YOU ARE HERE:
Children - Appendix 1: Description of appraisal methods
   Last updated: 23.08.01
Appraisal Design, Feb/March 2000
1. Introduction
An appraisal of needs and resources for children affected by AIDS was planned by the Khmer HIV/AIDS NGO Alliance (Khana) and its NGO partners. The aim of the appraisal was to explore the potential for integrating services which can benefit children affected by AIDS, into ongoing NGO work in HIV prevention and care.
Since there has been little previous exploration of the needs and resources for children affected by AIDS in Cambodia it was anticipated that the appraisal would raise more questions than it answered. It was intended that findings would act as a catalyst for further exploration by Khana partners (participatory project reviews in May 2000) and hopefully by other interested organisations.

2. Appraisal Objectives
The objectives of the appraisal were to work with a wide range of individuals and organisations to:
  • Determine vulnerability/resilience factors for children

  • Explore how HIV/AIDS-related life events impact on these factors

  • Identify the range of needs specific to children affected by AIDS

  • Identify existing resources which could or do address these needs

  • Identify barriers to addressing these needs

  • Suggest strategies to fill existing gaps in service provision


3. Appraisal Process
The appraisal was carried out by Khana staff and NGO partners with technical support from the AIDS Alliance. Individuals from 12 Khana NGO partners from 10 provinces facilitated the appraisal (see table 1). After a five-day planning workshop to enhance skills in appraisal facilitation, facilitators were divided into 6 teams of 3 people each. Each team spent 10 days working with individuals and organisations in either a rural or urban area, and also in the provincial town of that area. This was followed by a two-day feedback workshop to develop a framework for reporting the appraisal. Khana drafted a preliminary report, which was circulated for verification. The report then formed the basis of two workshops for Khana partner NGOs on “integrating services for children affected by AIDS into on-going HIV prevention and care projects”. These workshops were intended to broaden NGOs knowledge of the issues faced by children affected by AIDS and inform their subsequent process of review and project re-design.

4. Appraisal Locations
The appraisal was carried out in Phnom Penh, Battambang, Kratie, Kompong Thom and Prey Veng. Provinces were chosen because they have:
  • Different levels of INGO/UN agency activity with children

  • Different levels of Khana partner activity

  • Different risk factors including migration

  • High priority in the National HIV/AIDS Strategy


5. Appraisal Methods
Because there has been little previous work carried out in Cambodia on the needs of children affected by AIDS, it was difficult to know exactly which questions need to be answered. For this reason, the appraisal was carried out with the use of open-ended participatory tools and techniques. (30) These tools are highly visual and enabled participants with different levels of literacy and verbal skills to participate in the appraisal. (31) They also enable people to communicate more easily about sensitive or personal issues, and reduce the risk of personal disclosure.

Three main tools were adapted and pre-tested during a five day appraisal planning workshop – (i) vulnerability drawing and story, (ii) network diagram of AIDS-related life events and (iii) community support timeline (see table 2 for description of tools). The pre-testing was carried out with vulnerable children either in orphanage care (SFODA), in foster care (Bamboo Shoots Centre) or living on the street (FRIENDS). Facilitators asked follow up questions with reference to a general checklist of issues, which was developed during the appraisal planning workshop. Key points from the discussions were noted by each team and were attached to the flipchart sheets showing the outcome of the tools used during the session.

The tools were all intended to generate similar information from different perspectives, and therefore to provide a measure of triangulation. Participant observation was also used by the teams to supplement their findings.

Where it was difficult for participants to use these visual tools due to a lack of space or time, the checklist provided the basis for conducting a semi-structured interview.

Appraisal findings were supplemented by information from national and international sources, and by an analysis of six months worth of quantitative data related to children affected by AIDS which was collected by Khana partners.

[Footnotes
(30) Janet Harris, Chris Ellwood, Rosaline Barbour and Tilly Sellers. "Health-related knowledge and perceptions: Putting research into context for Belfast" Report for Belfast Health Authority, June 1996
(31) Robert Chambers. "Whose Reality Counts? Putting the first last" IT Publications, 1997]

6. Appraisal Issues
Following a preliminary literature review of experiences addressing the needs of children affected by AIDS in other countries, it was anticipated that the checklist would prompt for needs in the following types of areas, although would not be restricted to these areas:

Lower income, increased expenses
Indebtedness
Loss of property (e.g. jewellery, land
Increased household work & responsibility
Less money for medicine and sundries
Deterioration of house/shelter
Increased violence/impatience by parents
Shame, confusion of children
Ostracism/Isolation by relatives
Weaker/Lose contact with relatives & friends
Weaker/Lose contact with neighbours
Exposed to anti-social influence/behaviour
Poverty of relatives/potential foster families
Malnutrition
Increased susceptibility to illnesses
Less medical care
Less food
Disruption of education/life skills education
Less care/nurturing by parents
Stress/Depression/Shame/Anger of parents Stress, depression
Increased domestic violence
Ostracism/Isolation by friends
Ostracism/isolation by neighbours
Forced into bonded labour, sex work
Weakening of values due to exposure
Lack of infrastructure/facilities

Similarly, the types of resources to be probed during the appraisal may include, but would not be restricted to the following:

Employment/Income generation & savings/credit programmes
Community mutual support programmes
Advocacy to improve laws related to credit/pawn, land and child labour
Strengthening agriculture/fishery development programmes
Family counselling/crisis intervention programmes
PWA Group/Inter-family support programmes
Community education-solidarity strengthening programmes
Strengthening of values and civic education
Advocacy for improving access to basic services
Life skills programmes for children and youth
Sexual health improvement programmes for youth
Primary health care education including nutrition

7. Appraisal Participants
During the appraisal-planning workshop, each team made a detailed plan to decide who should be involved in the appraisal in each area. This included representatives from UN agencies, INGOs, NGOs, GOs (particularly from MoH, MoWVA, MoSA and MoRD), at national, provincial and district levels. It also included key informants at community level (leaders, elders, monks, teachers, CBOs, Women’s organisations etc.), PLWHA support groups, families affected by AIDS and vulnerable/orphaned children in different situations. Each team carried out between 15 and 30 appraisal sessions both with groups and with individuals in a variety of settings - in villages, district and provincial capitals. Facilitators asked ‘who should we talk to next’ at the end of each appraisal session in order to identify new organisations/groups and in order to verify their existing plan.

At the end of each day the teams conducted a review of findings and targeted where there were gaps either in types of participant, or types of issues.
At the end of the appraisal, approximately 60 people from 40 NGO, government and UN agencies attended a verification meeting in Phnom Penh. This was held to check out the validity of the main findings and to get people together to begin discussing first hand issues relating to children.

Ethical Considerations
Although Khana has good contacts in the appraisal areas who were able to provide follow-up services if requested by appraisal participants, certain measures were taken to reduce the likelihood of the appraisal negatively impacting on vulnerable participants – particularly children.

  • Appraisal facilitators were selected because of their experience both in the use of participatory tools, and in working with vulnerable groups (PLWHA and affected families, vulnerable youth and children).

  • All facilitators were given a letter to identify them and given details about the aims of the appraisal

  • Facilitators were trained not to raise expectations, but to be realistic about the possible impact of the appraisal.

  • Facilitators worked as a team, not on their own.

  • All participants were able to choose whether or not they wished to participate after being given details of the aims of the appraisal and about what would happen to the information.

  • An informal contract regarding time etc. was made with participants before the session begins

  • The visual/participatory tools used enabled participants to control their own level of participation and reduced the need for personal disclosure.

  • Where possible participants worked in groups to maximise discussion and further reduce the possibility of disclosure.

  • Permission was requested to ‘take’ information from the session (diagrams, drawings, notes etc.)

  • Names and contacts were only asked of people working for organisations.

  • Appraisal facilitators carefully observed participants’ comfort levels during each session and reacted accordingly.

  • Participants were asked if they would like to verify information in the draft report


Table 1: Appraisal Facilitators

APPRAISAL TEAM:1-Battambang
NAME: Im Loum
ORGANISATION: Huripruda (battambang)
NAME: Kov Pisey
ORGANISATION: AFD (Takeo)
NAME: Kong Samnang
ORGANISATION: SEADO (Banteay Meanchey)
  • *


APPRAISAL TEAM: 2 - Prey Veng
NAME: Oum Chantha
ORGANISATION:CCASVA (Prey Veng)
NAME: Phok Bunroeun
ORGANISATION: CCASVA (Phnom Penh)
NAME: Man Savann
ORGANISATION: Kasekor Thmey (Kg. Cham)
  • *


APPRAISAL TEAM: 3 - Kompong Thom
NAME: Prum Ny
ORGANISATION: MODE (Kg. Thom)
NAME: Uch Sakun
ORGANISATION: MODE (Kg. Thom)
NAME: Leng Sothear
ORGANISATION: CDRCP (Kg. Thom)
  • *


APPRAISAL TEAM: 4 -Kratie
NAME: Yous Thy
ORGANISATION: KWWA (Kratie)
NAME: Y Srey Neang
ORGANISATION: KWWA (Kratie)
NAME: Ros Monichoth
ORGANISATION: KBA (Banteay Meanchey)
  • *


APPRAISAL TEAM: 5 - Phnom Penh
NAME: Sam Sopheak
ORGANISATION: IDA HCT 1 (Phnom Penh)
NAME: Soeun Sotheany
ORGANISATION: IDA HCT 2 (Phnom Penh)
NAME: Um Sophan
ORGANISATION: Rachana (Takeo)
  • *


APPRAISAL TEAM: 6 - Phnom Penh
NAME: Prang Chanthy
ORGANISATION: Khana
NAME: Lychan Sophal
ORGANISATION:Khana
NAME:Ang Chamrourn
ORGANISATION:NAPA (Kg. Speu)
  • *


Alliance technical support was provided by:

Tilly Sellers, Alex Marcelino, Henrietta Wells

Table 2: Description of Appraisal Tools
Vulnerability drawing and story
Participants draw picture of 'vulnerable' child and 'non-vulnerable' child of different ages and make up a story about each one. Discussion about comparisons draws out vulnerability and resilience factors. Participants add HIV/AIDS to both stories. Discussion draws out impact of AIDS on vulnerability factors. Participants summarise by defining issues for CAA, what helps minimise the impact of AIDS for children and what hinders this process.

Network diagram of AIDS-related life events
Participants make a network diagram showing the links between different AIDS-related life events (father sick, mother diagnosed, father dies, mother dies etc.) and the impact of each event on the family. When the diagram was finished, participants indicate the action necessary to minimise negative impact on CAA at each of the network diagram nodes. Discussion draws out who could carry out the action and what was the most effective strategy to use in each case.

Community support timeline
Participants make timelines for boy/girl from 0-5, 5-10 and 10-15 yrs. On the timeline participants make drawings of 'who in the community was important to the child' at the different life stages. When the drawings were finished the participants discuss what relationship each of the drawings has with the child - what needs they help address. Participants were then asked to explain how the relationships would change at different life stages if the child's mother/father become sick and die of AIDS. Discussion draws out changing/additional needs of CAA, and who in the community would respond to these needs.