Tài liệu Multiple Vulnerabilities qualitave data for the stydy of orpharns and vulnerable children in South Africa ppt

Multiple vulnerabilities
Qualitative data for the study of
orphans and vulnerable children
in South Africa
Alicia Davids, Nkululeku Nkomo, Sakhumzi Mfecane,
Donald Skinner & Kopano Ratele
Edited by Donald Skinner & Alicia Davids
Free download from www.hsrcpress.ac.za
Compiled by the Social Aspects of HIV/AIDS and Health Research Programme,
Human Sciences Research Council
Published by HSRC Press
Private Bag X9182, Cape Town, 8000, South Africa
www.hsrcpress.ac.za
© 2006 Human Sciences Research Council
First published 2006
All rights reserved. No part of this book may be reprinted or reproduced or utilised in
any form or by any electronic, mechanical, or other means, including photocopying
and recording, or in any information storage or retrieval system, without permission
in writing from the publishers.
ISBN 0-7969-2139-3
Production management by comPress
Distributed in Africa by Blue Weaver
PO Box 30370, Tokai, Cape Town, 7966, South Africa
Tel: +27 (0) 21 701 4477
Fax: +27 (0) 21 701 7302
email:
www.oneworldbooks.com
Distributed in Europe and the United Kingdom by Eurospan Distribution Services (EDS)
3 Henrietta Street, Covent Garden, London, WC2E 8LU, United Kingdom
Tel: +44 (0) 20 7240 0856
Fax: +44 (0) 20 7379 0609

email:
www.eurospanonline.com
Distributed in North America by Independent Publishers Group (IPG)
Order Department, 814 North Franklin Street, Chicago, IL 60610, USA
Call toll-free: (800) 888 4741
All other enquiries: +1 (312) 337 0747
Fax: +1 (312) 337 5985
email:
www.ipgbook.com
Free download from www.hsrcpress.ac.za
CONTENTS
List of tables and figures v
List of authors vi
Acknowledgements vii
Acronyms and abbreviations viii
Executive summary ix
Chapter 1 Introduction — Donald Skinner and
Alicia Davids
1
Defining orphanhood and vulnerability 1
The situation of OVC in South Africa 2
Chapter 2 Background and aims of the
project —
Donald Skinner and
Alicia Davids
5
Aims of the research 5
Chapter 3 Methodology — Donald Skinner and
Alicia Davids
7

Semi-structured interviews 7
Research instrument 7
Sampling method 7
Sample Kopanong 8
Sample Kanana 8
Observations 9
Analysis 9
Chapter 4 Qualitative Report Of Ovc Living
Conditions And Services In The
Kopanong Municipality, Free State
Province —
Sakhumzi Mfecane, Donald Skinner
and Alicia Davids
11
Geographical context 12
Economic situation 14
Poverty and unemployment 14
Situation of youth 15
Situation of HIV/AIDS 17
Context of people living with HIV/AIDS 21
Context of OVC 24
Support systems for OVC 30
Challenges facing government departments 35
NGO, CBO and FBO support structures 37
Challenges facing NGOS/CBOS 39
Discussion 40
Free download from www.hsrcpress.ac.za
Chapter 5 Qualitative Report Regarding
The Situation Of Orphans And
Vulnerable Children (Ovc) In Kanana

And Umuzimuhle Townships, North
West Province —
Kopano Ratele, Donald
Skinner and Nkululeku Nkomo
43
Distinctive and common elements between the two townships 43
Umuzimuhle 43
Kanana 44
Major problems in the target areas: unemployment, poverty and
shortages of food 45
HIV/AIDS: impact on the community 49
The situation of OVC 54
Situation of households caring for OVC 61
Support structures for ovc in the community 73
Conclusion 78
Chapter 6 Overall Conclusions And
Recommendations —
Donald Skinner and
Alicia Davids
81
Care of OVC 82
Support for families and households that care for OVC 83
Support for communities that care for OVC 84
HIV prevention and intervention 84
Recommendations for state services 85
Recommendations for NGOs that support OVC 86
Appendices 89
References 105
Free download from www.hsrcpress.ac.za
v

Tables
Table 1 Ethnic composition in 2001 compared with the average for the district
in 1996 11
Table 2 Education levels for persons 20 years and older, 2001 12
Figures
Figure 1 Map of the Kopanong Municipality 13
v
LIST OF TABLES AND FIGURES
Free download from www.hsrcpress.ac.za

vi
Alicia Davids,
Health Promotion and Behavioural Intervention Research Unit, Medical Research Council
Nkululeku Nkomo,
Social Aspects of HIV/AIDS and Public Health, Human Sciences Research Council
Sakhumzi Mfecane,
WISER, University of the Witwatersrand
Donald Skinner,
Social Aspects of HIV/AIDS and Public Health, Human Sciences Research Council
Kopano Ratele,
Dept of Psychology, University of the Western Cape
AUTHORS
Free download from www.hsrcpress.ac.za
vii
This report reflects a collaborative endeavour involving many people. Although the list
below is not an exhaustive one, we wish to thank the following people and organisations
for their participation and unstinting support in this study:
• The WW Kellogg Foundation for their financial support and making this study possible
• The Nelson Mandela Children’s Fund, our partner for this project in South Africa.
• Our colleagues from the HSRC who assisted in providing information, doing

fieldwork, reading and editing and giving comments, including Alicia Davids,
Nkululeku Nkomo, Adlai Davids, Leickness Simbayi and Anna Strebel.
• Representatives from Kopanong, who provided assistance when needed. Particular
thanks is given to Jackie Lingalo, Mr Lethuteng and Thomas Tladi, District Manager
Department of Social Development; Mr Serf Van Schalkwyk, District Manager
Department of Agriculture; Mrs Rebecca Sempe, District Co-ordinator of the health
department; Mr Lerato Khetshane, District Manager Municipality; Mr Motshepehi;
Jacob Mphakwanyana, Teacher and HIV Educator; Vuyokazi Buwa, Social Worker
and Community Liason (OVC and HIV focused) Department of Social Development;
Ms Magazine Peterson, Councillor Springfontein; Mr Thabo Hlasa, ANC Chaiperson
Trompsburg; Mr Mancane Rigala, fieldwork guide Springfontein (now working for
municipality); Ms Mariana Sibunyane, Councillor Jagersfontein; Mrs Anna Morapelo,
Councillor Bethulie; Mr Michael Moitse Councillor Fouresmith; Mr Sello Ntaysane,
Mayor of Kopanong and Ms Nonceba Tafane, Philani Victim Support Centre.
• In Matjhabeng: Mr Mpho Ralipeli from the Matjhabeng AIDS Consortium; Ms Palesa
Mphatsoe (Social Development); Mr Clifford Clark from Mathjaben Christian Leaders
Forum; Mr Ernest Molefi (Morning Star); Mr M Khantsi from the Department of
Health; Ms Lebohang Mokoena Department of Home Affairs; Ms Nuku Radebe from
Meloding Day Care Centre advisory board; Ms Monica Mokalake (Day Care Centre
advisory board). The three women from Thabong and Bronville who gave us a tour
of Thabong and other areas surrounding the township, Elizabeth Noe, Gladys Khasu
and Rosina Thajana, and last, but not least, Rev Paul Okpon.
• In Kanana: Ms Nella Modjanaga and Mr Gideon Engelbrecht from the Department
of Health. They, particularly Mr Engelbrecht, facilitated interviews with people from
NGOs and nursing sisters at Grace Mokgomu Clinic. Matladi Lesupi and Nomonde
Lehloo, from KOSH Care and Support Group and Hospice respectively, both of
whom facilitated interviews with carers and OVC. Sibongile Dlamini and Ncebo
Molefe, who took us for a tour of Kanana and Umuzimuhle. Officials from the
Departments of Health, Education and Social Development, as well as from the
City Council of Klerksdorp (i.e the office of the speaker) who granted interviews.

Representatives from NGOs who granted interviews.
Finally, we would like to thank all the people who participated and provided information,
including those OVC and their carers without whose generosity this study would not have
been possible. Their participation is testimony that if we all put our energies together
we can obtain the information necessary to tackle the epidemic that confronts us all and
provide the much-needed care for orphaned and vulnerable children.
ACKNOWLEDGEMENTS
vii
Free download from www.hsrcpress.ac.za
viii
ACRONYMS AND ABBREVIATIONS
AIDS acquired immunodeficiency syndrome
ARV antiretroviral drugs
CBO Community based organisation
DoA Department of Agriculture
DoE Department of Education
DoH Department of Health
DSD Department of Social Development
FBO Faith based organisation
GDP gross domestic product
GMC Grace Mokgomu Clinic
HIV human immunodeficiency virus
IDP integrated development plan
KOSH District of Klerksdorp, Orkney, Stilfontein and Hartebeesfontein
NGO non-governmental organisation
OVC orphans and vulnerable children
PLWHA people living with HIV/AIDS
PMTCT prevention of mother-to-child transmission
STI sexually transmitted infection
RDP reconstruction and development programme

UNICEF United Nations International Children’s Fund
Free download from www.hsrcpress.ac.za
ix
EXECUTIVE SUMMARY
In 2002 the Human Sciences Research Council (HSRC) received funds from the Kellogg
Foundation to undertake research and interventions for orphaned and vulnerable children
(OVC) in three countries in southern Africa, these being South Africa, Botswana and
Zimbabwe. The project aims to contribute towards improvement of the conditions of OVC
in these countries. In South Africa, the HSRC partnered as the researchers with the Nelson
Mandela Children’s Fund (NMCF) as the facilitators of the interventions. The NMCF directs
the funding and provides support to local non-governmental organisations (NGOs) and
community-based organisations (CBOs) in identified sites to implement interventions. Work
is being done in two provinces identified as having a great need for such interventions.
Qualitative studies were conducted in Kopanong, a local municipality in the Xhariep
district, Free State, and Kanana, a local municipality in the southern Klerksdorp district,
North West Province. This research was conducted to develop an understanding of the
core dynamics affecting OVC in these communities. This information would facilitate
developing and implementing interventions to provide assistance to OVC, their carers
and their communities and act as part of the baseline information for evaluating these
interventions. Thirty in-depth interviews were conducted in Kopanong and 36 in Kanana.
Information was collected from government departments, NGOs/CBOs, OVC and their
carers, community leaders and community members. These explored in detail the
situation of OVC, status of people living with HIV/AIDS (PLWHA) and that of carers of
OVC. Finally, this phase intended to document services offered to OVC by government
and NGOs, identify strengths and weaknesses of these services and to identify possible
ways of improving them. A brief summary based on the results of the interviews follows.
Kopanong district, in the southern Free State province, covers a large area geographically,
but is very sparsely populated. It comprises some small towns, but consists mostly of
farms. The community is extremely poor, with high levels of unemployment. While some
of the towns are built close to the major highway leading to Bloemfontein, many of the

roads between the towns are untarred. The poor roads and long distances between towns
make community development and the provision of services more complicated.
Kanana, in the North West province, is a large, densely populated township close to
Orkney that constitutes part of a series of towns servicing the gold mines. The towns
comprise many migrant workers from across the country, their families and many others
who have come to seek work or income. There are a large number of informal houses in
the district, which contain their own health threats. The industry in the area is threatened
as the gold price comes under increasing pressure.
HIV/AIDS is a significant concern in the communities. The respondents all felt that the
poverty in the area was the most serious contributor, with the high levels of substance
abuse and the silence around and fear of HIV/AIDS also being serious. In Kopanong
particularly, there were very few HIV/AIDS interventions because even the large national
campaigns such as LoveLife did not have a presence there. A particular problem noted
was alcohol abuse among both youth and adults, which was regarded as resulting from
inactivity and pessimism about the future, as career prospects within the area are limited.
Alcohol abuse was felt to have multiple negative consequences, for example, engaging in
unsafe sex and wasting already limited financial resources.
A number of factors were felt to be contributing to children feeling vulnerable. Both
communities were reported already to have large numbers of children who had been
orphaned by HIV/AIDS, as well as by other causes. The number of fathers who were
Free download from www.hsrcpress.ac.za
x
x
absent made this worse. Concern was already being raised that there are insufficient
caretakers to look after the children who are in need of assistance. At the time of the
research, it appeared that virtually all of the children were living with a caretaker, with
few child headed households.
A number of the other contextual variables were given as contributing to the vulnerability
of children living in these areas. Prevalence of HIV/AIDS was already seen as high in
the communities, with respondents feeling that the figures were rising steeply. A further,

and ultimately greater, concern related to the financial capacity of existing households
to provide care. Poverty was felt to be the major factor that would lead to children not
being cared for in the future. Other factors included the impact of the desperate levels of
poverty, which respondents felt was forcing boys into crime and girls into survival sex as
a means of coping. Other concerns centred around substance abuse, both by carers and
the children themselves, and very high levels of child abuse. The latter included physical
and sexual abuse for the purposes of financial gain. This is a particular concern as the
damage done to children has long-term implications.
It appeared from the interviews that most caretakers who took in additional children were
doing this to provide care and were genuinely concerned about these children. Varying levels
of ubuntu (sense of community caring for one another) were found in both communities.
However concerns were raised about carers taking in children for the purposes to take
advantage of their grants. A number were accused of taking the grants for themselves and
providing minimal care and assistance to the children that they had taken on. Substance
abuse was felt to result in the adults not being available to provide care and direction, and it
absorbed most or all of the financial resources of the household. Concern about carers also
centred around the potential for their neglect of the children generally while child abuse too
was seen as a serious problem, including sexual, physical and financial abuse. This has
serious long-term implications and is difficult to prevent or address.
Unemployment results in inactivity and subsequent involvement in destructive lifestyles,
which further contribute to the vulnerability amongst community members. This has major
implications for the OVC who live in these communities. Carers who have limited or no
financial support and who are unemployed, care for the majority of OVC. Households
then lack resources to provide for children and are in turn resistant to taking on more
children. Often they lack access to basic necessities for a child, for example, school
uniforms, regular and healthy food, and have insufficient time to offer adequate individual
care. Concerns were also raised regarding social conditions that lead to some parents
neglecting their children and who rather entertain themselves in local shebeens than look
after their children, which further exacerbates OVC vulnerability.
The interviews showed municipalities characterised by poverty, high rates of

unemployment, limited resources, poor roads and infrastructure, and for many, problems
of access to services. Direct access to individual services varied. Most children had access
to health services, with virtually all living within accessible distance of a clinic. Difficulties
in talking about HIV made services for treatment and prevention in this area difficult to
reach. For example services are difficult to deliver as service providers are expected to
travel long distances on poor roads. The municipality of Kopanong is dispersed, which
exacerbates the slowness of service delivery.
Multiple vulnerabilities
Free download from www.hsrcpress.ac.za
xi
Government departments and NGOs/CBOs are doing their best to address local
problems but are often limited, particularly the NGOs/CBOs, by lack of funds and other
infrastructural constraints. Both communities have battled to sustain NGOs, a more
serious problem in Kopanong given the small towns and distances between them.
However, despite these problems, there is hope and commitment to improving the lives
of OVC and services offered to them. The HSRC and NMCF will work closely with the
communities and their representatives to try and address limitations expressed in the
delivery of services for OVC.

Executive Summary
Free download from www.hsrcpress.ac.za
Free download from www.hsrcpress.ac.za
11
CHAPTER 1
Introduction
Donald Skinner and Alicia Davids
South Africa is one of the countries in sub-Saharan Africa with the highest HIV
prevalence. A national study on HIV prevalence by Shisana et al. (2002) showed that
approximately 11% of South Africans are living with the HI virus. The Department of
Health Annual Antenatal surveys (2004) showed national figures among pregnant women

to be 27.9% in 2003 and 29.5% in 2004. It is further estimated that every day about 1 700
South Africans become infected with HIV (Department of Health, 2003).
The epidemic has serious implications socially and economically. One particular
consequence is an increase in the number of orphans. UNICEF estimates that currently
about 11 million children under the age of 15 years in southern Africa have lost one
or both parents; this number is expected to reach 20 million by 2015. According to the
UNAIDS annual report (2004), by the end of 2003 AIDS-related deaths gave rise to about
1.1 million orphans in South Africa. Johnson and Dorrington (2001) further projected that
if current sexual practices do not change, roughly 15% of all children under the age of
15 years are expected to be orphaned in South Africa in 2015. The statistics suggest that
South Africa has to prepare for a large number of children in need of care and there is a
need to develop interventions to attend to these needs. Other factors such as substance
abuse, civil violence, and other diseases, also contribute greatly to the number of orphans.
The state of orphanhood can greatly increase vulnerability among the affected children.
Prior to the death of the parent, in the case of HIV, a child may be required to provide
care for ill parents and may even be forced to leave school to fulfil this responsibility.
It needs to be recognised that children beyond those orphaned may have their lives
compromised. Children may be vulnerable due to poverty, abuse, violence and many
other causes. In recognition of this need the WK Kellogg Foundation agreed to fund the
HSRC to lead a large study looking at the potential needs of children affected by the
HIV/AIDS epidemic and to develop adequate responses.
Defining orphanhood and vulnerability
To be able to better understand the situation of children in these communities it is crucial
to understand the community’s definition of orphans and vulnerable children (OVC).
Current literature showed that definitions of an orphan differ from one country or context
to another (Smart, 2003).
Early in the project, six focus groups were conducted across the three countries to
establish a community-acceptable definition of OVC. The groups incorporated community
representatives, service providers, OVC and their carers. Based on their inputs the following
descriptions were accepted. An orphan refers to a child below 18 years who has lost one or

both parents. This could be due to AIDS, other illnesses, violence or other causes of death.
Drawing on this research the definition of what makes a child vulnerable is more complex
and focuses on contexts that centre around three core areas of concern (Skinner et al., 2004):
Free download from www.hsrcpress.ac.za
2
• material problems, including access to money, food, clothing, shelter, health care
and education;
• emotional problems, including insufficient caring, love, support, space to grieve and
containment of emotions;
• social problems, including lack of a supportive peer group, of role models to follow,
or of guidance in difficult situations, and risks in the immediate environment.
The situation of OVC in South Africa
By extension from this definition the situation of children is described, drawing on available
information from the literature on the epidemiological distribution of the factors of concern.
Evidence is drawn from the literature to describe the prevalence in South Africa of a
number of the conditions that are felt to contribute to the vulnerability of children.
Orphan status and care
In line with the report on the definition of OVC (Skinner et al., 2004), drawn from the
communities where the project is being done, found that the loss of either parent put
strain on the child, as the loss of the mother often means loss of the direct carer, while the
loss of the father puts the household in a difficult financial situation. HIV/AIDS stands out
as a cause of orphanhood, in that if one parent is infected with HIV, the probability that
the spouse too is infected is high (Bray, 2003). Migrant labour also constitutes a particular
form of loss of a parent for a period of time while they go in search of income.
Orphans and deserted children are very dependent on the availability and quality of
replacement carers for their ongoing support. With children taken in by extended families
or members of the community, pressure can be put on these families due to the increase
in the size of the households. The number of people per household does not provide
an accurate measure of children per carer, but is a guide. According to census 2001,
households of seven or more people constitute 13.9% of the population. (Statistics South

Africa, 2003). Data from across Africa indicate that where the epidemic is more severe,
and/or the extended family is weakened, orphaned children are more frequently cared
for by grandparents. The pressure of the increasing number of OVC has seen families
splitting and reforming in different ways in response to more stressful circumstances
(Bray, 2003). The long-term impact of this and the capacity to sustain care still need
careful monitoring and evaluation.
Of great concern is the high number of inadequate carers, including those who do not
have the skills, do not wish to assume the role, or are too old or too young to fulfil
the task. Many of those without the skill will have had bad role models themselves. Of
particular concern is the increasing numbers of grandparents who now have to take over
care of the orphaned children. While some are competent, many are too old to cope,
especially with large numbers of children (International HIV/AIDS Alliance, 2004).
Illness of a parent reduces their capacity for providing care, with HIV/AIDS generally
having a more devastating impact. There is also the psychological impact on the child of
having to watch parents’ illness and ultimately preparing for death. HIV usually affects
families long before parents die. Household incomes plummet when adults fall ill from
HIV so that illness of a parent often reduces their capacity to provide care for their
children, increasing the child’s vulnerability (Booysen, 2003).
Multiple vulnerabilities
Free download from www.hsrcpress.ac.za
Chapter 1
3
HIV/AIDS, other illnesses and disability among children
National seroprevalence figures for children aged 2–14 are 5.6%, while youth aged 15–24
are 9.3% (Shisana and Simbayi, 2002). While these are lower than the adult levels they
are still high. The prevention-of-mother-to-child transmission (PMTCT) programme, if fully
implemented, will reduce this risk.
Having HIV/AIDS, or being associated with the disease by being in the same household
as a person with the disease, or being an orphan of someone who has died of AIDS,
can raise stigma. The latter is heightened if there is insufficient care for the child after

the death of the parents. The child becomes seen as a threat or an indictment by the
surrounding community. Stigma can affect children in multiple ways, but in particular,
they are excluded from community support, and can begin to internalise the stigma
leading to the entrenchment of a highly damaged self image (Skinner & Mfecani, 2005).
Other health impacts on children include malnutrition and illness. In 1999, 21.6% of
children one to nine years of age were stunted, 10.3% were underweight and 3.7% were
wasted. Deficiencies in micronutrients, with implications for development, are also a
common problem. (Solarsh and Goga, 2004) Diseases of threat include TB, cholera,
measles, influenza and malaria. Disability among children is one area that warrants
separate attention. Both physical and mental disabilities are important to consider. It is
difficult here to give clear figures, as problems of definition are found again. In 1999,
a survey by the Community Agency for Social Enquiry (CASE, 1999) found a 5.9%
prevalence of disability in children.
Poverty
Wealth, disposable income, and other assets of the household are closely linked to child
health and welfare, which would be expected to be compromised in households losing
men and women at ages of prime economic activity (Bicego et al., 2003). Poverty impacts
on children in that they are deprived of clothing, adequate nutrition, access to services,
proper housing, etc. The impact is pervasive over time and throughout the country,
although certain provinces are worse than others. Poverty affects entire communities,
with children living in generally deprived contexts. The situation is worse on farms and
in rural areas, which are often also more invisible. There are varying constructions of
poverty, but using a straight World Bank approach of ‘a dollar a day’ (World Bank, 2000),
indications are that at least 45% of South Africans live in absolute poverty (Hill and Smith,
2003).
In 2002 one estimate found that 11 million children lived on less than R200 per
month (Streak, 2002).
Housing does have specific implications of its own, as poor informal housing is highly
associated with a range of negative health impacts including HIV infection and such
residents are more likely to be disadvantaged regarding access to services (Shisana and

Simbayi, 2002). Census 2001 showed that there are 1 376 706 informal houses plus
459 526 informal dwellings or shacks in backyards; this equates to 16.4% of all
households. The highest levels of informal housing are found in the Free State (26.1%)
and Gauteng (23.9%) (Statistics South Africa, 2003).
Access to services
Despite the national priorities of the Department of Health (DoH), Department of
Education (DoE) and Department of Social Development (DSD) to ensure that particularly
all children have access to services, significant gaps remain. If children are unable to
Free download from www.hsrcpress.ac.za
Multiple vulnerabilities
4
access services there are dangers of them being less healthy, not receiving an adequate
education and suffering other compromises to their development, for example, missing
a scheduled clinic visit for an immunization could predispose the child to an infectious
disease. One of the more consistent pieces of evidence of differential opportunities
for AIDS orphans is access to schooling. Both quantitative and qualitative data from a
number of African countries confirm significantly lower school enrolment rates in orphans
than in non-orphans (Desmond and Gow, 2002).
Abuse of children
The abuse of children is really a specific subset related to poor carers, concerning
especially those who deliberately try to extract benefit from the child, at the child’s
expense. Abuse takes many forms, including sexual, physical or emotional abuse, plus
abuse of grants and use of children for labour, with there being considerable variation
within these categories (Richter and Higson-Smith, 2004). Official figures that do exist are
certainly a massive undercount of the reality. Abuse remains one of the most devastating
events for children and the impact of this can last throughout their lives. While this
does not always occur within the family, the family does remain as the most likely site
of abuse.
Child prostitution and survival sex constitute an additional form of abuse or area of
vulnerability for children. Children may be forced by poverty into exchanging sex for

money in order to survive (Perschler-Desai, 2001) or may be forced by gangs into
prostitution (Molo Songololo, 2000).
Violence and substance abuse in communities
The principle problems of violence in communities relate to crime, the presence of
gangs, community and political violence, sexual violence and also domestic violence
(Standing, 2003; Anderson and Mhatre, 2003). Gender and domestic violence constitute a
particular problem as the impact of this is felt directly in the homes and is witnessed and
experienced directly by children. Problems are accentuated by the acceptance in many
communities that this is normal and the inadequate responses by police, although the
latter is being addressed within the SAPS (Jackson, 1997).
Substance abuse has been, and is, a consistent problem across South Africa. The problem
of excessive alcohol use is well established (Parry, 1997), but there is evidence of large
increases in the use of illegal drugs (Leggett, 2001; Ryan, 1997), especially with the
opening of the country’s borders following establishment of democracy. If the carers
themselves are abusing substances, it heightens the problems for children as resources are
wasted and the caretakers are often out of the house and incapable of providing care.
Overall vulnerability of children
Many of the factors contributing to vulnerability in children overlap. So if a child is
vulnerable in one context, they are more likely to be vulnerable in other contexts. Thus,
children who have lost their parents to HIV are also more likely to become part of a
household that is overcrowded and poor. In turn they are more likely to be subjected
to stigma and disease themselves. These contributions cannot simply be summed using
an arithmetic basis, but compound the problems and obstacles for children to find safe
spaces for healing and integration and to allow for the development of coping strategies.
The actual impact of orphanhood as a result of HIV/AIDS, plus the other sources of
vulnerability, need to be thoroughly examined.
Free download from www.hsrcpress.ac.za
55
CHAPTER 2
Background and aims of the project

In 2002 the HSRC received funding from the Kellogg Foundation to develop and
implement a five-year intervention project on the care of OVC, as well as households
and communities coping with the care of affected children in Botswana, South Africa
and Zimbabwe. The project comprises two components, firstly funding and technical
assistance directed at interventions to assist OVC and secondly research to develop
a better understanding of the situation of OVC and towards the development of best
practice approaches for interventions. The HSRC is collaborating with research institutions
in Zimbabwe and Botswana and with non-governmental organisations (NGOs) that would
act as implementing partners for the interventions. In South Africa, the Nelson Mandela
Children’s Fund (NMCF) was chosen to work with the HSRC as an implementing partner.
As an implementing partner, the NMCF works with, and directs project funding to, various
community-based organisations (CBOs) and faith-based organisations (FBOs) in the
intervention areas to deliver necessary services to those who need them. The project will
also work in partnership with all levels of government in each country, as well as with
the local communities at the various sites to ensure that the intervention programmes
continue after the project officially ends in December 2006.
The ultimate goals of the project are to develop, implement and evaluate existing and/or
new OVC intervention programmes to develop best practice approaches that will:
• improve the social conditions, health, development, and quality of life of vulnerable
children and orphans;
• support families and households coping with an increased burden of care for
affected and vulnerable children;
• strengthen community-based support systems as an indirect means of assisting
vulnerable children;
• build capacity in community-based systems for sustaining care and support to
vulnerable children and households, over the long term.
Certain research tasks were also undertaken as part of this project. The first was to
conduct a situation analysis that would identify services already available in these
study areas, identify their strengths and weaknesses and suggest ways of strengthening
them. This was followed by the baseline research, including qualitative interviews,

a census survey and a directed survey of OVC at this site. This information informs
both intervention plans being developed to assist OVC and indicators for monitoring
the interventions. At the end of the project the baseline research processes will be
repeated. This, together with process evaluations, will be used to assess the effect of the
interventions. This report is concerned with the qualitative research component, which
took place between 2003 and 2004.
Aims of the research
Qualitative research was conducted primarily to seek the views of the residents of
Kopanong and Kanana about the general living circumstances of OVC, the levels and
impact of HIV/AIDS, social problems present in the community, and the services available
to address the needs of OVC as well as of the general community. The latter included
government and non-government services. Secondly, this process also served as an
entry into the field. Through interactions with key stakeholders and certain community
Free download from www.hsrcpress.ac.za
6
members, researchers sought to create an atmosphere conducive for the subsequent
survey and interventions.
Multiple vulnerabilities
Free download from www.hsrcpress.ac.za
77
CHAPTER 3
Methodology
The focus of the qualitative research was on semi-structured interviews with a diverse
range of participants, but additional information was obtained from observations while
in the field.
Semi-structured interviews
Semi-structured interviews were guided by an interview schedule that was developed on
the basis of the objectives of the study and agreed upon by all researchers from the three
countries. The aim of the interview schedule was firstly, to ensure similarity of issues
discussed in all interviews and secondly, to ensure a certain amount of control over

issues discussed with participants. However, participants were also encouraged to explore
other issues that were outside the guide as long as they were still relevant to the overall
project. This resulted in the discovery of additional content areas that were later followed
up and incorporated into subsequent interviews and discussions. All interviews were
tape-recorded and later transcribed. Some were conducted in English while others were
conducted in indigenous local languages, particularly isiXhosa, Afrikaans and seSotho.
Research instruments
The complete interview guide used to gather the data can be found in the Appendices.
The items of the guide were adapted and varied according to the person being interviewed,
and the interviewer could introduce new items if these appeared important in the context
of the interview. The discretion about where to place the emphasis during the interview
was left to the interviewer, but the key items that needed to be covered were:
• The living situation of OVC, including care, access to services, housing and nutrition
etc., ranging from those in the worst conditions to those who were better off.
• The extent of HIV/AIDS as a problem in the community.
• Personal knowledge, beliefs and behaviour in relation to HIV; behaviour in question
was not only sexual behaviour, but also support and advocacy – the prime target of
these questions was the informant themselves, but they were also asked to reflect on
the general situation in the community.
• Attitudes of the community and carers towards OVC, especially incidents of
stigma and discrimination, as well as violation of human rights of those living
with HIV/AIDS.
• Challenges in caring for OVC.
• Policy and legislation for the protection of OVC.
• Initial evaluation questions about the implementing intervention organisation
in the sites.
• Major sources of information on HIV and AIDS.
• Challenges in protecting themselves from HIV.
Sampling method
Participants were sampled purposively to select key informant interviewees based on

their involvement in OVC and HIV-related work and their experiences of either caring for
OVC or being an orphaned / vulnerable child themselves. Other categories of participants
(community members and community leaders) were selected on the basis of their
knowledge of community issues and involvement in community development initiatives.
Free download from www.hsrcpress.ac.za
8
In South Africa interviews were carried out with representatives from local government,
NGOs, OVC, OVC carers and general community members and leadership. The emphasis
was first on selecting OVC and secondly, their carers, but it was often difficult to contact
and establish these interviews. Purposive sampling was used to ensure an adequate
distribution of respondents in the study. The number of interviews decided upon also
depended on the size and distribution of the target communities, the number of NGOs in
the communities and OVC-related state services in the region.
Sample Kopanong
The sample in Kopanong consisted of 30 interviews. The breakdown of participants
were as follows:
• Seven government officials from the: DoH; DoE; Department of Agriculture;
DSD (three) and the Kopanong municipality.
• Five Non-governmental Organisations: Oranje Vrou Vereeneging, Philani Victim
Support Centre, Lekomo HIV/AIDS Consortium; Bokolokong HIV Support group,
Bokomoso HIV Consortium.
• Four community members: the participants in this category included youth and
adults based in Kopanong referred to the research assistant as possible interviewees
by our contact people in their towns.
• Four community leaders: community leaders representing five towns were selected
on the basis of their availability and willingness to share their opinions about the
research topic. Due to limitations in sample and vastness of the municipality, leaders
from all nine towns could not be interviewed.
• Six carers based in Philipolis (four) and Springfontein (two): they were also selected
by the research assistant who was familiar to them, based on their willingness to

share their opinions on the project. Three of the carers cared for children whose
parents died of AIDS–related illnesses.
• Four OVC (three orphans and one vulnerable child) from Fauresmith, Philipolis
and Trompsburg. Originally 10 interviewees were selected, but many refused to be
interviewed or were too young to go through the research process. Replacement
interviews were sought, but problems occurred here too.
Sample Kanana
Thirty-six respondents were interviewed in Kanana. The specific interviews were
conducted with:
• Eight staff or officials from various governmental departments or agencies, including
clinics and schools.
• Nine participants from NGOs or CBOs working with OVC namely: Child Welfare,
Diocese, Hospice, Imbizo Service and Bread 4 Support, KOSH Care and Support
Group, Ondersteunings Raad, Philani Health Care Centre, Sizanani Educare Centre,
Suid Afrikaanse Vroue Federasie.
• Seven community leaders, in particular two traditional healers who were involved
in either NGO activities or government initiatives.
• Five carers of OVC, who were drawn from extended families, foster homes
and shelters.
• Seven OVC.
Multiple vulnerabilities
Free download from www.hsrcpress.ac.za
Chapter 3
9
One focus group interview was conducted. Stakeholders included OVC, persons giving
care to OVC, non-governmental organisations, and government officials. The focus group
was conducted by a facilitator who was supported by a co-facilitator, in order to ensure
that the group ran as smoothly as possible.
Observations
In addition to formal interviews, data were also collected by means of observation when

visiting the communities. We paid particular attention to housing structures, nature of
roads and accessibility of each town, levels of poverty, commercial activities and other
issues relevant for a better understanding of the context. Some interviews took place
inside households, so the living situations inside the house could be observed. Data
collected through observation was recorded by means of note taking.
Analysis
A thematic content analysis method was used to identify the major themes and discourses
that emerged from the transcriptions. For the analysis of the Kopanong data, Atlas ti was
used. Quotes that were considered representative of the analysis were selected. These
also allowed the community members more of a voice. Names and identifying details
were changed to protect informants where necessary.
Free download from www.hsrcpress.ac.za
Free download from www.hsrcpress.ac.za
1111
CHAPTER 4
Qualitative Report of OVC
living conditions and services
in the Kopanong Municipality,
Free State province
Sakhumzi Mfecane, Donald Skinner and Alicia Davids
Xhariep district is composed of three local municipalities, i.e. Kopanong, Mokohare and
Letsemeng. Kopanong is the biggest of the three municipalities with a total population
of 55 942, followed by Letsemeng (42 979) and then Mokohare (36 316). Xhariep district
has a total of 17 towns and nine of them fall under the Kopanong local municipality.
These are Trompsburg, Edenberg, Reddersburg, Springfontein, Gariep Dam, Jagersfontein,
Fauresmith, Bethulie and Philipolis. Bethulie is the biggest of the towns, with a total
population of 12 374 and Gariep Dam has the smallest population size (1179). In terms
of spatial occupation, Xhariep district is regarded as the biggest in South Africa, yet it has
the lowest population density in the Free State province. The district covers an area of
34 131.55 km

2
, but has a population of a mere 124 000 people.
The majority of the Xhariep population are African, followed by whites, coloureds and
Indians. Children (<18 years) constitute 33.96% of the population and 34.35% are youth
(18- 39), followed by middle-aged, 27% (40-64) and then elderly 6.71% (>64). Although
elderly people form the minority, many children rely on them for support since many of
the young people are unemployed or have died.
Table 1: Ethnic composition in 2001 compared with the average for the district in 1996
Area African Coloured Indian White
Kopanong 72.52% 17.83% 0.04% 9.62%
Letsemeng 64.99% 25.26% 0.04% 9.71%
Mohokare 89.33% 2.92% 0.02% 7.73%
Xhariep 2001 74.64% 16.19% 0.03% 9.14%
Xhariep 1996 72.92% 11.17% 0.07% 12.19%
Source: Stats SA (Census 1996 & 2001).
The majority of Xhariep residents have access to basic amenities. For example, clean
water is available to 91% of residents (IDP Xhariep, 2003). The source of water depends
mainly on the housing arrangements. For example, residents of informal settlements
use communal taps, which are available within a distance of 500 metres. Residents of
formal houses, on the other hand, make use of onsite taps, which may be either inside
or outside the house. Housing arrangements exhibit the national trend, whereby whites
Free download from www.hsrcpress.ac.za
12
predominantly occupy towns, while Africans and coloureds mainly dominate townships.
Coloured residential areas are also separated from those of the Africans, although the
distance between them is not far. The illiteracy rate for the district is 22.74% according to
Census 2001 (Stats SA, 2003). This has shown an increase of 1.33% since 1996. Table 2
provides a breakdown of education levels per municipality for 2001.
Table 2: Education levels for persons 20 years and older, 2001
Area No

schooling
Some
primary
Complete
primary
Some
secondary
Grade 12 Higher
qualification
Kopanong 20.94% 25.12% 8.52% 27.74% 13.02% 4.66%
Letsemeng 25.25% 26.16% 7.85% 24.32% 12.40% 4.02%
Mohokare 22.61% 30.40% 8.64% 22.54% 11.13% 4.67%
Xhariep 22.74% 26.86% 8.34% 25.28% 12.32% 4.46%
Source: Stats SA 2003.
As can be seen, the majority of people in the district have some primary school education,
but less than 9% have completed it. Less than 5% have an education beyond grade 12,
while only 12% have reached grade 12.
Geographical context
The community is difficult to work in due to the large size and the distribution of
the population across nine small towns. This is exacerbated by undeveloped road
infrastructure. Although the district is easily accessed through the national road and other
main roads, travelling within this district from one town to the next requires driving
on gravel roads. For residents of the Kopanong municipality, access to different towns
is further restricted by a lack of public transportation. They rely on taxis travelling to
Bloemfontein, which are unreliable and expensive. Other options are hiring a private car,
which is even more expensive.
The difficulty of driving long periods of time on gravel roads has implications for
service delivery by both government and NGOs. For example, social workers do not
have quality time to monitor the well-being of the children that they have placed. They
reported spending more time driving to certain places than attending to the needs of

children. Motor vehicles commonly broke down due to the poor quality of the roads.
These conditions discouraged service providers, for example doctors, from working in
the district.
But the biggest challenge in this district is the big size of the community, the
vast area, the vastness of the area. For instance, for me to move from here in
Koffiefontein to Smithfield the other sub office it’s a two hours drive, and if
you drive for two hours within the same district it’s too much. That is one big
challenge (DSD representative).
Multiple vulnerabilities
Free download from www.hsrcpress.ac.za
Chapter 4
13
Figure 1: Map of the Kopanong Municipality
Source Municipal Demarcation Board (2004)
Farm workers constituted a particularly difficult group to access. The majority are
uneducated and uninformed about certain government services available to them, so
very few are aware of the government services aimed at assisting OVC and their families.
Efforts are required to extend services to these residents. Currently DSD has no staff
that focus specifically on farms. All are based in residential areas around towns. Other
departments also need to attend to the situation of farm residents. For example the
Department of Home Affairs can help with acquiring identity documents, which can help
facilitate the grant process.
The second major problem resulting from the vastness of the district is
accessing OVC living on the farms. These are spread out over the whole
district, there is little prior information available on each farm, each farm has to
be visited and the farmer negotiated with separately and it is difficult to contact
people in advance of a visit. There are farms that are so difficult to access.
So much so that when you go to those areas they don’t know anything about
HIV/AIDS and on top of that some of them are infected already. People are not
informed because of their areas (DSD representative).

Economic situation
Kopanong Municipality makes the largest contribution to the total Gross Domestic
Product (GDP) of the district (42.41%), followed by Letsemeng (29.84%) and Mohokare
(27.75%) Municipalities (Xhariep District Municipality, 2005). The economy of the district
is dependent primarily on agriculture, which contributes 35.91% to the GDP of the
district, followed by government (16.17%). Mining contributes to the GDP by 6.35%.
The dependence on agriculture means that the economy of the district is at risk due to
the decline of the agricultural sector in the past few years. A long drought and the rise
Free download from www.hsrcpress.ac.za