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2. Scaling up support to orphans and vulnerable children
   Last updated: 29.06.02
2.1 Increasing impact through 'scale-up'
As the effects of HIV/AIDS grow, there is an urgent need to reach more OVC with improved care and support. Community mobilisation and capacity building are practical responses to the effects of HIV/AIDS on families and communities.

Little is known about how well communities are actually coping, what efforts appear to be successful, and what circumstances may affect those efforts. Even less has been documented about how effective community mobilisation approaches may be scaled up to benefit more children and families. In this report, we use the general term 'scale-up' to refer to the process of successfully expanding and improving efforts to meet the needs of OVC, which result in increased impact.

Three levels of involvement have been defined in relation to scaling up: community, facilitation and policy/resource levels; some organisations are involved at more than one level.

[See: 5 Expanding and Strengthening Community Action: A Study of Ways to Scale Up Community Mobilization Interventions to Mitigate the Effect of HIV/AIDS on Children and Families. Phiri S Foster G & Nzima. Displaced Children & Orphan Fund & War Victims Fund, Washington, 2001]

Scale-up needs to take place at each of these levels:

1. Community level

The primary response includes individuals, households and families, with support from groups such as community initiatives, faith-based congregations, CBOs and NGOs.

  • These groups need to reach more vulnerable children and families, improve the quality of the services they provide and become more sustainable.


2. Facilitation level

This includes local NGOs, international NGOs, religious and private organisations and district government departments and committees. The focus of this workshop was intermediary NGOs.

  • Intermediary NGOs need to provide more CBOs and NGOs with support. In addition, they need to improve the quality of the technical and financial support they provide.


  • There is need for more intermediary NGOs. This increase might come about by strengthening NGOs which currently implement services for OVC to assume a capacity building role and become intermediary NGOs. Alternatively, new organisations with a specific CBO/NGO support mandate may be established.


3. Policy/resource level

This includes government departments, national and international donors, non-governmental, religious, private and inter-governmental agencies.

  • Political commitment is crucial because of governments' ability to use existing structures, resources and networking capabilities to promote OVC activities.


  • Advocacy, policy development and resource mobilisation are key activities in creating a conducive environment.


  • There is need for organisations at this level to promote scaling-up through the establishment of an 'enabling environment' that promotes community mobilisation, capacity building and scaling-up at community and facilitation levels.


For each of these levels, participants analysed the roles of the following stakeholder groups in relation to scaling up:

  • Community groups and CBOs


  • Intermediary NGOs providing support to CBO/NGO OVC service providers


  • Government


  • International NGOs (INGOs)


  • Donors.


Roles and responsibilities that were identified for each of these stakeholders at different levels are recorded in Table 2 on pages 35 and 36.

2.2 Tributaries of impact
"The essence of scaling up is to have a substantial impact, improve quality, expand coverage, increase sustainability and strengthen our focus. That is what we have to do - even if it means we have to change our traditional ways of working, and enter new territory." Alick Nyirenda, Executive Director, CHEP, Zambia

At each of these levels, in order to maximise the positive impact on orphans and vulnerable children and the community, successful scale-up efforts must pay attention to issues surrounding the focus, coverage, quality and sustainability of the programmes. These issues may be termed the 'tributaries of impact.'

  • Focus: ensuring that programmes work most closely with individuals or groups that have the most significant effect on the epidemic's dynamic or consequences.


  • Coverage: ensuring that as many beneficiaries or organisations are reached as possible.


  • Quality: ensuring that programmes are appropriate to local context and the target group and are of consistently high standard.


  • Sustainability: ensuring the organisation, programme and its effects last and strengthen over time.


Each of the four tributaries is important if a programme is to be effective and have lasting impact. For example, many programmes are well focused, of high quality and have a sustainable base but pay little attention to issues of coverage. As a result, they have limited impact on the epidemic and it is difficult for them to be scaled up. Similar concerns exist in scaling up programmes that overlook focus, quality or sustainability. Increasing the scale of programmes which are deficient in a vital component will lead to little impact on the course and consequences of the epidemic (see Table 1 below).

In practice, it is rare for focus, coverage, quality and sustainability to be addressed all at the same time and to the same degree. At a particular point in the scale-up process, a community group may concentrate on increasing the focus or quality of their orphan support work, at the expense of increasing coverage. Or, an NGO support provider may concentrate on increasing coverage, without necessarily also seeking to improve the quality of the support it provides. However, over time, each must be tackled to increase impact. Focus, coverage, quality and sustainability are all essential components of any long-term scale-up strategy.

"Focus is very important to us, so we do not waste our resources." Exhilda Siakanomba, Programme Officer, Family Health Trust, Zambia

Table 1: Tributaries of impact of OVC activities: focus, coverage, quality and sustainability
Community level: Responses of frontline groups and organisations

(Focus)

  • Responsive to the needs of vulnerable children and their communities.


  • Targeting the most needy or vulnerable children, families or communities.


(Coverage)

  • As many orphans and vulnerable children as possible are reached and supported.


(Quality)

  • Support to vulnerable children and families is appropriate to the local context, informed by good practice and of a consistently high standard.


(Sustainability)

  • Community responses continue and evolve to meet changing needs.


  • Positive effects of community responses last over time.


  • Responses are owned by communities who are able to source external support where needed.


Facilitation level: CBO/NGO support

(Focus)

  • Targeting CBOs and NGOs that are already having an impact on the lives of OVC and which have a potential to increase the scale of their response.


  • Targeting NGOs with a potential to become intermediary organisations.


(Coverage)

  • Enough CBO/ NGO support providers to meet the technical support, organisational development and funding needs of community- based OVC responses.


(Quality)

  • Support provided to NGOs/ CBOs is comprehensive, appropriate to the local context, informed by good practice, and of consistently high standard.


(Sustainability)

  • CBO/ NGO support provision continues and evolves to meet changing needs.


  • CBO/ NGO support providers and the community groups they support are stronger organisationally and programmatically.


Policy/resource level: The enabling environment

(Focus)

  • Targeting individuals, governments, institutions and donors who have the potential to have a significant effect on the policy and resource environment.


  • Advocating for good practice and against strategies or policies which undermine community-based responses, for example vertical programming.


(Coverage)

  • Enough individuals, policy and resource organisations reached with appropriate information about good practice policies & strategies.


  • Ensuring that information and ideas are exchanged between relevant stakeholders in both the 'North' and the 'South'.


(Quality)

  • Reaching and influencing key decision- makers and other influential stakeholders with appropriate, prioritised information and ideas.


(Sustainability)

  • Steady, secure and increasing resources available for community OVC responses and relevant CBO/ NGO support.


  • Supportive policy and legal environment.


  • Political will and long- term commitment.


  • Sufficient and appropriate attention to OVC issues from stakeholders in the 'North' and the 'South'.


  • Substantial resources provided by national organisations.


Source: Expanding Community-Based Support for Orphans and Vulnerable Children
This is an extract from Expanding Community-Based Support for Orphans and Vulnerable Children , published by the International HIV/AIDS
Alliance with the Family AIDS Caring Trust, Zimbabwe, in 2002.

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