Frédérique Vallières , Adebola Adedimeji , David Kimani & Esther Nyokabi

1. A community based participatory situational analysis of orphans and vulnerable childrenRIFT VALLEY PROVINCE, KENYA FrédériqueVallières, AdebolaAdedimeji, David Kimani & Esther Nyokabi

2. Background • 47.5 million children in sub-Saharan Africa have lost of one or both parents(WHO 2010) • Burden of caring for additional children falls on ageing populations(Bicegoet al. 2003, FHI 2005, UNICEF 2005)

3. What are OVC? A construct often used to categorize children who are orphaned and/or who are at an increased risk of long-term damage caused by material, emotional and social deprivations in their environment (Skinner 2006).

4. What are OVC?

5. What are OVC?

6. What are OVC? A Kenyan context • Actual number of orphans is unknown but 2.4 million orphans are said to be in need of care and support (CGHD 2009, NACC 2009) • According to the National AIDS Control Council,11% of children under the age of 15 are orphans (NACC 2007) • The government of Kenya has a national action plan specifically directed at OVC (NACC 2009) • The Kenyan government has yet to agree on a working definition of OVC (CGHD 2009) • Government discussions on OVC in Kenya focus primarily on factors directly related to HIV (NACC 2009)

7. What does past researchsay about ovc?   • Mental health risks: anxious and depressive symptoms and disorders (Atwineet al. 2005). • Morbidity • Physical health risks: diarrhoeal, acute respiratory, HIV infection (Watts et al. 2007) • Underperformance in school (Ainsworth et al. 2005) • Food insecurity (Schenk et al. 2008) • School enrolment and attendance rates (Case et al. 2004, Mishraet al. 2007) • Access to schooling (Andrews et al. 2006) • Access to health services (Andrews et al. 2006) • Household incomes (Booyseen & Bachman 2002) • Food consumption (UNICEF & UNAIDS 1999)

8. Rationale • A need to scale-up responses towards OVC to respond to their needs • A need to conduct countrywide situational analyses OVC to assess risk • A need to increase the use of longitudinal follow-ups as a method of evaluating the effectiveness of OVC programmes over time

9. CBPR – Community based participatory research “A collaborative approach to research that engages partners from a community in all phases of the research process with a shared goal of producing knowledge that will be translated into action or positive social change for the community”Lantz et al. (2006, p.239)

10. Research Objectives • Identify the definition of OVC employed by local community-based interventions and compare it to the Kenyan government’s conceptualization of OVC. • Conduct a situational analysis of the OVC currently participating in the OVC programme. • Identify the most pressing needs of the OVC • Make specific recommendations on how and where to allocate available resources to the OVC in this context. • Make specific recommendations on how to improve the future training of community based care workers.

11. Methodology Questionnaire Focus Group Discussions • Food intake, education, child’s relationship with guardian, HIV and AIDS, risk-taking behaviour • Translated and back translated • Pilot tested and trained interviewer • Analysed using Excel • 173 Questionnaires analysed. • Addressed the same topics as covered in Qs • Limited to 16-18 year olds • 7 females and 8 males in two different FGDs • Conducted by a nurse and public health officer • Analysed using FrameWork Approach (NCSR 2010)

12. Results – Criteria for OVC • Their parents are living with HIV and AIDS • Are orphaned • Have parents or care givers who are ill or about to die • Do not have parents, a family or a home • Live in area with high HIV prevalence or proximity to high risk behavior • Live on the streets • Girl children are mostly considered vulnerable • Have their parents or guardians are in prison • Are isolated and discriminated against • Living on their own in child-headed house hold • Living in an unsupportive or unhealthy environment • Have inadequate medical care • Have a disability

13. Results – Criteria for OVC • Their parents are living with HIV and AIDS • Are orphaned • Have parents or care givers who are ill or about to die • Do not have parents, a family or a home • Live in area with high HIV prevalence or proximity to high risk behavior • Live on the streets • Girl children are mostly considered vulnerable • Have their parents or guardians are in prison • Are isolated and discriminated against • Living on their own in child-headed house hold • Living in an unsupportive or unhealthy environment • Have inadequate medical care • Have a disability

14. Results – OVC descriptives

15. Results – OVC categorisation

16. Results – Education At the time of the interview, participants had spent an average of 5.88 years in school (SD=3.132776545, CI95 =5.4, 6.3)

17. Results – Relationship to guardian

18. Results – HIV and AIDS • “Among those who use condoms, some use it occasionally while others use all the time but the majority use [condoms] all the time, owing to the fact that they are nowadays distributed for free by the government” • “AIDS is just a small disease and [some boys] think that you are naïve if you don’t have a girlfriend or AIDS” • “Principally use condoms to avoid getting pregnant, it is not even to avoid AIDS”.

19. Results – Risky Behaviour “Cleaning” • “Cleaning is a famous Kikuyu traditional practice in which the newly circumcised boys are supposed to have sex immediately after healing, to clean the chemicals and medicine that was used on their organ during healing after the cut. They are then not supposed to have sex with that ‘cleaning girl’ ever again, otherwise they will be cursed and their private organs will burst…many promptly fulfill their promises.” (Boy, 17 years old)

20. Results – Risky behaviour • “You’ll often find for us girls maybe you need something but the parent is not able to provide for that. So if we can’t get what we want we always go for alternatives, and most times we find ourselves desperate and desperate times call for desperate measures. So this drives us to engage in things that are not helpful in our lives.” (Girl, 17 years old)

21. Discussion • A pressing need to develop an agreed upon definition of OVC that seeks guidance at the community level and allows for the different contextual interpretations of vulnerability • A need for national and international responses to be more flexible in their definition of OVC • Community groups are an important resource to assist in data collection assessing the needs of OVC as it is understood in each community

22. Discussion

23. Discussion - recommendations

24. Conclusion • Supporting already existing community interventions and defining OVC at the community level we can decrease the risk of excluding children from programmes. • Reduce the probability that they will become OVC in the first place. • i.e. Increasing access to ARV for HIV +ve • Not increasing services to OVC only. Rather, what is more appropriate, is improving the access of all children to health, education and welfare services.

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