PSYCHOSOCIAL CONDITIONS OF ORPHANS AND VULNERABLE CHILDREN IN TWO ZIMBABWEAN DISTRICTS Simba Rusakaniko, Alfred Chingono, Stanford Mahati, Pakuromunhu F Mupambireyi, & Brian Chandiwana Edited by Parkie S Mbozi, M Boy Sebit & Shungu Munyati NATIONAL INSTITUTE OF HEALTH RESEARCH, MINISTRYOF HEALTHAND CHILDWELFARE BIOMEDICAL RESEARCH& TRAINING INSTITUTE Free download from www.hsrcpress.ac.za Prepared by the Biomedical Research and Training Institute (BRTI) and the National Institute of Health Research (NIHR) of the Ministry of Health and Child Welfare, Harare, Zimbabwe. Published by HSRC Press Private Bag X9182, Cape Town, 8000, South Africa www.hsrcpress.ac.za © 2006 HSRC, BRTI, NIHR & FACT First published 2006 All rights reserved. No part of this book may be reprinted or reproduced or utilised in any form or by any electronic, mechanical, or other means, including photocopying and recording, or in any information storage or retrieval system, without permission in writing from the publishers. ISBN 0-7969-2147-4 Print management by comPress Distributed in Africa by Blue Weaver PO Box 30370, Tokai, Cape Town, 7966, South Africa Tel: +27 (0) 21 701 4477 Fax: +27 (0) 21 701 7302 email: orders@blueweaver.co.za www.oneworldbooks.com Distributed in Europe and the United Kingdom by Eurospan Distribution Services (EDS) 3 Henrietta Street, Covent Garden, London, WC2E 8LU, United Kingdom Tel: +44 (0) 20 7240 0856 Fax: +44 (0) 20 7379 0609 email: orders@edspubs.co.uk www.eurospanonline.com Distributed in North America by Independent Publishers Group (IPG) Order Department, 814 North Franklin Street, Chicago, IL 60610, USA Call toll-free: (800) 888 4741 All other enquiries: +1 (312) 337 0747 Fax: +1 (312) 337 5985 email: frontdesk@ipgbook.com www.ipgbook.com Free download from www.hsrcpress.ac.za iii TABLEOFCONTENTS About the contributors iv Acknowledgements vi Operational definitions of concepts vii List of tables & figures viii Acronyms and abbreviations x Executive summary xi Chapter1Introduction1 1.1 The Situation of OVC in sub-Saharan Africa 1 1.2 HIV/AIDS and orphanhood in Zimbabwe 3 1.3 Zimbabwe OVC project 4 1.4 The baseline psychosocial survey (of OVC and their guardians) 4 Chapter2Methodology7 2.1 Study design 7 2.2 Study areas 7 2.3 Questionnaire development 8 2.4 Pre-testing of the instruments 9 2.5 Field work activities 10 2.6. Sampling procedures 10 2.7. Field monitoring activities 12 2.8. Data management 12 Chapter3Results:Chimanimani15 3.1 OVC aged 6–14 years 15 3.2 OVC aged 15–18 years 24 3.3 Guardians of OVC in Chimanimani 39 Chapter4Results:Bulilimamangwe51 4.1 OVC aged 6–14 years 51 4.2 OVC aged 15–18 years 59 4.3 Guardians of OVC 82 Chapter5Conclusions&recommendationsfor ChimanimaniandBulilimamangwe93 5.1 Conclusions 95 5.2 Recommendations 95 AppendicesandReferences Appendix 1: Vulnerability Score Assessment 97 References 98 Free download from www.hsrcpress.ac.za iv Authors Mr Alfred Chingono: MSc, Clinical Psychologist, College of Health Sciences, University of Zimbabwe, Team Leader for PSS (Zimbabwe) Professor Simba Rusakaniko: PhD, Consultant Biostatistician, College of Health Sciences, University of Zimbabwe (Zimbabwe) Stanford T. Mahati: MPhil, BSc (Hons) Sociology & Anthropology, Social Scientist, National Institute of Health Research (NIHR) Ministry of Health & Child Welfare, Harare (Zimbabwe) Pakuromunhu Freddie Mupambireyi: MSc Demography, BSc (Hons) Econs Statistician, University of Zimbabwe, Deputy Dean, Faculty of Commerce, Harare (Zimbabwe) Brian Chandiwana: BSc Econs, MBA, Health Economist, Biomedical Research & Training Institute, Harare, OVC Research Project Manager (Zimbabwe) Editors Shungu Munyati: MSc, PhD (Cand), OVC Research Project Director, Acting Director, National Institute of Health Research (NIHR), Ministry of Health & Child Welfare (Zimbabwe) Mr Parkie S. Mbozi: Communications Consultant, World Agroforestry Centre CRAF Dr M. Boy Sebit, Senior Lecturer, Clinical Psychologist, College of Health Sciences, University of Zimbabwe Other Contributors Peter P. Chibatamoto: MBA, MSc Infectious Diseases, Biological Sciences; HIV/AIDS (Mainstreaming) Technical Advisor UNDP, Windhoek (Namibia) Natsayi Chimbindi: BSc HEP, (Health Education), Biomedical Research & Training Institute Harare (Zimbabwe) Stephen Buzuzi: MSc, BSc (Hons) Sociology & Anthropology, Biomedical Research & Training Institute, Harare (Zimbabwe) Stella Gwini: BSc (Hons) Statistics, Biomedical Research & Training Institute, Harare (Zimbabwe) Wilson Mashange: Dip Med Lab Tech, Medical Laboratory Technologist, National Institute of Health Research (NIHR), Ministry of Health & Child Welfare, Harare (Zimbabwe) George Chitiyo: MSc, BSc Econs; Catholic Relief Services, Harare (Zimbabwe) Maxwell Chirehwa: BSc (Hons) Applied Maths (Cand), National University of Science and Technology, Bulawayo (Zimbabwe) ABOUTTHECONTRIBUTORS Free download from www.hsrcpress.ac.za v Timothy Mutsvari: BSc (Hons) Applied Maths, Biomedical Research & Training Institute, Harare (Zimbabwe) Teramai A. Moyana: BSc (Hons) Sociology & Anthropology; Biomedical Research & Training Institute, Harare (Zimbabwe) Chenjerai K. Mutambanengwe: BSc (Hons) Applied Maths (Cand), National University of Science & Technology, Bulawayo (Zimbabwe) Free download from www.hsrcpress.ac.za vi ACKNOWLEDGEMENTS The authors would like to thank the Biomedical Research and Training Institute (BRTI) together with the National Institute of Health Research (NIHR) former Blair Research Institute, of the Ministry of Health and Child Welfare for all the support it received from staff, through contributions of their time, skills, expertise and resources during the survey. Special thanks go to the Human Sciences Research Council (HSRC), in particular the new President and Chief Executive Officer, Consultant and Project Champion of OVC Project, Dr Olive Shisana, who together with the Principal Investigator of the Research Component of the project, Professor Leickness Simbayi and the Overall Project Manager, Dr Donald Skinner, supported the OVC research project. The team would like to thank Mr Rogers Sango from the Zimbabwe Central Statistics Office and a former employee of the same organisation, Mr Tichaona Chirimanyemba for their valuable technical input during the development of the research instruments, mapping, training of fieldworkers and fieldwork. The District Administrator for Bulilimamangwe, Mr Mzingaye Sithole, the Rural District Council Chairman for Bulilima (Mr Christopher Ndlovu), Plumtree (Mr Patrick Mabuza) and Mangwe (Mr Grey Ncube), traditional Chiefs and Councillors, are saluted for their facilitatory role in ensuring the successful implementation of the field data collection exercise. The research team appreciates the support they received from the Bulilima, Mangwe and Plumtree OVC Local Liaison Team: Mr Irvine Ncube, Mrs. Melta Moyo, Mr Frank Ngwenya, Mr Lincolin Ncube, Mrs. Sifiso Dube and Mr Alois Sibanda during the whole exercise of data collection. Gratitude is also extended to Mr Andrew Nleya and Mr Khumbulani Tshuma for their assistance during the fieldwork. In Chimanimani, we are grateful to the then District Administrator of Chimanimani Mr Edgar Nyagwaya, Chimanimani Rural District Council Chairman of Chimanimani Mr Joseph Harahwa, Traditional Chiefs and Councillors who facilitated the exercise. We acknowledge the support received from the Chimanimani OVC local liaison team members Mr Jobes Jaibesi, Mr Brian Muchinapo, the then District Nursing Officer the late Sister Mistress Ndhlovu and the new District Nursing Officer Sister Sifovo during the whole exercise. Our thanks are extended to the headmasters, teachers and nurses in all districts who readily assisted the research team, including supervisors and interviewers, with free training venues, accommodation and logistical support. We are also greatly indebted to the communities of Bulilimamangwe and Chimanimani for their co-operation and hospitality throughout. The field supervisors are highly commended for their sterling work. We also thank the interviewers who industriously collected the data. We would like to further acknowledge the work undertaken by the data entry clerks under the supervision of Mr Tendai Madiro and Mr Lowence Gomo. Sincere gratitude is also extended to the implementing partners, the Grant Maker FACT Mutare for their support during the entire psychosocial survey, and the WK Kellogg Foundation who generously funded the project. Free download from www.hsrcpress.ac.za vii In the context of the OVC project in Zimbabwe, the following definitions were used: Care-giver: a person who regularly voluntarily assists a household, whose members are related or not related to him/her, in doing household chores, offering advice, giving spiritual, psycho-social and material support. Child: a person under the age of 18 years. Child-headed household: a household in which a person aged 18 years and below is responsible for making day-to-day decisions for a group of persons who stay or who usually reside together and share food from the same pot, whether or not they are related by blood. Enumeration area: the smallest demarcation of a district that is a cluster of about 100 households. Guardian: parent/someone who assumes responsibility for someone else’s welfare on a day-to-day basis. Grant maker: organisation that sources resources and rolls out grants to community- based organisations to implement OVC interventions. Family AIDS Caring Trust (FACT) is the grant maker for the OVC project in Zimbabwe. Head of household: a person, regardless of age, who is responsible for making day-to- day decisions for a group of persons who stay or who usually reside together and share food from the same pot, whether or not they are related by blood. Household: a group of persons who stay or who usually reside together and share food from the same pot, whether or not they are related by blood. Local liaison teams: key people selected from the districts where research is being conducted who spearhead the OVC project activities. Orphan: a person under the age of 18 who has lost either one or both parents. Vulnerable Child: A child is considered vulnerable if he/she is living under difficult circumstances. These include children living in poor households, those receiving inadequate care, those with sick and terminally ill parents, those living in child-headed households, those dependent on old, frail or disabled care-givers, and children in households that assume additional dependency by taking in orphaned children. There is no direct relationship between orphanhood and vulnerability. One can be an orphan and yet not vulnerable and another can be vulnerable and not necessarily be an orphan. Ward: a ward is a composition of 500 to 600 households. OPERATIONALDEFINITIONSOFCONCEPTS Free download from www.hsrcpress.ac.za viii Table 2.1: Targeted and actual sample sizes of guardians by district 11 Table 2.2: Targeted and actual sample sizes of OVC by district 12 Table 3.1: Distribution of OVC by Household standard of living 16 Table 3.2: Inheritance-related issues as reported by orphans 17 Table 3.3: Distribution of family items inherited by people other than orphans/siblings 18 Table 3.4: Psychological issues (emotions) 19 Table 3.5: Psychological issues or experiences expressed by OVC 20 Table 3.6: Reported sexual experiences and abuse of OVC 22 Table 3.7: Distribution of reported indices of psychological well-being 26 Table 3.8: Distribution of orphans by the things that made them happy 28 Table 3.9: Distribution of OVC by their reported coping strategies 29 Table 3.10: Agencies and forms of assistance received by OVC or orphans? 31 Table 3.11: Reported sexual experiences of OVC 33 Table 3.12: Discussions held with OVC concerning parents’ illness 35 Table 3.13:Distribution of guardians by employment status and source of income 40 Table 3.14: Distribution of guardians according to what they perceived to be the main needs of OVC 41 Table 3.15: Guardians’ perceptions of the community’s concerns with regards to HIV/AIDS 42 Table 3.16: Distribution of guardians by reported communication on HIV/AIDS with children 43 Table 3.17: Perceptions about OVC situation in their neighbourhood 43 Table 3.18: Children’s reactions to the coming in of OVC into their households 44 Table 3.19: Demographic characteristics of child heads of households 45 Table 3.20: Household situation and sources of income 46 Table 3.21: Needs and problems within child-headed households 46 Table 4.1: Distribution of OVC according to their kinship to current Guardian 52 Table 4.2: Level of the OVC’s satisfaction with living in current households 52 Table 4.3: Distribution of family Items inherited by people other than orphans/siblings 53 Table 4.4: Psychological issues (emotions) as reported by OVC 55 Table 4.5: Psychological issues (experiences) 56 Table 4.6: Distribution of OVC by reported household economic situation 60 Table 4.7: Distribution of OVC by food consumption patterns 60 Table 4.8: Distribution of OVC by food consumed the day preceding the survey 61 Table 4.9: Distribution of OVC according to their relatedness to and their relationships with guardian and other household members 62 Table 4.10: Distribution of OVC by district according to reported treatment by their guardian 63 Table 4.11: Distribution of orphans’ expectations of their guardians 65 Table 4.12: Distribution of how orphans felt about their parent(s)’ death 66 Table 4.13: Orphans’ feelings and wishes with respect to inherited items 67 Table 4.14: Distribution of family items inherited by relatives other than orphans and their siblings 69 Table 4.15: Distribution of reported indices of psychological well being 70 Table 4.16: Reported usual coping strategies following parent(s)’ death 72 Table 4.17: OVC perceptions about how society members treated them 73 Table 4.18: Reported life changes following parent(s) death 74 Table 4.19: Agencies assisting OVC 75 Table 4.20: Forms of assistance received by OVC 75 Table 4.21: Reported sexual experiences of OVC 77 Table 4.22: Discussions held with OVC concerning parent(s)’ illness 78 Table 4.23: OVC’s educational level they attained by age group 83 Table 4.24: Distribution of perceptions of guardians on the impact of taking OVC into their household 84 LISTOFTABLESANDFIGURES Free download from www.hsrcpress.ac.za Chapter1 ix Table 4.25: Distribution of guardians according to what they perceived to be the main needs of OVC 85 Table 4.26: Distribution of guardians as per perceived challenges of heading a household 86 Table 4.27: Children’s reactions to the coming of OVC into their households 87 Table 4.28: Distribution of guardians by kind of support received 88 Table 4.29: Duration of OVC assuming responsibility of being head of household 88 Table 4.30: Household situation, sources of income and ways of making ends meet for child-headed households. 89 Table 4.31: Needs, challenges, problems and concerns for child-headed households 89 LISTOFFIGURES Figure 2.1: Location of Bulilimamanywe and Chimanimani Districts 8 Free download from www.hsrcpress.ac.za x AIDS AcquiredImmuneDeficiencySyndrome BRTI BiomedicalResearchandTrainingInstitute CBO Community-basedorganisation CIHP CentreforInternationalHealthandPolicy FACT FamilyAIDSCaringTrust FBO Faith-basedorganisation FHI FamilyHealthInternational HIV HumanImmunodeficiencyVirus HSRC HumanScienceResearchCouncil IRDP IntegratedRuralDevelopmentProgramme KABP KAP Knowledge,attitudesandpractices MRCZ MedicalResearchCouncilofZimbabwe NGO Non-governmentalorganisation NIHR NationalInstituteforHealthResearch OVC OrphansandVulnerableChildren PSS PsychosocialSurvey RH ReproductiveHealth SAfAIDS SouthernAfricaHIV/AIDSInformationDisseminationService SADC SouthernAfricaDevelopmentCommunity STI Sexuallytransmittedinfection UNAIDS JointUnitedNationsProgrammeonHIV/AIDS UNDP UnitedNationsDevelopmentProgramme WKKF WKKellogFoundation ZHDR ZimbabweHumanDevelopmentReport ACRONYMSANDABBREVIATIONS Free download from www.hsrcpress.ac.za . PSYCHOSOCIAL CONDITIONS OF ORPHANS AND VULNERABLE CHILDREN IN TWO ZIMBABWEAN DISTRICTS Simba Rusakaniko, Alfred Chingono, Stanford. strengthening existing OVC interventions and in evaluating the effectiveness of new interventions that would be implemented in the districts at the mid-point and