Across Africa and beyond, HIV programs for orphans and vulnerable children provide a critical opportunity to respond to Covid-19

May 12, 2020
A family at home in Tanzania before the Covid-19 pandemic. (Photo: Brian Clark/Pact)

Imagine that a dangerous, highly contagious virus is spreading around the world, and you are tasked with helping communities challenged by poverty and marginalization to protect themselves. Imagine that you could choose any tools you need. Near the top of your list might be a register of vulnerable households in the communities you serve, along with their phone numbers and plenty of trained community workers who have already built trusted relationships with those households.

At Pact, this is exactly what we have in communities in South Africa, Eswatini, Tanzania, Burundi, the Dominican Republic and beyond. This is because, before the Covid-19 pandemic, with funding from USAID and PEPFAR, Pact was working to improve the lives of orphans and other children vulnerable because of HIV. Much of Pact’s orphans and vulnerable children (OVC) programming uses a household-level case management approach, meaning Pact and its partners work directly with vulnerable families to help them overcome a range of challenges that contribute to their vulnerability. This includes helping caregivers to increase their income and gain parenting skills, and helping children access nutritious food, health services and school.

“Just like we’re seeing in the United States, vulnerable populations not only have to worry about the disease, but also the impacts of the disease on the services that they are often very dependent on,” says Tom Ventimiglia, Pact’s OVC technical lead. “With our experience and existing relationships and networks of community-based workers, we’re well positioned to quickly take measures to help those most at risk protect themselves from the virus as well as its secondary impacts.”

In Eswatini, Pact implements Insika Ya Kusasa (The Pillars of Tomorrow), a USAID-funded project that is preventing new HIV infections and bolstering opportunity among vulnerable children and adolescent girls and young women. Insika Ya Kusasa community volunteers who used to have regular in-person contact with more than 100,000 young women and vulnerable children are now checking in with them by phone, sharing critical information about how to prevent the spread of Covid-19, how to properly wash hands and how to build “tippy tap” stations for handwashing without running water.

“To bring down airtime costs, our community volunteers are conference-calling with four households at a time to touch base and share health messages, as well as using WhatsApp,” says Pact’s Choice Makufa, the project’s OVC technical lead. “Almost immediately we had families sending back photos of their tippy taps and videos of their children singing Happy Birthday as they washed. We’re seeing that ‘visiting’ by phone is working.”

Makufa notes that the project is prioritizing children living with HIV, making sure they are staying healthy and have enough medication to avoid lapses. “We’re minimizing visits to health facilities as much as possible, using calls to determine if there are immediate needs,” she says.

Because many families rely on informal work and trading of goods and services for their income, food insecurity has become a major concern during lock-down. Insika Ya Kusasa is working to redirect funding from slowed-down activities to provide emergency cash transfers to vulnerable households.

“We’ll be using mobile money transfers to avoid physical contact,” Makufa says, “making sure families have enough to cover basic staple items.”

In nearby South Africa, Pact’s Government Capacity Building and Support program, or GCBS, has been working since 2013 to help the country’s Department of Social Development to better support orphans and vulnerable children. After the pandemic began, GCBS immediately prepared messages to be shared with vulnerable families to help them stay healthy. Pact also quickly developed a set of tools for social workers to conduct telephonic case management of vulnerable children, including assessing Covid-19 risk.

GCBS is also prioritizing children living with HIV, making sure they continue to adhere to treatment amid lockdown, says Ranahnah Afriye, the project’s chief of party and Pact’s South Africa country director.

So far, GCBS has completed nearly 3,000 remote counseling sessions, with most of them lasting longer than anticipated because of additional support needs.

“Access to food and clean water are the most common issues that are coming up. South Africa has been in lock down for more than a month now, and that is devastating for those who live from daily wages. People haven’t been able to go to work,” Afriye says. “We’re looking at how we can support government food distribution efforts, including sharing HIV prevention messaging in conjunction with community disbursement of food parcels.”

GCBS is also working to build a new mobile phone app to digitally deliver YOLO – You Only Live Once – a government-sponsored program that helps teenagers and young adults overcome social and behavioral drivers of HIV. 

In Burundi and the Dominican Republic, Pact works with vulnerable children through the ACHIEVE project, a five-year global effort to reach and sustain HIV epidemic control among pregnant and breastfeeding women, adolescents and children. Because Burundi’s government has not issued a stay-at-home order, ACHIEVE community volunteers are continuing to visit households there. But now they are coming with special information on Covid-19, and they are following new training on how to hold visits outdoors while maintaining social distance, explains Stephanie Cálves, the project’s senior capacity development manager.

“We’re also working with our local partners on business continuity planning to make sure they are able to get through this difficult time successfully so they can continue to serve communities,” Cálves says.

In the Dominican Republic, which nearly completely shut down, community volunteers are shifting to phone-based case management, including sharing Covid-19 information. Many of the families ACHIEVE serves in the DR are migrants who have now lost employment. The project is preparing to provide them with additional food support, cooking fuel and hygiene kits.

“We’re also planning for how we can assist our treatment partners to make sure that our clients living with HIV have access to enough medicines, including through community distributions if needed to avoid frequent visits to health facilities,” says Ventimiglia.

Across its OVC projects, Pact is also helping families cope with added stress from home confinement, ensuring they know how to prevent and respond to instances of domestic or gender-based violence, which have been on the rise amid lockdowns.

“We are keeping our eyes open so that we recognize all the ways that Covid-19 may be affecting communities,” Ventimiglia says, “and working to incorporate a comprehensive response into our already important programming.”