By 2007, increasing numbers of HIV positive children and adolescents in Zimbabwe were being treated with anti-retrovirals and consequently were living with HIV rather than dying. It quickly became apparent however that these children had major psychosocial support needs if drug treatment was to be effective and their lives were to be worth living.
Dr. Monica Glenshaw who was then the DMO at Murambinda made the decision that Buhera district would pioneer such support and after a number of meetings of district stakeholders to discuss the issues, it was decided to establish a Resource Centre at MMH to offer complementary psychosocial support to children and young people on ART.
So CARC began in 2008, in a time of hunger and difficulty but with great enthusiasm. It was based initially in an old hut in the Hospital grounds and was staffed by volunteers – a Play Therapist from UK, nurses from the Hospital, counsellors from MSF, Newstart and New Life, and a head teacher and pastors form the local community.
CARC quickly outgrew the old hut and a new building housing playrooms and an office was built thanks to the generosity of SVMH, the Dutch Friends of Murambinda Hospital, and was then followed by a big new play hall. A programme of regular sessions was developed which including
- Health education
- Social activities
- Cultural activities
- Spiritual support and education.
All activities were delivered using play.
In July 2009 Mrs Evelyn Natale was appointed as full-time Coordinator of CARC. As a former District Nursing Officer she brought a large range of skills, experience and local contacts to the post and CARC has thrived and developed greatly under her leadership. This is thanks also to a Danish organisation, SUG, who have secured funding from the Danish Government for a sustained programme over 5 years.
CARC activities have been extended to include group and individual counselling, empowerment of children through active participation in expressive arts and leadership training. CARC has built a partnership with Africaid, based in Harare, who have trained adolescents elected by their peers at CARC to become Community Adolescent Treatment Supporters (CATS), leading psychosocial support sessions, offering individual counselling and conducting home visits to support antiretroviral treatment adherence among their peers.
CARC also established a Caregivers Support Group, to help caregivers to care confidently for HIV positive children. Topics covered include:
- Basic information on HIV and AIDS
- Opportunistic infections
- Antiretroviral Therapy
- Positive living and positive prevention
- Nutrition and HIV and AIDS
- Stress management
The caregivers also help each other by discussing challenges they face and trying to solve them. Disclosure for example is a very difficult subject for the caregivers, who find it very difficult and painful to tell a child that he/she is HIV positive. Sessions are held to empower them to disclose and these include discussions, lectures and a puppet show.
Sometimes caregivers also give each other material support, and SUG is currently supporting the development of nutrition gardens to help alleviate the effects of poverty. Educational support (payment of school fees) has also been provided for selected beneficiaries.
In 2017-18 The project was implemented the following sites :
Murambinda Mission Hospital 364 children and adolescents
Munyanyi Rural Health Center 103 children and adolescents
Betera Rural Health Centre 68 children and adolescents
Garamwera Rural Health Center 79 children and adolescents
Nerutanga Rural Health Center 54 children and adolescents
Bangure Rural Health Center 28 children and adolescents
Primary caregivers of the children and adolescents were part of the primary caregivers
The psychosocial support was provided using The Play Therapy Model
Activities started with singing and dancing and other games to bring the children together. This was followed by grouping the children into their various age groups and providing age appropriate sessions like building LEGO, writing, Auntie Stella, health education and spiritual support.
One to one counseling was offered to children and adolescents who had exhibited or expressed emotional problems.
REPORT ON VISIT TO CARC (Child & Adolescent Resource Centre) AT MURAMBINDA MISSION HOSPITAL, AS PART OF THE VISIT BY FRIENDS OF MURAMBINDA TRUSTEES MARY MILLER AND CAROLYN RIGBY IN MARCH 2020
CARC was started at Murambinda Hospital in 2008 to support HIV positive children and adolescents and their caregivers. Antiretroviral treatment had just been started for these children, but they faced desperate challenges.
On the visit Mary Miller and Beth Kirby met with Mrs. Evelyn Natale, CARC Coordinator, & Mr. Ronald Mativenga, CARC Social Worker
CARC is currently delivering 2 projects, ‘We Are the Future’ (WATF) funded by CISU from Denmark, and BIRA (Buhera Integrated Recovery Action) funded by the Jo Cox Memorial foundation through UKAID.
WATF delivers psychosocial support to between 500-700 children in 6 districts of Buhera. The majority are HIV positive and the rest are vulnerable children, mainly orphans or disabled. A psychosocial support group in each district meets monthly on Saturdays (to avoid clashing with school). The programme includes song and dance, games, arts & crafts, construction, spiritual support, individual counselling using a Play Therapy model, and caregiver training and support.
The children also benefit from Life Skills training, including hygiene, resilience, leadership, adolescent S&RH and life planning skills. Adolescents are offered opportunities for vocational training in clothing technology, carpentry, building, motor mechanics and blacksmithing.
BIRA started in November 2019 and aims to challenge gender inequality by increasing women’s opportunities for income generation and their ability to make economic decisions. A total of 1,200 female caregivers will be supported to participate in small income generating activities (IGA), starting with the commercial production of chickens. They will form groups of 10 members each and sill all be trained in business management, including marketing, by the Zimbabwe Ministry of Industry, Commerce & Enterprise Development (MICED). The Ministry of Women’s Affairs, Gender & Community Development will train all the caregivers on internal savings and lending. Each group will make up a binding constitution signed by all members and further signed and stamped by the village head.
Each group will receive a starter pack of 50 day-old chicks, 200g of stock feed and 250mg of stress pack. The groups will save the money they make and members will access loans and share out profits as specified in their respective constitutions. Members will invest the borrowed funds in their individual IGAs, and the profit they make will go towards meeting household needs. All the groups will be registered by MICED and the registration will give them access to sell their products to formal markets.
100 young women will be funded to attend vocational training college in Murambinda.
The baseline survey has shown that the current average income of female-led households in the district is US$ 8 per month. The 1,200 places in the BIRA programme are already oversubscribed and CARC will give priority to caregivers who are looking after children registered with CARC.
- WATF funding will end in June 2021 and the Danes have indicated that irrespective of the merits of the project it is unlikely that CISU will continue it.
- BIRA funding will end in September 2021 but there may a possibility of a Phase 2.
- Funders are increasingly requiring future funding bids to come from consortia rather than individual projects. CARC has a good working partnership with Rujeko, a South Africa / Zimbabwe NGO operating in the same field, but currently has a strained relationship with Africaid, a Zimbabwean NGO which from small beginnings currently receives major funding to operate at national level in 6 countries. A meeting is planned between CARC and Africaid to sort out how the two will work together in the future.
- Boys and young men are not included in the BIRA programme although at present slightly more than 505 of the CARC children are boys.
Mrs. Natale endured several months of working at half salary when there were delays in delivering the BIRA funding. She and her team, who are all volunteers apart from Mr. Mativenga and the 12 teenage CATS (Community Adolescent Treatment Supporters, who receive an allowance of US$25 per month) are to be massively congratulated on the current success of CARC, particularly the level of integration with Government and existing district structures and services, which both increase and embed the work that can be done.