VSO RAISA - scaling up support for Southern Africa’s caregivers Clive Ingleby Global Adviser – health, HIV and AIDS

1. Problem identification: SADC Gender Protocol (2008) - all states should have a policy on care givers. VSO/WHO research (2009) - South Africa, Malawi, Mozambique, Namibia, Zambia, Zimbabwe  Over 70% of those providing home based HIV and AIDS/PHC services in SADC countries are women and girls  Burden of care on women and girls overwhelming (at risk of further impoverishment)  Usually not compensated for unrecognised and unsupported work 2. Further research and good practice identification: Supported/informed by direct experience on the ground – RAISA’s work with CSOs 3. Evidence produced will support influencing of SADC parliamentarians: To establish national advocacy champions for care givers in 7 SADC countries 4. Care givers policies will be passed in up to 7 SADC Countries: To be drafted, adopted, resourced and implemented 5. End result Improved conditions for home based carers leading to better care for PLWHIV VSO RAISA strategic approach - the ‘theory of change’

Research: Initial joint research followed by further research on care givers conducted across the region Capacity building: Civil society – in 6 countries to create models of HBC good practice and to inform research and advocacy activity SADC Parliamentary Forum – to build capacity of MPs including eg.  Presentations at SADC PF meetings  Policy handbook for MPs  Exposure visit to Namibia to observe good practice  Training in advocacy, lobbying and representation by a VSO ‘Pol Vol’ (Baroness Margaret Jay) Regional alliance building: Regional alliance created with other prominent stakeholders eg. IFRC, Oxfam, World Vision, Save the Children to support advocacy and lobbying efforts with SADC Lobbying for HBC policy change: National meetings in 6 countries with eg. Ministers of health, ministers of gender, NAC directors, UNAIDS, WHO, NGOs, CBOs to lobby for HBC policy change - Processes followed to bring about change...

National and Community Homes Based Care Policy approved August 2012  launched by Deputy PM Thokozani Kupe at the VSO RAISA conference in Pretoria in November 2012 Recognises the contribution made by caregivers and supports stronger linkages between community health services and health service providing facilities Standardisation of HBC support packages including:  Provision of HBC kits (distributed by ministry of health)  Training delivered to HBCs in line with national guidelines  Commitment to remuneration of care givers enshrined in the policy Implementation of the policy begun in 2 provinces with intention to scale up once more resources secured Initial feedback from CBOs suggests:  Improved coverage and quality of care reported by PLWHIV eg. access to ART  Increased # of male caregivers reducing burden of care on women and girls Evaluation of impact to be conducted by VSO RAISA and WHO in August 2014  Will focus on changes in the lives of HBCs and PLWHIV and whether this can be attributed to policy change. Baseline study already conducted - Impact (1) – results from Zimbabwe

Mozambique: Mozambique MPs supported by VSO RAISA led calls for a law in care givers policy in parliament in December 2012 ‘National Policy for the Provision of Community and Home Based Care Services’ drafted in Feb 2013 and currently being discussed in parliament Zambia: Zambian parliamentarians supported by returning VSO Pol Vol Baroness Jay to draft care givers policy in August 2013 Regional and International Advocacy: HBC presentation made to SADC Gender Ministers meeting in Maputo (Feb 2013) The issue of HBCs promoted on international stage by Zimbabwean Deputy PM at Commission on Status of Women UN Conference in New York (March 2013)  Shared good practice from Zimbabwe to push governments to put policies in place that support women and girls Lobbying of DFID to champion community health workers including those who volunteer at forthcoming 3 rd Global Forum on Human Resources for Health ( in Brazil in November 2013) Impact (2) – building momentum across the region...and beyond.

- Evidence based research informed by direct experience on the ground is essential to bring about policy change – civil society (CBOs/ NGOs/INGOs) provide the bridge between communities and policy makers - Representation of care givers and PLWHIV as part of the advocacy and policy development process is essential - Invest in building the capacity of parliamentarians and other key influential stakeholders to build strong and influential support within legislative structures - Be prepared and able to respond to political change eg. National elections resulting in changes of government and ‘make-up’ of legislative structures (Malawi, Zambia) - Bringing policy makers together from different countries supports experience sharing, builds awareness of common issues and encourages the development of cross-border alliances leading to the potential for increased impact – one of the key ‘added values’ of regional programming - Attributing change to policy implementation is a challenge (need to develop M&E systems that address this) - Using HIV and AIDS HBC experience to strengthen wider community health care systems (integration) is the way forward Learning

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