Situational analysis of the socioeconomic conditions of orphans and vulnerable children in seven districts in Botswana pot

AIDS Acquired Immune Deficiency SyndromeBOCAIP Botswana Christian Aids Intervention Programme BOTUSA Botswana USA Project CBO community-based organisation DSS Department of Social Servic

pre Mandela Children’s Fund (NMCF) for the strategy of the W.K Kellogg Foundation (WKKF) for

the care of orphans and vulnerable children (OVC) in Botswana, South Africa and Zimbabwe

in commemoration of the WKKF’s 75th Anniversary

© 2007 Human Sciences Research Council

Copyedited by David Le Page

Typeset by Janco Yspeert

Cover design by Oryx Media

Cover photo: © Tessa Frootko Gordon/iAfrika Photos

Print management by Compress

Distributed in Africa by Blue Weaver

Distributed in North America by Independent Publishers Group (IPG)

Call toll-free: (800) 888 4741; Fax: +1 (312) 337 5985

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We cannot stop thanking the staff at Masiela Trust Fund for the support they provided during the study period.

Lastly, we thank Dr GN Tsheko for editing the final report

AIDS Acquired Immune Deficiency Syndrome

BOCAIP Botswana Christian Aids Intervention Programme

BOTUSA Botswana USA Project

CBO community-based organisation

DSS Department of Social Services

FBO faith-based organisation

HIV Human Immunodeficiency Virus

HSRC Human Sciences Research Council

IEC information, education and communication

MRC Medical Research Council

NGO non-governmental organisation

OVC orphans and vulnerable children

PMTCT prevention of mother-to-child transmission (of HIV)

STPA Short Term Plan of Action

TCM total community mobilisation

VCT voluntary counselling and testing

VDC village development committee

WKKF WK Kellogg Foundation

The overall aim of this project is to implement research-driven, evidence-based,

intervention programmes to assist children, families and communities affected by

HIV/AIDS in Botswana The overall philosophy is to empower communities to help themselves, and to ensure sustainability of the project after donor funding ceases

The situation analysis was carried out in seven research sites in Botswana These are Palapye, Letlhakeng, Kanye, Mahalapye, Molepolole, Serowe and Maun The data

collection methods used for the qualitative research included key informant interviews and focus group discussions Information was collected from orphans and vulnerable children (OVC), their caregivers, community members, community-based organisations (CBOs), government officials and community leaders; as well as members of non-governmental organisations (NGOs) and faith-based organisations (FBOs)

The objectives of the study are to improve the living conditions of orphans and vulnerable children; to support households and families to cope with the increasing burden of care for affected and vulnerable children; to strengthen community-based support systems under which vulnerable children exist; and to build community-based systems for

sustaining care and support to vulnerable children and their families

The seven sites are located at different distances from the capital city Gaborone but are reachable by (tarred) road Maun is the furthest away (around 1000 kilometres from Gaborone) and can be reached by both road and air, as this is the one village that has an airport

The major challenges facing orphans and vulnerable children are poverty related and include female-headed households, and inability of families to provide even the most basic necessities such as food, clothing and shelter The poverty of these children places them at greater risk of experiencing other social problems such as property grabbing, ill-treatment, abuse and congested households The findings are that there is free,

non-compulsory education as well as free medical services, orphan care and destitute programmes provided by the government at all sites The spirit of volunteerism is present within all communities, though it varies from one site to another

The absence of a policy that advocates for OVC makes it difficult for NGO, CBO, FBO and government officials to protect orphans and vulnerable children from property

Skinner et al (2004) define an orphan as a child who has lost both parents through

death, desertion or if the parents are unable or unwilling to provide care They further

define a child as someone who is aged 18 yearsand below, though in some cases 21 is

the cut-off age used

Skinner et al (2004) also define a vulnerable child as someone who has no or restricted

access to basic needs and whose rights are denied even if they have both parents The

Botswana Short Term Plan of Action (STPA) on the care of orphans defines an orphan as

a ‘child below 18 years who has lost one or two biological parents’ The STPA goes on to

categorise another group of orphans as social orphans and defines them as ‘abandoned or

dumped children whose parents cannot be traced’ (Ministry of Local Government, Lands

and Housing, Social Wellfare Division 1999) For purposes of this report, both definitions

cited above will be used A vulnerable child is a child who is either orphaned or is living

in crisis situations due to multiple causes Such situations may result in prostitution or to

living on the street These are children who belong to high-risk groups and lack access to

basic social facilities Risk is identified in terms of malnutrition, morbidity, death and loss

of education (World Bank and UNICEF 2002)

Findings from the Rapid Assessment on the situation of orphans in Botswana as cited by

the Ministry of Health (1998) indicate that many orphans do not have basic necessities

such as food, clothing, shelter and toiletries The assessment also established that their

human rights are violated, not only by society, but also by caregivers in some cases The

other problem that orphans face is that many caregivers are elderly grandparents who live

in poverty and are in some cases supported through the destitute programme or the

old-age pension scheme

Though the problem of orphans is not new in Botswana, the advent of HIV/AIDS has

contributed significantly to the escalating orphan problems in the country In 1999, the

number of registered orphans was 21 209 and the number doubled to 42 000 in 2003

Available data in the country shows that HIV/AIDS prevalence in all the districts is similar,

which means that all districts are affected This suggests that the problems of orphans

and their needs should also be similar across all the districts However, according to the

Botswana 2003 Second-Generation HIV Surveillance Report (National AIDS Coordinating

Agency 2003), HIV prevalence rates by districts show Kweneng West (includes

Letlhakeng) has an HIV prevalence of 27.0%, Kweneng East 32.1% (includes Molepolole),

Serowe/Palapye 43.3% (includes Serowe and Palapye), Mahalapye 37.4% Southern 25.7%

(includes Kanye) and Ngamiland 38.4% (includes Maun)

Given the magnitude of the problem, the government has declared the orphan problem a

national crisis needing immediate and long-term sustainable interventions by the various

stakeholders

Background to the OVC project

One of the biggest challenges facing southern Africa today is HIV/AIDS The governments

of southern African countries have called on every African to join the fight against this

disease The Human Sciences Research Council (HSRC), together with its partners within

the Southern African Development Community (SADC) region, were commissioned by

the WK Kellogg Foundation (WKKF) to develop and implement a five-year intervention

project on orphans and vulnerable children (OVC)

The project looks at the families and households coping with an increased burden of

care for affected children in Botswana, South Africa and Zimbabwe All three research

institutions have identified non-governmental organisations (NGOs), which are referred

to as grant makers, with whom to work The grant maker identifies local NGOs to

implement recommended interventions In South Africa, the Nelson Mandela Children’s

Fund (NMCF) was chosen to work with the HSRC and the Medical Research Council

(MRC) of South Africa In Zimbabwe, Family AIDS Caring Trust (FACT) was chosen to

work together with Blair Biomedical Institute and Biomedical Research and Training

Institute The University of Botswana (researchers) and Botswana Harvard Institute

chose to work with the Masiela Trust Fund The grant maker selects community-based

organisations (CBOs) and faith-based organisations (FBOs) to implement the appropriate

intervention programmes at all the sites that are identified

Outline of specific state plans to support OVC

There are two major government programmes that cater for the needs of OVC in

Botswana, namely the orphan care programme and the destitute programme These

programmes are coordinated through the Social Welfare Department under the Ministry of

Local Government Since the start of these programmes, all the districts through the Social

Welfare Department have taken responsibility for assessing, registering and supporting

orphans and destitute persons, depending on their need All seven sites of Kanye,

Kweneng West, Mahalapye, Maun, Molepolole, Palapye and Serowe have systems of

registering new orphans and destitute persons, as well as keeping this register up-to-date

The Botswana orphan care programme is guided by a Plan of Action, which has the

following objectives:

• responding to immediate needs of orphans i.e food, clothing, education, shelter,

protection and care;

• identifying the various stakeholders and defining their roles and responsibilities in

responding to the orphan crisis;

• identifying mechanisms for supporting community based responses to the orphan

problem; and

• developing a framework for guiding long-term development programmes for

orphans

In relation to the immediate needs of orphans, the orphan care plan of action

concentrates on the following areas:

• Provision of basic needs (food, clothing, toiletries and shelter): Many of the orphans

are without adequate food, clothing, decent shelter and toiletries Therefore, provision of these basic needs remains the most urgent task for the orphan care programme In collaboration with the Ministry of Health, a ‘food basket’ was

• Ensuring access to education: Orphans are provided with appropriate school

uniform, shoes and other miscellaneous school items to ensure that orphans remain

in school and get appropriate education

• Protecting orphans from abuse and neglect: The sociopolitical environment of orphans poses serious challenges to their livelihoods, well-being and security Their basic rights are often violated, so the orphan care programme sees to it that legal interventions that are in place to protect the rights of children also apply to orphans

• Providing alternative care for orphans and children in need: Given the complexity

of the orphan problem, the government identified the need to establish alternative care for orphans and drafted the ‘Regulations governing alternative arrangements for children in need of care’ These guidelines have identified foster care, guardianship, children’s homes, schools of industry, and approved child welfare shelters as possible alternative care systems for orphans These guidelines have not yet been approved for implementation, putting a limitation on the overall progress of the programme

The orphan care programme only caters for children classified as orphans in line with the provisions of the short term plan of action on care of orphans in Botswana of

1999 Those children referred to as ‘in need’ or ‘vulnerable’ are treated as destitute persons and are taken care of under the destitute policy The government of Botswana initiated the destitute programme in 1980 after the realisation that the extended family was disintegrating Before Botswana’s political independence, the extended family

system served as a major safety-net, meeting all kinds of needs, be they material, social

or emotional Independence brought urbanisation, migration and rapid economic

development These changes attracted the educated and the young to the urban areas in search of employment, leaving the elderly alone in rural areas In some cases, this led to

a gradual loss of support for poorer members of the extended family system As a result, the 1980 National Policy on Destitute Persons was formulated to systematically tackle poverty (Ministry of Local Government 2002) The revised 2002 destitute policy provides

a definition and guidelines for what should be considered before classifying a person as

a destitute Children who are under 18 years of age can be considered under the destitute policy These are children who:

• are ‘in need of care and may not be catered for under the orphan care programme’;

• ‘have parent(s) who are terminally ill and incapable of caring for the child; and

• ‘have been abandoned and [left] in need of care and are not catered for under the orphan care programme’

The destitute care programme focuses on the following areas:

• assessment of identified individuals or families;

• provision of food component for adult destitute persons;

• provision of cash component;

• provision of funeral expenses; and

• shelter for eligible destitute persons

The destitute policy caters for specific needs of children, such as food for children under

18 years of age Thus a food basket, as prescribed under the orphan care programme, is provided to all needy and vulnerable children

Children under the age of 18 years benefit as dependants and in addition are entitled to

receive the following benefits, depending on what kind of school they attend:

Table 2.1: Goods and services available to children through the destitute programme

Pre-school Primary Junior Secondary Senior secondary Vocational and tertiary

Goods

Uniform Uniform Uniform Uniform Protective clothing

Toiletries Toiletries Toiletries Toiletries Toiletries

Snack pack Pot fee Development

fee

Development fee

Sports feeSports fee Sports fee Sports fee TuitionTransport fee Hostel

requisites

Boarding requisites

Boarding requisites

Trade toolsFees Transport fee Transport fee Transport fee Transport fee

‘Street’ clothes ‘Street’ clothes ‘Street’ clothes ‘Street’ clothes ‘Street’ clothes

Touring fee Touring fee Touring fee Touring fee Touring fee

Accommodation support

Accommodation support

Accommodation support

Psycho-social support and mentoring plus career guidance

Psycho-social support and mentoring plus career guidance

Psycho-social support and mentoring plus career guidance

Note: Children who are dependants of a destitute person, and who turn 18, can continue to receive the above benefits until

they complete their education or training up to 29 years of age, under the youth policy extension rule The same is true for

those children from households that are assessed as being dysfunctional (Ministry of Local Government 2002).

Aims and objectives of the study

1 To assess the social conditions, health, development and quality of life of orphans

and vulnerable children

2 To identify family and household support systems for coping with the burden of

care for orphans and vulnerable children at family, ward, community, national and international level

3 To obtain additional information that would be useful in the OVC census baseline

and the BSS surveys for the study sites

4 To obtain any additional information that would be useful for sharing with Masiela

Trust, the grant-maker

5 To use the information obtained to build capacity in community-based systems for

sustaining care and support for vulnerable children and households, over the long term

The overall philosophy behind the project is to empower the communities to help

themselves, and this demands a very strong emphasis on planning sustainability of the

project once funding ceases

Aims of the situational analysis

The aim of this analysis was to collect information on conditions of OVC and services

in place that cater for OVC needs as offered by NGOs, CBOs, FBOs and government departments in the seven sites The information collected would inform the development

of interventions The situation analysis also served as an introduction to the communities for the researchers, and vice versa

The overall aim of the project is the development of interventions for OVC To do this we

are looking at current interventions, documented studies and information generated from

client groups The qualitative research feeds into this by drawing information from key

interest groups and by laying the basis for the survey and monitoring and evaluation

Data collection methods used for the qualitative research included key informant

interviews and focus group discussions Interviewers were trained on how to conduct the

interview and how to conduct themselves in the field Specific procedures for interviews,

such as introducing themselves, explaining the purpose of the study, and seeking

consent, were used Verbal or signed consent was invited after reading the consent form

to the participant In the case of children, consent from the parent or guardian was

sought before interviews could proceed Issues of anonymity and confidentiality were

addressed in the consent form

Research instruments

Key informant interviews

Key informant interview participants included OVC, their caregivers, community members,

members of NGOs, government officials and community leaders Length of interviews

varied depending on who was interviewed: OVC were interviewed for between 30 and

60 minutes, and the caregivers were interviewed for between 45 and 90 minutes The

members of NGOs, state officials and community leaders were interviewed for 60 to 90

minutes

Focus group discussions

Focus group discussions took place with OVC, their caregivers, community members,

members of NGOs, government officials and community leaders These discussions lasted

between one and two hours They were conducted in local languages and each had 5–12

participants There were two facilitators for each focus group; the primary interviewer and

the co-facilitator who provided support by taking notes, checking that the tape-recorder

was functioning well, and that all participants were engaged

Before the focus group started, facilitators provided participants with detailed information

regarding their participation, to ensure that issues of consent were addressed Participants

were informed about the sensitivity of the research topic and that if they were averse to

discussing personal issues in front of others, they could exercise their right to withdraw

from the study Permission was sought to tape-record the discussion

Sampling

The sampling plan was devised according to the groupings that needed to be

interviewed Though purposive sampling was used, efforts were made to ensure that all

significant sectors of the communities were systematically covered, thus ensuring even

representation of the community Each category is presented separately below, with its

sampling strategy A total of 40 interviews were conducted at each site (32 key informant

interviews and eight focus group discussions) NGO personnel facilitated the selection of

OVC (ten per site)

For the purposes of this study OVC were defined as children (children and youth

between 0–18 years) who meet the following criteria:

• maternal, paternal and double orphans;

• children who are in communities severely affected economically and socially by HIV/AIDS;

• children who are in households with terminally ill parents/family members;

• internally displaced children; and

• children who live in emotionally and financially distressed households

Balance regarding age, gender, and locality was ensured The purpose of interviewing OVC was to find out about their major needs, experiences, perceived attitudes of the community, suggestions of how they could be assisted, knowledge of HIV/AIDS, HIV/AIDS risk-related behaviour and strategies to improve their present conditions

Immediate caregivers of OVC (eight per site)

This category refers to people who offer immediate care for orphans and vulnerable children They included parents, relatives or other community members who are

responsible for the overall wellbeing of the OVC The purpose of interviewing caregivers was to find out their experiences and challenges in caring for OVC, living situations of OVC, attitudes of communities towards OVC, knowledge about legislation in place to protect OVC, and suggestions on how to help OVC in the country

CBOs, FBOs, NGOs (up to seven per site)

This category refers to NGOs based in the study areas which are working with OVC The nature, structure and size of these organisations differed Some are mainly made up

of volunteers, while others offer paid employment NGOs offer different services such

as care, support and counselling Emphasis was given to those providing services for OVC The main reason for interviewing this group was to find out the services they offer for OVC, major challenges, needs and concerns they have and how these related to the resources they have There was also a need to establish the living situations of OVC, the extent of HIV/AIDS as a problem, attitudes of communities towards OVC and the incidence of stigma The number of participants also depended on the context and the number of organisations available in each area

State officials (three per site)

This category refers to people who are working for government departments, for example the Ministry of Local Government (department of Social Welfare), Ministry of Health and Ministry of Education The main reason for interviewing this category was to identify government interventions towards OVC, and gather official thoughts on the size of the problem and its impact on the community, the living situations of OVC, attitudes of community members towards OVC, knowledge of care and support structures in place, major challenges, needs and concerns and how they relate to the resources they have

Community leaders (four per site)

Community leaders usually included the chief, village development committee

chairperson, church ministers and councillors In this category, interviews sought to

identify respondents’ and community attitudes to OVC, the living arrangements of OVC,

major challenges in relation to the care of OVC, and ideas about HIV/AIDS and risk

behaviour

Sampling for focus group discussions

Eight focus group discussions were conducted to gather information relating to

knowledge and beliefs about HIV/AIDS and risk behaviour Participants were asked to

discuss OVC issues Participants were grouped according to age and gender Categories

were ages 6–12 years; 13–18; 14–24, and 25 and above The age-groups were then

dividied into single sex and mixed sex groups

GN Tsheko, MS Segwabe, LW Odirile and SD Tlou

Description of the site

Palapye is situated in the Serowe/Palapye district It is one of the largest villages in

Botswana with a population of 26 293, of whom 12 087 are male and 14 206 female

(Central Statistics Office 2001) Thus females comprise 54% of the population Palapye

is in central eastern Botswana, about 275 kilometres north of the capital city Gaborone

Palapye is built around a coal-driven power station called Morupule The local mine

Morupule Colliery supplies the coal for the power station Most of the people living in

Palapye are employed by either the power station or the colliery The other groups of

people are mainly employed by the government in the Ministries of Health, Education

and Local Government However, most families still depend on livestock rearing and

ploughing for survival

Palapye is a semi-urban locality and uses Setswana as the predominant language It also

has advanced infrastructure The community has access to different shops (food, furniture,

and clothing), public phones, public transport, electricity, water, tarred roads and others

It is a typical village where some families still reside in one-roomed traditional houses

made of mud with a thatched roof Most of the households do not have running water

and proper sewerage Palapye has some urban houses, where families reside in modern

multi-roomed homes that have running water, proper sewerage and electricity The

Department of Water Affairs has provided community standpipes in the village for use by

villagers who do not have running water in their homes

The locality of Palapye still embraces the traditional style of extended family culture of

caring, although there are signs that the extended family has begun to disintegrate The

extended family has in the past always provided a safety net, but is now under great

pressure from social and economic changes that directly impact on the family’s ability

to provide care for orphans and vulnerable children The socioeconomic developments

taking place in the country have had both negative and positive impacts One of the

negative impacts at societal level has been the break-up of the extended family, as more

and more family members move into towns to seek employment As a result of these

movements, and the rise in the cost of living, families are no longer able to remain as

consolidated as they used to This has resulted in a tendency to have more nuclear and

fewer extended families

Palapye has both traditional and modern types of leadership: a chief, two deputy-chiefs,

a district commissioner, and other state officials such as the police, political councillors,

members of parliament and others

There is one primary healthcare facility and four clinics These are government-supported

facilities that provide for the healthcare needs of the community, including those of

orphans and vulnerable children The Botswana 2003 second-generation HIV/AIDS

surveillance does not single out numbers for Palapye as a community but includes

its numbers with those from the rest of the Serowe/Palapye district Prevalence for

the district was 43.3% in 2003 The healthcare system provides an array of services

to benefit people living with HIV/AIDS, and these include Prevention of Mother to Child Transmission of HIV/AIDS (PMTCT), Sexually Transmitted Infections treatment, tuberculosis treatment and access to antiretroviral treatment for both children and adults through Serowe and Mahalapye hospitals The Sekgoma Memorial Hospital based in Serowe is located about 45 kilometres west of Palapye, whereas Mahalapye Hospital is located about 60 kilometres south of Palapye People living in Palapye also have access

to a free voluntary counselling and testing centre, provided through Tebelopele, a local voluntary counselling and testing provider This centre uses rapid tests and has been supported by a collaboration between Botswana and the US government called BOTUSA There are schools in Palapye which are operated through both the private and public sector There are six daycare centres, one of which is run by a non-governmental

organisation (NGO) called House of Hope Other day care centres are provided through the private sector and charge monthly rates of between P300–P450 per child per

month There are eight primary schools and three secondary schools, all supported by government through the Ministry of Education

Through the Ministry of Local Government, Social Welfare Division, Palapye’s orphaned children benefit from the government orphan care programme The purpose of the programme is to identify and register orphans, as well as provide monthly rations in the form of food and toiletries Clothing is provided on a yearly basis By December 2004, the programme had registered 1 743 orphans

Orphans, who are registered with the government orphan care programme, become entitled to government support, which includes food, blankets, uniform and clothes

In some cases, these benefits are misused by caregivers and do not entirely benefit the orphans Some of the caregivers sell the provisions in exchange for alcoholic beverages

In cases where caregivers move in with orphans bringing in their families, they end up taking the supplies of orphans to feed and clothe their own children Some orphans in Palapye are exposed to abuse from caregivers In some cases, the presence of care-givers raises the possibility of sexual abuse The abused children are likely not to report such incidents, leading to an increase in child sexual abuse as well as vulnerability in children Orphans suffer other forms of abuse, such as where the care-giver expects them to run improper, unusual businesses such as sale of alcohol for long hours without sharing the responsibility with other children in the home

Housing is reported as a concern in caring for both orphans and vulnerable children

Most households have traditional housing, with no running water, electricity or proper

sewerage There is a general feeling that government should assist OVC by providing

improved living conditions in the home, rather than by providing orphanages The main

argument is that when improved housing is provided to households, caregivers would

be better able to give love and support to the children, as well as ensuring that they stay

together with their siblings A stable home ensures that they are brought up with the

same family values, beliefs and traditions Orphanages have been strongly criticised as not

bringing any value to the life of the child, as the child does not have a family with which

to identify, does not enjoy family love, care and respect, and hence grows up without

any family values with which to identify

The general conditions of OVC create emotional, social and psychological pressures

As much as there are social workers and other service providers who work towards

improving the lives of OVC, most of the interventions come in material form, and there

is a comparative absence of psychosocial support Social workers and other service

providers have reported the need to provide psychosocial support, but have not been

able to continuously do so due to human resource challenges

Challenges in caring for OVC

There are many challenges for caregivers of orphans Most of the caregivers are older

adults with their own health problems, hence they are not able to provide proper care

to the orphans In providing care to children, caregivers fetch water, cook, bathe the

children, wash the children’s clothing and do other important day-to-day household

chores Carrying out these chores is a big challenge for a sickly elderly woman In some

cases the caregivers have many orphans to care for and in such cases, resources become

even scarcer Government food support that is provided does help, but food preparation

demands strength and energy

Although government support is available, there are often delays in delivery of supplies,

especially clothing Some caregivers have experienced situations where their orphans

either did not receive winter clothing or received it very late, forcing these older women

to spend the little money they have to take care of the immediate needs of the children

The government destitute programme caters for vulnerable children; however most

families with vulnerable children are not aware of this provision, so that some deserving

children are not accessing these benefits

Housing is a major issue of concern for both orphans and vulnerable children, as in

some cases caregivers share rooms with the children, thus leading to overcrowding and a

generally unhealthy environment

Knowledge of HIV/AIDS in the community

Though actual numbers are not known, there was a general agreement among

respondents that a lot of people are infected with HIV/AIDS in the community The

infected are believed to be both young and old Some of the respondents believe that

the young get the virus through unprotected sex, while the older generation is generally

believed to be infected through care giving, since most of these caregivers do not always

use protection such as the gloves offered through the health-care system

a younger person would act as a prevention method Lack of knowledge is also

demonstrated by some caregivers who fail to use protective gloves when taking care of the sick Even though respondents displayed limited knowledge, they also acknowledged that there were a lot of sources of information on HIV/AIDS The challenge is that people are not taking advantage of the available sources of information to learn more about HIV/AIDS and they continue to engage in risky behaviours

The community felt that if HIV-positive people could go public with their HIV status, then prevention efforts would be enhanced Going public with one’s status would also help

in destigmatising HIV/AIDS Such a step will assist communities to start treating people living with HIV/AIDS with a more positive attitude than is presently the case

Government departments and their services

Ministry of Education

Palapye is a traditional village that has enjoyed positive developments in the area of education It has six day care centres, five of which are privately owned, charging fees ranging from P300–P450 (US$50-75) a month Only one day care centre belongs to a non-governmental organisation and gives priority to orphans Here, the orphan children are not expected to pay any fees There are seven primary, four junior secondary and one senior secondary schools These are all supported through the Ministry of Education All schools falling under the Ministry of Education offer free but not compulsory education

to all Batswana The first ten years constitute basic education This is made up of the first seven years of primary education followed by three years of junior secondary Entry into the final two years of senior secondary is determined by one’s success in the Junior Certificate examination, which serves as a selection test

There are also privately owned primary and secondary schools in the village Even though they do not directly fall under the Ministry of Education, they have a partnership with the Ministry in the sense that they function in a similar way, regarding years of study and criteria for selection into the next level

The Ministry has not been responsible for the education of children below primary school age It is only recently that the Ministry has begun looking into coordinating educational activities for children below primary school age

The government of Botswana, through the Ministry of Education, provides aided schools with the necessary human (trained personnel including administrators, teachers, education officers and education administrators) and physical (buildings,

government-furniture, books and stationery) resources The management of these resources at district level is the responsibility of Education officers

There is a school-feeding scheme whereby children are provided with nutritious meals at different times of the day In primary schools, children are fed a mid-morning meal, while

in secondary schools they are fed a mid-morning snack and lunch Children at private schools cater for their own meals, which they can usually afford

The Ministry of Education has an HIV/AIDS office One of its major responsibilities

is to ensure that HIV/AIDS is mainstreamed into the curriculum One active project

that the ministry is running, in partnership with other stakeholders such as the African

Comprehensive HIV/AIDS Programme (ACHAP), is the ‘talk back’ programme, which is

aired on national television every Tuesday at noon during school days As a result, most

schools in the country with electricity were equipped with a television so that they could

participate in the programme In Palapye, eight schools (both primary and secondary)

report having television sets and being able to watch the programme Out of these eight

schools, three reported problems such as having their television sets stolen and the other

two reported having experienced some technical problems which led to the students not

watching the programme for some time When this occurred, the teachers would normally

teach the topics of discussion without actually watching the programme live, to ensure

the students are working within the time schedule of the series

Schools are encouraged to work closely with other existing programmes meant to benefit

orphans and vulnerable children Such programmes include the orphan care and the

destitute programmes, both falling under the Ministry of Local Government The school

assists in identifying children in need Secondary schools go even further by having

teachers who provide guidance and counselling so as to take care of social needs of

students including those that are HIV/AIDS related

Ministry of Local Government

Palapye has both the orphan care programme which takes care of all registered orphans,

as well as the destitute persons programme, which can cater for children both below

and above 18 years old who are vulnerable Both programmes have funds allocated to

them on a yearly basis by government Due to the high demand for the orphan care

programme, the funds allocated always get exhausted before the end of the financial year

There are usually no other funds to rely on – donor funding in Botswana declined when

the country was reclassified as an upper middle-income country (World Bank 2007), so

that demand outstrips available donor resources

The food basket provided under the programme contains basic food items, toiletries and

meat These items are valued at P250 (US$45) and are offered on a monthly basis The

supplies are received through local supermarkets In addition to food and toiletries, there

is some money for clothing and blankets An assessment is done yearly to determine if

the child needs clothing and blankets

Once a person has been identified as qualifying to receive assistance, a needs assessment

is conducted to determine the kinds of services required The cut-off age for receiving

services is 18 under the orphan care programme Assessments are then done to determine

need once one has reached 18 years, and further assistance if any comes through the

destitute programme Services under the destitute programme are provided to children for

as long as they are students

Once the initial assessment is done and proof of need has been established, some of the

following steps are undertaken to cater for orphans, following guidelines from both the

orphan care programme as well as the destitute programme:

• providing for needs at school, including educational tours, transport costs, uniforms

and toiletries for those in boarding schools;

• providing for any specialised medical care requiring payment, such as dentistry,

ophthalmology, etc In Botswana, there is subsidised medical care, free for all

• provision of shelter for those who cannot get into boarding schools and those whose parents died without proper housing This is usually temporary shelter, where the programme sometimes provides tents for families to use;

• interventions in cases of property grabbing, even though there is no legislation that gives authority to the officers concerned This makes it difficult to intervene effectively as there is no protection in place;

• providing counselling as and when needed;

• facilitating placement into foster homes depending on need; and

• monitoring and evaluation of the programme by Social Welfare officers with

community development committees, to assess the success and failures of the programme

Collaborations, with NGOs involved in HIV/AIDS work such as House of Hope, Total Community Mobilization and People in Nature Trust, facilitate the referral process

Challenges faced by the Ministry of Local Government are listed below:

Staff shortage: Due to shortages of human resources, officers end up doing assessments from their offices instead of actually visiting homes The officers are also not able to provide effective counselling There is a need for additional human resources to cater for the growing number of orphans in the area

Property grabbing: There have been some cases of property grabbing, where orphans’ inheritances have been taken from them by relatives, usually paternal relatives There is

no policy in place governing inheritance and representing the needs of OVC Officers who may want to take up particular issues of inheritance with the relevant authorities feel that there is no legal authority that can be used to protect them if families threaten them Lack of understanding of the programme by some community members: Some families in the community take it for granted that they only need to register orphans if the orphans

in turn receive the food basket In the case of well-off families that do not need the food basket, families do not register their orphans, yet this is important for statistical purposes The department responsible for the registration of orphans continually engages in

dialogue with community members to encourage them to register all orphans, even when they do not need the food basket

Stigma: Regardless of how long HIV/AIDS has been in existence and how much

education has been done, stigma continues to be one of the main challenges that

handicaps progress The community needs more education on issues of HIV/AIDS, to try and decrease the extent to which people are stigmatised

Transport: Shortage of transport limits the success and the expansion of the programme Some areas cannot be reached by officials using available cars, due to the poor road conditions

Francistown, which is two hours drive north of Palapye The Ministry of Health and the

Ministry of Local Government administer the health systems and services The Ministry

of Health is responsible for all hospitals (district and referral) while the Ministry of Local

Government is responsible for all the mobile posts, health posts and clinics Healthcare

services are subsidised for all citizens This includes the provision of antiretroviral drugs

for both adults and children, immunisation for all children and a feeding scheme for

malnourished children The fact that there are mobile posts, health posts, clinics, district,

and referral hospitals makes healthcare fairly accessible throughout the country The main

challenges in healthcare are staff shortages, especially nurses and doctors, and in some

cases access is a serious obstacle

Botswana has two referral hospitals, with one in Francistown to cater for the needs of

the people in the northern part of the country (including Palapye), and one in Gaborone

catering for the needs of people in the southern part of the country If, for example, a

child in Palapye needs specialised care and the case is not an emergency, the family is

expected to meet transport costs to take the child to Francistown In cases where a family

is not able to meet such transport costs, the Ministry of Health has a system for awarding

transport warrants to families needing assistance Families that are not aware that they can

receive such assistance often end up not taking their children for medical follow-up

Residents of Palapye, both adults and children, access the antiretroviral therapy

programme from Sekgoma Memorial hospital, which is 45 kilometres from Palapye,

and from the Mahalapye hospital, 60 kilometres south of Palapye Serowe was one of

the first four sites in the country to provide access to the national antiretroviral therapy

programme in January 2002, while the Mahalapye site started operating one and half

years later Availability of public transport between Serowe, Palapye and Mahalapye is

excellent in the sense that there are buses leaving each area every 30 minutes According

to the Masa1 antiretroviral programme, by the end of March 2004, there were 26 603

patients with CD4 cell counts less than 200 and/or AIDS defining illnesses Of these,

14 400 patients were already on treatment, and 1 784 were treated in Serowe (there is

no specific information for Palapye alone, or for children)

NGO, FBO and CBO services

Home-based care

Home-based care volunteers care for orphans and vulnerable children, as well as those

who are ill They care for orphans and vulnerable children in partnership with other

NGOs, CBOs, FBOs and government programmes These caregivers work very closely

with the government orphan care programme and they assist with the identification of

orphans and provide psychosocial support to them One of the strengths of the orphan

care programme, as identified by the caregivers, is the supply and availability of food,

which is always provided on time However, items such as seasonal clothes take a long

time to reach those concerned, so that winter supplies for example may arrive after the

season The caregivers identified the main needs of orphans as love, food, clothing,

shelter and protection from abuse

Aside from the government’s involvement, some community members are supportive

towards those affected as well as towards the home-based care programme, and

hence the programme gets volunteers The main problem that the volunteers face is

1 Masa means ‘new dawn’ in Setswana.

Itsoseng Banana

Itsoseng Banana is a voluntary youth organisation that started caring for OVC long before the establishment of the House of Hope day care centre Some of the other projects that they started were poultry and gardening projects These projects have not been as successful as anticipated, due to financial constraints

At the time of volunteering to care for orphans, Itsoseng Banana had discovered that some children in the village stayed with their aging grandparents Unfortunately, some of these grandparents were visually challenged and could not provide adequate care This group therefore saw the need to establish a daycare centre, and so House of Hope was born Itsoseng Banana supports the building of orphanages, as they have realised that most children are without proper care in the homes where they live Once orphanages are established, they will encourage home-based caregivers to assist at these centres Itsoseng Banana volunteers claimed not to have enough knowledge about HIV/AIDS, but recognised that HIV/AIDS prevalence in the community is high In response, they have joined the HIV/AIDS fight through educating the community through song and drama Their activities are held in drinking bars and other public places The main challenge to what they do is transport, which they need to be able to visit different public places in the community

House of Hope

House of Hope was started in 1999 as a day-care centre for orphaned children The centre is currently housed in a building that can house 150–200 children These numbers are considered small, considering the current demand House of Hope works very closely with the Social and Community Development Social Workers The social workers refer OVC aged between 3–6 years to the centre The centre also gets referrals through the home-based care volunteers

The centre has admitted children who come from both child- and grandparent-headed households As more and more grandparents die, the care of these OVC automatically transfers to aunts and other living relatives In some cases, aunts are burdened with orphans from more than one household Initially, caregivers were reluctant to take their children to the centre, due to stigma associated with HIV/AIDS: some staff were perceived to be HIV positive This problem has now been addressed and the result has been an influx of children, forcing the centre to introduce a process of screening

House of Hope has received support from other governmental and non-governmental

organisations, as well as from the community of Palapye at large The support has taken

the form of approval to set it up, and contributions of many kinds, including financial, to

assist in the day-to-day running of the place Government has provided funding support

in the past but there is no guarantee that this support will come every year

House of Hope faces a number of challenges Some care-givers leave the responsibility

of caring for children entirely to the centre, and do not execute parental duties as and

when necessary, for example in cases of medical follow-up Some children do not receive

adequate care from care-givers The centre is faced with the challenge of referring such

children to social workers for appropriate placement Some community members do not

understand the role of the centre, stigmatising people working at the centre as being

HIV-positive The greatest challenges for House of Hope are staff shortages and financial

constraints

Total Community Mobilization programme

The Botswana National AIDS Coordinating Agency (NACA) and Humana People to People

(an international NGO working in the field of international development and cooperation)

started the Total Community Mobilization (TCM) programme in January 2001 The

programme started in Palapye in October 2001 and since then has been scaled up to

different parts of the country Palapye was one of the areas that were targeted, especially

when the antiretroviral drug programme started

The field officers visit, give lessons and provide information on HIV/AIDS to people in

the community The TCM fieldworkers visit households more than once and assist people

to make decisions on safer sexual behavior, Voluntary Counselling and Testing (VCT),

the use of antiretroviral drugs (ARV), Prevention of Mother to Child Transmission of HIV

(PMTCT) and positive living

In relation to orphans and vulnerable children, TCM assists with the identification of

orphans, referrals to the Social Welfare Department for registration, as well as providing

psychosocial support through counselling

One of the major challenges in relation to orphan care has to do with being able to

identify orphans, especially those in need of care It is also difficult to identify vulnerable

children and refer them for services, as most of them live on the streets and following

them up is not easy It is also not easy to identify the needs of OVC, as these vary from

food to love, clothing, security, shelter, education and information The field officers

realise that in some cases, the children’s rights are violated and the challenge for them is

in being able to know how to advocate for these children

Churches

The church is also actively involved in the care of OVC There were many churches

offering different community services There were two churches that specifically had

programmes related to OVC, namely Bible Life and Divine Firm Foundation of Life

Healing The services that the churches offer include feeding, recreation, rehabilitation,

counselling, transportation, and bible-sharing services Divine Firm Foundation of Life

Healing church mentioned that it has a youth impact training programme, where youth

are trained to offer care and support to the elderly and underprivileged Bible Life is

able to reach 60 OVC per month, providing them with food, counselling and transport

transportation and the human resources that it so much needs in order to reach out to needy populations.

The church knows about HIV/AIDS and feels it is the youth who are mostly infected Alcohol use is viewed as contributing to the transmission of HIV/AIDS The church supports people who go public about their HIV/AIDS status

Conclusion

Palapye, one of the largest villages in Botswana, falls within the Serowe/Palapye district where HIV prevalence is estimated at 43.3% There are about 1 743 registered orphans in Palapye who benefit from government support, which ranges from food rations, clothing and school requisites However, this programme is faced with challenges, such as abuse by caregivers, delays by government in delivering supplies, and issues of housing

sub-Despite the high HIV prevalence in the community, there are generally low HIV/AIDS education levels, which are further hampered by beliefs and misconceptions

The Botswana government has been innovative and resourceful in providing services

to the community It has ensured that HIV/AIDS is a crosscutting issue, with all its

departments having HIV/AIDS programmes The Education Department has been able to provide schools, aid for destitute children, and has also incorporated a feeding scheme The Ministry of Local Government, in addition to managing the OVC and destitute

programmes, also collaborates with NGOs/CBOs to advance its mission The Ministry of Health has ensured basic access to health facilities by establishing a primary hospital, four clinics and health posts In addition, patients on the antiretroviral programme get access

to drugs at a nearby hospital

There are many NGOs/CBOs in the community providing services, including based care, OVC care, life skills and empowerment training programmes Another

home-important element is the role of FBOs in the provision of community support, as they tap into the larger community Despite their countless successes, these organisations are constantly threatened by lack of funding, finding members of good calibre, and erratic community support Some of the problems that face orphan care in this area are a lack of psychosocial support and the disintegration of the extended family, due to the growing number of orphans and vulnerable children in the nation

GN Tsheko, MS Segwabe, LW Odirile and SD Tlou

Description of the site

Letlhakeng is situated in Kweneng West District It shares borders with the Khutse Game

Reserve in the West, Lentsweletau Sub-District in the North, Kweneng District in the East

and Southern and Kgalagadi Districts in the South West Letlhakeng is the capital of the

sub-district It is about 120 kilometres west of Gaborone, the capital city of Botswana The

population of Letlhakeng is 6 032 with 3 339 females and 2 693 males (Central Statistics

Office 2001) Females comprise 55.3% of the population

Letlhakeng is primarily a rural district and the communities depend on farming for

survival In some cases, families depend on hand-outs from government provided under

the destitute programme Though the dominant language is Setswana, the community

also uses other minority languages such as Sekgalagadi and Seshaga This is a typical

settlement with traditional housing, where most of the households do not have running

water, proper sewerage or electricity The department of Water Affairs provides standpipes

for use by villagers who do not have running water in their homes Most families use

fire-wood to cook, as opposed to using gas or electricity

Letlhakeng’s community still embraces the extended family culture of caring, although

there are signs that the extended family has begun to disintegrate The extended family

that has always provided a safety net is now undergoing tremendous social and economic

change that has a direct impact on the ability to provide care for orphans and vulnerable

children The socioeconomic developments taking place in the country have had both

negative and positive impacts One of the negative impacts has been the break-up

of the extended family, as more and more family members move into towns to seek

employment As a result of these movements, and the rise in the cost of living, family ties

are stretched, hence a tendency to have more nuclear as opposed to extended families

These social challenges have encouraged child-headed households

Letlhakeng has both the traditional and modern types of leadership: the headman, state

officials such as the police, political councillors and members of parliament Letlhakeng

village serves as the capital of the sub-district, so that residents from Kweneng sub-district

access most services from this village The infrastructure in Kweneng West is generally

poor The communities do not have easy access to different shops (food, furniture,

and clothing), public phones, public transport, electricity, water, tarred roads and other

amenities

There is one clinic with a maternity wing This is a government-supported facility

that provides for the healthcare needs of the community, including those of orphans

and vulnerable children The Scottish Livingstone hospital in Molepolole, which is 60

kilometres away from Letlhakane, provides an array of services to benefit people living

with HIV/AIDS These include PMTCT, treatment for Sexually Transmitted Infections and

by BOTUSA (a Botswana-US government joint initiative) The tarred road between

Letlhakeng and Molepolole makes communication and travel affordable

Through the Ministry of Local Government’s social welfare division, Letlhakeng orphaned children benefit from the orphan care programme This programme identifies and

registers orphans, as well as provides monthly rations in the form of food and toiletries Clothing is provided on a yearly basis By December 2004, the program had registered

542 orphans (Ministry of Local Government: Department of Social Services 2004)

There is one primary and one junior secondary school, and these are operated mainly through the Ministry of Education There are two day care centres in Letlhakeng and both are privately owned This means that parents have to pay for their children to go to the day care centre

General conditions facing OVC

Most OVC in Letlhakeng are born to single mothers The caregivers are therefore from the mother’s side and are mostly grandparents or elderly relatives, who are not able to provide proper care In some cases, the caregivers have to move in with the children bringing their own families along There are cases of child-headed households in

Kweneng West Most of the caregivers are poor and are supported through the destitute policy or old age pension scheme, whereby everyone who is aged 65 years or over draws

a monthly salary of P110 (US$18), whatever their socioeconomic status This is meant to assist in taking care of their basic needs, such as food and personal hygiene items Some elderly caregivers use these benefits to take care of their own needs as well as the needs

of the children with whom they live The conditions under which OVC are raised indicate that most of them live in poverty Indicators of poverty observed here include single mother households, elderly caregivers, and child headed households

When orphans are registered with the national orphan care programme, they become entitled to government support, which includes food, blankets, uniform and clothes In some cases, these benefits are misused/abused by caregivers and do not entirely benefit the orphans In cases where caregivers move in with orphans, bringing in their families, they end up taking the supplies of orphans to feed and clothe their own children Some

of the caregivers sell the provisions in exchange for alcoholic beverages

As far as abuse is concerned, the situation is similar to Palapye Depending on the

socioeconomic conditions of individual OVC, families can also be assisted with temporary shelter, as there are cases of families where parents died leaving children behind without any form of housing In some cases, the presence of care-takers brings in the possibility

of sexual abuse The abused children are likely not to report such incidents, leading to an increase in child sexual abuse Orphans also suffer other forms of abuse, such as where the care-taker expects orphans to run improper, unusual businesses, such as the sale of alcohol for long hours, without sharing the responsibility with other children in the home Housing is reported as an area of concern in caring for OVC Most of the households have traditional housing with no running water, electricity or proper sewerage There is a

general feeling that government should assist by providing improved living conditions in

the homes, as opposed to providing orphanages The main reason offered is that when

housing is provided in the home, the care-giver would be able to give love and support

to the children, as well as ensuring that they stay together with their siblings and are

socialised into the same values, beliefs and traditions Orphanages were highly criticised

as not bringing any value to the life of the child, as the child would not have a family to

identify with, would not enjoy family love, care and respect, and hence would grow up

without any family values with which to identify

Challenges in caring for OVC

There are many challenges facing OVC Most of the caregivers are elderly grandparents

who also have their own personal problems such as ailing health, and so are not able to

provide proper care to OVC In providing care to these children, caregivers fetch water

from standpipes, cook, and sometimes before cooking have to prepare the sorghum (with

mortar and pestle), bathe the children, wash children’s clothing, take care of children’s

schools needs, and in addition do the day-to-day household chores Carrying out these

many chores is a challenge for an elderly person It becomes even more of a challenge

where one person is taking care of as many as ten orphans in one household When

there are many children to take care of, resources become over-stretched The support

that government is providing is critical and highly appreciated, but the food that it

provides demands preparation by someone with energy and strength There are cases

where the care-giver drinks alcohol and, therefore, in addition to being elderly, spends

less time at home taking care of the needs of children

Government support is available to provide for basic necessities such as clothing, food,

shelter and educational needs However, there are often delays in delivery of supplies,

especially clothing When clothing does not come, especially winter clothing, caregivers

are forced to spend meagre resources (money or livestock, if any) on winter clothing

for the orphans Orphans who live in extreme poverty sometimes go without winter

clothing if delays are experienced Housing is a major issue of concern, as in some

cases caregivers share rooms with the children, leading to overcrowding and unhealthy

conditions Families in Kweneng West live in poor conditions and the type of housing

that people live in confirms this, as observed prior to interviews

Knowledge of HIV/AIDS in the community

The respondents did not know the actual numbers of people who are infected with

HIV/AIDS, but generally they were in agreement that a lot of people in the community

are infected Some of the respondents believe that both the young and the old are

infected They claim that the young get the virus through unprotected sex, while the

older generation is generally infected through caregiving, because they do not always

take advantage of protective gloves provided through the health facilities Respondents

also believed that alcohol plays a major role in the transmission of HIV/AIDS, especially

among the youth It was reported that in some villages, families depend on home-brewed

alcohol to raise funds to run the family They said home brew tends to be cheaper than

other alcohol, and attracts both young and old customers Respondents further reported

that some people, especially youth, get infected with HIV/AIDS while drunk, as there is a

greater chance of having unprotected sex when one is drunk

Generally there is lack of knowledge about HIV/AIDS Those who claim to know

something about HIV/AIDS also exhibit some misconceptions around transmission, prevention and cure For example, some people still believe that having sex with a younger person would act as a prevention method The lack of knowledge is also

demonstrated by some caregivers who fail to use protective gloves when taking care of the sick as they believe that using gloves might be a sign that they are shunning their own children

There are sources of information about HIV/AIDS in the community, which include local health facilities and NGOs, although these are not considered adequate The problem identified is that people are not taking advantage of the available resources to learn more about HIV/AIDS As a result people continue engaging in risk behaviours due to ignorance The community feels that if HIV-positive people could go public with their HIV status, then prevention efforts would be enhanced Going public with one’s status would also help in destigmatising HIV/AIDS, as it is felt the community would then accept people living with HIV/AIDS, and not isolate and stigmatise them as is presently the case

Government departments and their services

Ministry of Education

This study site is in one of the less developed parts of the country Despite this, the government, through the Ministry of Education, has created schools to benefit children

in these areas Presently there are five primary schools and one junior secondary school

in the study areas Students who pass their junior certificate examinations are admitted

to senior secondary schools outside their villages of origin All schools falling under the Ministry of Education offer free but not compulsory education to all Batswana from primary through to secondary level

In the study sites, neither primary nor secondary schools reported having television sets which would allow students to watch the HIV/AIDS ‘talk back’ programme The junior secondary school in Letlhakeng is the only one that has been electrified

Ministry of Local Government

Kweneng West has both the orphan care programme, which takes care of all registered orphans, as well as the destitute persons programme, which cater for children both below and above 18 years old who are vulnerable Both programmes get allocated funds on a yearly basis Due to the high demand for the services provided, the funds allocated are always exhausted before the end of the financial year

Ministry of Health

The study site does not have a primary hospital, but has two clinics namely Letlhakeng and Khudumelapye These clinics both have a maternity ward There are five health posts, with three located in Letlhakeng and the other two located at Diphuduhudu and Dutlwe The study sites also have ten mobile healthcare stops Mobile stops are common

in most settlements where there is no physical structure in place to provide healthcare People who live in these settlements are usually aware of the days that stops are made at their settlements

The nearest primary health hospital is in Molepolole, the capital for the Kweneng District, which is 60 kilometres away The nearest referral hospital is in Gaborone (capital city)

and is about 120 kilometres east of Molepolole The Ministry of Health and the Ministry

of Local Government administer the health systems and services between them The main

challenges in healthcare are shortages of staff, especially nurses and doctors, and in some

cases access in Kweneng West is a serious obstacle

Residents of Kweneng West, both adults and children, access the antiretroviral therapy

programme from Scottish Livingstone Primary hospital (in Molepolole) or Princess

Marina Hospital in Gaborone if they choose to do so Availability of public transport

between Molepolole and Gaborone is excellent, as there are buses leaving either area at

least every one hour Travel is also made easier by the fact there is a tarred road from

Gaborone to Letlhakeng, going via Molepolole According to the Masa antiretroviral

programme, by the end of March 2004, there were 26 603 patients with CD4 cell counts

less than 200 and/or AIDS defining illnesses in Botswana Out of these 14 400 were

already on therapy through the government programme, with 155 in Molepolole (no

specific information for children is provided) (Ministry of Health 2004)

NGO, FBO and CBO services

Home-based care

Home-based care volunteers in Kweneng West care for orphans and vulnerable children,

as well as other members of the community who are ill The services they provide to

OVC include referring them to social service providers so that they can be assessed

and enrolled in appropriate programmes, as well as visiting homes to find out how

families are coping with the burden of orphans and providing support The caregivers

acknowledge that there are lots of OVC who are cared for by the government As in

Palapye, one of the strengths of the government orphan care programme identified by

home-based care volunteers is that the supply and availability of food is always on time

Also as in Palapye, items such as seasonal clothes take such a long time to reach those

concerned that winter supplies for example, may only arrive after winter

Apart from the government’s involvement, the community is also supportive to those

affected and infected, and to the home-based care programme, hence the programme

gets a good number of volunteers The main problem that the volunteers face is

transportation There is a critical shortage of transport, compounded by the fact that

villages/settlements in Kweneng West are far apart, and the roads are in very poor

condition Lack of transportation limits the number of volunteers who can get involved

with the project, as well as the number of households that can be reached to provide the

much needed service

Home-based care volunteers have little knowledge of the HIV/AIDS policy However, the

caregivers are aware of the antiretroviral drug programme offered through Molepolole

Primary Hospital, and they encourage their clients to test and enrol with the programme

as appropriate They also encourage their clients who are taking treatment to adhere to it,

and provide psychosocial support

Home village health committee

Home village health committees are non-income generating groups that work closely with

nurses and assist in caring for sick people and OVC, as well as in keeping the villages

clean All the villages in Kweneng West have village health committees and these are run

by volunteers The groups get oriented to health concerns in the village by the nurses

is best for sick people and OVC In response to these challenges, the groups have started sourcing funds to provide shelter for orphans The main challenge they have in achieving this aim is that the groups do not have skills in proposal writing, so it is difficult for them

to put together well-written proposals which they can send to prospective sponsors.OVC and village development committees

This group works closely with the Social Welfare Development Officers The group is made up of volunteers whose main contribution is to the care of orphans This involves going around the settlements/villages to identify orphans who have not been registered Not all the settlements/villages in the study site have these committees The settlements/villages that do not have OVC committees have what they call village development committees (VDC) which, in addition to addressing developmental issues, also address OVC issues Once they have identified new orphans, they pass these names to the social welfare officer for assessment and registration in the orphan programme The group also does follow-ups in OVC homes to ensure that OVC are well cared for and that their handouts are not misused The number of people who volunteer to be in these committees also differs from one settlement/village to the other, as membership is based

on interest and whether one has the time to commit to the project

Most of the settlements and villages in the study site are very small, and as a result there are good working relations between the different committees The committee members understand their different roles and work towards meeting the different goals and

complementing each other’s efforts However there are challenges which were identified, which include laziness on the part of some members, poor cooperation between

members, as well as the wish for some volunteers to be paid

Conclusion

Letlhakeng is a traditional community of extended families that have always provided a safety net, now undergoing social and economic changes that has a direct impact on the ability to provide care for orphans and vulnerable children These social challenges have encouraged child-headed household which is a serious challenge

Most of the OVC are born to single mothers, and the caregivers from the mother’s side are mostly grandmothers or elderly relatives who are unable to provide proper care There are also cases of child-headed households in Kweneng OVC often lack of enough care and emotional support The elderly caregivers have their own health, physical and social challenges The support that the government provides is critical and highly appreciated, but carers often lack the energy to prepare it

Not many people in Letlhakeng have enough knowledge on HIV/AIDS issues Young people are thought to get infected through unprotected sex, while the older generation

is thought to be infected through care-giving Generally, there is enough information

dissemination on HIV and AIDS through sources of information in the community, which

include local health facilities and NGOs, CBOs and FBOs The problem identified is that

regardless of all these sources, people are not taking advantage of the available resources

to learn more about HIV/AIDS

There are relatively few NGOs, FBOs and CBOs in Kweneng West, leaving serious

gaps in the support of OVC Despite this challenge, the spirit of volunteerism is present

within this community, as evidenced by the presence of more than two initiatives that

mainly use volunteers to run on a daily basis These groups include the Home-based

Care, Village Health and the OVC Committees and they are putting a lot of their time

into making a contribution towards the care of OVC and other sick persons The groups

however are poorly resourced, as evidenced by lack of transport to assist in making

home visits easier in the case of the home-based care groups Even though the village

health committee in this area has a garden project, lack of transport makes it difficult to

deliver vegetables to their clients who are at home and not able to come to the clinic

Lack of gardening skills is another challenge, as most of the volunteers garden on a trial

basis, while they live in a country that always experiences high temperatures and is prone

to droughts and water supply can never be guaranteed Volunteers in these groups also

lack the skill to put together well-written proposals that can win them sponsorship to

improve on their projects

One of the observations made is that the churches in the Kweneng West area do not

seem to play an active role in the care of orphans and vulnerable children, as compared

to the other sites The spirit of volunteerism in this area is left to the three Community

Based Organisations mentioned above The situation in the other sites was different, as

there are some churches involved in the care and support of OVC There is a need for

the church to get involved, as the church can play a significant role in addressing the

emotional and spiritual needs of OVC

GN Tsheko and A Kabanye-Munene

Description of the site

Serowe is situated in the Serowe/Palapye district It is one of the largest villages in

Botswana with a population of 42 444, 19 093 of whom are male, and 23 351 female

(Central Statistics Office 2001) This means females comprise 55%of the population

Serowe is in central eastern Botswana, about 300 kilometres north of the capital city

Gaborone Serowe is located in one of the fertile, well-watered areas of the country

This means that most people are engaged in farming, with most families depending on

livestock rearing and ploughing for survival Serowe is well known to have rich families

who have benefited from this sector As it is a centre of trade and commerce, many

people are employed by government in the Ministries of Health, Education and Local

Government

Serowe is a semi-urban locality and uses Setswana as the predominant language It also

has advanced infrastructure The community has access to different shops (food, furniture,

and clothing), public phones, public transport, electricity, water, tarred roads and others

It is a typical village where some families still reside in one-roomed traditional houses

that are made up of mud with a thatched roof and no proper sewerage Some families

reside in modern multi-roomed houses that have running water, proper sewerage and

electricity The Department of Water Affairs has provided community standpipes in the

village for use by villagers who do not have running water in their homes

The people of Serowe still embrace the traditional style of extended family culture of

caring, although there are signs that the extended family has begun to disintegrate The

extended family has always provided a safety net but is now undergoing tremendous

social and economic change that has a direct impact on the family’s ability to provide

care for orphans and vulnerable children The socioeconomic developments taking place

in the country have had both negative and positive impacts One of the negative impacts

at societal level has been the break-up of the extended family, as more and more family

members move into towns to seek employment As a result of these movements, and

the rise in the cost of living, families are no longer able to be as intact as they used to

be This has resulted in the tendency to have more nuclear type as opposed to extended

families Such constraints have led to child headed households

Serowe has both the traditional and modern types of leadership comprising of a chief,

and deputy-chiefs, district commissioner and other state officials such as the police,

political councillors, members of parliament and others

The Botswana 2003 second-generation HIV/AIDS surveillance does not single out Serowe

as a community but includes its numbers with those from the rest of the Serowe/Palapye

district The prevalence for the district was 43.3% in 2003 The healthcare system provides

an array of services to benefit people living with HIV/AIDS and these include PMTCT,

Through the Ministry of Local Government, Social Welfare Division, Serowe orphaned children benefit from the government orphan care programme The purpose of the programme is to identify and register orphans, as well as provide monthly rations in the form of food and toiletries Clothing is provided on a yearly basis By December 2004, the programme had registered 1 425 orphans.

General conditions facing OVC

The majority of the caregivers of OVC are grandmothers and aunts Some of these caregivers are illiterate and do not consider it necessary for the children in their care to attend school

In some cases, they literally hide these children in the back yards to make it impossible for anyone to reach them Only one orphan-headed household was identified during the visits, although there are many youth-headed households without a resident elder

Most households reported having to make few changes to cope with orphans and

vulnerable children, as these children had lived with them since they were born Some families reported that they are actually under less financial strain caring for orphans than they were during a period of caring for now-deceased parents

The majority of households caring for OVC were large, and over half had no resident income earner They mainly manage to meet the children’s material needs through

reliance upon the government’s food basket and clothing allowance, donations, and material and physical support from relatives and sometimes neighbours

So far, families have developed few coping strategies for managing emotional and

psychosocial experiences and consequences of fear, distress, grief and anger upon

terminal illness, bereavement and orphanhood Grieving grandmothers are often unable

to console the orphan, or even acknowledge the reality of losing a loved one This calls for the extension of psychosocial support systems in the community to help families cope emotionally

Challenges in caring for OVC

Discussions from the interviews indicated that a major concern in this community was the increasing number of orphaned and vulnerable children Registration of OVC with social workers is essential for providing basic care and support for them The support includes provision of clothes, school uniforms and food baskets However, non-registration of OVC was cited as a problem Some of the people interviewed identified limited knowledge on the part of families, of the procedures involved in the registration of the OVC, attitudes

of community members and caregivers towards registration of OVC, and lack of enough social workers as factors that contributed to the magnitude of the problem Some

individuals or families did not register OVC because of the stigma attached to poverty Some working caregivers felt too embarrassed to register OVC, because they believed that doing so implies they are poor

Some of the needs and challenges in caring for OVC were identified as follows:

Food: Some of the orphans and caregivers do not go to collect their food rations, due

to fear of stigmatisation There is a need to find ways to encourage the OVC to enjoy

their benefits and feel they are accorded privacy For example, it would be better for

the orphans to be given food coupons, in order to reduce the fear of stigmatisation

However, even for those who do collect their food rations, in some cases this food is not

well prepared (by the elderly grandmothers who take care of them) and worse still, some

caregivers sell the food rations There is misuse of food rations and sometimes caregivers

fight with orphans over the food

Clothes: Clothing includes school uniforms and casual clothing Some of the OVC are

shy and refuse to collect a school uniform even when they need it Some orphans refuse

scholarships and stigmatise the use of school uniforms

Shelter: Shelter was mentioned as the main problem and challenge facing the OVC and

their caregivers Though some of the OVC have proper shelter, most of them sleep in

one-roomed houses with other members of the family In many situations, it was found

that the houses OVC occupy with their relatives are not large enough to accommodate all

of them, or the house is in appalling condition This compromises the health, security and

privacy of the OVC and their caregivers

Resources: Another major challenge for the community, caregivers, state officials,

NGOs, CBOs, FBOs, and OVC was the shortage of resources Often the grandmothers

are unemployed, old and cannot meet the required standards of care for the OVC If

resources were available, there would be a need to have assistance in such households

As a community leader (the Chief) put it, ‘the community is overwhelmed and it can

not meet the challenges posed by this problem NGOs are helping and the churches are

playing their part but the resources are limited.’

Life style change and defiance: Orphans have difficulties coping with parental loss and

having to adapt to living with new families Physical changes cost them a lot emotionally

and it is a challenge to help them cope Some of the OVC lack self-control and give

caregivers a hard time They are disobedient and attempt to blackmail caregivers so that

they can have their own way

Stigma: Some respondents mentioned that the community stigmatises orphans This,

however, is beginning to change as people are starting to understand the difficulties

facing OVC and understand that they need support Some people, though, do not

understand what an orphan is There is a need for thorough education about OVC and

the opportunities accessible to them, both from the community they live in and from the

state

Knowledge of HIV/AIDS in the community

People in this community are knowledgeable about HIV/AIDS They acknowledge that

most local deaths are from HIV related causes However it was not hard to establish

that a significant number of caregivers and even older OVC do not grasp crucial facts

about transmission, prevention, and living with HIV/AIDS There are a lot of myths

and misconceptions about HIV/AIDS People need to understand that AIDS is a disease

without a cure, and also understand that ARVs only help to prolong life In some cases,

It was apparent that most of the OVC encountered had lost their parents to HIV/AIDS The consequent loss of family resources was evident, as OVC were often left with

minimal resources, due to the costs of caring for a sick relative Some respondents also mentioned that the state has used a lot of resources on HIV/AIDS matters, while companies and organisations have lost employees and families have lost breadwinners

To counter the spread of HIV/AIDS, most of the respondents agreed that disclosure of one’s status is very important and should be encouraged Open and close communication between children and parents was called for, to encourage open discussions on HIV/AIDS Most OVC do not discuss sexual matters with their caregivers or guardians It was recommended that reproductive health education should start early, so that OVC could make the right choices and avoid sexual relationships

Government departments and their services

Department of Social Services

The Department of Social Services under the Ministry of Local Government plays a pivotal role in the sustenance, security and development of OVC The OVC need support and to feel embraced by society so that they can comfortably realise their life aspirations The Department of Social Services provides the OVC with social counselling in situations like bereavement, sexual harassment, negligence and others Counselling is critical to support OVC psychologically and accord them a meaningful and hopeful future

The department also offers moral and psychosocial support to ensure that OVC are not subject to social ills like HIV/AIDS, rape, prostitution, crime, poverty and other forms of abuse or exploitation OVC are also provided with basic needs support such as foster care grants, education fees, child support grants, food rations and social relief The Social Services Department aims to protect OVC and accord them a chance to become citizens who contribute positively to national development

Challenges faced by the Department of Social Services:

• the number of children in need of care and protection, as well as the demand for shelter has been growing rapidly;

• the department is unable to provide some necessities, including clothing (other than school uniforms) due to budget constraints;

• shortages of staff: Limited resources often result in inadequate human resources, which leads to excessive work loads for those engaged Social workers are confronted with diverse simultaneous predicaments in dealing with, for example, orphans, the destitute, juvenile delinquents, etc In addition, the numbers of OVC increase every year and the department and its social workers are unable to cope with the demand for their services and the resulting workload;

• address problems: OVC change addresses without notifying the department, thus making it impossible to fully offer services as beneficiaries cannot be located; and

• unstable food purchase order: Food basket prices differ according to the supplier, making budgeting difficult