Change package for
Quality Improvement in
Orphans and Vulnerable Children
Programmes in Kenya
SEPTEMBER 2013
This change package was prepared by University Research Co., LLC (URC) for review by the United States Agency for International Development
(USAID) and was authored by Roselyn Were, Stanley Masamo, and Jemimah Owande of USAID ASSIST and Emma Akinyi, Muhamed
Akulima, Emily Murungi, Millicent Oluoko, and Stella Wachira of APHIA Plus. The work described was conducted under the USAID Health
Care Improvement (HCI) and USAID Applying Science to Strengthen and Improve Systems (ASSIST) projects, which are made possible by the
generous support of the American people through USAID, with funding from the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR).
Cover photo: Children under the Maua Methodist Hospital - Meru, Kenya
Photo credit: Allan Gichigi and Elijah Kanyi (Afroshok media)
Change package for
Quality Improvement in
Orphans and Vulnerable Children
Programmes in Kenya
By:
Roselyn Were (USAID ASSIST), Stanley Masamo (USAID ASSIST), Jemimah Owande (USAID ASSIST),
Emma Akinyi (APHIA Plus Nuru ya Bonde), Muhamed Akulima (APHIA Plus Kamili), Emily Murungi (APHIA Plus Nairobi Coast),
Millicent Oluoko (APHIA Plus Western Kenya), Stella Wachira (APHIA Plus Nairobi Coast)
September 2013
DISCLAIMER
The contents of this change package are the sole responsibility of University Research Co., LLC (URC) and do not necessarily
reﬂect the views of the United States Agency for International Development or the United States Government.
© September 2013
University Research Company., LLC (URC) / USAID ASSIST (Kenya)
Design and layout by Esther Kahinga
Acknowledgement
We would like to acknowledge all the people who contributed to the development of this change package
especially the Quality Improvement Teams and coaches who worked tirelessly to ensure improvement
in service delivery for orphaned and vulnerable children (OVC) across the country. This work would not
have been complete without the support of the Department of Children Services, APHIA and AMPATH
PLUS and the Community Based Organizations whose work is disseminated through this document. The
development and production of the OVC Change Package was supported by the USAID Applying Science
to Strengthen and Improve Systems (ASSIST) Project.
The work of the USAID (ASSIST) Project is supported by the American people through the United States
Agency for International Development (USAID) and its Bureau for Global Health, Oﬃce of Health Systems.
The project is managed by University Research Co., LLC (URC) under the terms of Cooperative Agreement
Number AID-OAA-A-12-00101. The ASSIST Project team includes URC, Broad Branch Associates;
EnCompass LLC; FHI 360; Harvard University School of Public Health; Health Research, Inc.; Institute for
Healthcare Improvement; Initiatives Inc.; Johns Hopkins University Center for Communication Programs;
Women Inﬂuencing Health Education and Rule of Law, LLC.
For more information on the work of the USAID ASSIST Project, please visit www.usaidassist.org.
i
ii
Table of Content
Background for Quality Improvement of Orphaned and Vulnerable Children Programs .........1
Quality Improvement Process ................................................................................................3
Change Ideas .......................................................................................................................15
Annexes ...............................................................................................................................27
List of teams testing change in each service area ..........................................................28
List of participants .......................................................................................................31
iii
List of acronyms
AACs
ASSIST
AMPATH
APHIA
CBO
CHW
CHV
CSI
CU
DCS
GOK
HCI
HIV / AIDS
KCPE
KCSE
LIP
NSC
OVC
PDSA
PSS
QI
QIT
URC
VSL
USAID
Area Advisory Councils
Applying Science to Strengthen and Improve Systems
Academic Model Provinding Access to Healthcare
AIDS Population and Health Integrated Assistance
Community Based Organization
Community Health Worker
Community Health Volunteer
Child Status Index
Community Unit
Department of Children Services
Government of Kenya
Healthcare Improvement Project
Human Immunodeﬁceincy Virus / Aquired Immune Deﬁcinecy Syndrome.
Kenya Certiﬁcate of Primary Education
Kenya Certiﬁcate of Secondary Education
Local Implementing Partner
National Steering Committee
Orphans and Vulnerable Children
Plan Do Study Act
Psychosocial Support
Quality Improvement
Quality Improvement Teams
University Research Company
Voluntary Saving and Loaning
United States Agency for International Development
iv
Foreword
The term “orphans and vulnerable children” (OVC) includes not only children orphaned by their parents’ death, but
also children considered vulnerable to psychological traumas endangering their health and well-being, including
living with a chronically ill parent. In 2003, the launch of the U.S. President’s Emergency Plan for AIDS Relief
(PEPFAR) called for interventions that met the needs of OVC aﬀected by HIV and AIDS. The response to the PEPFAR
call was the development of emergency humanitarian eﬀorts to address the plight of the large numbers of OVCs
resulting from the HIV and AIDS epidemic. This means programs did not address integration or sustainability
due to the emergency nature of the response. In recent years however the emergency response has not been
appropriate and PEPFAR through the United States Agency for International Development (USAID) has emphasized
on programs that address quality improvement as an integrated aspect of OVC programming. Moreover, lessons
learned from OVC programs have revealed the need to improve service quality and to strengthen harmonization
across partners.
But how do we deﬁne quality? While there are many deﬁnitions of quality, one that is often used is the deﬁnition
from the United States Institute of Medicine (IoM), that says quality is the “ degree to which health services for
individuals and populations increase the likelihood of desired health outcomes and are consistent with current
professional knowledge or evidence” .
Quality has six dimensions,
• safety
• eﬀectiveness
• patient centeredness
• timeliness
• eﬃciency
With regard to quality improvement, this has been described as the systematic approach that uses speciﬁc
v
techniques to improve quality and the most important ingredient in successful and sustained improvement being
that way in which the change is introduced and implemented .
The University Research Company (URC), LLC notes that quality improvement (QI) uses quantitative and qualitative
methods to improve the eﬀectiveness, eﬃciency, and safety of service delivery processes and systems, as well as
the performance of human resources in delivering products and services. Using this deﬁnition and various quality
improvement approaches and models such as the ‘Plan-Do-Study-Act’ (PDSA) model, a key focus for URC is
addressing quality programming for OVC . This change packages draws on experiences from Kenya following a
2 year program that implemented change ideas in collaboration with 6 USAID implementing partners across the
country.
This change package was developed following a harvest meeting where quality improvement teams shared the
results of what they had successfully implemented over a period of two years since the ﬁrst improvement team
was formed, though majority of the teams were formed much later. The package begins with some background
information on the journey towards quality improvement for orphans and vulnerable children programming
followed by a guide for changes that have proven to work. Case studies of some of the teams that implemented
the change ideas presented here are shared in a seperate booklet Improving the lives of vulnerable children in Kenya:
Experiences from implementing quality service standards
We invite you to study and utilize this package for all OVC programming.
Dr. Faith Mwangi-Powell
COP- URC Kenya.
vi
1
BACKGROUND FOR QUALITY IMPROVEMENT
OF OVC PROGRAMS
The plight of Orphans and Vulnerable Children
(OVC) is an issue of national concern in Kenya. It is
estimated that there are over 2.6 million orphans in
the country, 47% of whom are orphaned as a result
of Human Immunodeﬁciency Virus and Acquired
Immune Deﬁciency Syndrome (HIV and AIDS).
policy on OVC to underpin intervention. In its
commitment to improve the lives of OVCs in Kenya,
the Government introduced the National Policy on
Orphans and Vulnerable Children, which intendeds
to ensure that every Kenyan child who is orphaned
or vulnerable is protected and supported in order to
achieve their full potential.
In response to an increasing number of OVC in
Kenya, a National Steering Committee (NSC) on
OVC was constituted in May 2004, to deliberate
upon interventions tha would address the plight of
OVC. A rapid assessment on the state of OVC was
carried out in June 2004, with the support of various
development partners. The assessment informed
on the regrettable vulnerability of children that
demanded immediate action. Consequently the
NSC realized the need to come up with a national
Eﬀorts to provide care and support to OVC have
expanded rapidly both in terms of partners
delivering services and resources allocated to meet
the needs of these children. This has resulted in an
increase in the number of children reached without
equivalent focus on the quality and impact of
services delivered.
A situational analysis conducted in 2009 to assess
the quality of services provided to OVC identiﬁed
1
various gaps including;
1. Quality of services oﬀered by some
organizations has been inappropriate leading to
stigmatization and discrimination of OVC by the
rest of the community and wastage of resources
2. Existing interventions only support small
proportion of OVC
3. Inadequate and inaccurate data on the needs of
the children before intervention is launched
4. Lack of regulation on the duration a service
provider should support a beneﬁciary
5. Lack of social mapping of OVC service providers
making it diﬃcult for the Department of
Children Services (DCS) to monitor and
coordinate their operations.
To support and streamline the standards and
quality of OVC care, the Department of Children
Services and stakeholders initiated the process
of developing service standards for quality
improvement of service delivery.
The minimum service standards have eight service
areas with speciﬁed desired outcomes that guide
improvement work as shown in table 1.
2
Table 1: The eight service areas
Service area
Desired outcome
Food & Nutrition
OVC and other household members should have enough nutritiousfood to eat
throughout the year and should not be anxious of where they will ﬁnd food for the
next meal.
Education
All orphans and vulnerable children have the right to education in a well-structured
school with a proper teaching and learning system.
Health
OVC and their households must have access to good health care services so as to
promote and maintain a healthy lifestyle.It is important to ensure children aged 0-5
years go to the clinic, get immunization and are treated when sick.
Psychosocial support
This is the emotional, social, spiritual, mental and physical support given to OVC and
their households to promote all-round growth and development.
Shelter & Care
OVC and their households must live in a structure that is safe,
secure, habitable and with enough space for comfortable living
with at least one responsible adult caregiver.
Child preotection
Orphans and vulnerable children should be free from any
and all forms of abuse, neglect, discrimination and exploitation.
Household Economic Strengthening Households should be able to regularly and safely meet the basic
needs of the OVC on their own.
Coordination of care
There should be a structured and well monitored system bringing
together service providers who provide quality and essential services
to OVC and their households.
3
2
QUALITY IMPROVEMENT PROCESS
2.1 Dissemination of Standards
to key players in OVC programmes from across
the country. The launch programme ensured
participants were guided through the key
The dissemination of the standards over the
year was an elaborate process that began even
before the ﬁnalization and eventual launch of the
Minimum Service Standards for Quality Improvement
of Orphans and Vulnerable Children Programmes,
Kenya (hereafter reﬀrered to as the Standards).
Through partnership with the AIDS Population
and Health Integrated Assistance (APHIA)
implementers across the country, over 100 Quality
Improvement Teams (QITs) were taken through the
standards and have been using them to guide their
work.
During the national launch, copies of the
Standards in soft and hard copy were distributed
Oﬃcials from the Ministry, UNICEF, HCI and Child Geusts during
the Minimum Standards launch
4
components of the standards and discussions were
held on the application of these standards at the
point of service delivery.
2.2 Capacity building of Department of Children
Services on OVC QI
From March - July 2012, HCI conducted trainings for
283 government personnel from the Department
of Children Services and Nairobi City Council. The
outcome of the trainings was the development
of region-speciﬁc work plans that are being
implemented jointly with HCI, the Department
of Children Services and APHIA Plus the national
USAID mechanism for service delivery for HIV/
AIDS. The following activities have been ongoing
since the training;
After the national launch, HCI together with
the OVC Technical Working Group conducted
dissemination workshops in 8 regions of Kenya. In
total over 800 OVC service providers attended the
meetings. District and county level dissemination
work plans were developed for implementation
under the coordination of the Ministry of Gender
Children and Social Development through the
Department of Children Services.
•
Besides the USAID funded Academic Model
Providing Access to Healthcare (AMPATH) and
APHIA plus implementers other service delivery
teams that are linked to the government’s Area
Advisory Councils (AAC) at grassroots level have
also been supporting the dissemination exercise. A
total of nine thousand copies of the standards were
printed for distribution.
•
•
•
•
5
Disseminating service standards to implementers
at county, district, division and location levels
Stakeholder mapping and development of
directories of OVC service providers
Harmonizing reporting and data management
from the location level up to the province
Building the capacity of point of service
delivery providers in the standards and Quality
Improvement
Conducting county and district level learning
sessions, documentation, reporting and
consolidation of results
Province
5. APHIA Plus Nairobi /Coast – Nairobi and Coast
Province
6. APHIA Plus North Arid Lands (closed in 2012 and
relaunched as Imarisha)- North Eastern region ,
Upper Eastern, Samburu and Turkana.
The Department then conducted periodic
stakeholder meetings and supportive supervision
for the implementers.
The government’s capacity to provide leadership
for Quality Improvement (QI) has been enhanced
through training.
APHIA addresses various population and health
issues including OVC. Under the OVC component,
APHIA works with Local Implementing Patners
(LIPs) usually Community Based Organizations
(CBOs)and local Non-Governmental Organizations
(NGOs) at grassroot / community level. The
NGOs / CBOs then form QITs that work with the
community to identify and assist OVC within that
community. AMPATH directly implements their
OVC component.
2.3 Institutionalizing QI at the Point of Service
Delivery
HCI which was later replaced by the Applying
Science to Strenthen and Improve Systems
(ASSIST) in October 2012, continued to support the
APHIA/AMPATH plus implementers in QI through
coaching and mentorship and learning sessions at
both national and project levels. HCI works with
6 projects one of which faced a close out in 2012.
They include:
1.
2.
3.
4.
For QI to be implemented at the point of service
delivery, representatives from CBOs that work with
the above projects were trained as QI coaches. They
then shared on the standards to their respective
communities and later formed QITs.
APHIA Plus Kamili - Central and Eastern provinces
APHIA Plus Nuru Ya Bonde - Rift Valley province
AMPATH plus - Uasin Gishu and Western Kenya
APHIA Plus Western Kenya – Western and Nyanza
6
The QIT brings together about 15 members of
the community who possess valuable skills in
addressing the common challenges children
face. The team generally consists of teachers,
community health workers or volunteers, nurses,
agricultural extension oﬃcers, district / volunteer
children oﬃcers, a representative of the provincial
administration like chief, spiritual leaders like
pastors or imams, representatives of the area
advisory council, guardians and OVC. A total of 150
QITs have been formed across the country.
systems and child levels. The changes at systems
level will inform an improvement in the service
delivery process as designed by the organization
whereas the changes at child level will focus on
addressing the felt needs of each individual child
and their households.
2.4 Learning Sessions
National Learning Sessions were organised to
provide an opportunity for QITs from across the
country to share to learn from one another, and
for HCI consolidate the results of the work done
To assess improvement on child outcomes, the
by QITs. Project speciﬁc learning sessions also
Child Status Index tool is administered on children
took place at the APHIA level. Representatives
as baseline data collection with a repeat CSI
of QI teams were brought together to share the
administration six months later. This linked with the successes and failures they had encountered
service tracking data that is collected monthly helps in testing change ideas using the QI model for
determine whether the changes instituted by the QI improvement (see ﬁgure 1).
teams made a diﬀerence in the lives of the children.
In problem identiﬁcation , the QI team compares
2.6 Process of harvesting key changes
the overall CSI data with the results of the self
For over 2 years more than 100 QITs across the
assessment based on the standards. This helped the country with support from AMPATH and APHIA
teams agree on change ideas that have the highest plus have innovated and tested many change ideas
probability of leading to improvement at both
geared towards improving the quality of service
7
same challenges.
For a change to have worked, the teams had to
share evidence (data) and experiences (qualitative
data) with the others and demonstrate whether
these change ideas lead to improvement or not.
Langley et al – The Improvement Guide, JB, 2009
A harvest meeting was held on 20 - 21 May 2013
with representatives (Champions) of the QITs,
APHIA plus, AMPATH and HCI. The harvest involved
the classiﬁcation of change ideas into service areas
and then ranking them. The ranking was based on
four parameters:
• evidence - how many teams tested it
• simplicity
• scalability
• relative importance - its contribution to the
results achieved.
The teams members described in detail how each
change idea was tested or implemented and the
results of the implementation. Teams that tested
the various changes are indicated in bold in the
column ‘Notes on evidence.’
USAID HEALTH CARE IMPROVEMENT PROJECT
Figure 1: The Quality Improvement Model, adapted from
Langely, P. et. al. (2009) The Quality Improvement Guide
delivery to OVC in Kenya. With support from HCI
the QITs documented and shared these change
ideas during project and national learning sessions.
The sessions gave the teams an opportunity
to share the change ideas that had had a clear
demonstration to work in improving the well being
of the OVC with QITs that were struggling with the
8
3. CHANGE IDEAS
9
3.1 Service Area: Food and Nutrition
1
Change Idea
Steps to implement
Notes on evidence
Improving food
production through
provision of certiﬁed
seeds
•
Through support from the Ministry of Agriculture
carry out assessment to identify the seeds required
for each area, then conduct a community awareness
meeting targeting caregivers with information on the
new seeds.
Ensure timely distribution of the seeds for increased
yield.
In collaboration with the Ministry of Agriculture carry
out continuous follow up to ensure the caregivers are
tending to the crops appropriately.
•
•
With support from Ministry of health, carry out
targeted awareness creation to caregivers on proper
nutrition especially for children under the age of ﬁve.
Continuous growth monitoring by community health
workers (CHWs) to assess nutrition status of children.
•
Through collaboration with partners identify the
source of water appropriate for the region.
Seek resources from the community and partners
and dig wells or dams to ensure continuous supply of
water
Formation of water management committee to
ensure water is used appropriately e.g. household use
and irrigation.
Have systems to ensure the levies collected from sale
of water are properly managed.
•
•
•
2
Nutrition education
to caregivers
•
•
3
Ensure access to
consistent supply of
water
•
•
•
•
10
•
•
Tested in 26 sites with moderate results
Good idea however the biggest challenge
is getting GOK staﬀ to assist communities
when no ﬁnancial support is available.
Identiﬁcation of the correct seed and
time for planting also requires agricultural
professionals to support the caregivers.
Adoption of irrigation technologies in case
of insuﬃcient rain fall increases yields.
Matunda Jua Kazi, ACK Embu
Tested in 12 sites with high results showing it
can easily be adopted and scaled up in other
sites.
•
The trainers need to adopt local language
and use of pictorials for eﬀective delivery,
and understanding.
Shangia CU, Bukonoi
Tested in 2 sites with high results. However
for scale up there is need to adapt to speciﬁc
environment. e.g. areas with a low water
table need to adopt other methods.
•
The water management committees need to
have basic management and ﬁnancial skills
for proper resource management.
Shangia
3.2 Service Area: Education
1
Change Idea
Steps to implement
Notes on evidence
Enhance parents/
caregivers involvement
in the education of their
children
•
•
•
•
•
•
2
Ensure timely payment
of school levies and other
educational materials
including sanitary pads for
girls
•
•
•
•
Awareness creation through school management
committee, chief meetings (barazas), CHW household
visits and other forums on the importance of education.
Initiate monthly meetings between the class teachers and
caregivers where vital information regarding the child’s
performance, challenges and strengths are shared and
discussed
Through the caregivers monthly meetings ensure
importance of education is part of education sets received
by the caregivers
Continuous monitoring by the caregivers and the CHWs
through the school register to ensure all children attend
school as required.
CHWs tracking parental involvement through the class
teacher register.
Identify children whose caregivers cannot aﬀord payment
of school levies.
Link to other partners including cooperates and
government systems that support education.
Link caregivers to alternative economic activities to
improve household income
In cases of delays in school fees payment discuss with
the head teachers/principles early enough to ensure the
children are not sent away from school
11
•
•
Tested in 17 sites with very high
results
Very viable and can be adopted in
any environment.
There is need for ﬂexibility to
accommodate the busy schedule
of the caregivers.
Shangia CU, Dago Dala Hera, YARD
•
Tested in 17 sites with moderate
results. Very challenging because
of the procedures within various
organizations which the QIT may
have no control over. However,
with planning and submitting
requests at the beginning of the
school term most organizations
are able to make payments in
time
APHIA Plus Western Kenya , Nuru ya
bonde
3
Change Idea
Steps to implement
Encourage students to
initiate individual and joint
study plans to improve
their performance
•
•
•
•
•
Notes on evidence
Create awareness targeting school going children on •
Tested in 2 sites and showed high
why it is important to have their parents involved in
results. Can be adopted in any
their education and performance
environment
Through the CHWs and the teachers ensure each child •
Academic clinics were adopted by
has developed a personal plan for improvement.
Cheer up from other CBOs.
Institute student-led tuition and coaching i.e. have
those in higher classes coach those in lower classes
Cheer up, Dago Dala Hera
Through the children clubs ensure education and
performance are an integral part of their discussions
Establish mentorship program in schools (academic
clinics)
12
3.3 Service Area: Health
1
Change idea
Steps to implement
Notes on evidence
Promote hand washing
•
Carry out advocacy and outreach campaigns in schools
and households.
With support from partners distribute leaky tins to
schools with permanent sources of water.
Encourage peer monitoring in schools where children
monitor each other to ensure they wash their hands
appropriately.
Initiate health clubs in schools with a patron to ensure
continuity
De-worming primary school children and administering
Vitamin A.
•
Carry out advocacy and outreach campaigns in schools
and households on importance of ensuring water safety
Encourage caregivers to treat water before use within
the household
•
•
•
•
•
2
Advocate for safe drinking •
water
•
•
Tested in 6 sites with high results.
Can be scaled up but needs adaptation for speciﬁc sites i.e. areas with
scarce water supply.
The children are trained to make
leaky tins using local resource like
tins, buckets, jerry cans e.t.c.
LOCODEI, NOFI, Shangia, Kinani CU
•
Tested in 6 sites with moderate
results, requires more advocacy and
awareness creation.
Challenges faced in areas with
perennial water shortage
Shangia CU, NOFI, LOCODEI
13
3.4 Service Area: Shelter and Care
1
Change idea
Steps to implement
Renovation of dilapidated
houses
•
•
•
Notes on evidence
Identiﬁcation of most dilapidated houses.
•
Mobilized resource from local business
men and women
Worked with the caregiver to provide labor.
•
•
Tested in 12 sites with moderate results.
However, the renovation cost is expensive
and may not be sustainable in the long
run.
A CBO in Eastern mentioned it is cheap
because of local labour. WOFAK in Nuru Ya
Bonde also used very minimal resources.
Linking caregivers to household economic
activities ensures they repair their houses
with minimal external support e.g Hakishep in Kibera and Hope Worldwide Kenya
in Eastern
Hakishep, WOFAK, Hope Worldwide Kenya
14
3.5 Service Area: Child Protection
1
Change idea
Steps to implement
Notes on evidence
Enhance awareness to the
community and children
on importance of child
protection
•
Awareness creation targeting the community through
churches, chief meeting (barazas) and school meetings on
importance of child protection and referral processes
Training CHWs on child rights and protection
Training children on child rights
Ensuring child protection during home visits by CHW
Formation of child rights clubs in school and ensuring they
learn to be each other’s keepers
Involve the community animators such as paralegals, parent
educators and CHVs in child protection through counseling,
reporting and sharing information with the community
members.
Organize feedback sessions with the children in schools and
churches to get information on what aﬀects them through
songs, exercises, skits, drama, talks and poems.
•
Map areas where children are likely to get exploited e.g. local
brew dens, video shows and areas where truck drivers park
Sensitize local brew sellers and identify hotspots where children are not allowed to access
Monitor areas truck drivers park and ensure no children go
there by involving the police children’s desk and children’s
oﬃce.
Link with partners to provide OVC with basic needs to avoid
them engaging in sexual exploitation.
•
•
•
•
•
•
•
2
Identify areas with high
prevalence of child abuse
•
•
•
•
15
Tested in 20 sites with good
results. Can be easy adopted
and scaled up.
AMPATH Port Victoria, AMPATH
Kapsoya, Kagwa, Dabaso,
Bukonoi
Tested in 12 sites with
high results. Requires
collaboration of the
provincial administration and
the AAC
AMPATH Budalangi,AMPATH
Kapsoya, Dabaso
3
Change idea
Steps to implement
Notes on evidence
Identify and withdraw OVC
from child labour
•
•
•
•
Map out and identify the details of children involved in child
labor i.e. their names, where they came from, local elders and
caregivers during household visits.
In partnership with provincial administration and the police
child desk carry out a mop up of children involved in child
labor.
Hold awareness meetings with members of the community
especially business community on the implication of child
labor
•
Tested in 6 sites with high
results. There is however
need for massive awareness
creation and education to
the caregivers if this is to be
sustained.
Households linked to house
hold economic strengthening
have minimal cases of child
labour
Shangia, AMPATH Budalangi,
4
Establishment of children
help desks within the police
station
•
•
•
Incorporating a representative of the police in the QIT
Discussions with the police oﬃcer in charge to set aside a
desk where children can report abuse cases
Collaboration with other partners including provincial
administration and AAC to speed up investigation and
processing of the cases
16
•
Tested in 5 sites with high
results.
AMPATH Kapsoya, AMPATH
Port Victoria, REEP
5
Change idea
Steps to implement
Notes on evidence
Ensure legal registration of
OVC and caregivers
•
•
•
•
•
•
•
6
Establishing legal clinics
•
•
•
•
Awareness creation during meetings with area chief on
importance of legal registration.
Share with the provincial administration and the registrar
Mobilization of caregivers who don’t have national identity
cards or birth and death certiﬁcates. Awareness creation
involving the registrar oﬃce and provincial administration on
importance of these documents is important.
There is need to ensure the police clearly understand child
rights and their role in ensuring children enjoy their rights if
the desk is to be eﬀective.
There is also need for close monitoring by various partners to
ensure no violation of child rights.
There is need to empower children to be able to report in case
they don’t receive the required service at the desk
•
Tested in 20 sites. With very
good results.
Can be easily adopted and
scaled up
Kagwa, Dago Dala Hera,
Dabasu, Hakishep
Mapping local community members with expertise in legal
•
matters
Inviting them for a presentation on legal issues aﬀecting OVC
and their households and the impact on the entire community
Identifying those willing to volunteer their time to support.
•
In collaboration with the legal volunteers, DCO and the area
chief convene legal clinics quarterly.
One CBO implemented
this change idea and had
remarkable progress in child
protection cases.
Its adoption and scale up was
a challenge because most
legal practitioners are based
in major cities and very
few are willing to volunteer
their time and resources to
participate in legal clinics.
Cheer up
17
3.6 Service Area: Household Economic Empowerment
1
Change idea
Steps to implement
Notes on evidence
Promote access to ﬁnancial
services to the caregivers
through Village Saving and
Loaning (VSL) activities.
•
Awareness creation through trained CHWs on
the importance of VSL and how it operates to the
caregivers. This will demystify the myths around
loans.
Carry out training on VSL to the caregivers.
Mobilize members to join and register.
Encourage saving and loaning by the caregivers
•
Awareness creation on diversiﬁed sources of
household income e.g. farming, energy saving
jikos, solar driers etc
Allow the caregivers to identify and select which
source is most appropriate for them
Link with relevant institutions and organizations
for capacity building and monitoring
Through caregiver support group track progress
of each caregivers
Through CHW monthly meetings track progress
and identify challenges.
Close monitoring by the caregiver or OVC support
group is important for growth and development.
•
•
•
•
2
Diversiﬁcation of
household income
•
•
•
•
•
•
18
Tested in 10 sites with good results,
However at the start up stage awareness
creation is important to clear the myths
and beliefs around loans among the
caregivers
KENWA, Msambweni CORPS, Shangia,
Hakishep, AMPATH Budalangi
Tested in 10 sites with fair results.
Important lesson is to allow the OVC
or caregiver to identify which income
generating activity they want to pursue.
Kagwa, Dago Dala Hela, KENWA, Shangia,
Msambweni CORPS
3.7 Psychosocial Support
1
2
Change idea
Steps to implement
Notes on evidence
Strengthening community
and household capacity for
provision of psychosocial
support to OVC and caregivers
•
•
•
Conducting sensitization
activities to create awareness
on psychosocial support
needs to caregivers and their
households.
•
•
Training caregivers of psychosocial
support with support from trained
counselors
There is need for clear guidance to the
CHWs on what is deﬁned as psychosocial
support and how to measure results.
Use practical and interesting
methodologies e.g. drama and songs to
pass the message
19
Tested in 4 sites.
Diﬃcult to measure results.
MOCASO, Redeemed Gospel Church
3.8 Service Area: Coordination of Care
1
Change idea
Steps to implement
Notes on evidence
Harmonize OVC service delivery
•
•
•
•
•
•
•
•
Map out organizations providing OVC
care and support in the region through the
department of social services
Hold meetings with representatives of the
organization and map out their activities
detailing activities, number of children,
region covered and duration of project.
Develop a database with the relevant
details.
In cases of duplication of work, hold
meeting with the partners through
the department of social services and
department of children services for
redistribution or adoption of diﬀerent
service areas.
Quarterly meeting through the department
of children service to review progress of
each organization.
Develop a database of OVC to reduce cases
of double support.
20
Tested in 3 sites with improved results.
However, this is the core business of the
department of children services and they
should take the lead or drive the process
to ensure every actor adheres to the set
standards.
Njukini CU
4. ANNEXES
21
AMAPATH AMPATH Port Victoria
x
AMPATH Kapsoya
x
APHIA
Hope Worldwide Kenya - Makueni x
Plus Kamili Twana Twitu
x
Save the Children Meru
x
Ruiru Baptist Church
x
Ngoliba
x
Makindu Children Centre
x
Shephards of Life
x
x
x
x
x
x
x
x
x
x
Society of Women Aganist AIDS in x
Kenya (SWAK)
x
x
Cheers Up
x
St. Joseph HIV Self Help Group
x
x
x
Food for the Hungry
x
x
Terry Child Support
x
x
22
x
Coordination of
care
Shelter
Child
Protection
Psychosocial
Support
Health
Economic
empowermennt
Education
Community based org/
QI team
Nutrtion
Partner
Food security
ANNEX 1: LIST OF TEAMS TESTING CHANGE IN EACH SERVICE AREA
Little Servants of the Sacred
Heart
Coordination of
care
x
YARD
APHIA
Plus
Nairobi
Coast
Shelter
Child
Protection
Psychosocial
Support
Health
Economic
empowermennt
Education
Nutrtion
Community based org/
QI team
Food security
Partner
x
Cheda
x
Catholic Diocese of Kitui
x
Anglican Church of Embu
x
CARITAS Nyeri
x
HAKISHEP
x
KICOSHEP
x
MOCASO
x
Shangia Community Unit (CU)
x
x
x
x
x
x
x
x
x
x
x
x
x
x
Mkunumbi CU
x
Children Hope Foundation
x
x
x
Redeemed Gospel Church
x
KENWA Korogocho
x
x
x
x
Progressive Care Coalition
x
MOHAB
x
Msambweni CORPS
x
23
x
x
x
LOCODEI
Coordination of
care
Shelter
Child
Protection
Psychosocial
Support
x
Njiru Organic Farming Integrated
x
x
St. Francis
APHIA
Plus Nuru
ya Bonde
Health
Economic
empowermennt
Education
Nutrtion
Community based org/
QI team
Food security
Partner
x
x
Njukini CU
x
Dabasu CU
x
Evangelising Sisters of Mary
x
Catholic Diocese of Eldoret
x
Mother Francesca
x
LIFA
x
Catholic Diocese of Ngong
x
Kenya National Organization
of Peer Education and Training
(KNOTE)
x
x
x
x
x
x
x
x
Beacon of Hope
x
Narok District Network Forum
x
Deliverance Church Nakuru
x
WOFAK
x
x
24
Kagwa
x
x
x
x
Bukonoi
x
x
x
x
x
Osiep Kiye
x
25
x
x
Coordination of
care
Shelter
x
x
REEP
Matunda Jua Kazi
Child
Protection
Psychosocial
Support
Health
Economic
empowermennt
Dago Dala Hera Community Unit
Education
APHIA
Plus
Western
Nutrtion
Community based org/
QI team
Food security
Partner
ANNEX 2: LIST OF PARTICIPANTS
NAME
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
James Kamau
Herbert Kahindi
Mesaidi Mwarandu
Lydia Simiyu
Douglas Kariuki
Javanson Njue
Christine Kalume
Millicent Akinyi
Irene Masudi
Susan Odero
Joseph Makokha
Jackson Muge
Subira Kingi
Abdalla Mwatari
Omar Suya
Metrine Mudibo
Emily Murungi
Peter Odongo
LOCAL IMPLEMENTING
PARTNER
PROJECT
Hope Valley
Shangia Community Unit
Shangia Community Unit
Shangia Community Unit
Cheer up
ACK Embu
Kinani
Hakishep
Dago Dala Hera
Dago Dala Hera
Bukonoi Sama Bungoma
Bukonoi Sama Bungoma
Dabaso CU
Msambweni Corps
Locodei
Redeemed Gospel Church
Aphia plus Coast
AMPATH Plus
APHIA Plus Kamili
APHIA Plus Nairobi Coast
APHIA Plus Nairobi Coast
APHIA Plus Nairobi Coast
APHIA Plus Kamili
APHIA Plus Kamili
APHIA Plus Nairobi Coast
APHIA Plus Nairobi Coast
APHIA Plus Western Kenya
APHIA Plus Western Kenya
APHIA Plus Western Kenya
APHIA Plus Western Kenya
APHIA Plus Nairobi Coast
APHIA Plus Nairobi Coast
APHIA Plus Nairobi Coast
APHIA Plus Nairobi Coast
APHIA Plus Nairobi Coast
AMPATH Plus
26
NAME
LOCAL IMPLEMENTING
PARTNER
PROJECT
AMPATH Plus
APHIA Plus Nuru ya Bonde
APHIA Plus Kamili
APHIA Plus Nairobi Coast
APHIA Plus Western Kenya
APHIA Plus Kamili
19.
20.
21.
22.
23.
Lilian Astiavula
Emma Akinyi
Muhamed Akulima
Stella Wachira
Millicent Oluoko
AMPATH Plus
Aphia plus Rift Valley
Aphia plus Kamili
Aphia plus Nairobi/Coast
Aphia plus Nyanza/Western
24.
25.
26.
27.
28.
29.
30.
31.
32.
33.
34.
Lukas Ndung’u
Joash Apollo
Scevar Swaro
Felix Miti
Patrick Kinyae
Charles Mukabi
Lydiah Atieno
Stanley Masamo
Roselyn Were
Jemimah Owande
Irene Mutea
YARD
REEP
REEP
NOFI
Njukini Community Unit
MOCASO
MOCASO
HCI
HCI
HCI
HCI
27
APHIA Plus Western Kenya
APHIA Plus Western Kenya
APHIA Plus Nairobi Coast
APHIA Plus Nairobi Coast
APHIA Plus Nairobi Coast
APHIA Plus Nairobi Coast
USAID HCI
USAID HCI
USAID HCI
USAID HCI
28