Case Management for Orphans and Vulnerable Children (OVCs) and their Care Givers

Using the 2012 President’s Emergency Plan for AIDS Relief (PEPFAR) OVC Guidance , PEPFAR Country Operational Plan (COP) technical guidance on OVC as guiding principles and recognizing the Government of Malawi’s Minimum Service Standards for Quality Improvement for OVC Programs in Malawi, One Community is implementing a comprehensive package of activities targeting OVC, caregivers ,their households and communities. Service provision follows the socio-ecological model within the 90-90-90 lenses while allowing for a targeted continuum of care for most vulnerable OVC.Specifically, One Community implements interventions for OVC and their caregivers across five domains namely: general Case management, Healthy (Access to Health including HIV Services), Safe (child Protection & Psychosocial Support), Schooled (Education and ECD) and Economic Strengthening as crosscutting.

The case management commences by the identification of children and adolescent subpopulations made vulnerable by or to HIV and assessing child, adolescent & family socio-economic status and risk (across all areas: healthy, safe, stable, schooled) every 6 months. This is followed by developing strengths based case management plans for children and caregivers, direct services provision or through monitored and documented referrals. One C has developed a comprehensive referral linkage system supported by a systematic mapping of resources available for OVC and their caregivers. Awareness raising of available services is conducted at different forum which include community fairs, small group sessions and home visits.

Healthy (Access to Health including HIV Services) includes screening and promotion of HIV testing among OVC using risk assessment tool, providing risk reduction counseling for older HIV positive OVC and symptomatic screening for TB, STI and major depression. Additionally, this includes nutritional assessment (MUAC and BMI), counseling and referral for malnutrition as well as ART adherence assessment, counseling and support . At the household level, there is promotion of safe water & hygiene, nutrition and malaria prevention. Older HIV positive OVC are also targeted for condom promotion, distribution, HIV counseling and referral for family planning. Additionally, OVC are referred to Health facilities for diagnosis and treatment of TB, STI and major depression, treatment of moderate and severe malnutrition, linkage for ITN, provision of FP services, linkage for ART initiation and follow up ART monitoring and adherence counseling by health care providers. One Community provides support for disclosure is provided to children living with HIV, train their caregivers on appropriate, Strengthen/establish support Groups (for older OVC living with HIV and link their caregivers to Village Savings and Loans.

Safe (Child Protection & Psychosocial Support) services include assessment of children for child violence, abuse, exploitation and neglect. One Community, through its CRPs works closely with trained community case managers and Child Protection Workers (where they are available) to refer cases of Violence, Abuse Exploitation and Neglect. In communities where case workers are not available One Community links cases directly with the Social Welfare Office for guidance In addition the program provides psycho-social support for children and their caregivers through individual, group-based and relationship based activities, positive parenting skills building (including discipline, communication on adolescent risk, HIV disclosure),Mental health screening for caregivers and economic strengthening (HES) activities, such as savings groups. Through referrals, the program is supporting clinic-based child abuse and GBV response services (including emergency medical services/PRC), mentorship activities- role modelling, professional counselling, clinical and spiritual services including linkages to cash transfer programs.

Schooled (Education and Early Childhood Development) services in One Community include identifying key at risk children for education support and associated barriers, providing temporary school block grants to promote enrollment and progression (still under consideration), supporting Early Childhood Development (ECD )through parental skills building, facilitating enrolment in ECD services at community level, provide Psychosocial support services, VSL for caregivers to address barriers to access education, facilitating access to primary and secondary education through temporary and targeted support through linkages to back to school programs and child protection services