Bottlenecks and Drip-feeds 08/04/06

Report - CINDI (Children in Distress network) conference in Pietermaritzburg, 3 – 8 April 2006 ( Renate Cochrane)
Recipients: LUCSA HIV/AIDS desk and LUCSA funded projects

“Bottlenecks and Drip-feeds” is the title of the keynote address given by Geoff Foster.(Save the children UK) at the recent CINDI conference. The failure of funds reaching those children who are most in need was an overriding concern expressed at the conference. Financial resources for orphan programs have increased substantially but funds often get stuck in organizational bottlenecks and don’t reach those who are affected. Of one dollar spent from donor funds, less than 5 cents translate into direct help. 

An extensive study commissioned by ‘Save the Children’ has found very few examples of effective mechanisms for channeling resources to community-level organizations responding to the needs of vulnerable children. During the conference, appeals went out to all organizations, especially FBOs (faith based organizations) that are rooted in the communities, to engage in advocacy work to overcome the bottleneck.

Drip-feed and technical support

The ideal model for efficient funding is “drip feeding”. A constant, never ceasing trickle (i.e. moderate funds) into the ground-stream of community level interventions. It was recommended to increase technical support for CBOs (Community Based Organizations and FBOs). Eg assist with financial administration and writing of funding proposals/ drawing up of budgets / coaching in language proficiency to enable people in the community to write simple reports in English.

How do we hold public officials accountable?

A number of high ranking government representatives were present and the atmosphere was at times very tense when they tried to justify the inertia of government departments. In some areas in SA, it may take up to two years to obtain a birth certificate. Yvonne Spain, CINDI director, spoke publicly: “The lack of service delivery by the Department of Home affairs is criminal” .

Social workers are often non-existent. (No figures were given for vacancies of social workers posts - figures for vacant nursing posts are 37 000.)

KZN (Kwa Zulu/ Natal) seems one of the worst hit provinces regarding the scarcity of social workers. A Lutheran project shared the case of a youth headed household:

Case study

The eldest sister is 21 and has already given birth to 3 children. She uses the child support grants (R 190 per child/per month) for her 3 biological children to support her 4 younger siblings. The project care workers have been to Social Services in Pietermaritzburg regularly during the past year – without success. The young “sister-mother” has not been visited by a social worker and cannot access state support for her younger siblings.

Ironically, it seems easier in KZN, to receive a disability grant (R 780 a month) for HIV+ status. So far, the grant has not been taken away from people who are on ARVs. This is quite different from other provinces where parents on ARVs are suddenly without income as the disability grant has stopped.

Integrated care projects

Another focus was the integrated model of care projects. Repeated appeals came from key note speakers and small groups presenters: “Don’t separate treatment education,

counseling, orphan care and home based care. Send your orphan care workers to treatment literacy workshops and involve TAC (Treatment Action Campaign) activists in orphan care. Don’t forget those children who stay at home to nurse their sick parents. Encourage parents to seek medical help and explain, for example, that TB is not AIDS and can be cured. Prevent orphan-hood by means of treatment support and education for sick parents.”

The move towards integration was indeed heartening for me as LUCSA has promoted the integrated care model. I was employed by LUCSA to add the treatment component to LAAP ( LUCSA AIDS Action Plan.)

Below I list some innovative “good practice” models in the hope that project leaders might be inspired. It is my deepest regret that I have not tried harder to get sponsorships for some coordinators of LUCSA supported projects to attend the conference.

Child counseling at schools.

Every orphan care worker knows the desperate plea by teachers: “can you please assist us with our traumatized children? We have children crying all day, others have become very aggressive and hit their class mates, others are totally withdrawn and don’t talk at all…..”

A group of teachers in Pietermaritzburg developed the “school counseling project”. 2 counselors are allocated to a school. They are members of the community who are being trained by professionals. The requirement is standard 10 and the positions are advertised. How do they choose the candidates? After a short interview the candidates are asked to play with the children for 30 minutes. Professional child-psychologists observe the play-time and make their choice. The school counselors receive a stipend and on-going training. (Funded by the Save the Children/UK)

“Adopt an orphaned household” - family sponsor model:

Thandanani, a Pietermaritzburg based organization, introduced this model in order to be less dependent on big donor funds. They approached churches in affluent parts of KZN and asked if any Christian families are prepared to sponsor orphaned households. They gave a profile of specific households and spelt out the needs.

Example of a household in need: The oldest sister is 17 years old and she has to look after 3 younger siblings. She does not receive any grant as she is under 21. There are no relatives. The needs were listed (school fees/uniforms/basic clothing/basic food) and amounted to about R 500 a month. Two affluent families have taken on sponsorship for 3 years. It will take about 3 years for the eldest sister to start the process of applying for a government foster grant (Legal age is 25 but social workers can motivate for a grant from 21 years onwards)

Thandanani care workers administer the sponsor funds and organize food parcels and clothing. 

The coordinator shared the story of the youth headed household profiled above: After one month of Thandanani assistance, relatives appeared from nowhere and offered to take the children.(!) The Thandanani staff was adamant that is was not in the best interest of the children to move away and they protected the household. The children were traumatized when their relatives showed sudden interest in material benefits. 

The other positive factor of the household-support was the reaction of the community. The children were no longer seen as potential thieves and the “orphan-stigma” was visibly reduced. Some orphans were even invited to visit their neighbours which has never happened before.

The children know the first names of the sponsor family but they don’t know the address and the entire correspondence and financial responsibility is carried by the Thandanani office.

Psycho-social support for abused “grant children”

A rough estimate is that more than 50% of orphaned children are well cared for by grand-parents and relatives (SA). We find, however, a disturbing level of abuse among the less well cared for which is often related to the South African welfare grant system. Relatives buy hire-purchase goods with the grant money and the distressed children feel totally unloved, often drop out from school and develop symptoms of emotional neglect. Care workers need to continue monitoring foster-care families. Youth-headed households also need counseling and guidance as many young “sibling parents” don’t have the maturity to be heads of households. We heard of a youth-headed household where the 23 year old sister received a full foster care grant for 4 younger siblings (over R 2 000 monthly) . Suddenly she had a good income but she ran away as she could not cope with the responsibilities. She received the monthly grant from the Department of Social Development after one single visit by a social worker who never returned. She never received advice or guidance not to mention counseling. Such cases are a sad illustration of collapsing government support structures.

Children’s villages

Community based care is the best. There is, however, a romantic perception among donors overseas that the African extended family will absorb children as long as they receive some material support. The extended African family is often a myth. Relatives do exist but they live in one-room shacks in the city. An increasing number of orphaned children are abandoned with no-one to care for them. For these children temporary shelters (sort of “sanctuaries”) need to be established. The ideal model is a children’s village within an existing community. This can mean a cluster of houses in the same street or simple buildings on church premises. Even better, to renovate empty buildings on mission stations. 

Abandoned children will be taken in until a suitable foster-care placement is found. The foster-care families will be monitored by care workers and the contact with the children’s village will remain allowing fostered children to return to play with their friends. 

In South Africa such villages can be registered as children’s homes (takes ca 2 years). Registration means that the state pays R 1 500 per child/per month. For a home with 50 placements this secures a monthly income of R 75 000. The village must have good credentials and financial records to get registered. The involvement of a church, assisting with monitoring is always a bonus. Government will not promote children’s homes, as too many such homes have become ruthless business enterprises. The churches, however, could play a big role in preventing such exploitation for personal gain. A faith based children’s village has a better chance to get registered.

Memory work and resilience in times of AIDS

This is the title of the book that introduces the memory box program. The director of the program is Prof Philippe Denis, a theologian and church historian who recognized the need of orphaned children to develop a sense of personal history, identity and resilience . They will have a better chance of reaching mature adulthood if they have been guided along the path of remembering their parents. Memory work is healing work for traumatized children. The book has a full training manual and is highly recommended for those who want to learn more about bereavement counseling for children. (Cluster publications 2005 ) Some organizations focus so much on treatment and preparing for the second chance in life that the memory box work has been forgotten. It was felt that this is a deep loss and the suggestion was mooted to promote the concept of a “life box” which should start when you become a parent.

The memory box is such an invaluable concept and tool to lead our children to stable adulthood that it should not be replaced by only focusing on treatment.

Creativity as a vehicle of hope

Religion/Media/Creativity were presented together in an afternoon program.

The film “a child is a child” was shown and few eyes remained dry. The film is accompanied by music and portrays orphaned children who develop coping mechanisms.

(To order as DVD/or video: )

The discussion centered around methods of dealing with pain. How can the church be involved and bring back hope?

A group of traumatized women have started a creativity project, making quilts and appliqués with motives (often symbolically) depicting their traumas.

PACSA (Pietermaritzburg Agency for Christian Social Awareness) started self-help groups based on models developed by the healing and memory institute.

Churches can support Soul City staff who want to start active lobbying for introducing a children’s channel in TV. Many children spend hours in front of TV (often operated by a car battery). The South African TV programs have deteriorated to a very deplorable level and some programs can be categorised as “media child abuse.”

CINDI dolls

A touching (figuratively and literally) instrument of solace is the “CINDI doll”. The smiling doll is used in trauma counseling for abused children but the soft and cuddly knitted dolls are comforting for orphaned and lonely children as well. Many children living in deprived conditions have NOTHING that belongs to them. The doll (for boys and girls) is given to them by care workers and this companion will be with them during the night, cuddled in their arms. They can share sorrows and sadness with this friend. The CINDI doll is an idea that can be taken up by church partnerships overseas. Many people overseas would like to do something more than sending money. To knit hundreds (thousands and the millions we need to match the number of orphaned children) of dolls would be a meaningful contribution to raise awareness of the plight of children in distress in Southern Africa.

Volunteers or care workers?

All projects start with volunteers to visit homes and schools and take care of vulnerable children. Most of these volunteers are unemployed ( mainly women) who struggle to feed their own families. All volunteers hope to receive some income at some stage. Donors are reluctant to give funds for stipends (not to mention salaries). The conference heard many voices deploring the fact that those daily workers who are the back-bone of the projects don’t receive any remuneration. Some volunteers receive soap in their care-kit to be used to wash the patients but they have no cash to buy soap for themselves. Projects are encouraged to advocate for fair stipends for care workers.

Counseling and “off-loading” for care workers.

Ideally, care workers should have weekly meetings with trained professionals to unload and de-stress. Burn out and “compassion fatigue” are on the increase. Professional psychologists are, unfortunately, not always available. Project managers are thus encouraged to structure de-briefing sessions even without professional guidance. A good method is to sit around a circle and let everyone share her/his story. No interruptions, no questions asked during the sharing in the circle. Afterwards a limited amount of time can be given to respond to each other. This method only needs a minimally skilled facilitator who can “rotate” with every session. It is a self-help group for care workers and a weekly (or forth-nightly) session is highly recommended.

Support group for caregivers/guardians

AIDS workers are aware of the vital importance of support groups for PWAs. In the same way, support groups for caregivers can play a crucial role to strengthen coping skills. The method can be the same as above: sharing your burden by speaking in a “safe space” without interruptions or judgment. Some care projects make monthly support group meetings for caregivers compulsory for receiving food parcels. Traveling costs will be re-funded. Resource persons from the community can be invited.

Donor funding – “show us your latest financial statement?”

The bottle-neck “plug” plagues many community based organizations. There is the first hurdle of submitting a well formulated funding proposal but the catch 22 situation is the lack of financial statements at the beginning of a project. For example, a group of concerned women want to start a feeding scheme for children they found scavenging for food at the municipal dumping grounds. They apply to small businesses or companies for initial funds but they cannot show a financial statement as they have not had any monetary donations yet. Examples were given of CBO groups that had to close soup kitchens for hungry children because they did not receive any technical guidance (how to write a funding proposal in English) nor financial assistance. Mission instituted churches have a great advantage in this respect as most “main-line” churches have an HIV/AIDS desk and donor partners overseas. The best results have been achieved in projects where church and community work together and technical support is given.


A surprising number of speakers stressed the fact that more programs must be geared towards boys if we want to make inroads in prevention. For example, boys learn that a well-brought up girl will “fight and say no” if she wants sex. It is not good enough to teach girls that they have a right to say “no” – we also need programs that reach boys.

Fatherhood project

Our society is in desperate need of positive role models of fathers who show active interest in the lives of their children. The amount of child abuse has lead to a state of paranoia in our society. The speaker presenting the fatherhood project gave an example of a father who walked down the street holding the hand of his 5 year old daughter when some residents notified the police as they suspected him to be a child abuser. The media does not play the role it should: our society needs to see many more caring fathers in TV series and adverts.

Way forward for LUCSA?


· The method of giving seed-grants to emerging projects is an excellent way to overcome the bottleneck by assisting projects on the ground. Once the project-team can submit their first financial statements, avenues will open up for further “drip-feed” funding. Ongoing technical support (e.g. basic book-keeping and administration) is necessary.
· LUCSA to continue promoting the integrated care projects. (treatment knowledge and support / VCT / OVC care/ youth programs geared at prevention.)
· The best orphan-care model is where a care worker is responsible for ca 6 to 10 orphaned households (with guardian) in the community. Child/youth headed households to have 1 care worker for 1 or 2 households. These care workers, however, should receive stipends. LUCSA to lobby for fair stipends and communicate this need with LWF and other donor agencies overseas.
· Ongoing TRAINING for care workers. This is absolutely essential and must not be neglected in the face of the acute crisis. Professional child counseling trainers need to be identified and recommended to projects.
· Monitoring and mentoring of care workers. The best organization in South Africa is NACCW. National Association of Child Care Workers. Networking will be highly beneficial.
· There is a great need for ‘drop-in’ centres (after-school care centres for OVCs) and children’s villages. LUCSA member churches, particularly those with empty buildings on previous mission stations, are encouraged to look at the option of opening up “sanctuaries” for orphans and vulnerable children.
· To encourage projects in member churches to form partnerships with CBOs and African Indigenous Churches in order to reach more children in need.
· To look at the feasibility of “online language companions” (native speakers in US or UK). Funding proposals have to be written in English. Many project coordinators are very capable managers but not proficient in English. Lutheran companion synods in the United States could be approached to assist with such a program.
· LUCSA to identify best resources re: videos/DVDs and books/manuals on child counseling.
· To set up a system of “resources sponsorship” where project coordinators can submit a motivational letter requesting resources like educational videos and manuals/books. (eg the video: “a child is a child” / “yesterday”)
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