Case Study Number 12
Isibani Sethemba The evolution of integrated approaches to vulnerability in the context of HIV and AIDS
www.oxfam.org.au
Credits Title: Case Study Number 12 Isibani Sethemba: The evolution of integrated approaches to vulnerability in the context of HIV and AIDS Published: May 2011 by Oxfam Author: Mark Mattson Editor: Yves Vanderhaeghen Design: LUMO (www.lumo.co.za) Copyright: Oxfam Australia gives permission for excerpts from this book to be photocopied or reproduced provided that the source is properly and clearly acknowledged. Disclaimer: The views in this publication are those of the respective authors and do not necessarily represent those of Oxfam Australia or any funding agency. The interview and review process was participatory and consent around content and inclusion of personal information was given to Oxfam by interviewees. Contact Details: Oxfam County Office in South Africa Oxfam House, 56 Clark Road, Glenwood, Durban, 4001, South Africa Tel: +27 (0) 31 201 0865 Email: infosouthafrica@oxfam.org.au Oxfam Australia 132 Leicester Street, Carlton VIC 3053, Australia Tel: +61 3 9289 9444 Email: enquire@oxfam.org.au www.oxfam.org.au Isibani Sethemba Nkondosini Reserve, Ingwavuma, 3968 P O Box 272, Ingwavuma, KwaZulu-Natal, South Africa, 3968 Tel: +27 (0) 35 591 0793 Email: munya@orphancare.org.za www.orphancare.org.za
Photo Š Matthew Willman | Oxfam
Contents
3 4 8 16 18 20
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Introduction Literature review Interviews An evolving, integrated approach Conclusion References
MOZAMBIQUE
Ingwavuma
Tembo Elephant Park
SWAZILAND
Lake Sibaya
Mkuze
Mkuze Game Reserve Sodwana Bay National Park
Nongoma Lake St. Lucia Hluhluwe
The Greater St. Lucia Wetlands Park Messina
St. Lucia
Hluhluwe Umfolozi Park Pietersburg Empangeni
Johannesburg
Pretoria Swazi Land
LadySmith
Upington
Kimberly Bloemfontein
Richards Bay Lesotho
Durban
De Aar
Atlantic Ocean
East London Saldanha Mosselbaai
Indian Ocean
Port Elizabeth
Cape Town
Figure 1. The location of Ingwavuma in northern KwaZulu-Natal, South Africa, near the eastern border of Swaziland
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Indian Ocean
1. Introduction This report is the product of an Oxfam project to document good
also works with less tangible aspects of community resilience and
practice at Isibani Sethemba , a non-governmental organisation
wellbeing, offering psycho-social and spiritual support to its clients.
(NGO) based in the town of Ingwavuma in the district of
The organisation is embedded within the communities it serves, and
Umkhanyakude, in northern KwaZulu-Natal, South Africa.
is sensitively attuned to their needs. These qualities are anchored
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by documentation and data management systems which enable the Isibani Sethemba’s mission is to provide “physical, emotional,
organisation to engage and track a large clientele. These systems
psychological, spiritual and economic services to the
also promote dialogue and connectivity within the organisation, and
people of Umkhanyakude.”
support its strategic decision making.
Isibani Sethemba’s website describes Umkhanyakude as one of
The brief of this project was to document the integrated nature of
the most deprived areas in South Africa. It suffers from illiteracy,
Isibani Sethemba’s programs, and the organisational learning that
unemployment and high incidences of HIV and AIDS. Basic
authored them, by interviewing beneficiaries and staff members.
infrastructure is lacking, and population growth rates are high.
Interviews were conducted with various representatives of four HIV
The town of Ingwavuma lies in the Lebombo mountains near the
and AIDS Support Group Gardens to highlight the relation between
eastern border of Swaziland. It has a single main road with a hospital,
HIV and AIDS and food security. These interviews were supplemented
shopping centre, women’s centre, post office, prison, welfare
with a visit to a homestead garden and followed by conversations
department, home affairs office and magistrate’s court.
with Isibani Sethemba staff. Finally, interviews with two senior staff
Isibani Sethemba operates in the three surrounding tribal areas which
members and Isibani Sethemba’s Director were distilled into a
cover about 2,100km².
short essay highlighting key lessons informing the organisation’s integrated approach.
Isibani Sethemba works among rural communities that are deeply affected by poverty and the HIV and AIDS epidemic. It focuses its efforts on palliative care, HIV and AIDS prevention, food security and the assistance of orphans and vulnerable children. Isibani Sethemba
1. Isibani Sethemba means “Light of Hope” in isiZulu, the language spoken in the project area
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2. Literature review 2.1 HIV, AIDS and food security
From the perspective of Isibani Sethemba’s food security program, and according to De Waal and Whiteside (2003), point 4 has great relevance, for the following reasons:
Current literature on HIV and AIDS is closely linked with the concept of new variant famine (NVF), a term introduced by Alex de Waal and Alan Whiteside in 2003. NVF specifically links the HIV and
1. Nutritional status affects mother-to-child transmission of HIV.
AIDS epidemic to an unprecedented food security crisis in southern
2. Nutritional deficiencies suppress the immune system, causing HIV
Africa. In summary, these authors proposed that the burden of care
to replicate more rapidly, and speeding progression from
in AIDS-affected communities has reduced the viability of farming
HIV to AIDS.
livelihoods and created a new category of vulnerable households
3. HIV inhibits nutrient absorption so that people with HIV have
in which adults are ill, or have died. It follows that such households
are highly exposed to misfortunes such as poverty and drought, and
4. Good nutrition is essential for antiretroviral treatment to be
that the likelihood of famine has increased as a result (De Waal and
effective, and some ARVs must be taken on a full stomach;
Whiteside, 2003).
that is nutritional support programs are an important aspect
of ARV compliance.
higher-than-normal nutritional needs.
De Waal and Whiteside proposed four new explanatory factors to
2.2 What is famine?
account for NVF. These factors constitute the essence of the NVF hypothesis, and reflect the fact that southern Africa is the location of the world’s worst AIDS epidemic:
Famines, in general, do not simply imply a lack of food (De Waal, 2003). Rather, food in-security derives from a complex mix
1. HIV and AIDS cause household-level labour shortages, and
of environmental, social, economic and political factors which
a rise in the number of dependants (note: agricultural livelihoods
undermine the ability of local livelihood strategies to provide food
are highly labour intensive).
at the household level (see Ziervogel et al, 2006). While AIDS-
2. Adult mortality leads to a loss of assets and skills.
affected households suffer food in-security as a result of morbidity,
3. The burden of care is large for ill adults and orphans,
mortality and orphan fostering (Kaschula, 2008), it is important to
differentiate the role of HIV and AIDS from the many other factors
requiring a significant diversion of labour and resources.
4. There is an extremely negative relationship between
contributing to food in-security and poverty (O’Brien, Quinlan and
Ziervogel, 2009). Thus, it follows that interventions need to go
malnutrition and HIV.
beyond “emergency relief” (Baro and Deubel, 2006) and reactionary “food aid” (Jooma, 2005) frameworks. The challenge is to understand intensifying conditions of political, socio-economic and environmental vulnerability (Jooma, 2005) that affect the distribution of, access to and affordability of food (Ziervogel et al, 2006).
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Photo Š Mark Mattson
2.3 Food
local ecological knowledge that is needed to recognise, prepare and conserve them.
The impact of HIV and AIDS on food security in southern Africa is The literature attests to the role of wild foods in bolstering:
widely accepted (for example Ziervogel and Drimie, 2008), and the importance of nutritional support and diet in treating HIV and AIDS is well established (De Waal and Whiteside, 2003; UNAIDS, 2008).
1. Food security (Twine and Hunter, 2008; Van Wyk
For these, and other reasons, the provision of food gardens and
associated infrastructure is clearly of great service to AIDS-affected
2. Economic resilience (Kaschula, 2008)
communities. In the context of NVF, however, the literature addresses
3. Nutritional/micro-nutrient security, dietary diversity and resilience
broader relationships between poverty/food in-security, AIDS and the
of agricultural systems in the face of climate instability (Barucha
environment (Twine and Hunter, 2008; Ziervogel and Drimie, 2008).
and Pretty, 2010).
and Gericke, 2000)
Indeed, rural areas in southern Africa experience the inseparable effects of rising HIV prevalence, growing food in-security, dependence
Thus, the contribution of wild foods, and their minimal labour
on natural resources, climatic variability and environmental
and financial costs (Kaschula, 2008) are notable, and alert us to
degradation. Nowhere is the convergence of these factors more
the importance of cultural links between agro-diversity and wild
important than in southern Africa, which has the highest rates of HIV
biodiversity (see Barucha and Pretty, 2010).
infection in the world (Twine and Hunter, 2008). The interplay of these factors has many implications, not all of which can be discussed here
Food security interventions should thus take account of wild foods,
(but see Barucha and Pretty, 2010). The focus on agriculture in food
the habitats that support them and the indigenous knowledge that
security interventions has resulted in under-evaluating the importance
enables their use.
of wild foods/resources, the ecosystems that supply them and the 5
2.4 Orphans
The convergence of AIDS, poverty and food in-security paint a bleak picture for children, as their nutrition, education and rights
De Waal and Whiteside (2003) call attention to NVF as a
become subordinate to the short-term survival needs of families
phenomenon unprecedented in its level of orphaning. The Isibani
(Drimie and Casale, 2008). Irwin et al (2009) call for bold new
Sethemba website (www.orphancare.org.za) carries the widely cited
responses to effect crucial lessons that have been learned about
estimate that by 2015, some 5.7 million (or 32%) of all children in
supporting vulnerable children. According to these authors, and
South Africa will have lost one or both parents due to AIDS. But the
in summary, an integrated response is required in which social
literature notes that the global response to HIV and AIDS has paid
protection to vulnerable families is offered by the state to support
insufficient attention to children (for example Irwin, Adams and Winter,
families/children based on need and not HIV or orphan status. It
2009). These authors note that:
has been learned that children need support in and through their families, who must in turn be helped to develop the long-term
1. Global political commitment and resources are insufficient.
caring capacities they need. These family-centred responses are
2. Poor families support affected children with minimal assistance.
best initiated from within communities by local social networks (for
3. Important community responses are poorly
example churches)2 and community organisations offering health,
education and social support. Community input is thus crucial in
understood and assisted.
developing policies and programs. In addition, HIV-prevention
4. Implementation of key services does not meet children’s needs.
2. Isibani Sethemba works with approximately 120 Christian churches in the area. While it is accurate to describe them as faith based organisations, this term would be unknown in Ingwavuma, where they are identified solely as churches.
Photo Š Matthew Willman | Oxfam
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Photo © Matthew Willman | Oxfam
2.5 Responding to vulnerability
efforts urgently need to address the social and economic inequalities that drive women and girls’ vulnerability, and thereby amplify the effects of AIDS on children.
The AIDS literature describes an epidemic with a spectrum of behavioural, psychological, cultural and systemic (political, economic
It is strongly argued in the literature (for example Irwin et al, 2009;
and environmental) dimensions (Brown, 2006; Hochachka, 2006;
Meintjes and Giese, 2006; Hill et al, 2008) that in settings of
O’Brien et al, 2009) which reinforce each other to jeopardise many
widespread destitution, the ongoing focus on orphans obscures
communities, and especially children (Drimie and Casale, 2008). The
the deprivation, suffering and vulnerability that all children
demographic profile of AIDS (De Waal, 2003) produces selective
face, and that children’s needs rather than their orphan status
mortality in younger woman – traditionally the caregivers in society.
must be the primary focus when designing interventions.
This loss creates stresses on the social and economic fabric of
Notably, research in Ingwavuma (see Meintjes and Giese,
society (Jooma, 2005) and a burden of care causing households and
2006) specifically suggests the extent to which children
communities to become socially dysfunctional (De Waal, 2003).
from poverty-stricken households suffer many of the same
These communities are vulnerable to famine, and may not respond
hardships as orphans.
to conventional forms of assistance that helped them to recover in the past (De Waal, 2003). The multidimensional nature of these situations calls for integral approaches in organising information, diagnosing problems and prescribing solutions (Brown, 2006). 7
3. Interviews 3.1 Support Group Garden interviews
not infected, and the group stated that the garden breaks down stigmatisation and promotes the sharing of ideas –
3.1.1 Kwajona Support Group Garden:
“... there is no discrimination between sick and not sick”. The group understood that having HIV required them to eat vegetables,
“When we are working together we talk about lots of things ... the
and viewed the garden in this light. They knew from doctors that
garden has made us stronger; we are fresh, we are shining.”
their illness required both exercise and relaxation, and that the garden provided both of these things, and kept them busy.
The group said the garden had provided food for them and their
3.1.3 Ntabayengwe Support Group Garden:
families, generated income and ended costly trips to Jozini to buy tomatoes, cabbage and spinach. One man said that “even in winter” he had not gone hungry, while another said his gardening colleagues
“People need lots of encouragement to stay on ARVs ... the
had taught him much, and helped him to realise that “I am not the only
communities love us because we work with them as friends.”
one who is sick”. A home based carer said that the garden had made her job easier, as people now had food, while another appreciated the
Below is an interview with the Ntabayengwe garden group’s support
garden as a place where she could “talk to others about my illness,
group facilitator (SGF), Nelson Manukuza and home based carers
and learn what to do”. Another member said she had learned to
(HBCs) Fikile Mafuleka, Sibusiso Ndlovu and Thandiwe Dlamini. (Note:
protect her seedlings from insects, and to make compost. The
HBCs are recruited from the communities they serve, and are thus
group valued the garden as a space where they could “get together
familiar with their clients’ needs in a way that outsiders could not be).
and talk”, and agreed that if they recovered from their illnesses that they would “carry on gardening” as it kept them strong; as
The group had received training with Isibani Sethemba as HBCs, and
one interviewee said, “No one can die because of HIV. We have
work Mondays to Thursdays visiting people living with HIV or AIDS, or
learned how to survive.”
TB, to monitor treatment compliance, collect sputum, and speak to young people about abstinence, safe sex and the importance of knowing their
3.1.2 Madeya Support Group Garden:
HIV status. Conversations also cover the importance of disclosure to families and friends, and the dangers of drugs and alcohol for people
“We work nicely with other support group members, we share
living with HIV. The HBCs also encourage people to start gardens
information and help ourselves. So far so good.”
in support of ARV compliance, and are helping people with HIV to accept the long-term nature of ARV treatment. The group stated that
The interview with Thembekile Zikhali, Doreen Ngema, Nomusa
disclosure encourages compliance and reduces stigma, and that
Mpotshane and Dumisani Mpontsane confirmed the oft-repeated
many people now have hope that they can live positively with their
theme that their lives had been improved by selling surplus
illness. While men are still resistant to joining support groups and
produce to buy matches, candles, maize and rice; and providing
using condoms, the situation is a great improvement on previous
fresh vegetables for their families without having to travel to shops.
years when, one HBC recalled, “I saw many teenagers die of AIDS,
Madeya is worked by people living with AIDS and people who are
and I believed I could change them because some didn’t know why 8
they were dying.” The HBCs said that “sometimes it is difficult, but we go door to door... and people call us – they put their trust in us.” Nelson (the SGF) supports the HBCs by supplying them with medicines, organising CD4 counts, and adherence training for ARVs and TB medication, among other subjects. He updates HBCs with changes in treatment and ARV use, and helps to resolve problems they report, which may call for referral of patients to a hospital or clinic, or of orphans to Isibani Sethemba. Nelson wants each support group to have their own business, as the main problem they face is poverty ... and water for their gardens.
3.1.4 Bhambanana Support Group Garden: Happiness Mabuyakhulu (Support Group Facilitator) Happiness’s role is to speak to her clients about HIV and AIDS and the importance of ARVs. She also gives advice on generating income (sewing and gardening), delivers painkillers and provides a nutritious post-meeting meal to her clients as a way of supporting their attendance. Her clients know that the food from their gardens is good for them, and there is a strong perception in the Bhambanana group that their garden underpins ARV compliance. Happiness said the HBCs in her team bring awareness into the community, and a high level of surveillance – they visit most of their clients weekly, conduct checks on orphans, and are the first people whom community members approach. This monitoring allows Happiness to track the needs of clients monthly, and to assist when HBCs report problems. HBCs make sure foster families know about orphan grants, and support clients practically with fetching water, cooking, washing, accompanying weak patients to hospital and arranging transport to return the deceased to their homesteads. HBCs also help foster families to look after orphans, thus building the strength of the Photo © Matthew Willman | Oxfam
community at large to care for its most vulnerable members. 9
Photo Š Mark Mattson
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3.1.5 Bhambanana Support Group Garden: Flora Dhlamini, mother and gardener
cares for, and for whom the garden and her chicken breeding scheme helps her to buy food and clothes. Nokuthula knows that her produce is “good for the children” and only buys goods that she can’t grow, like sugar and cooking oil. Isibani Sethemba hosts workshops on how
“If lunch is spinach, then supper is cabbage and tomorrow is lettuce.”
to care for orphans which Nokuthula attends twice a year. All four of Flora is the mother of a 13-year-old daughter who, like many others
her charges have memory boxes, and while one adolescent “does
in Ingwavuma, was helped by Isibani Sethemba to start a garden
not want to talk”, Nokuthula is of the opinion that their memory boxes
which has become a community-within-a-community. “The garden
have helped the remaining three.
makes us happy and encourages frankness and sharing ... other
3.3 Isibani Sethemba staff interviews
members of the group have become my friends.” Flora said Isibani Sethemba staff motivate the group, ask how they feel, and provide medication. She said her pre-gardening CD4 count of 125 went
3.3.1 Church Liaison Officer – Jimmy Mathenjwa
up to 280 after she started eating the vegetables she’d grown. “I understand that these vegetables are good for me and I like to
“They must know you are ready to help in every sense. You have to
be in my garden because I can even grow imifino there.” Flora
listen rather than advocate. You are not just passing by ... there is
sells her surplus produce so that she can buy soap and candles.
only you and them in the room.”
She is assisted by one of the group’s HBCs to stay on the ARVs which Isibani Sethemba helped her to obtain, and said that “I feel I
Jimmy Mathenjwa’s work is about spirituality and children; he meets
understand all I need to know about HIV and ARVs.”
Isibani Sethemba’s need for a trained minister with an additional calling that places him somewhere between pastor and parent.
3.2 Household visit and interview, Gwaliweni: Nokuthula Nexster
Jimmy is a link in Isibani Sethemba’s partnering with local churches, which has seen congregants and pastors reach out to orphans and vulnerable children (OVCs) and provide assistance, surveillance and comfort, so that “they still feel surrounded by adults who care for
“The children are fresh and big.”
them”. The family support teams (FSTs) deployed by the churches Fortunately, Nokuthula likes “to grow things”, which she does on
are trained by Isibani Sethemba and mentored by Jimmy to work with
behalf of four relatives from an adjoining homestead who were
OVCs, assisting with vaccinations, medicine, hygiene, schoolwork
orphaned at an age at which she “knew they would not survive alone”.
and day-to-day concerns; their proximity to the community allows
Nokuthula has been supported in her efforts by Isibani Sethemba’s
Jimmy to identify individual children for one-on-one visits, and to
supply of seedlings, tools, watering cans and a 200l water drum, and
provide spiritual guidance and support. The trust and intimacy
says that “I work with a smile”. Isibani Sethemba’s social worker and
afforded in such settings elicits the dimension of Jimmy’s faith
paralegals have helped her to obtain grants for two of the children she
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in which “... the Holy Spirit knows the lives of people and what
approached and worked with. The workshops lead to follow up visits at
they need”. Jimmy has “seen the lives of children changing”; he
schools or homes, as HBCs and FSTs, who are intimately embedded
has watched them move from “isolation to belonging”, establish
in the communities they serve, direct Buyisile to the children who
healthy peer groups, settle at school and engage with the grief and
need her most. This process helps children to stay in school, form
disorientation that attend the loss of their parents.
friendships and regain a measure of self-acceptance and esteem.
3.3.2 Memory Box Worker – Buyisile Qwabe
3.3.3 Garden Facilitator – Phila Mafuleka
“I take them aside and ask them to talk about their feelings of loss.”
“I wish them to continue in their gardens because there’s healthy life in a garden.”
Buyisile brings to Isibani Sethemba a qualification in psycho-social support, bereavement counselling, memory box work and play
Phila’s father is a farmer who taught him to plant vegetables, and
psychotherapy – she is the interface between Isibani Sethemba and
by the time he reached matric he was personally supplying produce
its most at-risk clients: orphans and vulnerable children between the
to Ingwavuma’s Spar supermarket. When Isibani Sethemba began
ages of two and 18 years old. Isibani Sethemba hosts orphans on
looking for a nursery manager to grow crop seedlings in 2007 the
five-day camps at which similar aged children are brought together
Spar manager recommended his former supplier. Phila likes helping
and helped to express repressed emotions of loss and bewilderment.
people, he likes children, and he likes to see people eating vegetables
Their point of contact in this fragile process is Buyisile, who uses
... spend a day with him and you will see this for yourself. For all his
art, games, toys, memory boxes ... and her own gentle presence to
youth, Phila is acutely aware of the relationship between poverty and
create the atmosphere of safety that enables disclosure, and sets
HIV, of how poor nutrition hastens progression to AIDS, and that the
in motion the long journey of relating directly with their feelings.
efficacy of ARVs is reduced by hunger. These are the perspectives
Children lessen their sense of isolation by speaking in front of others who have also lost parents, or, if they are unable to manage this, receiving counselling from Buyisile. All children are given memory boxes in which they keep photographs, family trees, letters, artwork and small possessions, such as earrings, that belonged to their parents. Memory boxes serve as a ritual through which loss can be
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Photo Š Matthew Willman | Oxfam
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Photo Š Matthew Willman | Oxfam
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through which Phila views his gardens as he travels the length and
surveys provide further feedback on the quality, or lack thereof,
breadth of Ingwavuma visiting his clients. We both know that the
of service. This is why Lindani works at his computer all day,
gardens cannot solve all of their problems, but they are, nonetheless,
and says... “I’m proud to do this ... my eyes are focused on the
places of hope and even healing, and Phila is greeted warmly, and
field, on the clients, on the quality of the service we are providing.”
given vegetables wherever he goes.
3.3.5 IT and Transport Administrator – Nathi Ndlazi 3.3.4 Data Quality Officer – Lindani Sihlongonyane “If you find three hungry families and you can only help one, then “I am working at my computer, but my eyes are outside!”
you must help that one.”
Lindani discerns clearly the link between sitting at his keyboard,
“But his knowledge of computers does not compare with his knowledge of orphans – Nathi’s parents died, leaving him head of his household at the age of 13.”
and tackling the suffering that lies beyond his door. Isibani Sethemba serves 9,5503 clients who receive varied, and crosscutting interventions. The organisation also employs 235 staff, most of whom are members of the communities they serve,
Nathi is Isibani Sethemba’s self-taught IT Manager, responsible for
collecting information daily on their clientele. Isibani Sethemba’s
30 networked computers in a busy, growing organisation. But his
responsiveness to these clients is made possible through the
knowledge of computers does not compare with his knowledge of
management of the resulting data set, which enables staff to
orphans – Nathi’s parents died, leaving him head of his household at
target and strategise service delivery. For this reason, staff are
the age of 13. His loss preceded the arrival of NGOs in the area, and,
trained to collect data, and data officers alert staff to gaps in
not wishing to join his extended family in Swaziland, he received no
the client knowledge base, and problematic data sets. Data
counselling or support of any kind, and now feels that it is too late,
quality improvement officers “shadow” field staff to assess
even though he is “afraid” of his memories. “My parents were very
the correspondence or “match” between services offered
spiritual ... their faith is what gave me strength, their influence is still
on the ground and the codes that are used to capture them,
with me,” he says. Nathi is happy to be working for an organisation
so that both fieldworkers and office staff have the same
that helps orphans, and says that “you cannot help others unless you
understanding of what the numbers are telling them. This
are strong in faith and unselfish”. When asked about the experience
match is crucial, as field staff approach the data officers
of losing his parents he says:
daily to refresh their knowledge of their clients, and to see if they are meeting their targets. Staff workplans are highly
“At 13 it is unbelievable ... even on the day of the funeral. A week later
systematised and tracked through the data management
you start to accept it.” Nathi recently attended a conference in Cape
system, allowing for performance monitoring; client satisfaction
Town at which he met orphans from all over the world, and which was helpful and healing for the 13-year-old boy who thought “I was the only one”.
3. This client base is made up of 2,340 individuals in the home based care program, 2,545 orphans and vulnerable children and 4,665 in the voluntary counselling and testing program.
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4. An evolving, integrated approach A conversation with Ann Dean (Director), Vee Dlamini (OVC Program Manager) and Munya Mandipaza (Deputy Director) of Isibani Sethemba
Individuals are best assisted and monitored in and through their communities. This approach is facilitated via the makeup of Isibani Sethemba’s staff, approximately 95% of whom have grown up in the area. The
“In the whole interactive and indivisible web – ecological, social
approach also led (in 2006) to Isibani Sethemba’s engagement with
and personal – there is need and suffering which must claim our
local churches. These approaches (HBCs and church involvement)
attention” (Ken Jones, 1993).
called forth the community’s innate resourcefulness and compassion in the face of crisis. The ability to grow the organisation’s capacity
The evolution of Isibani Sethemba’s efforts in Ingwavuma is perhaps
by building this capacity within client communities, rather than
suggested by the above quotation, because it is a story about the
importing it from elsewhere, is notable. It has been moulded in
indivisibility of need, and the claim of this need on the organisation’s
large measure by an early collaboration with the Hospice Palliative
attentions and strategies. Initial interventions began in 2000 in
Care Association who have provided valuable mentoring. This has
response to the detection of malnutrition in young children, and were
resulted in an emphasis on quality of life, dignity in death and support
material in nature, consisting of food parcels. Ongoing assessment
in bereavement. These approaches have presumably performed a
led to the realisation that children’s vulnerability reflected not only the
great service by strengthening the cohesion and self-reliance of the
growing spread of AIDS among their parents, but also high levels of
community at large. To care for AIDS sufferers and OVCs is to care
unemployment in households. Because these two problems could not
for the entire community. In fact, interior/psychological assistance
be separated, a response was needed to embrace them both. For
for societies and individuals is needed in order to make processes of
Isibani Sethemba, this fact has acted as a driver of deeper analyses
change and transformation sustainable (see Wilber, 2001).
and more encompassing approaches.
“Ongoing assessment led to the realisation that children’s vulnerability reflected not only the growing spread of AIDS among their parents, but also high levels of unemployment in households.”
Many needs are inseparable from their underlying causes, and require interventions addressing both. The next step in the unfolding of Isibani Sethemba’s work was to help parents to live with HIV and AIDS, rather than simply reacting to their deaths.
This realisation ultimately led to the organisation’s change of name from Ingwavuma Orphan Care to Isibani Sethemba (Light of Hope)
An ongoing shift from reactive to proactive approaches was also to
in 2008. The theme of supporting overall community resilience also
characterise Isibani Sethemba’s development.
gave rise to the food security program. A compelling rationale for food security interventions is also to be found in the links between
By 2005, Isibani Sethemba had begun operating in schools and through
poverty and the epidemiology of AIDS, the extremely negative relation
HBCs. This signalled a move to interventions that were embedded within the community and driven by community mobilisation. 16
between malnutrition and HIV, the role of nutrition/food availability in maintaining ARV compliance and the low agricultural potential and historical neglect of the Ingwavuma area. Notable is Isibani Sethemba’s co-operation with partner organisations to optimise impact, for example with provincial government departments (department of agriculture), home affairs, local hospitals, other NGOs and funders. It is easy to overlook this aspect, but the interpersonal skills and emotional intelligence that enable such fruitful relationships are part of Isibani Sethemba’s overall effectiveness. With respect to funding, there is a growing realisation that donors insisting on short-term, measurable impacts do a disservice to NGOs working on complex problems. Isibani Sethemba has been lucky to receive some flexible funding which allows it to pursue less tangible interventions such as building the capacity of community members who help to look after vulnerable children, and employing a professional social worker. Of further importance is Isibani Sethemba’s attention to its own functioning as an organisation; that is its information management system (IMS) promotes high levels of connectivity/ communication and internal monitoring. This capacity (both in terms of software/IT and employee willingness) for organisational self-reflection is clearly part of Isibani Sethemba’s responsiveness and receptivity to its clients. The computerised IMS has been crucial in enabling it to register and record detailed biographies of its clients, and to track the needs of a large client base, often through targeted interventions and/or referrals. This dynamic documentation control and internal communication allows service delivery to be quantified, and demonstrates the importance of such technologies to an organisation’s effectiveness. Photo © Matthew Willman | Oxfam
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5. Conclusion In responding to the challenges posed by AIDS and poverty, and in fulfilling its mission to provide “physical, emotional, psychological, spiritual and economic services to the people of Umkhanyakude”, Isibani Sethemba has evolved to balance its interventions across the domains that its mission statement highlights. The organisation’s presence and experience within the client community sensitised it to these needs, and it is significant that Isibani Sethemba’s mission statement is not simply an ideal, or aspiration. It is also a statement acknowledging the cultural, interior, physical and systemic elements of vulnerability. These elements suggest both a framework for responding to need, and a way of understanding the organisation’s learning process in doing so.
“Isibani Sethemba’s mission statement is not simply an ideal, or aspiration. It is also a statement acknowledging the cultural, interior, physical and systemic elements of vulnerability.” Isibani Sethemba’s openness to these dimensions has led to an integrated approach which optimises its impacts. As Isibani Sethemba acquired more funding, staff and facilities, and as it fine-tuned its organisational systems and processes, it was able to extend its influence into the above-mentioned domains in increasingly comprehensive ways. It follows that the domains identified in Isibani Sethemba’s mission statement are profoundly interrelated, and that they must be viewed as a whole. It further follows that partial approaches will lead to sub-optimal impacts in which the unattended dimensions may sabotage the overall efforts being made. The experience of Isibani Sethemba suggests that to respond to vulnerability is to respond to these dimensions. Photo © Matthew Willman | Oxfam
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Photo Š Matthew Willman | Oxfam