VSO RAISA - scaling up support for Southern Africa’s caregivers

1. VSO RAISA - scaling up support for Southern Africa’s caregivers Clive Ingleby Global Adviser – health, HIV and AIDS

2. VSO RAISA strategic approach - the ‘theory of change’ • 1. Problem identification: • SADC Gender Protocol (2008) - all states should have a policy on care givers. • VSO/WHO research (2009) - South Africa, Malawi, Mozambique, Namibia, Zambia, Zimbabwe • Over 70% of those providing home based HIV and AIDS/PHC services in SADC countries are women and girls • Burden of care on women and girls overwhelming (at risk of further impoverishment) • Usually not compensated for unrecognised and unsupported work • 2.Further research and good practice identification: • Supported/informed by direct experience on the ground – RAISA’s work with CSOs • 3. Evidence produced will support influencing of SADC parliamentarians: • To establish national advocacy champions for care givers in 7 SADC countries • 4. Care givers policies will be passed in up to 7 SADC Countries: • To be drafted, adopted, resourced and implemented • 5. End result • Improved conditions for home based carers leading to better care for PLWHIV

3. Processes followed to bring about change... • Research: • Initial joint research followed by further research on care givers conducted across the region • Capacity building: • Civil society – in 6 countries to create models of HBC good practice and to inform research and advocacy activity • SADC Parliamentary Forum – to build capacity of MPs including eg. • Presentations at SADC PF meetings • Policy handbook for MPs • Exposure visit to Namibia to observe good practice • Training in advocacy, lobbying and representation by a VSO ‘PolVol’ (Baroness Margaret Jay) • Regional alliance building: • Regional alliance created with other prominent stakeholders eg. IFRC, Oxfam, World Vision, Save the Children to support advocacy and lobbying efforts with SADC • Lobbying for HBC policy change: • National meetings in 6 countries with eg. Ministers of health, ministers of gender, NAC directors, UNAIDS, WHO, NGOs, CBOs to lobby for HBC policy change

4. Impact (1) – results from Zimbabwe • National and Community Homes Based Care Policy approved August 2012 • launched by Deputy PM ThokozaniKupe at the VSO RAISA conference in Pretoria in November 2012 • Recognises the contribution made by caregivers and supports stronger linkages between community health services and health service providing facilities • Standardisation of HBC support packages including: • Provision of HBC kits (distributed by ministry of health) • Training delivered to HBCs in line with national guidelines • Commitment to remuneration of care givers enshrined in the policy • Implementation of the policy begun in 2 provinces with intention to scale up once more resources secured • Initial feedback from CBOs suggests: • Improved coverage and quality of care reported by PLWHIV eg. access to ART • Increased # of male caregivers reducing burden of care on women and girls • Evaluation of impact to be conducted by VSO RAISA and WHO in August 2014 • Will focus on changes in the lives of HBCs and PLWHIV and whether this can be attributed to policy change. Baseline study already conducted • -

5. Impact (2) – building momentum across the region...and beyond. • Mozambique: • Mozambique MPs supported by VSO RAISA led calls for a law in care givers policy in parliament in December 2012 • ‘National Policy for the Provision of Community and Home Based Care Services’ drafted in Feb 2013 and currently being discussed in parliament • Zambia: • Zambian parliamentarians supported by returning VSO PolVol Baroness Jay to draft care givers policy in August 2013 • Regional and International Advocacy: • HBC presentation made to SADC Gender Ministers meeting in Maputo (Feb 2013) • The issue of HBCs promoted on international stage by Zimbabwean Deputy PM at Commission on Status of Women UN Conference in New York (March 2013) • Shared good practice from Zimbabwe to push governments to put policies in place that support women and girls • Lobbying of DFID to champion community health workers including those who volunteer at forthcoming 3rd Global Forum on Human Resources for Health ( in Brazil in November 2013)

6. Learning • Evidence based research informed by direct experience on the ground is essential to bring about policy change – civil society (CBOs/ NGOs/INGOs) provide the bridge between communities and policy makers • Representation of care givers and PLWHIV as part of the advocacy and policy development process is essential • - Invest in building the capacity of parliamentarians and other key influential stakeholders to build strong and influential support within legislative structures • Be prepared and able to respond to political change eg. National elections resulting in changes of government and ‘make-up’ of legislative structures (Malawi, Zambia) • Bringing policy makers together from different countries supports experience sharing, builds awareness of common issues and encourages the development of cross-border alliances leading to the potential for increased impact – one of the key ‘added values’ of regional programming • Attributing change to policy implementation is a challenge (need to develop M&E systems that address this) • Using HIV and AIDS HBC experience to strengthen wider community health care systems (integration) is the way forward

7. Thank You