Responding to the needs of orphans and vulnerable children OVC in Cambodia KHANAs experience Pok Pan

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Responding to the needs of orphans and
vulnerable children (OVC) in CambodiaKHANAs
experience Pok PanhavichetrExecutive
Director, Khmer HIV/AIDS NGO Alliance (KHANA)
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Background to KHANA

• Established in 1996 as a project of the Alliance
• Registered as national NGO in 2000
• Mission to build capacity of Cambodian NGOs to
  respond to the HIV/AIDS epidemic
• Currently provides technical and financial
  support to 42 Local NGOs in 14 Provinces and 3
  municipalities
• USAID support for KHANA is through the Alliance
• KHANA receives direct funding from JSDF/World
  Bank, JICA, Global Fund, EU/UNFPA and UNAIDS
  (small grant)
• Ongoing technical support from the Alliance

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KHANA programme strategies

• KHANA works in partnership with local NGOs
  through the
• following strategies
• Mobilising NGOs and focusing resources
• Strengthening the capacity of NGOs and CBOs to
  implement
• HIV prevention
• Care and support for PLHA and their families,
  including children affected by AIDS
• Advocacy to reduce stigma and discrimination
• Documenting good practice and sharing lessons
  learned
• Strengthening strategic alliances to scale up the
  response to HIV/AIDS

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Why children?

• HIV prevalence rate is 2.6 (highest in SE Asia),
  with one third of new infections as a result of
  mother to child transmission
• 259,000 people (238,000 adults and 21,000
  children) have been infected with HIV in Cambodia
  since start of epidemic
• 94,000 people have died of AIDS
• 7.8 of children below 15 in Cambodia have lost
  one or both parents approximately 335,000
  children

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Participatory appraisal of CAA

• KHANA conducted participatory assessment of needs
  and resources of children affected by AIDS in Jan
  2000
• 900 people participated in the appraisal, 55 of
  whom were children, including 413 orphans
• Participatory tools eg drawing, mapping were used
  to encourage children to discuss the issues and
  to minimise personal disclosure
• Key findings CAA face many factors of
  vulnerability, poverty exacerbated by these
  factors, girls particularly vulnerable, adults
  saw orphanages as the answer but children
  disagreed
• Outcomes KHANA integrated care support for OVC
  into home based care programme. Currently
  supporting 29 NGOs to work with OVC
• 2 Project models supported (1) community based,
  (2) faith based

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Community-based response

• Children supported to remain in the community
  where they live (siblings, relatives, foster
  families)
• Integrate support for OVC with community
  development programmes to provide
• Income generation activities for carers and OVC
  themselves
• Welfare support, eg food (partnership with WFP)
• Support for schooling eg negotiation of school
  fees, school materials and uniforms etc
• Support to OVC regarding inheritance rights eg
  house, land etc
• Referral to vocational training (older children)
• Peer/psycho-social support eg retreats for OVC
• Stigma and discrimination activities with local
  community to mobilise support for OVC, including
  involvement of Buddhist monks and village elders

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Faith-based response

• Mobilise Buddhist monks to establish hospice for
  PLHA and child-care centres for orphans within
  the pagoda to provide
• Accommodation and food for homeless children
  (partnership with WFP)
• Medical care for children, including those who
  are HIV (ARVs through MSF-Belgium)
• Primary education
• Referral to vocational training (older children)
• Peer/psycho-social support eg sabbay sabbay
  days (happy happy days) for OVC
• Mobilise community to care for children within
  the centre and PLHA in the hospice

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Why these approaches?

• Several factors have led to the successful
  implementation of these approaches in Cambodia
• importance of family support structure (eg
  parents care/provide for children until they get
  married, children take care of parents in their
  old age extended families comprising 3
  generations live together)
• Buddhism is primary religion. Buddhist monks are
  highly respected and traditionally have a role in
  providing education to the community
• Lack of Government welfare support structures (eg
  no reliable pension, no unemployment benefit, no
  health insurance)
• Many community development programmes being
  implemented since 1993 by international and local
  NGOs, to re-build infrastructure and social
  support following years of conflict
• Home based care programme has provided an
  appropriate structure to respond to the needs of
  PLHA and OVC
• This approach may be relevant to other Buddhist
  countries eg Thailand and other resource-poor
  settings eg Burkina Faso
• Accommodation and food for homeless children
  (partnership with WFP)
• Medical care for children, including those who
  are HIV (ARVs through MSF-Belgium)
• Primary education
• Referral to vocational training (older children)
• Peer/psycho-social support eg sabbay sabbay
  days (happy happy days) for OVC

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Key Strengths of these approaches

• Both models described build upon existing
  community structures, thus promoting
• Community Involvement mobilising and maximising
  use of community resources
• Comprehensive responses Linking HIV prevention
  messages with care support and addressing
  stigma and discrimination
• Community cohesion Keeping children with their
  siblings and their community avoids dislocation
  and the need for re-integration in the future
• Potential Scale up putting communities at the
  centre of the response enables an easy expansion
  of coverage
• Sustainability relying on community resources
  (rather than external resources) is the
  foundation of long-term sustainability

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Main challenges

• Finding foster families Community members are
  often very poor, causing difficulties in
  identifying appropriate foster families
• Ensuring safety and welfare of children Risk of
  children being exploited or abused
• Access to employment for older OVC Competitive
  job market can not guarantee enough money to feed
  their families, even for those with vocational
  training
• Lack of genuine consultation with children Many
  people think orphanages are the answer. Children
  are rarely asked about their needs or desire.
• Replication of model Difficulties in convincing
  others (including some donors) of the value of
  community-based approach, when they favour
  orphanages

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Lessons learned

• Participatory assessment and ongoing consultation
  with children about their needs is essential for
  developing appropriate and effective responses
• Home based care programmes are the entry point
  to
• Identifying and providing comprehensive support
  OVC
• Mobilising community members, including PLHA, to
  take care of children
• Involving monks contributes to psycho-social
  support for children accommodation, food,
  educations and counselling
• Integration of HIV/AIDS into community
  development maximises support for PLHA and OVC eg
  micro-credit schemes, income generation,
  vocational training