Bigshoes Foundation Basic Child Health Training Programme

VISION

Improving the medical care of orphaned and vulnerable children (OVC), with special emphasis on those affected by HIV/AIDS. They aim to do this by partnering with Government and other organizations to:

• Provide HIV testing, adoption medicals, anti-retroviral (ARV treatment and palliative care for OVC
• Provide child health focused training for child caring professionals and caregivers
• Advocate and influence policy around the health care for OVC

OVERVIEW

The Bigshoes Foundation Basic Child Health Training Programme seeks to empower caregivers working in children’s homes and the community with basic child health skills to adequately meet the health care needs of children in their care as part of their strategy to improve the overall medical care of OVC. The improved capacity of caregivers in this area will improve the basic health of the children in their care. As a result of the intensive training programme, the children receive better nutrition, emotional support, palliative care and management of minor injuries and illnesses. Caregivers are able to monitor the normal development of each child and look out for signs of discord correctly. This will in turn relieve the burden on the public health care system and Bigshoes’ medical clinics and outreach as better management of basic child health means that more time can be spent on complex medical problems, accurate HIV diagnosis and adoption medicals. The comprehensive five-day training programme covers topics including: First Aid ‘save a child’; Hygiene, nutrition and Growth, Routine Health Care and Infectious Diseases; Common Childhood Illnesses and Development; Childhood HIV/AIDS and ART; Disclosure and Paediatric Palliative Care (PPC). The programme specifically targeting caregivers working in children’s homes also includes a module on record keeping in the children’s home.

WHAT WE LIKE ABOUT THIS PROJECT

• Complimentary to other programmes implemented by the organisation
• Responding to an identified need
• Vehicle for sharing good practice in basic child health care

EXPECTED LIFE CHANGE

An investment of R290,767.50 will help approximately 250 child health caregivers be capacitated to adequately respond to the basic health care needs of the estimated 1,500 children in their care. Estimated direct life change at R193.79

NEED

NEED There is an urgent need to improve health care for orphaned and vulnerable children (OVC) living in communities. The Infant Mortality Rate (IMR, defined as the number of children dying in the first year of life per 1000 live births) in South Africa reached 59 deaths / 1000 births in 2002, the worst experienced since 1977. This is believed to be largely due to the effects of the HIV epidemic on children’s health. HIV impacts directly on the health of infected children and indirectly on the health of affected children whose parent’s death or poor health is often a barrier to their own well being. The HIV epidemic has changed the face of children’s homes in South Africa and an increasing number of new children’s homes have been established in response. Unfortunately, the institutions responsible for the children’s homes, have not kept pace with the changing environment. Consequently, there are few systems in place to adequately address the health care needs of children living in difficult circumstances, even those living in registered children’s homes.

ACTION PLAN

Preparation

The training programme has been implemented on an ongoing basis for the past five years and consequently, related preparation is complete. * Training participants are nominated by children’s homes and community based organizations. * Training materials will be printed according to the number of participants. * Pre-tests are conducted to indicate the baseline level of information held by participants

Implementation

• 5 Children’s Home Caregiver workshops of 5 days each (with an average of 25 participants per workshop)
• 5 Community member workshops of 5 days each (with an average of 25 participants per workshop)

Monitoring

• Post-tests are conducted to indicate the change in content knowledge of participants
• Electronic databases record information regarding the training participants and training activities.
• Statistics collected by trainers are sent to the Assistant Director on a monthly basis for collation.
• Changing patterns are identified and programmes are modified accordingly.

ORGANISATION ASSESSMENT

Purpose

Bigshoes has a clear definition and expression of the organisation’s reason for existence, which developed out of research conducted in 2003. This research was focused on the impact of HIV on the Johannesburg children’s homes. Their mission statement is formally documented and used to inform the organisation’s activities in line with their intended social impact. Through their extensive networks and continuous engagement with their target beneficiaries, the organization maintains a current understanding of the social issue they are addressing.

Strategy

The organization’s core programmes and services are well-defined and complimentary as an overall strategy to achieve their mission. Their service offering is focused on four key components including: medical clinics and outreach, paediatric palliative care, an abandoned baby project and basic child health training. Bigshoes Foundation proactively participates in a wide range of relevant collaborations, alliances and networks to enhance their impact and contribute to organizational learning. They have well-established relationships with hospitals, children’s homes, hospices, NPO’s delivering complimentary services, government departments and research institutions.

The organisation reviews its strategy and approach based on its knowledge of current good practice and a dynamic environment leading to changing needs. The organisation was previously known as the Children’s Homes Outreach Medical Programme (CHOMP) and changed its name and expanded its focus beyond children’s homes in 2005 when they identified that, the conditions under which many orphaned and abandoned children in communities live, increases their vulnerability. Consequently, the target group expanded beyond children’s homes to include OVC living in grandparent and child headed households in communities. The change in name of the organization followed accordingly.

Bigshoes Foundation also contributes to the body of knowledge in their area practice through the sharing of research, materials and lessons learnt. The original research informing the establishment of Bigshoes was submitted in fulfillment of a Masters Degree in Paediatrics and was published. Bigshoes also influences practice through the sharing of lessons learnt and modeling good practice in their training programme for child caregivers and policemen and social workers (abandoned baby project). Although Bigshoes has a limited geographic reach, they have plans to replicate their model, which they have begun in Durban and have begun the national roll-out of a specific training programme at the invitation of the National Association of Child Care Workers (NACCW).

Resources

Bigshoes Foundation has a clear understanding of the key resources (staff, expertise, systems, infrastructure, finances, leadership) they need to function optimally and deliver on their social mission. They generally have the resources they require to function at present, but could do with additional ‘gap funding’ in the area finances and would like an IT specialist to consult on their data capturing and management information (MIS) systems to see where they could improve. The management team has experience, skills and expertise in their area of social development and in organizational management.

Bigshoes Foundation initially ran as a programme under Wits Health Consortium due to the nature of its inception (out of research). They are currently in the process separating and formally registering as a separate organisation and plan to be operating independently as of Jan 2009. To date, they have registered as a Section 21 company and have an active board in place, with two outstanding members to be nominated. Bigshoes has appointed a consultant from KPMG to manage the NPO and PBO registration processes and establishment of founding documents.

The organisation has an internal staff member who will fulfill their Human Resources Function and they are currently actively recruiting a bookkeeper. Their payroll function will be outsourced to Labournet.

The organisation recognizes the value of a well-defined fundraising strategy and is currently formalizing a strategy for growing and diversifying their funding base. They make use of an annual fundraising plan. Members of the management team with experience in fundraising drive the fundraising process.

Governance

As mentioned above, Bigshoes Foundation is in the process of finalizing and establishing most of their governance structures, including formal registration, financial and related external reporting systems.

Bigshoes Foundation makes use of some electronic database and management reporting systems. The clinic programme keeps a database record of all activities. They generate quarterly statistical reports on their activities from this and include anecdotal input from the doctors.

The organisation conducts financial planning and a budget, which guides plans and activities. They do not currently have independent financial statements as they currently still fall under Wits Health Consortium. Hey report donors in their required formats.

Sustainability

Bigshoes Foundation is currently reliant on a relatively small base of funders for the majority of their annual funding requirements. They have implemented some income generating activities, which seem to be carried out more on an ad hoc basis rather than a comprehensive strategy. They request contributions towards the costs of the five-day training programme and a fee of R600 for the course, where possible. They also receive a R300 contribution from children’s for the adoption medicals when it is for overseas families who can afford it.

The organisation will also become eligible for government subsidies from the Departments of Health and Social Development when they are fully registered as an NPO. They anticipate that this process will be complete by April 2009 and will subsequently apply for the relevant subsidies to improve their sustainability.

The organisation has reasonably strong and varied leadership and can continue to function according to its current strategy without the presence of one or two key individuals. They have recently appointed a new Executive Director, who is being developed for the leadership of the organisation under the current Chief Executive Officer.

The organisation currently conducts planning for one year at a time, which has not been documented in the past. They are currently working towards the development of comprehensive strategic planning and have appointed an external facilitator for their September 2008 strategic planning session. They are also reportedly including a focus on enhancing their demonstration of impact in this strategic planning session. To date, their systems have recorded output-related activities and achievements with some discussion and insight around developmental outcomes but no formal testing of this. There has been no external evaluation of the organisation’s performance and results.