Slowly but Surely: Evaluations of Three Programs Supporting Most Vulnerable Children in Tanzania Show Some Benefits

This 14-page policy brief, published by MEASURE Evaluation, provides a summary of key findings from three orphan and vulnerable children (OVC) programme evaluations conducted in Tanzania. It examines the policy and programmatic implications of study results and offers recommendations for service providers and other decision-makers at the programme and national levels. The three OVC programmes evaluated were Mama Mkubwa and Kids' Club implemented by The Salvation Army (TSA), which had been operating for two years in the Mbeya region; Tumaini Project implemented by CARE International, Family Health International, and a faith-based organisation Allamano, operating for five years in Iringa region; and Jali Watoto, implemented by Pact and a community-based organisation, SAWAKA, operating for four years in Karagwe, Kagera region. The evaluations found that the programmes are beneficial to OVC, but some care and consideration is needed in terms of minimising jealousy in the community and ensuring supportive family relationships.

According to the brief, all three programmes incorporated some level of community-based intervention activities. However, this was the main focus for the Jali Watoto programme, which implements community-based HIV prevention, care, and support initiatives designed to educate and sensitise youth and other community members to increase community support for OVC and people living with HIV and AIDS, and reduce stigma. The evaluation found that the effects of the Jali Watoto programme were mixed, ranging from positive, negative, to neutral. Positive effects of the Jali Watoto included increased community in-kind support to OVC households and enhanced HIV prevention knowledge among children. Also, there were other marginal positive effects including better emotional health among caregivers, and improved self-esteem among children.

Home visiting was the most common intervention approach instituted by all three programmes. The evaluations show that the effects of home visiting on children and caregivers varied by programme. Specifically, home visiting under the Allamano programme was associated with higher levels of adult support and lower isolation, while it was associated with higher levels of child self-esteem among TSA beneficiaries. Also, under Allamano, receipt of home visiting was associated with better reported health status among children but not for caregivers. However, home visits were not positively associated with the emotional state of caregivers.

Kids’ clubs was another intervention implemented by all three programmes. The kids’ clubs are expected to provide children with recreational opportunities and serve as a forum to deliver psychosocial support and key information to enable them to make better and healthy decisions about their lives. The evaluations found that a higher proportion of children in the Allamano intervention group had attended a kids’ club (about 44%) compared to those in the TSA and Jali Watoto programs (27% and 11%, respectively). The evaluations examined the effects of kids’ club attendance on children's self-esteem, social skills, emotional well-being, and support networks. Overall, participation in the Allamano kids’ club was associated with significantly fewer emotional problems, better pro-social behaviour, and increased adult support among children. For TSA, no significant differences were found between programme beneficiaries reporting kids’ clubs attendance and those not reporting attendance on any of the psychosocial outcomes examined. For both programmes, a majority of the children who attended a kids’ club reported participating in activities such as games, songs, and dance (95% for TSA and 87% for Allamano). However, the training curricula were somewhat different. Where Allamano volunteers taught about health hygiene, chores at home, and good behaviour, TSA volunteers provided psychosocial/community counselling, discussed stigma and discrimination, and provided OVC care.

In spite of the positive effects across all programmes, some activities appear to have had unintended negative effects. Several results across all programmes suggest that service delivery to OVC and their households may indirectly induce jealousy, resentment, and other negative attitudes towards HIV-affected families and OVC from the surrounding community, and increase expectations of external support from non-governmental organisations. Also, some programme interventions were negatively associated with family relationships. In the TSA programme evaluation, caregivers whose children had attended a kids’ club meeting had less positive feelings towards their children than those whose children had never attended. In the Jali Watoto programme, caregivers in the intervention group reported poorer family-functioning than those in the comparison group. The brief states that these findings may be indicative of household tensions among family members that need to be addressed. For example, kids’ clubs take a child away from helping with chores at home without caregivers' consent.

The brief makes a number of recommendations for policies and programmes:

• continue to engage most vulnerable children caregivers in identifying and supporting OVC;
• strengthen the monitoring systems to register and track OVC;
• improve the quality and intensity of programme services among beneficiaries;
• develop and promote comprehensive training and support for volunteers;
• provide incentives for volunteers;
• involve caregivers and children in designing interventions to address OVC needs;
• enhance linkages among OVC care and support providers;
• conduct regular assessments of programme coverage and client participation;
• prioritise evaluations as an integral part of overall programme implementation;
• incorporate direct support to strategies designed to improve child psychosocial well-being;
• address perceived negative attitudes from the community towards programme beneficiaries; and
• conduct a follow-up survey among the same sample of consenting participants.