Developing interventions to benefit children and families affected by HIV/AIDS : a review of the COPE [Community-based Options for Protection and Empowerment] program in Malawi for the Displaced Children and Orphans Fund

The project is being implemented by Save the Children Federation. The evaluation covers the period 4/95-10/96, against a PACR of 4/97. COPE, which is planning to expand beyond the initial target area in Mangochi town to Namwera, has an elaborate management information system for measuring needs and assessing impact and is on track for achieving numerical targets for most key objectives. The project, operated by a highly dedicated staff, is seen positively by the majority of community members and leaders, and government and nongovernmental personnel. However, COPE's multiple interventions appear to be too expensive to implement at scale: cost per beneficiary (a total of 4,154 household members, 58% of them children) is $162. To increase household income, COPE is operating a microenterprise credit scheme using village-bank methodology called Group-Guaranteed Lending and Savings (GGLS) for groups of 15-20 women, and is also supporting gardening on wetland (dimba) plots. As of 9/96, 343 individuals had participated in GGLS (292) or gardening (51); the target is 500. It is not clear whether these interventions, which have reached 36% of targeted households, have made sustainable improvements in the households' economic situation. While participants said the programs had enabled them to buy better quality food, the interventions may not be reaching (and may not be possible for) the most vulnerable households, whose labor capacities are extremely limited. Community support may be the best hope for aiding such households. However, in comparison to other NGO credit programs in Malawi, GGLS appears to be reaching the deepest into the survival economy. COPE's primary health intervention has been to train caregivers and community volunteers to treat common ailments and make patients as comfortable as possible. Home-based care training appears to be having a very positive impact, including indirect benefits for children. As of 9/96, 201 household caregivers had been trained in home-based care; the target of 500 will not likely be reached by the end of the current program. COPE has also trained 257 others (e.g., religious leaders, community volunteers) in home-based care and 15 as home-based care trainers. Care of at-home patients has been measurably improved in 95 households against a target of 100. Thirty-nine children had been referred to under-five clinics and 45 to the hospital. To promote psychosocial well-being, COPE has secured matching donations for secondary school expenses of adolescents for primary-target families and has supported structured recreation, as well as drama groups and skills training linked with other nonformal education. Skills training has been the slowest to get off the ground. Scholarships have been provided to 94 of a targeted 100 secondary school students, the most tangible benefit of the program's psychosocial activities. In the area of advocacy and training, COPE has helped develop the government's "Orphan Care Program: 1996-98", helped orient the National Task on Orphans toward community-based action, and sensitized businessmen and parliament members to needs of the community, including scholarships. An intern has begun advising other Malawi organizations how to protect the inheritance rights of widows and orphans. COPE has also secured cash or in-kind contributions from 9 of a targeted 20 private-sector institutions and individuals; trained 123 of a targeted 200 government service providers and policymakers, NGO staff, and community members in children's psychosocial development; and secured admission to government schools for 14 COPE students. Given expected substantial increases in the number of AIDS-affected children and families over the next several years, COPE should focus more on catalyzing community-based groups with a commitment to serve the most vulnerable children and families; currently, COPE is dependent on the short-term involvement of the program's 11 paid field workers. The following are lessons learned. (1) In Namwera, it will be important to work more with existing structures, institutions, and organizations. (2) The program must seek to engender community ownership in interventions. (3) Planning for community involvement must begin at the outset. One important step is encouraging communities to identify their problems and ways to address them. (4) In planning interventions, it is important to pay attention to the seasons when people have more time available for new activities (March-August in Mangochi). (5) Modeling behavior can help change behavior. Concrete actions can be models and catalysts. (6) GGLS has worked to meet the needs of some categories of COPE families. (7) Home-based care has been welcomed in the communities where training has been done and has had a substantial multiplier effect. (8) Approaches are needed that can be taken to scale. Program interventions should not only address the needs of the immediate community, but also consider the overall scope of the problems in the country. (9) Calculating and monitoring cost-per-beneficiary figures for different interventions can be an important management tool. Budgeting, accounting, and other information systems need to be designed to facilitate calculation of such figures.