Training, credentialing, supervision and evaluation of para professional community social services vary as well based on local context, the existence or lack of formal social services or social welfare structures as well as the professional and local cultural stance on how vulnerable people are to be supported and helped.

Recognizing this, the Alliance formed the Interest Group on Para Professionals in the SSW (IGPP) in September 2013, which has been open to all members of the Alliance. Zeni Thumbadoo, National Association of Child and Youth Care Workers in South Africa, and Nathan Linsk, PhD, University of Illinois at Chicago, co-facilitate the group. Currently there are more than 30 member participants who represent seven countries from North America, Europe and Africa.

The Competency Framework for Para Professional Social Service Workers

The group developed a competency framework for para professionals that outlines the functions and competencies and can be used to provide program guidance, accountability and ultimately inform both training and supervision. 

Today, we are releasing the full document, including the guiding principles and competency framework. We hope that all of you will take a look, try it out and provide feedback to make the next edition even more robust.

You can find the competency framework here.

Let me say a few words about the three key sections of the document:

1) Guiding Principles

The purpose of this section is to provide a set of principles that will be a useful base from which to develop programs and activities related to how programs can work to better plan, develop and support para professional social service workers. (For additional information on the Guiding Principles, please see the day one blog.)

2) Core Functions and Competencies

The purpose of describing core functions and competencies is to more clearly define the range of work of para professional social service workers. The competency framework can be used toward the development of service and training programs for para professionals working as direct care workers in the social service sector. These functions and competencies should serve as a useful base to develop such programs; however, based on the type of services provided as well as the professional and regional context, they often will need to be supplemented by functional areas and competencies specific to the context or discipline related to those served by the para professional workers. 

The overall functions and competencies are generic in that they may apply to most para professional cadres, but at the same time not all para professionals are expected to need all of these competencies. Specific groups may have more specialized functions and competencies that can be combined with these generic functions and competencies in training and service programs

These functions may be viewed as a "menu" of competencies that may be helpful in developing service programs as well as training and supervising workers who do this work. They may be useful as well in developing credentialing or qualifying descriptions of these workers, including job descriptions, scopes of work or schemes of service. Potentially they may also be used to ensure ethical practice and enforce related laws and professional standards that relate to para professionals practicing in these fields.

The document presents eight overall functional areas as follows:

a)  Communication skills
b)  Direct work with children, youth and families
c)  Application of knowledge related to client needs
d)  Community work
e)  Collaboration skills
f)  Organization and leadership
g)  Monitoring and evaluation
h)  Developing self and others

Each functional area is divided into a series of competencies that provide more detail. Practice competencies are specific expected abilities that a worker may use in their work; these competencies can be used to develop or evaluate their skills and may be a part of a work description. Training competencies can be used to develop training objectives and activities as well as evaluate training success.

3) Specialized Functions and Competencies – Child and Youth Care Workers

Toward more specialized competencies, the current document also outlines functions and competencies associated with one specialized area of para professional social service work – Child and Youth Care Workers (CYCW). Child and youth care practice focuses on the infant, child, and adolescent, within the context of the family, the community and the life span. The developmental-ecological perspective emphasizes the interaction between persons and the physical and social environments, including cultural and political settings. This is an internationally recognized field with standardized competencies and training at the professional level that enables a career ladder for para professional child and youth care workers. The internationally accepted child and youth care competencies for professional CYCW can be found online. The IGPP document is a first effort to define specialized competencies for para professional CYCW.

It is hoped that future versions of the document will incorporate specialized functions and competencies for other types of cadres, including para social work and community development.

A major contribution…let us know what you think

Developing and publishing the guiding principles and competencies for community level social service workers is a major contribution to the field. The IGPP is congratulated for the hard work that went into the initiative and the document. I should add that validation exercises have been carried out in Kenya and Uganda with the specific aim of assessing the relevance of the framework’s functions and competencies to a specific group of para professional workers.

So, please read through the document – we hope you learn from it and, most important, if you have reactions and ideas and suggestions, please contribute them, as we want this to be a living document that grows and becomes more finely tuned based on broad input and experience. We request that as you use these tools you let us know how you do so, what groups you target and what are the results including needed modifications. Please email us with any and all comments and feedback. We look forward to hearing from you.

And thank you for joining us during this year’s social service workforce week. Take a look back through the week’s information here. If you haven’t become a member of the Global Social Service Workforce Alliance yet, we invite you to do so.