A baseline study on psychosocial support of orphans and vulnerable children in two villages in Botswana GN Tsheko K Bainame LW Odirile & M Segwabe Free download from www.hsrcpress.ac.za Compiled by the Masiela Trust Fund’s OVC Research Unit, Botswana, in collaboration with the Social Aspects of HIV/AIDS and Health Research Programme, Human Sciences Research Council, South Africa Published by HSRC Press Private Bag X9182, Cape Town, 8000, South Africa www.hsrcpress.ac.za First published 2007 ISBN 978-0-7969-2178-9 © 2007 Human Sciences Research Council and Masiela Trust Fund Copyedited by David Le Page Typeset by Simon van Gend Cover design by comPress Print management by comPress Distributed in Africa by Blue Weaver Tel: +27 (0) 21 7014477; Fax: +27 (0) 21 7017302 www.oneworldbooks.com Distributed in Europe and the United Kingdom by Eurospan Distribution Services (EDS) Tel: +44 (0) 20 7240 0856; Fax: +44 (0) 20 7379 0609 www.eurospangroup.com/bookstore Distributed in North America by Independent Publishers Group (IPG) Call toll-free: (800) 888 4741; Fax: +1 (312) 3375985 www.ipgbook.com Free download from www.hsrcpress.ac.za Tables and figures iv Acronyms and abbreviations v Acknowledgements vi Executive summary vii The situation of orphans in sub-Saharan Africa 1 Overview of the OVC situation in Botswana 1 Government response to the plight of orphans 2 Background to the OVC project 4 Objectives of the study 5 Description of study sites 6 Populations and samples 8 Study instruments 9 Ethical considerations 10 Data collection procedures 10 Data management 11 Orphans and vulnerable children ages 6–14: Survey findings 12 Discussion of findings: OVC ages 6–14 in Palapye 15 OVC ages 15–18 in Palapye: Survey findings 18 Discussion of findings: OVC ages 15–18 in Palapye 24 Parents/guardians of OVC in Palapye: Survey findings 27 Perceptions of HIV/AIDS and other health-related issues 29 Discussion of findings: Parents/guardians of OVC in Palapye 30 Orphans and vulnerable children ages 6–14: Survey findings 32 Discussion of findings: OVC ages 6–14 in Letlhakeng 35 OVC ages 15–18 in Letlhakeng: Survey findings 36 Discussion of findings: OVC ages 15–18 in Letlhakeng 42 Parents/guardians of OVC in Letlhakeng: Survey findings 43 Perceptions of HIV/AIDS and other health-related issues 45 Discussion of findings: Parents/guardians of OVC in Letlhakeng 46 Conclusions 48 Recommendations 49 Free download from www.hsrcpress.ac.za iv Table 3.1: What OVC 15–18 in Palapye miss about their late mothers – percentage distribution by gender 21 Table 3.2: Quality of relationships between OVC 15–18 and their guardians, in Palapye 21 Table 3.3: Primary confidants of OVC ages 15–18 in Palapye 23 Table 3.4: Most common health problems mentioned by OVC 15–18 in Palapye 24 Table 3.5: Employment status categories of parents and guardians of OVC in Palapye 28 Table 3.6: Key needs of OVC in Palapye, as identified by parents/guardians 28 Table 4.1: OVC 15–18 in Letlhakeng: Household resources 38 Table 4.2: Primary confidants of OVC ages 15–18 in Letlhakeng 39 Table 4.3: Factors leading OVC in Letlhakeng to feel hopeful about life 40 Table 4.4: Employment status of parents and guardians in Letlhakeng 44 Table 4.5: Key OVC needs described by parents and guardians in Letlhakeng 45 Figure 1.1: Trends and patterns of registered orphans from 1999–2004 2 Figure 1.2: Specific needs of orphans and vulnerable children 4 Figure 2.1: Map of Botswana 6 Figure 3.1: OVC 15–18 in Palapye: Reasons for not attending school, by gender 19 Figure 4.1: OVC 15–18 in Letlhakeng: Reasons for not attending school, by gender 37 Free download from www.hsrcpress.ac.za v CBO community-based organisations FBO faith-based organisation HIV/AIDS Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome 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/AIDS) PSS psychosocial support SADC Southern African Development Community SPSS Statistical Package for Social Sciences STI sexually transmitted infection VCT voluntary counselling and testing (for HIV/AIDS) WKKF WK Kellogg Foundation Free download from www.hsrcpress.ac.za vi The researchers and authors of the document, Dr GN Tsheko, Mr K Bainame, Ms M Segwabe and Dr LW Odirile would like to thank all those who made it possible for this work to be completed. This study was supported by the Kellogg Foundation and undertaken by Masiela Trust Fund OVC Research-Botswana under the umbrella of the HSRC in South Africa. The researchers are indebted to the field assistants, all respondents, and community leaders in Palapye and Letlhakane who participated in this study. A special thanks goes to Dr K Solo and Ms G Moalosi who were involved with the original drafting of the report. We cannot stop thanking the staff at Masiela Trust Fund for the support they provided during the study period. Free download from www.hsrcpress.ac.za vii This study describes a baseline psychosocial survey conducted in two communities in Botswana, in preparation for a five-year intervention project intended to help orphans and vulnerable children (OVC) in these communities. The Human Sciences Research Council (HSRC), together with its research partners within the Southern African Development Community (SADC) region (the University of Botswana and the Botswana Harvard Partnership in Botswana as well as the National Institute of Health Research [formerly Blair Research Institute] and the Biomedical Research & Training Institute‘s Centre for International Health and Policy in Zimbabwe) have been commissioned by the WK Kellogg Foundation (WKKF) to develop and implement a five- year intervention project for OVC commencing in 2003. The project is intended to assist families and households coping with an increased burden of care for affected children in Botswana, South Africa and Zimbabwe. The HSRC chose the Masiela Trust Fund as a grant maker to work with researchers from the University of Botswana. The Masiela Trust Fund in turn selected various community-based organisations (CBOs) and faith-based organisations (FBOs) to implement the appropriate interventions at all the identified sites. The general aim of the project is to ease the increased burden of care for OVC. The purpose of the psychosocial survey (PSS) was to gather baseline OVC data to facilitate the introduction and evaluation of the effectiveness of orphan care intervention programmes for strengthening community participation and empowerment of OVC in two research sites in Botswana. This information will be used in evaluating the effectiveness of the new OVC interventions that will be implemented in the two sites in Botswana as part of the overall OVC project. The two research sites are Palapye in the Serowe/Palapye sub-district and Letlhakeng in the Kweneng West district. The sample for the study was randomly selected using the census data that was collected prior to the PSS survey. Instruments for data collection were questionnaires for 6–14 years, 15–18 years and one for parents/ guardians. All instruments were adapted from the generic one compiled by HSRC. A total of 828 parents/guardians of OVC were interviewed, 505 in Palapye and 323 in Letlhakeng. The pattern of responses in Palapye and Letlhakeng were very similar. The majority of parents/guardians for OVC were mostly females. This means that the majority of caregivers are females and it is possible that the majority of these households are female headed. Female-headed households are generally characterised by poverty. The findings of the study also show high levels of illiteracy among the study population with only a few of the respondents reaching tertiary level. This reflected in the fact that most of the guardians do not have proper jobs and depend on temporary jobs, farm work and other jobs that do not bring enough income for the caregivers to cater for all the children in their care. Having insufficient money, caregivers are not always able to provide for the basic things that are needed for survival. A majority of the parents/guardians reported that they had heard about HIV/AIDS. Both parents and guardians reported an increase in the number of both orphans and vulnerable children living in their neighbourhood. HIV/AIDS was cited as the main reason for the increase of OVC. Misconceptions about HIV/AIDS obviously persist, as some claimed they could tell whether someone is infected just by looking at them. In Palapye, a total of 258 children aged 6–14 years were interviewed and in Letlhakeng, 84. Most of the children are in school (90% in Palapye and 70% in Letlhakeng). Reasons Free download from www.hsrcpress.ac.za viii commonly given for not being in school included lack of funds, having completed school or being under age. The claims of some of those respondents to have completed school were questionable, as most people do not finish at 14 years. This probably means the OVC in question did not do well during their Junior Certificate Examinations, and they needed to be supported to continue beyond Junior Certificate. The underlying causes of non-school attendance need to be investigated in an effort to promote access to education for all children of school-going age. The study revealed both the negative and positive aspects of the respondents’ emotional wellbeing. Feelings of happiness, of being hopeful about the future and good relations between respondents and their guardians where guardians encourage OVC positively have all been noted. All these reported positive feelings play an important role in the respondents’ over emotional wellbeing. For the age group 15–18 years, 139 children were interviewed in Palapye while 77 were interviewed in Letlhakeng. A majority of these children were in school (77% in Palapye and 55% in Letlhakeng). A large majority of those who were not in school explained this by saying that they had failed. Despite the positives noted, the study showed that OVC’s go through a lot of negative emotional phases in their everyday lives. Feelings of unhappiness, worry, trouble falling asleep, frustration and anger were all noted at high percentages (exceeding 40 per cent). The study concludes that conditions under which children live in the households surveyed are mostly conducive to well-being, save for those children who live in households that are headed by elderly females – where there are inadequate resources and children are often short of food and money. The study further concludes that the cultural and traditional norms of inheritance are entrenched and work to the disadvantage of children who have lost parents. This is particularly common in those cases where children are still young and there is no consultation. Free download from www.hsrcpress.ac.za 1 Introduction The situation of orphans in sub-Saharan Africa The AIDS epidemic has created an estimated 15 million orphans worldwide. Eighty per cent of these orphans live in Sub-Saharan Africa (Kanabus & Fredriksson 2004). Tragically, the number of orphans in Sub-Saharan Africa will continue to rise in the years ahead. This is partly due to the high proportion of adults in the region already living with HIV/ AIDS, and the continuing difficulties in expanding access to life-prolonging antiretroviral treatment (UNICEF 2003). In Zambia, one of the countries hardest hit by the HIV/AIDS epidemic, the traditional mechanism for the care of vulnerable children, the extended family, has started to break down under the twin pressures of poverty and disease (Fleshman 2001: 3). The estimated number of children orphaned because of AIDS in Zambia is 630 000. The HIV/AIDS epidemic has deepened poverty and exacerbated a myriad of existing deprivations. The responsibility of caring for orphaned children is a major factor in pushing many extended families beyond their ability to cope (UNICEF 2003). Furthermore, orphans may grow up without basic material resources and may lack the love and support that more emotionally-invested caregivers usually provide. They may be discriminated because of the sero-status of their parents, or they may be forced to discontinue their education because of lack of money or the need to take care of their siblings (HSRC 2003). Children orphaned by HIV/AIDS are disadvantaged in numerous and often devastating ways. For instance, in addition to the trauma of witnessing the sickness and death of one or both parents, they are likely to be poorer and less healthy than non-orphans. They are more likely to suffer damage in their cognitive and emotional development, to have reduced access to education, and to be subjected to the worst forms of child labour (UNICEF 2003). This is particularly true in Sub-Saharan Africa where few social support systems exist outside of families and where basic social services are largely inadequate (Kanabus & Fredriksson 2004). There is a general consensus in the literature that help for orphans should be targeted at supporting families and improving their capacity to cope, rather than at setting up institutions for children, as orphanages are not a sustainable long-term solution (UNAIDS 2002). In addition, institutional care can cause permanent setbacks in the lives of children: those sent away from their villages may lose their rights to their parents’ land and other property, as well as their sense of belonging to a family and a community. Overview of the OVC situation in Botswana The number of orphans in Botswana has increased tremendously in recent years and HIV/AIDS is the main contributing factor to this increase. In 1999, the number of registered orphans was 21 209, and this number has more than doubled in five years to 47 964 by 2004 (Social Welfare Division Database 2004). Free download from www.hsrcpress.ac.za 2 Figure 1.1: Trends and patterns of registered orphans from 1999–2004 Source: Ministry of Local Government (Department of Social Services, 1999–2004) Botswana’s registered orphans are cared for under the orphan care programme and they are supplied with a food basket that contains the main basic food and toiletry items on a monthly basis. The programme also supplies school uniforms, clothes and blankets as and when needed. Findings from the Rapid Assessment on the situation of orphans in Botswana (Muchiru 1998) indicated that many orphans still do not have access to basic necessities such as food, clothing, shelter and toiletries. The assessment also established that these children’s basic fundamental human rights were being violated both by society and by caregivers, including relatives. In some cases for example, orphans’ food rations are sold or shared among relatives. There are instances of orphans being used as cheap labour by the business community. The problem is further aggravated by many caregivers being aged grandparents who live in abject poverty and are themselves in many cases dependent on the destitute programme or on old-age pensions (Ministry of Local Government 1999). The advent of HIV/AIDS has not only increased the problem of orphans but also compounded the phenomenon of vulnerable children. The long-term sickness and eventual death of a parent or both to HIV/AIDS exposes their children to all kinds of abuse. For instance, it is frequently mentioned that many vulnerable children end up leaving their homes to join the ranks of ‘street children’ while some remain in poverty in their homes. According to Solani (2002), the main underlying reason why children go to the streets is poverty. Government response to the plight of orphans In view of the rapid increase of the number of orphans, the government of Botswana, through the Ministry of Local Government which has sectoral responsibility for protecting, 1999 2000 2001 2002 2003 2004 0 5 000 10 000 15 000 20 000 25 000 30 000 35 000 40 000 45 000 50 000 Free download from www.hsrcpress.ac.za [...]... the Botswana Harvard Partnership in Botswana, the National Institute of Health Research, and the Biomedical Research & Training Institute’s Centre for International Health and Policy in Zimbabwe) was commissioned by the WK Kellogg Foundation (WKKF) to develop and implement a five-year intervention project for orphans and vulnerable children (OVC), and families and households coping with an increased burden... Palapye, which is the capital of the sub-district, is the main hub of economic activities The major economic activities in Palapye are mining and quarrying, manufacturing (including repair of machinery and equipment), construction, wholesale and retail trade (including repair of motor vehicles and personal household items), hotels and restaurants, and real estate business In the Serowe/Palapye sub-district,... originally developed by two organisations, Strengthening Community Participation for the Empowerment of Orphans and Vulnerable Children (SCOPE) and Family Health International (FHI) for a similar project in Zambia, 1 and were adapted for use in this study The questionnaires concerned measured various issues such as food intake, psychosocial issues, risk taking, decision-making processes and emotional... of absenteeism of biological parents, partly as a result of HIV/AIDS Orphans have generally watched their parents get ill and eventually die As a result, they suffer extreme emotional pain, forcing them to deal with issues of loss and bereavement at a very early age Additionally, being raised by grandmothers places orphans at an added disadvantage, as the quality of care they get is compromised Grandmothers... questionnaire was used to measure various issues such as background information on father, mother and OVC; food intake; psychosocial issues such as coping with the loss of a mother and/ or father; child/guardian/teacher relationships; relationships in household; the child’s feelings towards a late mother/father/guardian; and sexual involvement and abuse The questionnaire also measured the responses and support. ..caring for and mitigating the impact of HIV/AIDS on children, developed a Short-Term Plan of Action on the care of orphans in 1999 Some of the key activities/projects of the programme are discussed below National orphan care programme The government of Botswana initiated a national orphan-care programme in 1999 to coordinate, through the Social Welfare Department under the Ministry of Local Government,... feelings on the late mother/father/guardian, displaced and non-displaced OVC, eligible orphans, eligible vulnerable children and sexual involvement and abuse The questionnaire also measured the response, decision-making processes, cultural modes of caring and inheritance, risk taking, emotional well-being, experiences of stigma and health and HIV/AIDS-related issues PSS questionnaire for 15–18 year olds This... people are engaged in agriculture, hunting and forestry and 57 in manufacturing, including the repair of machinery and equipment A total of 80 are in construction activity, 84 are in wholesale and retail trade including repair of motor vehicles Public administration employs 351 people and 92 work in education Free download from www.hsrcpress.ac.za In the Kweneng West sub-district, the unemployment rate... support offered by NGOs, CBOs, FBOs and the state, decision-making processes and inheritance, cultural modes of caring, risk taking, emotional well-being and health, and HIV/AIDS related issues Parents/guardians PSS issues questionnaire The questionnaire for guardians measured demographic details of the child and that of the guardian The questionnaire also measured their perceptions and experiences of HIV/... group of respondents, that is, the 6–14 and 15–18 year-olds, and the guardians/parents/heads of households Orphans and vulnerable children ages 6–14: Survey findings Background information The sample from Palapye site consisted of 258 (121 males and 137 females) respondents A large majority of the respondents in this age bracket were Batswana comprising of 98.8% of the sample Out of the 258 respondents, . A baseline study on psychosocial support of orphans and vulnerable children in two villages in Botswana GN Tsheko K Bainame LW Odirile & M Segwabe Free. Committees. Land Boards are another authority found in Palapye. The mandate of the Land Board is to administer land applications and allocations. The District