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Empowering Caregivers of Orphans and Vulnerable Children in Swaziland

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Empowering Caregivers of Orphans and Vulnerable Children in Swaziland African Journal of AIDS Research 2017, 16(4): 355–363 Copyright © The Authors Open Access article distributed in terms of the Creative Commons Attribution License [CC BY 4.0] (http://creativecommons.org/licenses/by/4.0) AJAR ISSN 1608-5906 EISSN 1727-9445 https://doi.org/10.2989/16085906.2017.1387579 Empowering caregivers of orphans and vulnerable children in Swaziland Syloid Choice Makufa1*, Daisy Kisyombe1, Nicole Miller1 and Nanette Barkey2 1Pact, Mbabane, Swaziland 2Pact, Washington, DC, USA *Corresponding author, email: [email protected] This paper reports on the health and psychosocial impacts of a programme designed to economically empower female caregivers of orphans and vulnerable children (OVC). The results presented are from a cohort of 492 female caregivers who participated in savings groups and were responsible for 887 OVC. The data showed that the caregivers had increased earnings, borrowed more, repaid their loans, and expanded their businesses. Important health impacts were found for both the caregivers and the OVC. Access to health care increased and the proportion of OVC and caregivers who reported being too ill to take part in daily activities decreased. Results showed that WORTH savings group members increased their financial resources and used them to improve the wellbeing of OVC in their care. The economic and social empowerment had a positive impact on child protection, child wellbeing and health. Keywords: empowerment, financial inclusion, integrated development, savings groups Introduction Background Pact is an international non-governmental organisation Poor women in rural Swaziland are responsible for myriad that designs and delivers integrated solutions to complex family responsibilities such as sourcing food and water; problems in developing countries. This paper reports the caring for children, even those who are not their own; results of an economic strengthening intervention for female the health of family members; and participating broader caregivers of orphans and vulnerable children (OVC) in community initiatives. These women often have limited Swaziland that was designed to empower them and improve access to income, credit, employment opportunities and their health and the health of the OVC in their care. These economic power. According to the most recent Swaziland findings are from the Rapid and Effective Action Combating Demographic Health Survey (CSO/Swaziland & Macro HIV/AIDS (REACH) II project funded by the United States International Inc., 2008), about half the women aged 15–49 Agency for International Development (USAID) which Pact years are employed compared to 86% of men; 47.9% of implemented between 2010 and 2015. The project was households surveyed were headed by a female. designed to mitigate the impact of HIV on OVC households A comparison of orphan data between 2010 and 2014 (Pact, 2015). REACH II provided women with standardised shows a slight decrease in the proportion of children who information about HIV, child protection, and care of OVC, lost one or both parents from 23.6% (CSO/Swaziland & and equipped them with the skills to discuss these with their UNICEF, 2011) to 20.4% (CSO/Swaziland & UNICEF, families. 2016). However, the proportion of vulnerable children in this For more than 20 years, Pact has implemented its time frame doubled from 29.5% (CSO/Swaziland & UNICEF, evidence-based WORTH methodology for economic 2011) to 60.1% (CSO/Swaziland & UNICEF, 2016). The strengthening (Mayoux, 2008). WORTH is based on the OVC needs include food, school accessories (uniforms, premise that dependency is not empowering, so WORTH shoes, and bus fare), clothes, proper shelter and improved does not provide seed money, matching grants or subsidised access to health care and legal protection. Gender-based interest rates. Instead, WORTH trains women how to save violence is rife in Swaziland and statistics show that 48% of their own money and to invest it for income generation, in women have experienced some form of sexual violence in combination with capacity development on community their lifetime (UNICEF, 2007). banking, micro-enterprise and marketing skills. Under the The WORTH intervention was implemented between REACH II project WORTH members also learnt about child August 2013 and February 2015 in three tinkhundla protection, care and support, and HIV and AIDS. REACH (analogous to districts) of the Lubombo (Lubulini, Nkilongo) II used WORTH to strengthen OVC households’ economic and Shiselwini (Somntongo) regions of southern Swaziland security, empower caregivers, and improve the care and (Figure 1). health of OVC. Economic strengthening was one component WORTH was introduced as part of an integrated approach of an integrated project; this paper focuses on the effects of to improve the wellbeing of OVC, targeting female caregivers caregiver WORTH participation on targeted OVC outcomes. with household economic strengthening and women’s African Journal of AIDS Research is co-published by NISC (Pty) Ltd and Informa UK Limited (trading as Taylor & Francis Group) 356 Makufa, Kisyombe, Miller and Barkey HHOHHO REGION SWAZILAND 1. Timphisini 1 Tinkhundla boundaries of each region 2. Ndzingeni 4 3. Mhlangatane 14 Survey coverage 4. Ntfonjeni 5. Pigg’s Peak 3 6. Madlangampisi 5 7. Lobamba 2 8. Mbabane West 9 9. Mbabane East 6 10 LUBOMBO REGION 10. Hhukwini 13 1. Sithobela 11. Maphalaleni 2. Mpholonjeni 12. Motshane 11 3. Siphofaneni 13. Nkhaba 4. Nkilongo 14. Mayiwane 5. Matsanjeni North 12 9 6 8 10 6. Dvokodvweni 8 11 1 7. Lubuli 5 8. Hlane 7 9. Lomahasha 6 13 10 10. Mhlume 16 14 11. Lugongolweni 7 15 9 2 2 4 8 MANZINI REGION 11 5 1. Kukhanyeni 3 2. Mtfongwaneni 12 3. Mahlangatja 3 4. Mangcongco 5. Ludzeludze 3 4 6. Emkhiweni 1 7. Lobamba Lomdzala 11 SHISELWENI REGION 8. Ntondozi 5 1. Sigwe 9. Lamgabhi 4 2. Ngudzeni 10. Mafutseni 3. Khubuta 11. Nhlambeni 2 7 6 4. Mtsambama 12. Ngwempisi 7 1 5. Gege 13. Mhlambanyatsi 6. Mbangweni 14. Manzini North 12 8 7. Sandleni 15. Manzini South 9 8. Hosea 16. Kwaluseni 13 14 9. Zombodze 10 10. Shiselweni I 11. Nkwene 12. Maseyisini 13. Matsanjeni 14. Somntongo Figure 1. Map of Swaziland with intervention areas highlighted empowerment interventions. This component of the REACH II group elected a four-member management committee project relied on empowerment workers (EWs) who recruited who received further training on group management, and female OVC caregivers to join the WORTH savings and safe money handling. The EWs introduced and facilitated lending groups. The women participated in activities related discussions around child protection, OVC care and support, to income generation, group savings, prevention of gender- HIV and AIDS, sexual and reproductive health, gender roles, based violence, HIV prevention, and the care and support and gender-based violence prevention and response. Pact for the OVC in their households. At weekly meetings, the prepared discussion guides/lesson plans and held monthly women saved and lent each other money and participated training sessions to ensure standardised delivery of session in EW-facilitated discussions on the care and support of topics. The EWs’ reports were reviewed to monitor the children, HIV, establishment of small businesses, profit uptake of loans and proportions of women establishing small tracking and marketing. The EWs also monitored the group businesses and monitoring their profitability. activities and advised on the establishment and expansion of small businesses. Six EWs were employed by Pact Objectives who trained them on the management and support of the groups. The training included the use of mobile technology The theory driving the intervention was that WORTH to report weekly on group activities (total group savings, groups would increase access to savings, loans, and loans, purposes of loans, number and type of small business the development of profitable micro-enterprises for OVC established, and number and type of discussions facilitated). caregivers, and simultaneously be a platform to discuss the As the WORTH groups were formed, the EWs provided health, psychosocial support, protection, education, and training on saving and lending principles, record keeping, sexual reproductive health needs of OVC, with both the small business development and profit tracking. Each economic and educational aspects combining to improve African Journal of AIDS Research 2017, 16(4): 355–363 357 OVC outcomes. The increased household economic security routine WORTH programmatic data collection in accordance would empower the women with funds to help meet the with Pact’s ethics policy and guidelines (Pact, 2014) that needs of OVCs while the training, learning dialogues, and require confidentiality and respect of individuals’ data and group discussions would increase their agency for decision adherence to do no harm principles. The data were collected making and taking. The programme established at baseline as part of routine monitoring and evaluation activities, not as a the WORTH group members’ savings and the number research study. However, informed consent was secured from and type of micro-enterprises they owned, as well as their all participants before data collection exercises. Respondents perceptions of and knowledge about child-care, and gender were aware that their participation was voluntary and they norms that contribute to gender-based violence. Data were could choose to not answer any questions asked of them. collected on members’ demographic, socio-economic status, All cases of reported abuse were referred for post-abuse health, education, and incidence of abuse and psychosocial care and the project ensured that OVC received those characteristics of OVC under their care to compare against services, and counselling was offered to the caregivers. The end-line values. aggregated data and summary findings were shared with the empowerment workers and WORTH group members for their Methods learning and use. Study design Data analysis The design followed a cohort of women who were active The data were analysed using SPSS V.21 software for WORTH members for at least 12 months, along with OVCs data analysis. The data were first exported from Mobenzi in their care.
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