Approaches to caring, essential elements for a quality service and cost-effectiveness in South Africa

Desmond, Chris; Gow, Jeff; Loening-Voysey, Heidi; Wilson, Theresa; Stirling, Bridget

doi:10.1016/s0149-7189(02)00055-1

Cited by 16 publications

(20 citation statements)

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“…An important conclusion from implementers of programmes in this review (Drew, Makufa, & Foster, 1998;Foster, 2002b;Foster et al, 1996;SCOPE-OVC/Zambia & Family Health International/Zambia, 2003) and reiterated by authors from other settings (Beard, 2005;Bhargava & Bigombe, 2003;Desmond & Gow, 2002;Giese, Meintjes, Croke, & Chamberlain, 2003;Levine, Michaels, & Back, 1996;McKerrow, 1996;Mutangadura, Mukurazita, & Jackson, 1999;Richter, Manegold, & Pather, 2004;UNICEF, 2003;Williamson, 2005) is that without community motivation, longterm external funding, and technical support, community programmes are unsustainable; in any case implementers should be transparent about their exit strategy and/or plans for scale-up.…”

Section: Study Findingsmentioning

confidence: 67%

“…At least one study [17] had aimed to conduct a baseline but was unable to do so due to logistical and resource constraints. Two of the studies AIDS Care 929 [5] Malawi Á Orphan Care Activities (Ledward et al, 2001) [6] Rwanda Á FXB Village Model (Desmond, 2007;Wilson & Berkman, 2007) [7] Rwanda Á Mentoring Youth-Headed Households (Brown et al, 2005;Boris et al, 2006;Horizons, 2007aHorizons, , 2007bThurman et al, 2006b) [8] South Africa Á Costing (Desmond & Gow, 2001;Desmond et al, 2002) [9] Tanzania Á CARE Tumaini Programme Assessment (Attawell et al, 2005;MEASURE Evaluation, 2007) [10] Tanzania Á Most Vulnerable Children (Mhamba, 2004) [11] Tanzania Á Vijana Simama Imara (VSI) (Clacherty & Donald, 2005) [16] Zambia Á Bwafwano Programme Chatterji et al, 2007;Dougherty et al, 2005) [17] Zambia Á Chikankata Programme (Mulenga, 2002) [18] Zambia Á Reaching AIDS-affected People with Integrated Development and Support (RAPIDS) (Population Council, 2006b;Population Council, 2008;RAPIDS, 2006;Schenk et al, 2008aSchenk et al, , 2008b [19] Zimbabwe Á Families, Orphans and Children Under Stress (FOCUS) (Drew et al, 1998;Foster et al, 1995;Foster et al, 1996;Foster et al, 1997aFoster et al, , 1997bFoster, 2002b;Lee, 1999;Lee et al, 2002) [20] Zimbabwe Á Psychosocial support interventions (Gilborn et al, 2006) n/a [16,18] employed multiple (two) rounds of data collection following intervention introduction, in order to track change trajectories during programme implementation. Without baseline data, four...…”

Section: Methodologiesmentioning

confidence: 99%

“…Where possible, they are seen as preferable to institutional care, since they emphasise community self-reliance, build on traditional norms of extended family support, avoid separating children from their communities, and encourage local leaders to oversee child wellbeing (Beard, 2005;Phiri, Foster, & Nzima, 2001;Strebel, 2004;Williamson, 2004). Complementary initiatives may also address food insecurity through supplementary feeding, nutrition or agriculture programmes; support school attendance by providing uniforms or fees; or strengthen primary healthcare through school-based or facility-based interventions (Desmond & Gow, 2002;Subbarao, Coury, & World Bank, 2004). Such programmes share a common goal of improving children's wellbeing, ultimately working towards achieving the Millennium Development Goals of improved children's health and education.…”

Section: Introductionmentioning

confidence: 99%

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Community interventions providing care and support to orphans and vulnerable children: a review of evaluation evidence

Schenk

2009

AIDS Care

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Children affected by HIV in their families and communities face multiple risks to their health, education and psychosocial wellbeing. Community interventions for children who have been orphaned or rendered vulnerable take many forms, including educational assistance, home-based care, legal protection and psychosocial support. Despite a recent influx of funding for programme implementation, there exists little evidence to inform policymakers about whether their investments are improving the lives of vulnerable children and meeting key benchmarks including the Millennium Development Goals. This paper reviews the current evidence base on evaluations of community interventions for orphans and vulnerable children (OVC) in high HIV-prevalence African settings, focusing on studies' methodologies. Sources reviewed include published research studies and evidence from the unpublished programmatic "grey literature" located through database and internet searches. A total of 21 studies, varying in scope and generalisability, were identified. Interventions reviewed address children's wellbeing through various strategies within their communities. Evaluation methodologies reflect quantitative and qualitative approaches, including surveys (with and without baseline or comparison data), costing studies, focus groups, interviews, case studies, and participatory review techniques. Varied study methodologies reflect diverse research questions, various intervention types, and the challenges associated with evaluating complex interventions; highlighting the need to broaden the research paradigm in order to build the evidence base by including quasi-experimental and process evaluation approaches, and seeking further insights through participatory qualitative methodologies and costing studies. Although findings overall indicate the value of community interventions in effecting measurable improvements in child and family wellbeing, the quality and rigour of evidence is varied. A strategic research agenda is urgently needed to inform resource allocation and programme management decisions. Immediate imperatives include building local technical capacity to conduct quantitative and qualitative evaluation research, and strengthening monitoring and evaluation systems to collect process and outcome data (including costing) on key support models. Donors and implementers must support the collection of sound empirical evidence to inform the development and scale-up of OVC programmes.

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Section: Study Findingsmentioning

confidence: 67%

Section: Methodologiesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Community interventions providing care and support to orphans and vulnerable children: a review of evaluation evidence

Schenk

2009

AIDS Care

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“…In reality, the relationship between resources and care is influenced by many aspects of the care environment. For example, families are generally far more efficient in translating resources into care than institutional care environments (Desmond, Gow, Loening-Voysey, Wilson, & Stirling, 2002).…”

Section: The Challenges In Defining Carementioning

confidence: 99%

Costs and care: Directing resources to children

Desmond

Betancourt

Garvey

2010

Vulnerable Children and Youth Studies

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While it does not cost a great deal to make a difference in the life of a child living in poverty, that does not mean that they are cheap to care for. To avoid confusion there is a need to distinguish between expenditures on care, marginal costs of care and total cost of care. Expenditures on children are the amounts of money spent on their care. The marginal cost of care is the cost of achieving a specific increase in the level of care. The total cost of care is the cost of providing a given level of care. While much can be said about differences in expenditures and marginal costs, little can be said about differences in total costs. Clearly, expenditures are far greater among the rich, while the marginal impact of additional spending is far greater among the poor. Total costs of care, however, cannot be compared easily because the care itself is not comparable. To compare care requires a definition of care. This article focuses upon this issue and points to the limitations inherent in conceptualizing aspects of care as cumulative rather than interactive. The focus on the interactive nature of care highlights the importance of the care environment. As most children live in families and communities, the strengths, resources and capacities of these care environments and their interactive nature is similarly highlighted.

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“…It has been shown to be at least 10 times and up to 100 times more costly than family care (Desmond, Gow, Loening-Voysey, Wilson, & Stirling, 2002). The establishment and maintenance of such facilities may divert external support from families Downloaded by [Korea University] at 17:51 26 December 2014 who, with help, could care for vulnerable children at home.…”

Section: Introductionmentioning

confidence: 99%

AIDS orphan tourism: A threat to young children in residential care

Richter

Norman

2010

Vulnerable Children and Youth Studies

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The dominant global perception that sub-Saharan Africa is experiencing an "AIDS orphan crisis", coupled with growing trends in international voluntourism, has fostered a potentially high-risk situation for already vulnerable young children in the region. This article reviews the current discourse on what is being called a crisis of care for children, as well as literature on out-of-home/family care and its adverse impacts on child development. We also describe an emerging "AIDS orphan tourism", and show how short-term attachments formed between children in group residential care and volunteers may worsen known impacts of institutional care. This article advocates against the exploitation of especially vulnerable young children in sub-Saharan Africa for commercial gain by tour operators in the current growth of "AIDS orphan tourism". We instead propose that young people who wish to volunteer their time and talents to assist children less fortunate than themselves be properly informed about children's development and attachments to others, as well of the vulnerabilities and rights of young children, especially those outside of family care.

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Approaches to caring, essential elements for a quality service and cost-effectiveness in South Africa

Cited by 16 publications

References 0 publications

Community interventions providing care and support to orphans and vulnerable children: a review of evaluation evidence

Community interventions providing care and support to orphans and vulnerable children: a review of evaluation evidence

Costs and care: Directing resources to children

AIDS orphan tourism: A threat to young children in residential care

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