Jenny: HIV is affecting millions of African children—the scale is overwhelming. Yet seemingly simple, single actions can make a tremendous difference in a child’s life. Children First sees this every day by working at the grassroots level. What do you think is the smallest scale act (single thing) implemented by the program that is yielding the biggest positive result or change for OVCs in Zimbabwe?
Susan: Twenty-five percent of children in Zimbabwe are orphaned or very vulnerable. The scale is huge, with 3.5 million children living below the food poverty line. About 90% of the care burden falls directly on family members and the community.
The most important accomplishment of this project has been making people listen to children. I mean really listen to them. It’s not a symbolic action, the truth is that if you don’t listen then you wouldn’t know what the problem is and you can’t fix it. It seems obvious, but in program design it isn’t. We have demonstrated that it’s imperative to design your program to allow children’s voices to reach decision-making levels. Our project has a child advisory group, which meets on Saturdays to ensure these school-going children are able to attend. What that means is that our project staff have to be flexible with our schedules to meet the children’s needs.
We’ve also facilitated a public-private dialogue by linking home-based care programs to health facilities, and really getting the attention of facility-based providers. This strengthened link between community and clinics has resulted in a much shorter window of time between a child testing positive for HIV and starting ARV treatment, reduced from a 4-6 month gap down to 3 weeks. This is not just about being more effective and saving time —it’s about saving lives, really a difference between life and death.
Jenny: In 2008, a month after the Children First program in Zimbabwe began its work, contentious national elections compounded a politically unstable situation: school and health systems shut down, and the economy collapsed. What made you/World Education/Bantwana stay in such a difficult environment?
Susan: The point of even being there was to help vulnerable populations, those most in need. That’s what Bantwana is about, looking for local solutions to community problems. You don’t leave because things get difficult—in fact, it created more of a reason to be there! The question was really how do you work? Logistically, yes the context was difficult, but in fact I have found that the “soft challenges” found elsewhere in Africa are not as present in Zimbabwe. I have worked in other country settings with soft challenges like corruption and lack of commitment, whereas the difficult situation in Zimbabwe actually has forced donors to become more coordinated, more determined, and less competitive than elsewhere. And the local communities and civil servants we work with in Zimbabwe are really supportive and receptive and less jaded than other places. That’s really the positive lesson. Yet it was frightening to live and work in such a violent environment in 2008 and 2009; it really felt—and was— like being in a justice vacuum. Providing aid was seen as a political act.
Jenny: How does the fact that Children First maintained its presence through the 2008/2009 difficulties affect/influence the program’s work now?
Susan: We have more credibility with all the partners and end recipients. By being there throughout, we built trust and so much of what we do well is based on that. Also, we have an appreciation of the challenges, which makes us more sensitive to the technical needs and realities of our partners. We understand where they are, and so we can go a lot deeper in our work and have that much more of an effect.
Jenny: What are the greatest remaining gaps for children in Zimbabwe? How could we better meet their needs?
Susan: OVCs accessing health services in local clinics is still a major problem. Kids are referred to clinics via school where they are assessed. Even when a child is able to get to a clinic, there is often a lack of supplies and drugs. The problems in Zimbabwe, like in other places, are systemic. We at JSI and World Education are in a unique position because we have a good relationship with the Ministry of Health and can reinforce areas of collaboration.
Jenny: What lessons have been learned in Zimbabwe that you feel could be applied in other settings, such as Uganda where you are from?
Susan: Two things, mainly: firstly that—with sustained efforts— a small group of people can really make a big difference toward effective links within a public health services delivery system—you just don’t stop. I really appreciate that now. Secondly, that to narrowly interpret program targets limits us (program implementers) from finding solutions that serve a broader group of people. We are really anchored in the community where the demand happens and there’s a lot of work still to be done in linking to supply programs.
At Children First, we are developing training materials and step-by-step resources to leave behind once this project is over, for local groups to use going forward. This is how we are transferring local solutions—generated by the communities themselves—into replicable models. We are taking great efforts to ensure that the program will leave behind useful tools to take the work forward.