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					TUTULANE AIDS ORGANIZATION ORPHANS AND VULNERABLE CHILDREN (OVC) VULNERABILITY SURVEY Final Report

“With Tutulane, you will never walk alone. In good times and in sadness, we are
with you. We hold your hand and we walk together. Let’s help one another. Page | 1

TUTULAN E AIDS O R GA NIZ A TION ORPH AN S AND VULNER A B LE C HILD REN (OVC) VULNER A BILITY SU RVEY

Final Repor t June 2008

Written by: Kennedy Oulu(Technical Adviser) Tutulane AIDS Organization – Chitipa program Northern Region (MALAWI)

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Since 1997, Tutulane AIDS Organization has cherished the privilege of serving the vulnerable and disadvantaged in Chitipa district, Northern region of MALAWI. Without regard to race, creed or nationality, Tutulane provides HIV/AIDS prevention, care and support and mitigation to the community, PLWHIV and Orphans and vulnerable children in the whole of the district in the wake of the pandemic, its incidence and prevalence and the ravages caused by its impact on the community systems and structures. This is accomplished through community interventions and projects in fields such as; Health and HIV/AIDS, Gender and human rights, education, food security and nutrition, rights advocacy for the vulnerable and disadvantaged. Published in 2008 by: Tutulane AIDS Organization Private Bag 26 Chitipa-Zambia Road, Opp. Chitipa MRA Chitipa-MALAWI Written by: Kennedy Oulu (Technical Adviser-Tutulane) Cover Photo: Orphans and vulnerable children within TA Mwaulambya(Chitipa District), engaging in sports during a children’s corner at Tutulane AIDS Organization. ©Copyright 2008 Tutulane AIDS Organization The views expressed in this document are those of the authors. Readers may copy or translate this report for non-profit use, provided copies or translations are distributed free. Please give appropriate citation credit to the author and to Tutulane AIDS Organization.

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TABLE OF CONTENTS:
Table of Figures: ...........................................................................................................................................56 Acronyms…………………………………………………………………………………………………………….6 Acknowledgements…………………………………………………………………………………………………7 Executive summary…………………………………………………………………………………………………8 Background…………………………………………………………………………………………………………..9 Introduction to the OVC vulnerability survey………………………………………………………………..11 Methodology……………………………………………………………………………………………………….13 Limitations of the study………………………………………………………………………………………….17 Findings…………………………………………………………………………………………………………..…18 Results……………………………………………………………………………………………………………....22 Conclusions and recommendations……………………………………………………………………………..29 Appendices Appendix 1-Tabulated data/Questionnaire instrument 1……………………………………………………30 Appendix 2-Analysed results 2a-Key informant survey results(Kameme)…………………………………………………..…35 2b-Key informant survey results(Mwaulambya)…………………………………………………37 Appendix 3-FGD results(Kameme and Mwaulambya)…………………………………………………..…..43 Appendix 4-Survey instruments used 4a-OVC instrument 1…………………………………………………………………….………….46 4b-Key informant instrument 2…………………………………………………………………..55 4c-FGD questions. Instrument 3…………………………………………………………………..57 Appendix 5-Translated versions of survey instrum ents 5a-Nyika version……………………………………………………………………………………59 5b-Lambia version………………………………………………………………………………….67 References………………………………………………………………………………………………79

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TABLES AND FIG URES: TABLES AND FIG URES:
List of Tables: Table 1:Group villages triangulated by TA……..………………………………………………12 Table 2: Totals of OVC interviewed desegregated by analysis categories…..………………….22 Table 3: Sources of RH, safe sex and HIV/AIDS info by gender……………………………….23 Table 4: Sources of RH, safe sex and HIV/AIDS info by vulnerability categories…..…………..56
Table 5: Media preference by gender (all vulnerable groups)………………………………………………24 Table 6: Sources of condoms by gender (all vulnerable groups)……………………………………………25 Table 7: OVC households' expenditure categories by gender and TA……………………………………..26 Table 8: Rights and property categories by gender and TA………………………………………………...26

List of Figures: Fig. 1: Number of OVC interviewed desegregated by survey categories………….……………………….28 Fig. 2: OVC sources of RH, safe sex and HIV/AIDS info by gender and totals…….…………………….28 Fig. 2b: Sources of RH, safe sex and HIV/AIDS info by vulnerability groups……….……………………29 Fig. 3: Rights and access to land and property by TA……………………………….………………………29

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ACRONYMS:
AIDS – Acquired Immune Deficiency Syndrome ART – Anti-Retroviral Therapy ARV(s) – Anti-Retrovirals CBO-Community Based Organization DSWO – District Social Welfare Office FGD – Focus Group Discussion GVH(s) – Group Village Headman (men) HIV – Human Immuno-deficiency Virus HTC – HIV Testing and Counselling MRA – Malawi Revenue Authority NGO – Non Governmental Organization OVC – Orphans and Vulnerable Children RH – Reproductive Health STI(s) – Sexually Transmitted infections=Sexually Transmitted Diseases TA(s) – Traditional Authority (ies) USAID – United States Agency for International Development VCT – Voluntary Counselling and Testing

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ACKNOWLEDGE MENTS:
TUTULANE AIDS ORGANIZATION wishes to sincerely acknowledge and thank the following organizations, departments and people who contributed immensely their time and or resources to make this survey a success: We acknowledge the financial assistance of PACT-MALAWI/USAID, which went a long way to fund the actual planning and implementation of this survey. We acknowledge the assistance of the District Social Welfare Office-Chitipa, through Mr. Rodwell Chunga for providing the secondary data of Orphans and vulnerable children in the district even at a time when the final report was not out. Appreciation also goes to the DSWO for the technical backstopping provided in instrument development for the survey, to ensure a uniform data capture mechanism for reliable monitoring and evaluation. We wish also to acknowledge the community leaders; especially the Chiefs of TAs Mwaulambya and Kameme; the Group Village Headmen and the village headmen for giving our researchers unfettered access to the community, helping in identification of the Orphans and vulnerable children, and informing the community of the survey. We are in acknowledgement of the school head teachers, church leaders and community based organizations within these TAs for allowing us to access records of orphans under their support. We wish to appreciate the continuous technical assistance that was received through the Internet, especially from the list serve afro-nets We are greatly indebted to the respondents who generously gave their time to provide the information that forms the basis of this report, and to the interviewers who toiled even during the rainy weather to conduct the grand obligation of collecting the information required. Without all of you, this report would not have seen the light of day.

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EXECUT IVE SU MMARY:
This OVC vulnerability survey is a response to the plight of orphans in Chitipa district. It was commissioned by Tutulane AIDS Organization, in collaboration with PACT-M/USAID, Egmont Trust (UK) and Firelight Foundation (US) with the following objectives in mind; 1.. To develop a database of OVC in the two TAs of Mwaulambya and Kameme as a reference 1 point for future planning and coordinating response for care and support of OVC 2.. To rank the OVC in the two TAs based on different vulnerability indices for registration and 2 a focused support 3.. To prioritise the key problems that are faced by OVC in the two TAs 3 4.. To understand the extent of the orphan problem being an impact of HIV/AIDS in the two 4 TAs The survey was conducted with the following hypotheses in mind; • Many orphans who are currently being supported by the DSWO are not genuine since no survey has been conducted to clearly identify them. • Most orphans are ill-treated and cannot access their inalienable rights to education • OVC have different priorities and those who are being helped, get assistance in areas which are Non-priority, leading to misallocated support which does not ensure sustainability The vulnerability survey was conducted in two TAs of Mwaulambya and Kameme with a total of 32 researchers being 18 for Mwaulambya and 14 for Kameme. These researchers were coordinated by two supervisors, one for each TA. It took two months to complete the administration of the interviewer-administered questionnaire for OVC, a total of 4 days to conduct the key informants’ survey and 4 days to complete the focus group discussions with selected OVC. Data entry and analysis, being manual took one and half months. A total of 2 383 OVC were interviewed. This represented 1234 male and 1159 female. 42 opinion leaders were interviewed under key informants, and 77 selected from the 2 383 as most vulnerable OVC covered under focus group discussions. 20 group villages were triangulated and OVC there-in interviewed during the survey period. The whole of TA Kameme with seven group villages was covered and 13 out of 29 group villages in the vast TA Mwaulambya. The following issues arose from the survey as captured in the findings and results; • Community leaders are not open on the situation and existence of orphan headed households in the community because they think it reflects negatively on them • OVC need substantial support in terms of education, food and nutrition • Glaring poverty drives OVC into early marriages and commercial sex work to make ends meet and support their siblings. • OVC in households with a size of more than 5 and within the age group of 5-15years prioritise food support to help feed their siblings • OVC of primary school going age, feel ill-treated. Instead of going to school, they are forced to graze animals, do other piecework to generate monies to buy uniforms, learning materials etc which interferes with their performance and concentration in school. • Lack of parental care and guidance predisposes OVC to unbecoming and risky behaviour in their quest to manage their financial constraints/doldrums. These are just but highlights to the myriad problems unearthed within and during this survey. This report thus presents the findings, methodology, results and recommendations as a basis for coordinated support for OVC in the district.

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BACKGROUND :
Tutulane AIDS Organization is a CBO transforming into an NGO. It is based in Chitipa Boma, about 2Km on Chitipa-Zambia road, opposite the MRA offices and operating at the former Malawi Young Pioneers (MYP) base in Chitipa. Formed in 1998, it runs the following programs; • HTC services in the district(2 static and 3 mobile outlets) with 32 VCT counsellors • HBC services(148 clients under care) • Community based child centres(22 in total) • Resource centre/Library • Youth program on HIV/AIDS • Community sensitization campaigns through: Theatre for development, PASAKA1, INSAKA2, ART literacy campaigns • Vocational skills centre for OVC Vision: Tutulane envisions...... An informed, empowered and motivated society, which is healthy and lives positively against the adversity of HIV/AIDS pandemic and its impact. Mission Statement: Tutulane seeks to… Effectively provide quality and comprehensive HIV and AIDS prevention, capacity building, treatment and impact management services to those infected, affected and vulnerable in the community. Value statement: The impact of combining resources and interventions in improving the lives of target can only be measured from the perspective of the beneficiary. Tutulane ensures that these means are managed transparently, with accountability and participatorily to produce a positive and sustainable impact on the lives of the community. Tutulane AIDS Organization within this project essentially covers the whole of Chitipa district located North East of the northern region of Malawi. Chitipa district borders Tanzania to the north and Zambia to the east. It is approximately 700Km from Lilongwe, the capital city of Malawi. It has 5 traditional authorities, 5 constituencies and 22 wards with about 15 tribes The total land area is 4, 288 square kilometres with a projected population of 161 271(2006) and an annual growth rate of 2.4%.

1

PASAKA is a concept adopted by Tutulane AIDS Organization from PADARE of Zimbabwe. It means working with men in a partriarchical culture to spearhead the respect of women rights and advocating against cultures which predispose women and girls to vulnerability especially in the context of HIV/AIDS
2

INSAKA is a model developed by Tutulane to bring adults and youth together to discuss culturally sensitive issues of reproductive health, sex and sexuality and HIV/AIDS with a view to influence behaviour change. Culturally, discussion of such issues within this culture is considered taboo.

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Chitipa district has a HIV/AIDS prevalence rate of 18 %( District AIDS Coordinating Committee2005), way above the national average of 14.4%. This high prevalence rate is contributed by the following factors; • Lack of income generating activities among women population in the district • Bad cultural practices such as wife inheritance, polygamy, early and forced marriages etc. • Low HIV risk perception The whole district has only 10 VCT sites, situated at the health centres, except Tutulane’s VCT site, which is the only stand alone site in the district. These centres are situated close to the roads and thus those in the interior cannot access HTC services. The district has only 2 centres which provide ARVs; Chitipa District hospital and Kaseye Health centre both in TA Mwaulambya. People have to travel long distances to access VCT and ART services. There are only 469 people living with HIV on ARVs in the district (Socio-economic profile, 2006-2009; Chitipa District) In summary, the following are issues in Chitipa district, that Tutulane AIDS Organization seeks to address through the Community REACH project; • Patients travel long distances with poor infrastructure and poverty to access ARV and most cannot even access this service • The actual number of OVC in the district is not known and most lack basics like proper care, nutrition support and school fees • Most girls don’t access information on reproductive health and HIV compared to boys • HBC services are not comprehensive since most care givers are not trained

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INTRODUCTION TO THE OVC VULNERABILITY SURVEY :
Tutulane AIDS Organization, being a CBO that implements HIV/AIDS programs has been involved in care and support of OVC under mitigation of impact within TA Mwaulambya for the last 10 years. In the OVC programs, the following lessons had been learnt over time; • Most of the OVC accessing support within her programs are not genuine • The support given to OVC in most cases cannot be sustained due to misplaced priorities • The DSWO have not done a comprehensive survey of the orphan situation in the district • Most CBOs report the number of OVC to DSWO as a means to win donor support for their programs • The number of OVC in the community still continues to rise With the above lessons learnt, Tutulane thought it necessary to come up with an approach which will ensure that genuine orphans are categorised within their vulnerability categories so as to coordinate focussed support which will be sustainable and manage the problem of OVC in the community. This formed the basis of the survey: OVC vulnerability survey for TA Mwaulambya and Kameme. The OVC vulnerability survey was conducted in the two TAs between the months of December 2007 and April 2008, with the following objectives; 1. To identify vulnerable OVC in the two TAs and rank them based on indicator levels of vulnerability for coordinated and focused care and support. 2. To develop a reference point for OVC in the community for future support 3. To determine the extent of access to different rights which make them more vulnerable 4. To register the OVC so identified with the DSWO for coordinated support 5. To appreciate the priorities of OVC as a basis of sustainable support This survey was thus conducted under various levels of vulnerability which were deemed to be the major causes of vulnerability among the target. The following were the levels of vulnerability under which the survey was conducted; 1. Access to education 2. OVC household food security 3. Access to behaviour change information(Reproductive health and HIV) 4. Economic livelihoods 5. Access to rights and property 6. Access to primary health The approach used to conduct the survey involved the following processes, most of which are further clarified in methodology section; • Gathering of secondary data on OVC in the district • Instrument development • Survey methodology training for the researchers • Instrument translation into Lambia and Nyika languages • Sampling and triangulation • Pre-test of the questionnaires • Development of final survey instruments • Actual field survey • Data entry
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• Data analysis • Survey report • Communication of survey results Random sampling and triangulation was used to identify the group villages to be covered during the actual survey. The following Group villages were thus covered during the survey. Table 1: Group villages triangulated by TA Category/No. GVHs covered in TA GVHs covered in TA Mwaulambya Kameme 1. • Mkombanyama • J.Kameme 2. • Mwenechinunkha • Ipenza 3. • Lufita • Dangali 4. • Mwenifumbo • Navitengo 5. • Ibanda • Lunda 6. • Mwenechinunkha • J.Mwang’amba 7. • Masyesye • Reuben 8. • Mwenifuvya 9. • Katutula 10. • Mwakabanga 11. • Mwachizimu 12. • Mbilima 13. • Kapenda TOTAL 13/29 7/7 The actual survey used 3 different sets of questionnaires, thus; • OVC questionnaire instrument: This instrument was administered by the interviewers on the identified OVC directly and filled • Key informant instrument: This targeted getting information about OVC and their situation from opinion leaders in the community to compare with the results from the questionnaire instrument. • Focus group questionnaire: This targeted select number of OVC to state their situations and possible recourse from their own perspectives The OVC targeted in this survey included total orphans, partial orphans and children with disability falling within the age group of 14-20 years old and households of OVC, targeting all the children within such households.

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METHODOLOGY:
The OVC vulnerability survey employed both qualitative and quantitative survey methods of data collection. 3.1: QUANTITATIVE SURVEY 3.1.1 Sampling procedure The sampling for the survey identified the two TAs based on the operational catchment of Tutulane AIDS Organization. The triangulation of the group villages to cover was only different for TA Mwaulambya being larger than TA Kameme. TA Kameme was covered in totality, with all villages sampled. In TA Mwaulambya, group villages were targeted based on the reports of OVC collected during secondary data gathering and previous surveys. Two regions were thus considered in TA Mwaulambya thus; Mwaulambya-Kaseye and Mwaulambya-Songwe. The sampling clusters was two-stage, the first being individual OVC and the second being OVC households 3.1.2 Individual OVC: A list of all OVC as compiled by the Ministry of Gender and social welfare was assessed and compared with the list of OVC developed by the Village Development Committees (VDCs), CBOs implementing intervention programs on OVC and Tutulane AIDS ORGANIZATION. The OVC were then selected based on the age group of 14-20 years and whether they were Total or partial orphans. Priority was given to all Total orphans within the select villages. The interviews were conducted in the homes where the orphan stays but with the actual orphan alone, and in environments where they felt comfortable. Some were identified from schools where they learn through the teachers. 3.1.3 OVC Households: The OVC households were sampled based on information generated from the VDCs and the community as a baseline. The community have never accepted the existence of orphan headed households and most of information used in sampling came from the reports from previous surveys done by Tutulane AIDS Organization. Based on this background the survey went ahead to identify all the OVC households and confirm the situation 3.1.4 Questionnaires Three types of questionnaires were used in the survey. These questionnaires were developed based on the indicators that the survey needed to assess and to test some of the hypotheses that were held before the beginning of the survey. These questionnaires were then translated into two predominant languages within the two TAs under consideration. In TA Mwaulambya both English and Lambia versions were used, whereas in TA Kameme, English and Nyika versions were used. The questionnaires were used to collect information both qualitative and quantitative from the target groups on the following topics; • Access to education • OVC household food security
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Access to behaviour change information: Reproductive health and HIV; Economic livelihoods • Access to rights and property • Access to primary health The questionnaires were pre-tested within Group village Mkombanyama in TA Mwaulambya. This helped to come with the final English, Nyika and Lambia versions. From the lessons learnt in pretesting, further changes were made in the questions, some stricken out and some interviewing skills updated for the researchers. • • Training The recruitment of survey field staff was based on the following preconditions; • Experience in carrying out surveys • Interviewing skills • Ability to speak the local languages • Understanding of the rights of children The training was conducted for three days and contained the following; personal values, value of others, interviewing methods, interview processes, understanding the questionnaires, research ethics, verbal and non verbal communications, filtering judgemental messages and children rights. The training encompassed both theoretical and practical components. In depth discussions of the instruments developed formed the heart of the training. Translation of the questionnaires was accomplished within the training. At the end of training, a pre-test was organized before another discussion and instrument updating session. The end of this marked the beginning of deployment. A total of 32 participants successfully qualified from the training and two teams were selected for the field work. One team composed of 18 were attached to survey in TA Mwaulambya and 14 deployed to TA Kameme • Data collection: The two teams were coordinated by one supervisor/team leader each. Data collection took place between 15th December 2007 to 15th April 2008. This involved 2 months of OVC questionnaire and 10 days (5 each) for key informants and focus group discussions. Completed field questionnaires were handed to Tutulane AIDS Organization offices in Chitipa by the supervisors/team leaders. • Data analysis: Data entry was done in phases. After the end of administration of OVC questionnaire, data entry began immediately. This exercise took 2 weeks. The other data entry sessions began after the end of key informants and focus group discussions. Manual data entry procedures were used.

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3.2: QUALITATIVE SURVEY Research setting: This study was conducted in the two TAs: Kameme and Mwaulambya Study design: The study took place in April 2008. It was undertaken to complement the quantitative survey and also to triangulate the data generated in the quantitative survey. The tools used were focus group discussions. This targeted 10-15 OVC selected based on their degree of vulnerability after the ranking exercise. A total of 5 teams were used. Mwaulambya had 3 teams, each with a facilitator, note-taker and observer with 10-15 discussants/participants. Kameme had 2 teams of the same design. Data collection tools: Focus group discussion question guides were used in this study. A moderator followed a pre-developed interview guide that directed discussions among groups of 10-15 OVC. The respondents were male and female OVC who had been rigorously selected as the most vulnerable among the number interviewed based on the afore-mentioned vulnerability indices. ETHICAL CONSIDERATIONS: Considering that HIV/AIDS and OVC issues are still sensitive, and that the survey targeted orphans and vulnerable children, ethical considerations had to be put in place. A letter requesting the district to give authority to Tutulane AIDS Organization was sent to the District commissioner before the survey was conducted. The chiefs responsible for the two TAs were also notified of the pending survey, its importance, period and objectives. The research team was trained on values that accompany such surveys, the rights of children, who they would interview and the code of conduct of interviewers. They were also oriented on the importance of seeking consent before interviewing and preparing the respondents on what to expect and or otherwise. The respondents were also informed to stop the process whenever they felt they did not want to continue. DATA ANALYSIS: Data analysis was done using the following themes, which formed the objectives of the survey: Access to education, OVC household food security, Access to behaviour change information (Reproductive health and HIV), Economic livelihoods, Access to rights and property and Access to primary health. The framework used in the analysis was developed to capture all the information relevant to the objectives of the survey. Data was then coded, sorted and summarised into issues and sub-issues, drawing out the general quotes and rare/common themes. QUALITY ASSURANCE MECHANISMS: • Data collection team The data collection teams were selected based on previous experience in carrying out social surveys and working with children. They were trained in values, ethics, and instrument administration and coding. This ensured uniformity in coding. They were also selected based on their command of local languages to ensure uniformity in interviewing.

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• Translation The translation was done at the end of the training of researchers. The Kameme team translated the English questionnaire into Nyika dialect whereas the Mwaulambya team into Lambia. The translated versions were then discussed before the final copies were certified as true version and printed. • Measures to increase trustworthiness The following were done to increase trustworthiness; • Data analysis started immediately the first phase of the survey was completed to reduce data loss • The supervisors/team leaders were involved in cross checking the filling of questionnaires every day before submitting them to the office for evaluation again. This ensured that incomplete questionnaires were sent back in time for updating. • The researchers were restricted to filing at most 4 questionnaires a day to ensure maximum concentration and quality.

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LIMITAT IONS OF THE STU DY:
This survey, being the first of its kind in Chitipa District, and probably the whole of Malawi involved working with a number of interested partners, who individually contributed useful information. The planning and management of the survey itself was holy coordinated by Tutulane AIDS Organization, since most partners had little knowledge and information on how to conduct this survey approach in the District. The survey however had the following limitations; • It was not possible to survey all the orphans and vulnerable children in TA Mwaulambya • The survey relied heavily on respondents self reports which in most cases is socio-culturally determined and thus questions on sex and sexuality were either not answered or misrepresented due to the respondents need to be culturally right. • The field work was done during the rainy season which affected access to all orphan households • Some orphans and vulnerable children deliberately misinformed the researchers with the expectation of benefit after the end of survey.

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FINDINGS:
A: ACCESS TO EDUCATION: This quote from one of the OVC summarizes the dilemma of access to education…….” I was sent home by my teacher because I had no uniform and books. When I went home to my step mother (Guardian), she told me that if we don’t have money for food, where do I expect her to find money for uniform. She advised that I should do some piecework to save money to buy such things. I have failed. I cannot go back to school because the other pupils will laugh at me, when I have no uniform…… I’d better graze animals to get some money”…Abraham Simkonda/Kameme The transition rate of OVC from primary to secondary schools within the TAs covered is below 50%, and far worse for children with disabilities who have added challenge of stigma and discrimination. This represents a high drop out rate at primary level, coupled with higher apathy to continue education after dropping out. With these doldrums, food and education are interchangeably the highest OVC expenditure categories. • 56% of boy-orphans fail to transit to secondary schools, compared to 58% of girl-orphans. Only 8% of children with disabilities considered transit to secondary schools. • The apathy rate of rejoining school is almost similar across gender. 26% of boys and 25% of girls wish to go back to formal education systems whereas only 5% of both gender anticipate joining informal systems of education. Among the disabled, none wishes to go back to school citing stigma and discrimination • 29% of OVC pay for their own education. • The highest OVC expenditure category is food, followed by education at primary school, but this changes when in secondary school, where education costs override expenditure on food • Most OVC have dropped out of school mainly because of their or their households’ inability to buy school uniforms, learning materials and to provide for school fees. B: OVC HOUSEHOLD FOOD SECURITY: Improving food security of OVC households, not only increases nutrition levels but also enables OVC to invest in other essential needs beside food. This gives them an opportunity to access education. A nutritionally balanced diet for them requires capacity building as a component of food security initiatives. To improve their household food security, OVC, including children with disability have established farms or food gardens, although only 4% access nutritionally balanced diet at least thrice a week Availability of food gardens among OVC subsidizes the expenditure on food thus making funds available for other essential needs. Most of the production is still at subsistence levels More girl-OVC will most likely resort to relatives and or begging to get money for their food needs than boy-OVC. More of the boys instead chose piecework to subsidise their household’s food needs compared to girls.

• • •

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C:

ACCESS TO REPRODUCTIVE HEALTH AND HIV/AIDS INFORMATION: Access to reproductive health and HIV/AIDS information among OVC follows context, convenience and also dependent on the social relations of the OVC being considered or whether they are total or partial orphans. Nevertheless issues surrounding sexual intercourse and STIs are still sensitive subjects among OVC especially when such discussions are inter-generational. The home/household remains the most unlikely source of such information by OVC, whereas school and campaigns the most likely sources • • None of the OVC interviewed acknowledges having had sexual intercourse and or contracting STIs. This can be attributed to the cultural sensitivity surrounding these issues in the community The major sources of reproductive health, safe sex and HIV/AIDS information among OVC are school and campaigns at 36% and 35% respectively, whereas the most unlikely source of the same is the home/household. The church is making significant contribution at 15%, but the hospital and peers are less significant (Although, more boys will still prefer the peer as girls will the hospital). Desegregation by category of vulnerability shows that Girl-total orphans prefer hospitals and churches than boy-total orphans. Children with disability will mostly get the information from hospitals and homes, in contrast to most of the other categories. Girl OVC are not comfortable accessing RH/HIV/AIDS information from their homes/households

• •

Preferred media for accessing the above information: • 70% of OVC prefer audio-visual media, 26% VCT, whereas the children with disability, especially the visually impaired prefer print media, notably braille. • When preference is desegregated by gender, significantly more male prefer VCT and print media than female Source of condoms: • 90% of male-OVC access condoms through campaigns. Girls are shy discussing condoms and do not know or appreciate the existence of female condoms. • OVC cannot afford to invest in purchase of condoms from the shops even when they need it due to financial constraints and competing priorities. D: ACCESS TO PRIMARY HEALTH CARE: “Sometimes when I go to the hospital for treatment alone, nobody takes me seriously. I may be so sick, but the adults will not give me a chance in the queue, the doctors also think I am lying. I thus take too long and many a times I am forced to just look for money to go to the chemist/drug store, or even the drug centres under Tutulane AIDS Organization……Astrida Silungwe(13), Solomon Village” Access under this category was divided into: First line of support when sick, source of medicine, and source of funds for medications and treatment. ……Hospitals remain the first line of support, source of medicine and treatment. In absence of funds for medications, OVC will most likely not prioritise healthcare. Traditional healers are also sources of medicine though less significant. First line of support when sick: • The hospital is the first line of support for OVC when they are sick at 90% overall.
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• • •

Boys tend to prefer drug stores after hospital, a contrast from girls who go to relatives after hospitals It is only the children with disability who significantly involve the parents when sick, after prioritising the hospital. Friends and siblings are rarely prioritised, nor contacted as first line of support when sick.

Source of medicine: • The common source of medicine for OVC when sick is the hospital (90%), drug stores (7%) and traditional healers (3%) • 2% of OVC acknowledge paying for treatment at the hospital, or sometimes getting demoralised at the hospital due to long queues and slow services. Source of funds for treatment and medication: • Parents are the main source of funds for treatment and medication, closely followed by relatives/guardians • Male-total OVC get such support from relatives/guardians, but individual OVC do not pay from their pockets, acknowledging that it is not priority to them. E: ECONOMIC LIVELIHOODS FOR OVC HOUSEHOLDS:

The large OVC household sizes coupled with poverty and in access to essential needs make them more vulnerable. To support themselves, they will most likely look for support elsewhere via different means. Food and education needs though override all the other needs. • • • F: 68% of OVC households have a size of 5-10, compared to 32% with a household size of 1-4 In descending order; Clothing, education and food account for the highest expenditure categories among OVC. Health is the least expenditure category for these households. Orphan households oftenly get support for either food or education needs. ACCESS AND RIGHTS TO PROPERTY:

The propensity to own and protect land and property by OVC differs by gender and is high among male more so due to the cultural orientation of gender to ownership. This is also lent credence by the low percentages of OVC intention to emigrate from their land and property. Ownership of property: • More male OVC own property than female OVC at 61% to 39%. The female-OVC care less about property issues because they will be married. This also translates to ownership of land where 67% males own land compared to 33% female. • Ownership of land among OVC is still very low in absolute terms due to minority status and grabbing by relatives and guardians Condition of inherited property; • More male OVC follow up on their properties to assess their condition than female OVC. 54% of boys acknowledge that the properties are in good condition versus 46% of girls. Emigration intentions:
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•

2% of boys and 1.4% of girls expressed intentions of emigrating within two years. There is a strong attachment of the OVC to their property

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RESULTS:
The results are summarised and categorised according to the vulnerability indices considered. These indices include; 1. Access to education 2. OVC household food security 3. Access to behaviour change information(Reproductive health and HIV) 4. Economic livelihoods 5. Access to rights and property Table 2: Totals of OVC interviewed desegregated by analysis categories TAs/Category TA Kameme TA Mwaulambya TOTAL Male 368 866 1234 Female 318 841 1159 Partial Orphans 510 1190 1700 Total orphans 152 494 646 Disabled OVC 13 14 27 In Primary school 529 1104 1633 In secondary school 33 388 421 Out of school 113 194 307 A: • • • • • • • B: • Access to education: There are 518 boy-orphans in primary school compared to 466 girl-orphans. 144 boyorphans in secondary school versus 124 girl-orphans. 39/150 boy- OVC wish to go back to formal education systems against 28/113 girl-OVC 7/150 boy- OVC wish to go back to informal education systems against 6/113 girl-OVC There are 12 disabled in primary, 1 in secondary and 7 out of school. None wants to go back to school due to stigmatization and discrimination. 96 OVC out of 330 pay themselves through their education, compared to 234 who get assistance Food is the highest consumer of OVC income, closely followed by education at the primary level, but this changes at the secondary level Most OVC in primary school are out of school because of uniform and or learning materials as opposed to lack of school fee at the secondary level OVC household food security OVC households with food gardens that supply food needs: • It is impressive that OVC in the community and their households have put measures to improve food security. 380 boy-Total-orphan households have food gardens compared to 298 girl-Total orphans. 859 boy-partial orphan households versus 865 girl-partial orphan households. • The situation is also improving among disabled households with 17 male-disabled households against 7 female-disabled households.

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Nutritional balance of food intake: • Only 20/494 of the households considered acknowledge taking a nutritionally balanced diet at least thrice a week Income from garden versus expenditure on food: • Most of the households registering incomes from the garden sales acknowledge spending less on food, although the expenditure on other essential needs consumes all of it. • Availability of food gardens reduces the cost of spending on food, even though most still do subsistence farming. Source of food money: • More girls than boys are involved in begging to meet their households food needs i.e. 11/6, creating even more vulnerability to HIV/AIDS. • More boys are involved in piecework to subsidise their households’ food needs at 1331 against 496 for girls. This entrenches the cultural orientation of men to breadwinning. • More girls depend on financial assistance from relatives to meet their household’s food needs than boys at 320 to 233. • None of the OVC interviewed, accepts involving in sex for gifts to earn money for their households food needs. This requires further research. Access to behaviour change information (Reproductive health and HIV)

C:

Had sexual intercourse, STIs or treatment thereof • All the OVC interviewed (2395) have never had sexual intercourse. • This is either due to their age or failing to discuss issues of sex with the interviewer. This holds for both total, partial and disabled OVC • None also have had sexually transmitted infections before, and therefore none has pursued treatment for the same Common sources of information on reproductive health, safe sex and HIV/AIDS Table 3: Sources of RH, safe sex and HIV/AIDS info by gender. Gender/Category Peer School Home Hospital Church Campaigns Girls 34 617 01 90 224 462 Boys 205 544 29 30 272 675 Total 239 1161* 30** 120 496 1137* • OVC get most of their information on reproductive health, safe sex and HIV/AIDS from the school set up and through campaigns. The difference in the two is marginal. • Home/Households is the most unlikely set up where they will get this information, closely followed by peer and hospital • The church has started making a significant contribution to information on reproductive health, safe sex and HIV/AIDS to the OVC

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Table 4: Sources of RH, safe sex and HIV/AIDS info by vulnerability category. Vulnerability Gender Peers School Home Hospital Church Campaigns TOTAL group/source of information Total M 15 323 0 0 44 234 616 orphans F 0 96 0 61 97 204 458 T 15 419 0 61 141 438 1074 Partial M 190 320 20 20 225 441 1216 orphans F 34 521 0 28 127 256 966 T 224 841 20 48 352 697 2182 Children with M 0 1 9 10 3 0 23 disability F 0 0 1 1 0 2 4 T 0 1 10 11 3 2 27 Total orphans: • More girl-total orphans get such information from; Hospital and churches, than boys. • A significant percent of 46.6% get the information from campaigns compared to 53.4% of boys • More boys get such information from; peers school and campaigns. • The total orphans do not seek this information from home/households Partial Orphans: • More male-partial orphans access the information through; peers, home, church and campaigns, as compared to girl-partial orphans • Contrastingly, more girl-partial orphans access the information via; school, and hospital • Children with disability: • Children with disability do not get information from peers, since they don’t have opportunity to even meet as a peer • A higher number get this information from Hospital and home/household. Essentially there are where they have more interactions, although more of the girl-disabled get the information from campaigns. NOTE: Girl OVC rarely seeks information on reproductive health, sexuality and HIV/AIDS from home/households as opposed to boy-OVC, especially partial orphans and children with disability. Preferred media: Table 5: Media Preference by gender (all vulnerable groups) Gender Audio-visual Print VCT TOTAL M 948 90 645 1683 F 939 25 61 1025 T 1887 115 706 2708 • Most preferred media for accessing information on RH, sexuality and HIV/AIDS is audiovisual, then VCT. Print media is least appropriate. • The disabled though prefer print media, preferably in Braille for those who are visually impaired, although this information is rarely available in that medium. Source of condoms:
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Table 6: Sources of condoms by gender (all vulnerable groups) Gender Hospital Shops Campaigns Total M 23 1 220 244 F 0 T 23 1 220 244 • Girls are shy discussing issues of condoms • Girls do not know nor appreciate the existence of female condoms • Most condoms are accessed through campaigns. The hospital also makes some significant contribution • OVC cannot afford to invest in purchase of condoms even when they need it due to financial constraints and priorities: D: ACCESS TO PRIMARY HEALTH CARE: First line of support when sick: • 81% of male-total orphans prefer hospital as first line of support when sick compared to 85.3% of girl-total orphans. This is followed by relatives for girls at 11.6% and drug store for boys at 12.1%. • 100% male partial orphans and 91.9% female partial orphans prefer hospital, whereas 8.1% girl-partial orphans also use drug stores. • 91.6% of children with disability go to hospital as first line of support compared to 8.4% who goes to the parent. • Friends and siblings are not contacted as first line of support. Source of medicine: • The common sources of medicine for OVC are hospital, drug stores and traditional healers in descending order. By percentages this represents: 90.3%, 6.7% and 3% respectively • The hospital is the most important source of medicine to OVC. Drugs stores and traditional healers also make some significant contribution. • About 2% acknowledge paying for treatment in hospitals Source of money for health/treatment: • Parents are the major OVC source of money for health at 46.5%, then relatives at 34.3% and lastly guardians at 19.2%. • Individual OVC do not pay for health from their own pockets. • All male –total OVC get such monies from relatives and or guardians. E: ECONOMIC LIVELIHOODS: This index compared the household size and expenditure categories of the OVC. The following were the findings;

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Table 7: Traditional Authority category TA Kameme TA Mwaulambya Total • • • • •

OVC households’ expenditure categories by gender and TA Househo # with highest household expenditure per ld size month(By category) 1-4 27 32 59 510 45 79 124 Food Educatio n 500-1000 1000-2000 Health 100-500 100-500 Clothing 600-1000 1000-5000 800-3000

500-800 5002000 500-1400 750-1500

124/183(68%) of the OVC live within households of a size between 5-10, only 32% in households with sizes of 1-4 The highest expenditure categories for these OVC households is clothing, education and food in a descending order Health is the least consumer of the OVC household budget Alternative support for OVC is insignificant in contributing to their household budgets The frequent support when given to orphans is either for food or education needs.

F: RIGHTS AND ACCESS TO PROPERTY: Table 8: Rights and property categories by gender and TA TA category # of OVC # with # with land owning property in as part of property good property condition/care TA Kameme TA Mwaulambya Total M F M F M F 15 12 42 24 57 36 10 10 22 19 32 29 66 37 67 30 133 67 # planning to emigrate/move out 10 7 17 10 27 17

Ownership of property: • More of the boys interviewed own property than girls at about 61% compared to 39% • Most of girls feel that they will be married and thus do not care about issues of property Condition of property; • 54% of boys with property acknowledge that their property are in good condition compared • To 46% for girls • More of the boys follow up on their property to assess the condition than girls Ownership of land: • 66.5% boys against 33.5% of girls acknowledge owning land as one of the properties under their custody. • This is despite the fact that ownership of land by OVC is still very low due to their age and also issues of grabbing by relatives and guardians Emigration intentions: This question sought to understand the period that OVC have to develop and use the land, to determine which type of land use to employ.
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Out of all the OVC interviewed, only 27 boys and 17 girls have definite plans of emigrating from their community and leaving their property including land. There is a strong relation with property.

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GRAPHICAL REPRESENTATION OF RESULTS:

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CONCLUSIONS AND RECOMM ENDAT IONS:
1. Access to education: The high OVC dropout rate at primary school level (57% mean) across gender is attributable to the cost burden of education on the OVC vis-à-vis the competing priority of satisfying food demands at the household level. Cutting down on the cost of education such as uniforms, development funds, learning and teaching materials, and tuition fees; will retain them in school; subsidize their food needs, improve their transition rate to secondary schools, thereby contributing to reduction in vulnerability. This can be accomplished through a government policy shift to make FPE compulsory or programmatic focus targeting support on such provisions which increase the OVC expenditure on education. 2. OVC household food security: Lack of food security at household level, predisposes OVC to begging and resorting to potential child labour which also contribute to school drop out. But, availability of food at the household level does not necessarily contribute to improve OVC nutrition. Interventions linking sustainable food security and nutrition for OVC will not only minimise school drop out rates, child labour, and child sex work but also improve school performance. 3. Access to reproductive health, safe sex and HIV/AIDS information:

Being predominantly a school-going cohort with close community ties, most OVC access such info from school and community campaigns. Churches also play a significant role. To improve RH/safe sex/HIV/AIDS info access among OVC, more focus should be targeted to schools, community campaigns and churches being the significant contributors of the same. Improving the capacity of schools, religious institutions and community change agents to provide accurate and factual information within OVC friendly contexts are approaches that must be scaled up. 4. Access to primary health care:

Hospitals remain the first line of support, source of medicine and treatment for OVC. In absence of funds for medications or treatment, OVC will most likely not prioritise healthcare. Traditional healers are also sources of medicine though less significant. The provision of health services at the hospitals/clinics should recognise that OVC even when they are unaccompanied by adults still require health care and should be attended to as patients not spectators. Services should also be made OVC friendly. 5. Economic livelihoods of OVC households:

As is the Maslow’s pyramid of needs, OVC households will thrive to satisfy their food needs first, before considering education. The large average household size of 5-10 puts more pressure and demand for food, clothing and education, being the major expenditure categories. This varies with the average age within such households. In all cases though, health needs are only met after the above three have been catered for. 6. Access and rights to land and property: The propensity to own and protect land and property by OVC differs by gender and is high among male (64%) than female (36%) due to the cultural orientation of gender to property ownership. This is also lent credence by the high percentages of OVC intention to live on their land and or property (>98%). This attachment to land and property increases the potential to productive use of land and property by OVC, making sustainable interventions feasible. Nevertheless, advocacy on women’s right to own land and property should be intensified, together with increased registration and protection of OVC inheritances, land and property.
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Description: Community development survey results