Grant Recipient Describes Award-Winning Social Protection Project in Kenya
Last year, the Coalition for Children Affected by AIDS and ViiV Healthcare’s Positive Action awarded $40,000 in grants to eight organizations that could show how the use of social protection supports HIV testing, treatment, and care for children in low- or middle-income countries. Each winner received $5,000 to produce either a scientific article, video or written case study to show what works.
One of the winning proposals was submitted by Cheer Up, a community-based organization supporting 9,000 children affected by HIV and AIDS in Kiambu, Central Kenya. The Coalition spoke to Muhamed Akulima, a technical mentor for the organization, about its award-winning Household Economic Strengthening (HES) program to combine HIV and social protection support for children affected by HIV.
Q: Why did Cheer Up decide to combine social protection with HIV support to children?
We saw that children affected by HIV were struggling to access and take their ARVs due to poverty and poor nutrition. We also wanted to find a way to help them that was sustainable and empowering for children and their caregivers in the long-term. So in 2012 we developed the Cheer Up household economic strengthening (HES) program. It was intended to function as a supplement to the cash transfers received by vulnerable families via the Government of Kenya’s CT-OVC (Cash Transfer for Orphans and Vulnerable Children) program by providing entire households with a sustainable and empowering way of supporting OVCs.
Q: How does the program work?
We work with community health volunteers and others in the local health system to identify households in which there are OVCs who are in particular need of HIV testing, treatment, and care. These could be households where a child is cared for by an adult or other family member living with HIV; where a child has lost one or both parents to HIV/AIDS; where a child is struggling to attend health appointments or be tested or adhere to treatment; or where they are more generally at high risk of infection. Community health volunteers then carry out a ‘Household Vulnerability Assessment’ to identify the HIV risks and challenges to the child, as well as the broader economic needs of his or her household. Households are categorized from “highly vulnerable” to “not vulnerable,” depending on their level of need.
From there, we work with the household to identify what would empower them. Do they have the space to start a small business from home? Do they need training? What are they physically able to do? Next, we discuss what kind of business they would like to engage in, based on what is marketable and valuable in the region. For example, a family that lives near a wool factory might receive sheep. Other times it may be poultry or a dairy cow. If they want to run a salon out of their house, we will buy hairdryers and supplies.
Q: Are caregivers required to repay Cheer Up for the business supplies?
We give them seed funding as a free grant, so there is no need for repayment. It really requires good will on the side of the recipient. Almost 90% of the families we work with have an HIV-positive child living in the household, and we make it clear that these grants are intended to help the children first and foremost.
Q: How many households are participating in the program?
Cheer Up is supporting 821 households, including 216 that are receiving economic interventions. Within those homes, we are reaching around 9,000 children. Approximately 65 households have received high-grade dairy cows, 120 have received Merino sheep, and 31 caregivers received support to start or boost their small businesses. We have also linked 378 OVC households to Savings and Internal Lending Communities (SILC).
Q: How has the program helped children affected by HIV?
Thanks to HES and targeted HIV testing and counseling, our number of HIV-positive children receiving care and treatment jumped from 90 in 2013 to 188 by the end of 2016. The proportion of children tested for HIV also increased from 28% to 96% over the same time period. All 188 HIV-positive children in our HES households had a 100% adherence rate to treatment, with 92% achieving viral suppression.
Q: Do you have any success stories you can share?
Yes. One of our clients, Mary (name changed), was HIV-positive and caring for two children. She joined the Cheer Up program in 2018 due to her 11-year-old daughter’s HIV status. At the time, her daughter had a high viral load of 8,543 copies. A suppressed viral load is below 1,000 copies, so the girl was at very high risk of contracting an HIV-related infection.
Mary was struggling to provide for her family due to her low literacy level and poor health. After enrolling in the program, a case manager and community health volunteer carried out a vulnerability assessment and developed a case plan for the household. Mary was referred to a health facility where she could access information on antiretroviral drugs. She had a small plot of land outside her house, so we helped her grow a vegetable garden to ensure access to nutritional food that would boost her children’s immunity. We also gave her a dairy cow to increase her income and help fertilize her garden with manure.
After eight months, Mary and her daughter were able to suppress their viral loads through proper nutrition and adherence to antiretroviral drugs. The cow produces 15 liters of milk per day – the family keeps two liters and sells the other 13 liters to a local cooperative. She now earns about 15,000 Kenyan shillings ($145 USD) from milk sales per month. She also sells the surplus produce from her vegetable garden to her neighbors for additional income. This has enabled her to provide for the family’s basic needs and pay school fees for the children.
Mary told us: “Cheer Up has made our lives better, and I now have hope for a better tomorrow. I can comfortably be independent without depending on the program, so as to give another person the chance to be empowered like me.”