Situational analysis of the socioeconomic conditions of orphans and vulnerable children in seven districts in Botswana pot

Situational analysis of the socioeconomic
conditions of orphans and vulnerable children in
seven districts in Botswana

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Edited by GN Tsheko


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Research report prepared by the Human Sciences Research Council (HSRC) and the Nelson
Mandela Children’s Fund (NMCF) for the strategy of the W.K. Kellogg Foundation (WKKF) for
the care of orphans and vulnerable children (OVC) in Botswana, South Africa and Zimbabwe
in commemoration of the WKKF’s 75th Anniversary.
Published by HSRC Press
Private Bag X9182, Cape Town, 8000, South Africa
www.hsrcpress.ac.za
First published 2007
ISBN 978-0-7969-2195-6
© 2007 Human Sciences Research Council
Copyedited by David Le Page
Typeset by Janco Yspeert
Cover design by Oryx Media
Cover photo: © Tessa Frootko Gordon/iAfrika Photos
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The researchers (Dr GN Tsheko, Prof. SD Tlou, Ms M Segwabe, Dr LW Odirile) and Ms A
Kabanye-Munene) who co-authored some parts of the document, would like to thank all
those who made it possible for this work to be completed. This study was supported by
the Kellogg Foundation and undertaken by Masiela Trust Fund, OVC Research-Botswana
under the umbrella of the Human Sciences Research Council’s (HSRC) Social Aspects of
HIV/AIDS & Health research programme in South Africa. The Masiela Trust Fund and the
HSRC are indebted to the field assistants, respondents, and community leaders in Palapye,
Letlhakane, Kanye, Molepolole, Mahalapye, Serowe and Maun who participated in this
study. We are also grateful to our research team, the members of which have worked
tirelessly in the preparation of instruments, collection of data and report writing.
We cannot stop thanking the staff at Masiela Trust Fund for the support they provided
during the study period.

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Lastly, we thank Dr GN Tsheko for editing the final report.

iv


antiretroviral

AIDS

Acquired Immune Deficiency Syndrome

BOCAIP

Botswana Christian Aids Intervention Programme

BOTUSA

Botswana USA Project

CBO

community-based organisation

DSS

Department of Social Services

FBO

faith-based organisation

HBC

home-based care

HIV

Human Immunodeficiency Virus

HSRC

Human Sciences Research Council

IEC

information, education and communication

MRC

Medical Research Council

NGO
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ARV

non-governmental organisation

OVC

orphans and vulnerable children

PMTCT

prevention of mother-to-child transmission (of HIV)

STPA

Short Term Plan of Action

TCM

total community mobilisation

VCT

voluntary counselling and testing

VDC

village development committee

WKKF

WK Kellogg Foundation

v


The overall aim of this project is to implement research-driven, evidence-based,
intervention programmes to assist children, families and communities affected by
HIV/AIDS in Botswana. The overall philosophy is to empower communities to help
themselves, and to ensure sustainability of the project after donor funding ceases.

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The situation analysis was carried out in seven research sites in Botswana. These are
Palapye, Letlhakeng, Kanye, Mahalapye, Molepolole, Serowe and Maun. The data
collection methods used for the qualitative research included key informant interviews and
focus group discussions. Information was collected from orphans and vulnerable children
(OVC), their caregivers, community members, community-based organisations (CBOs),
government officials and community leaders; as well as members of non-governmental
organisations (NGOs) and faith-based organisations (FBOs).
The objectives of the study are to improve the living conditions of orphans and vulnerable
children; to support households and families to cope with the increasing burden of care
for affected and vulnerable children; to strengthen community-based support systems
under which vulnerable children exist; and to build community-based systems for
sustaining care and support to vulnerable children and their families.
The seven sites are located at different distances from the capital city Gaborone but are
reachable by (tarred) road. Maun is the furthest away (around 1000 kilometres from
Gaborone) and can be reached by both road and air, as this is the one village that has an
airport.
The major challenges facing orphans and vulnerable children are poverty related and
include female-headed households, and inability of families to provide even the most
basic necessities such as food, clothing and shelter. The poverty of these children places
them at greater risk of experiencing other social problems such as property grabbing,
ill-treatment, abuse and congested households. The findings are that there is free,
non-compulsory education as well as free medical services, orphan care and destitute
programmes provided by the government at all sites. The spirit of volunteerism is present
within all communities, though it varies from one site to another.
The absence of a policy that advocates for OVC makes it difficult for NGO, CBO, FBO
and government officials to protect orphans and vulnerable children from property
grabbing.
Most service providers, including both government and non-governmental organisations
mentioned issues such as transport, financial and staff shortage as their major challenges
in delivery of services.

Our findings reveal that HIV/AIDS stigma continues to be a major challenge, despite the
maturity of the epidemic, and the extent of education to sensitise the community to the
need for support and acceptance of those infected. A general lack of knowledge about
HIV/AIDS was found, as evidenced by myths surrounding transmission, prevention and
cure. Communities need more education on issues of HIV/AIDS, especially to try and
decrease the extent to which people are stigmatised.

vi


Introduction

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Skinner et al. (2004) define an orphan as a child who has lost both parents through
death, desertion or if the parents are unable or unwilling to provide care. They further
define a child as someone who is aged 18 years and below, though in some cases 21 is
the cut-off age used.
Skinner et al. (2004) also define a vulnerable child as someone who has no or restricted
access to basic needs and whose rights are denied even if they have both parents. The
Botswana Short Term Plan of Action (STPA) on the care of orphans defines an orphan as
a ‘child below 18 years who has lost one or two biological parents’. The STPA goes on to
categorise another group of orphans as social orphans and defines them as ‘abandoned or
dumped children whose parents cannot be traced’ (Ministry of Local Government, Lands
and Housing, Social Wellfare Division 1999). For purposes of this report, both definitions
cited above will be used. A vulnerable child is a child who is either orphaned or is living
in crisis situations due to multiple causes. Such situations may result in prostitution or to
living on the street. These are children who belong to high-risk groups and lack access to
basic social facilities. Risk is identified in terms of malnutrition, morbidity, death and loss
of education (World Bank and UNICEF 2002).

Findings from the Rapid Assessment on the situation of orphans in Botswana as cited by
the Ministry of Health (1998) indicate that many orphans do not have basic necessities
such as food, clothing, shelter and toiletries. The assessment also established that their
human rights are violated, not only by society, but also by caregivers in some cases. The
other problem that orphans face is that many caregivers are elderly grandparents who live
in poverty and are in some cases supported through the destitute programme or the oldage pension scheme.
Though the problem of orphans is not new in Botswana, the advent of HIV/AIDS has
contributed significantly to the escalating orphan problems in the country. In 1999, the
number of registered orphans was 21 209 and the number doubled to 42 000 in 2003.
Available data in the country shows that HIV/AIDS prevalence in all the districts is similar,
which means that all districts are affected. This suggests that the problems of orphans
and their needs should also be similar across all the districts. However, according to the
Botswana 2003 Second-Generation HIV Surveillance Report (National AIDS Coordinating
Agency 2003), HIV prevalence rates by districts show Kweneng West (includes
Letlhakeng) has an HIV prevalence of 27.0%, Kweneng East 32.1% (includes Molepolole),
Serowe/Palapye 43.3% (includes Serowe and Palapye), Mahalapye 37.4% Southern 25.7%
(includes Kanye) and Ngamiland 38.4% (includes Maun).
Given the magnitude of the problem, the government has declared the orphan problem a
national crisis needing immediate and long-term sustainable interventions by the various
stakeholders.

1


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Background to the OVC project

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One of the biggest challenges facing southern Africa today is HIV/AIDS. The governments
of southern African countries have called on every African to join the fight against this
disease. The Human Sciences Research Council (HSRC), together with its partners within
the Southern African Development Community (SADC) region, were commissioned by
the WK Kellogg Foundation (WKKF) to develop and implement a five-year intervention
project on orphans and vulnerable children (OVC).
The project looks at the families and households coping with an increased burden of
care for affected children in Botswana, South Africa and Zimbabwe. All three research
institutions have identified non-governmental organisations (NGOs), which are referred
to as grant makers, with whom to work. The grant maker identifies local NGOs to
implement recommended interventions. In South Africa, the Nelson Mandela Children’s
Fund (NMCF) was chosen to work with the HSRC and the Medical Research Council
(MRC) of South Africa. In Zimbabwe, Family AIDS Caring Trust (FACT) was chosen to
work together with Blair Biomedical Institute and Biomedical Research and Training
Institute. The University of Botswana (researchers) and Botswana Harvard Institute
chose to work with the Masiela Trust Fund. The grant maker selects community-based
organisations (CBOs) and faith-based organisations (FBOs) to implement the appropriate
intervention programmes at all the sites that are identified.

Outline of specific state plans to support OVC
There are two major government programmes that cater for the needs of OVC in
Botswana, namely the orphan care programme and the destitute programme. These
programmes are coordinated through the Social Welfare Department under the Ministry of
Local Government. Since the start of these programmes, all the districts through the Social
Welfare Department have taken responsibility for assessing, registering and supporting
orphans and destitute persons, depending on their need. All seven sites of Kanye,
Kweneng West, Mahalapye, Maun, Molepolole, Palapye and Serowe have systems of
registering new orphans and destitute persons, as well as keeping this register up-to-date.
The Botswana orphan care programme is guided by a Plan of Action, which has the

following objectives:
•
responding to immediate needs of orphans i.e. food, clothing, education, shelter,
protection and care;
•
identifying the various stakeholders and defining their roles and responsibilities in
responding to the orphan crisis;
•
identifying mechanisms for supporting community based responses to the orphan
problem; and
•
developing a framework for guiding long-term development programmes for
orphans.
In relation to the immediate needs of orphans, the orphan care plan of action
concentrates on the following areas:
•
Provision of basic needs (food, clothing, toiletries and shelter): Many of the orphans
are without adequate food, clothing, decent shelter and toiletries. Therefore,
provision of these basic needs remains the most urgent task for the orphan care
programme. In collaboration with the Ministry of Health, a ‘food basket’ was

3


•

•

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•

established for orphans and other children in need of nutritional care. The food
basket contains all the necessary food items, for example maize-meal, rice, meat and
vegetables, as well as toiletries and other items. This is issued once a month.
Ensuring access to education: Orphans are provided with appropriate school
uniform, shoes and other miscellaneous school items to ensure that orphans remain
in school and get appropriate education.
Protecting orphans from abuse and neglect: The sociopolitical environment of
orphans poses serious challenges to their livelihoods, well-being and security. Their
basic rights are often violated, so the orphan care programme sees to it that legal
interventions that are in place to protect the rights of children also apply to orphans.
Providing alternative care for orphans and children in need: Given the complexity
of the orphan problem, the government identified the need to establish alternative
care for orphans and drafted the ‘Regulations governing alternative arrangements for
children in need of care’. These guidelines have identified foster care, guardianship,
children’s homes, schools of industry, and approved child welfare shelters as
possible alternative care systems for orphans. These guidelines have not yet been
approved for implementation, putting a limitation on the overall progress of the
programme.

The orphan care programme only caters for children classified as orphans in line with
the provisions of the short term plan of action on care of orphans in Botswana of
1999. Those children referred to as ‘in need’ or ‘vulnerable’ are treated as destitute
persons and are taken care of under the destitute policy. The government of Botswana
initiated the destitute programme in 1980 after the realisation that the extended family
was disintegrating. Before Botswana’s political independence, the extended family
system served as a major safety-net, meeting all kinds of needs, be they material, social
or emotional. Independence brought urbanisation, migration and rapid economic
development. These changes attracted the educated and the young to the urban areas in

search of employment, leaving the elderly alone in rural areas. In some cases, this led to
a gradual loss of support for poorer members of the extended family system. As a result,
the 1980 National Policy on Destitute Persons was formulated to systematically tackle
poverty (Ministry of Local Government 2002). The revised 2002 destitute policy provides
a definition and guidelines for what should be considered before classifying a person as
a destitute. Children who are under 18 years of age can be considered under the destitute
policy. These are children who:
•
are ‘in need of care and may not be catered for under the orphan care programme’;
•
‘have parent(s) who are terminally ill and incapable of caring for the child; and
•
‘have been abandoned and [left] in need of care and are not catered for under the
orphan care programme’.
The
•
•
•
•
•

destitute care programme focuses on the following areas:
assessment of identified individuals or families;
provision of food component for adult destitute persons;
provision of cash component;
provision of funeral expenses; and
shelter for eligible destitute persons.

The destitute policy caters for specific needs of children, such as food for children under
18 years of age. Thus a food basket, as prescribed under the orphan care programme, is

provided to all needy and vulnerable children.

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Children under the age of 18 years benefit as dependants and in addition are entitled to
receive the following benefits, depending on what kind of school they attend:
Table 2.1: Goods and services available to children through the destitute programme
Pre-school

Primary

Junior Secondary

Senior secondary

Vocational and tertiary

Uniform

Uniform

Uniform

Uniform

Protective clothing

Toiletries

Toiletries

Toiletries

Toiletries

Toiletries

Snack pack

Pot fee

Development
fee

Development
fee

Sports fee

Sports fee

Sports fee

Sports fee

Tuition

Transport fee

Hostel
requisites

Boarding
requisites

Boarding
requisites

Trade tools

Fees

Transport fee

Transport fee

Transport fee

Transport fee

‘Street’ clothes

‘Street’ clothes

‘Street’ clothes

‘Street’ clothes

‘Street’ clothes

Touring fee

Touring fee

Touring fee

Touring fee

Touring fee

Accommodation
support

Accommodation
support

Accommodation
support

Psycho-social
support and
mentoring plus
career guidance

Psycho-social support
and mentoring plus
career guidance

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Goods

Services

Psycho-social
support and
mentoring

Psycho-social
support and
mentoring

Psycho-social
support and
mentoring plus
career guidance

Note: Children who are dependants of a destitute person, and who turn 18, can continue to receive the above benefits until
they complete their education or training up to 29 years of age, under the youth policy extension rule. The same is true for
those children from households that are assessed as being dysfunctional (Ministry of Local Government 2002).

Aims and objectives of the study
1.
2.

3.
4.
5.

To assess the social conditions, health, development and quality of life of orphans
and vulnerable children.
To identify family and household support systems for coping with the burden of
care for orphans and vulnerable children at family, ward, community, national and
international level.
To obtain additional information that would be useful in the OVC census baseline
and the BSS surveys for the study sites.
To obtain any additional information that would be useful for sharing with Masiela
Trust, the grant-maker.
To use the information obtained to build capacity in community-based systems for
sustaining care and support for vulnerable children and households, over the long
term.

The overall philosophy behind the project is to empower the communities to help
themselves, and this demands a very strong emphasis on planning sustainability of the
project once funding ceases.

5


Aims of the situational analysis

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The aim of this analysis was to collect information on conditions of OVC and services
in place that cater for OVC needs as offered by NGOs, CBOs, FBOs and government
departments in the seven sites. The information collected would inform the development
of interventions. The situation analysis also served as an introduction to the communities
for the researchers, and vice versa.

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Methodology
The overall aim of the project is the development of interventions for OVC. To do this we
are looking at current interventions, documented studies and information generated from
client groups. The qualitative research feeds into this by drawing information from key
interest groups and by laying the basis for the survey and monitoring and evaluation.

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Data collection methods used for the qualitative research included key informant
interviews and focus group discussions. Interviewers were trained on how to conduct the
interview and how to conduct themselves in the field. Specific procedures for interviews,
such as introducing themselves, explaining the purpose of the study, and seeking
consent, were used. Verbal or signed consent was invited after reading the consent form
to the participant. In the case of children, consent from the parent or guardian was
sought before interviews could proceed. Issues of anonymity and confidentiality were
addressed in the consent form.

Research instruments
Key informant interviews
Key informant interview participants included OVC, their caregivers, community members,
members of NGOs, government officials and community leaders. Length of interviews
varied depending on who was interviewed: OVC were interviewed for between 30 and
60 minutes, and the caregivers were interviewed for between 45 and 90 minutes. The
members of NGOs, state officials and community leaders were interviewed for 60 to 90
minutes.
Focus group discussions
Focus group discussions took place with OVC, their caregivers, community members,

members of NGOs, government officials and community leaders. These discussions lasted
between one and two hours. They were conducted in local languages and each had 5–12
participants. There were two facilitators for each focus group; the primary interviewer and
the co-facilitator who provided support by taking notes, checking that the tape-recorder
was functioning well, and that all participants were engaged.
Before the focus group started, facilitators provided participants with detailed information
regarding their participation, to ensure that issues of consent were addressed. Participants
were informed about the sensitivity of the research topic and that if they were averse to
discussing personal issues in front of others, they could exercise their right to withdraw
from the study. Permission was sought to tape-record the discussion.

Sampling
The sampling plan was devised according to the groupings that needed to be
interviewed. Though purposive sampling was used, efforts were made to ensure that all
significant sectors of the communities were systematically covered, thus ensuring even
representation of the community. Each category is presented separately below, with its
sampling strategy. A total of 40 interviews were conducted at each site (32 key informant
interviews and eight focus group discussions). NGO personnel facilitated the selection of

7


participants in each category, but researchers checked that participants were distributed
according to the criteria used. Sampling for key informant interviews was divided into the
categories below.
OVC (ten per site)

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For the purposes of this study OVC were defined as children (children and youth

between 0–18 years) who meet the following criteria:
•
maternal, paternal and double orphans;
•
children who are in communities severely affected economically and socially by
HIV/AIDS;
•
children who are in households with terminally ill parents/family members;
•
internally displaced children; and
•
children who live in emotionally and financially distressed households.
Balance regarding age, gender, and locality was ensured. The purpose of interviewing
OVC was to find out about their major needs, experiences, perceived attitudes of the
community, suggestions of how they could be assisted, knowledge of HIV/AIDS, HIV/
AIDS risk-related behaviour and strategies to improve their present conditions.
Immediate caregivers of OVC (eight per site)
This category refers to people who offer immediate care for orphans and vulnerable
children. They included parents, relatives or other community members who are
responsible for the overall wellbeing of the OVC. The purpose of interviewing caregivers
was to find out their experiences and challenges in caring for OVC, living situations of
OVC, attitudes of communities towards OVC, knowledge about legislation in place to
protect OVC, and suggestions on how to help OVC in the country.
CBOs, FBOs, NGOs (up to seven per site)
This category refers to NGOs based in the study areas which are working with OVC.
The nature, structure and size of these organisations differed. Some are mainly made up
of volunteers, while others offer paid employment. NGOs offer different services such
as care, support and counselling. Emphasis was given to those providing services for
OVC. The main reason for interviewing this group was to find out the services they offer
for OVC, major challenges, needs and concerns they have and how these related to the

resources they have. There was also a need to establish the living situations of OVC,
the extent of HIV/AIDS as a problem, attitudes of communities towards OVC and the
incidence of stigma. The number of participants also depended on the context and the
number of organisations available in each area.
State officials (three per site)
This category refers to people who are working for government departments, for example
the Ministry of Local Government (department of Social Welfare), Ministry of Health and
Ministry of Education. The main reason for interviewing this category was to identify
government interventions towards OVC, and gather official thoughts on the size of the
problem and its impact on the community, the living situations of OVC, attitudes of
community members towards OVC, knowledge of care and support structures in place,
major challenges, needs and concerns and how they relate to the resources they have.

8


Community leaders (four per site)
Community leaders usually included the chief, village development committee
chairperson, church ministers and councillors. In this category, interviews sought to
identify respondents’ and community attitudes to OVC, the living arrangements of OVC,
major challenges in relation to the care of OVC, and ideas about HIV/AIDS and risk
behaviour.
Sampling for focus group discussions

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Eight focus group discussions were conducted to gather information relating to
knowledge and beliefs about HIV/AIDS and risk behaviour. Participants were asked to
discuss OVC issues. Participants were grouped according to age and gender. Categories
were ages 6–12 years; 13–18; 14–24, and 25 and above. The age-groups were then

dividied into single sex and mixed sex groups.

9


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Palapye
GN Tsheko, MS Segwabe, LW Odirile and SD Tlou

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Description of the site
Palapye is situated in the Serowe/Palapye district. It is one of the largest villages in
Botswana with a population of 26 293, of whom 12 087 are male and 14 206 female
(Central Statistics Office 2001). Thus females comprise 54% of the population. Palapye
is in central eastern Botswana, about 275 kilometres north of the capital city Gaborone.
Palapye is built around a coal-driven power station called Morupule. The local mine
Morupule Colliery supplies the coal for the power station. Most of the people living in
Palapye are employed by either the power station or the colliery. The other groups of
people are mainly employed by the government in the Ministries of Health, Education
and Local Government. However, most families still depend on livestock rearing and
ploughing for survival.
Palapye is a semi-urban locality and uses Setswana as the predominant language. It also
has advanced infrastructure. The community has access to different shops (food, furniture,
and clothing), public phones, public transport, electricity, water, tarred roads and others.
It is a typical village where some families still reside in one-roomed traditional houses
made of mud with a thatched roof. Most of the households do not have running water
and proper sewerage. Palapye has some urban houses, where families reside in modern

multi-roomed homes that have running water, proper sewerage and electricity. The
Department of Water Affairs has provided community standpipes in the village for use by
villagers who do not have running water in their homes.
The locality of Palapye still embraces the traditional style of extended family culture of
caring, although there are signs that the extended family has begun to disintegrate. The
extended family has in the past always provided a safety net, but is now under great
pressure from social and economic changes that directly impact on the family’s ability
to provide care for orphans and vulnerable children. The socioeconomic developments
taking place in the country have had both negative and positive impacts. One of the
negative impacts at societal level has been the break-up of the extended family, as more
and more family members move into towns to seek employment. As a result of these
movements, and the rise in the cost of living, families are no longer able to remain as
consolidated as they used to. This has resulted in a tendency to have more nuclear and
fewer extended families.
Palapye has both traditional and modern types of leadership: a chief, two deputy-chiefs,
a district commissioner, and other state officials such as the police, political councillors,
members of parliament and others.
There is one primary healthcare facility and four clinics. These are government-supported
facilities that provide for the healthcare needs of the community, including those of
orphans and vulnerable children. The Botswana 2003 second-generation HIV/AIDS

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surveillance does not single out numbers for Palapye as a community but includes
its numbers with those from the rest of the Serowe/Palapye district. Prevalence for
the district was 43.3% in 2003. The healthcare system provides an array of services
to benefit people living with HIV/AIDS, and these include Prevention of Mother to

Child Transmission of HIV/AIDS (PMTCT), Sexually Transmitted Infections treatment,
tuberculosis treatment and access to antiretroviral treatment for both children and adults
through Serowe and Mahalapye hospitals. The Sekgoma Memorial Hospital based in
Serowe is located about 45 kilometres west of Palapye, whereas Mahalapye Hospital is
located about 60 kilometres south of Palapye. People living in Palapye also have access
to a free voluntary counselling and testing centre, provided through Tebelopele, a local
voluntary counselling and testing provider. This centre uses rapid tests and has been
supported by a collaboration between Botswana and the US government called BOTUSA.
There are schools in Palapye which are operated through both the private and public
sector. There are six daycare centres, one of which is run by a non-governmental
organisation (NGO) called House of Hope. Other day care centres are provided through
the private sector and charge monthly rates of between P300–P450 per child per
month. There are eight primary schools and three secondary schools, all supported by
government through the Ministry of Education.
Through the Ministry of Local Government, Social Welfare Division, Palapye’s orphaned
children benefit from the government orphan care programme. The purpose of the
programme is to identify and register orphans, as well as provide monthly rations in the
form of food and toiletries. Clothing is provided on a yearly basis. By December 2004, the
programme had registered 1 743 orphans.

General conditions
Most OVC are exposed to conditions of poverty from a very early age and some of these
children were born to single mothers. The caregivers are mostly from their mother’s side
of the family and are often grandparents or elderly relatives who are not able to provide
proper care. In some cases, the caregivers have to move in with the children, bringing
their own families along. Most of the caregivers are poor and are supported through the
destitute policy or old age pension scheme, through which everyone who is aged 65
years or over draws a monthly salary of P110 (US$18), irrespective of their socioeconomic
status. This is meant to assist with basic needs, such as food and personal hygiene items.
Some elderly caregivers use these benefits to take care of their own needs as well as the

needs of the children with whom they live.
Orphans, who are registered with the government orphan care programme, become
entitled to government support, which includes food, blankets, uniform and clothes.
In some cases, these benefits are misused by caregivers and do not entirely benefit the
orphans. Some of the caregivers sell the provisions in exchange for alcoholic beverages.
In cases where caregivers move in with orphans bringing in their families, they end up
taking the supplies of orphans to feed and clothe their own children. Some orphans in
Palapye are exposed to abuse from caregivers. In some cases, the presence of care-givers
raises the possibility of sexual abuse. The abused children are likely not to report such
incidents, leading to an increase in child sexual abuse as well as vulnerability in children.
Orphans suffer other forms of abuse, such as where the care-giver expects them to run
improper, unusual businesses such as sale of alcohol for long hours without sharing the
responsibility with other children in the home.

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Housing is reported as a concern in caring for both orphans and vulnerable children.
Most households have traditional housing, with no running water, electricity or proper
sewerage. There is a general feeling that government should assist OVC by providing
improved living conditions in the home, rather than by providing orphanages. The main
argument is that when improved housing is provided to households, caregivers would
be better able to give love and support to the children, as well as ensuring that they stay
together with their siblings. A stable home ensures that they are brought up with the
same family values, beliefs and traditions. Orphanages have been strongly criticised as not
bringing any value to the life of the child, as the child does not have a family with which
to identify, does not enjoy family love, care and respect, and hence grows up without
any family values with which to identify.

The general conditions of OVC create emotional, social and psychological pressures.
As much as there are social workers and other service providers who work towards
improving the lives of OVC, most of the interventions come in material form, and there
is a comparative absence of psychosocial support. Social workers and other service
providers have reported the need to provide psychosocial support, but have not been
able to continuously do so due to human resource challenges.

Challenges in caring for OVC
There are many challenges for caregivers of orphans. Most of the caregivers are older
adults with their own health problems, hence they are not able to provide proper care
to the orphans. In providing care to children, caregivers fetch water, cook, bathe the
children, wash the children’s clothing and do other important day-to-day household
chores. Carrying out these chores is a big challenge for a sickly elderly woman. In some
cases the caregivers have many orphans to care for and in such cases, resources become
even scarcer. Government food support that is provided does help, but food preparation
demands strength and energy.
Although government support is available, there are often delays in delivery of supplies,
especially clothing. Some caregivers have experienced situations where their orphans
either did not receive winter clothing or received it very late, forcing these older women
to spend the little money they have to take care of the immediate needs of the children.
The government destitute programme caters for vulnerable children; however most
families with vulnerable children are not aware of this provision, so that some deserving
children are not accessing these benefits.
Housing is a major issue of concern for both orphans and vulnerable children, as in
some cases caregivers share rooms with the children, thus leading to overcrowding and a
generally unhealthy environment.

Knowledge of HIV/AIDS in the community
Though actual numbers are not known, there was a general agreement among
respondents that a lot of people are infected with HIV/AIDS in the community. The

infected are believed to be both young and old. Some of the respondents believe that
the young get the virus through unprotected sex, while the older generation is generally
believed to be infected through care giving, since most of these caregivers do not always
use protection such as the gloves offered through the health-care system.
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There is still a general lack of knowledge about HIV/AIDS. Those who claim to know
something about HIV/AIDS also exhibit some misconceptions around transmission,
prevention and cure. For example, some people still believe that having sex with
a younger person would act as a prevention method. Lack of knowledge is also
demonstrated by some caregivers who fail to use protective gloves when taking care of
the sick. Even though respondents displayed limited knowledge, they also acknowledged
that there were a lot of sources of information on HIV/AIDS. The challenge is that people
are not taking advantage of the available sources of information to learn more about HIV/
AIDS and they continue to engage in risky behaviours.
The community felt that if HIV-positive people could go public with their HIV status, then
prevention efforts would be enhanced. Going public with one’s status would also help
in destigmatising HIV/AIDS. Such a step will assist communities to start treating people
living with HIV/AIDS with a more positive attitude than is presently the case.

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Government departments and their services
Ministry of Education
Palapye is a traditional village that has enjoyed positive developments in the area of
education. It has six day care centres, five of which are privately owned, charging fees
ranging from P300–P450 (US$50-75) a month. Only one day care centre belongs to a nongovernmental organisation and gives priority to orphans. Here, the orphan children are
not expected to pay any fees. There are seven primary, four junior secondary and one
senior secondary schools. These are all supported through the Ministry of Education. All

schools falling under the Ministry of Education offer free but not compulsory education
to all Batswana. The first ten years constitute basic education. This is made up of the
first seven years of primary education followed by three years of junior secondary. Entry
into the final two years of senior secondary is determined by one’s success in the Junior
Certificate examination, which serves as a selection test.
There are also privately owned primary and secondary schools in the village. Even
though they do not directly fall under the Ministry of Education, they have a partnership
with the Ministry in the sense that they function in a similar way, regarding years of study
and criteria for selection into the next level.
The Ministry has not been responsible for the education of children below primary school
age. It is only recently that the Ministry has begun looking into coordinating educational
activities for children below primary school age.
The government of Botswana, through the Ministry of Education, provides governmentaided schools with the necessary human (trained personnel including administrators,
teachers, education officers and education administrators) and physical (buildings,
furniture, books and stationery) resources. The management of these resources at district
level is the responsibility of Education officers.
There is a school-feeding scheme whereby children are provided with nutritious meals at
different times of the day. In primary schools, children are fed a mid-morning meal, while
in secondary schools they are fed a mid-morning snack and lunch. Children at private
schools cater for their own meals, which they can usually afford.

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The Ministry of Education has an HIV/AIDS office. One of its major responsibilities
is to ensure that HIV/AIDS is mainstreamed into the curriculum. One active project
that the ministry is running, in partnership with other stakeholders such as the African
Comprehensive HIV/AIDS Programme (ACHAP), is the ‘talk back’ programme, which is

aired on national television every Tuesday at noon during school days. As a result, most
schools in the country with electricity were equipped with a television so that they could
participate in the programme. In Palapye, eight schools (both primary and secondary)
report having television sets and being able to watch the programme. Out of these eight
schools, three reported problems such as having their television sets stolen and the other
two reported having experienced some technical problems which led to the students not
watching the programme for some time. When this occurred, the teachers would normally
teach the topics of discussion without actually watching the programme live, to ensure
the students are working within the time schedule of the series.
Schools are encouraged to work closely with other existing programmes meant to benefit
orphans and vulnerable children. Such programmes include the orphan care and the
destitute programmes, both falling under the Ministry of Local Government. The school
assists in identifying children in need. Secondary schools go even further by having
teachers who provide guidance and counselling so as to take care of social needs of
students including those that are HIV/AIDS related.
Ministry of Local Government
Palapye has both the orphan care programme which takes care of all registered orphans,
as well as the destitute persons programme, which can cater for children both below
and above 18 years old who are vulnerable. Both programmes have funds allocated to
them on a yearly basis by government. Due to the high demand for the orphan care
programme, the funds allocated always get exhausted before the end of the financial year.
There are usually no other funds to rely on – donor funding in Botswana declined when
the country was reclassified as an upper middle-income country (World Bank 2007), so
that demand outstrips available donor resources.
The food basket provided under the programme contains basic food items, toiletries and
meat. These items are valued at P250 (US$45) and are offered on a monthly basis. The
supplies are received through local supermarkets. In addition to food and toiletries, there
is some money for clothing and blankets. An assessment is done yearly to determine if
the child needs clothing and blankets.
Once a person has been identified as qualifying to receive assistance, a needs assessment

is conducted to determine the kinds of services required. The cut-off age for receiving
services is 18 under the orphan care programme. Assessments are then done to determine
need once one has reached 18 years, and further assistance if any comes through the
destitute programme. Services under the destitute programme are provided to children for
as long as they are students.
Once the initial assessment is done and proof of need has been established, some of the
following steps are undertaken to cater for orphans, following guidelines from both the
orphan care programme as well as the destitute programme:
•
providing for needs at school, including educational tours, transport costs, uniforms
and toiletries for those in boarding schools;
•
providing for any specialised medical care requiring payment, such as dentistry,
ophthalmology, etc. In Botswana, there is subsidised medical care, free for all
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•

•

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•
•
•

children under the age of 12 years. Children over the age of 12 years, who are either
orphaned or living in a family where the bread winner is registered as a destitute
person, are entitled to receive medical care at the expense of government;

provision of shelter for those who cannot get into boarding schools and those
whose parents died without proper housing. This is usually temporary shelter, where
the programme sometimes provides tents for families to use;
interventions in cases of property grabbing, even though there is no legislation
that gives authority to the officers concerned. This makes it difficult to intervene
effectively as there is no protection in place;
providing counselling as and when needed;
facilitating placement into foster homes depending on need; and
monitoring and evaluation of the programme by Social Welfare officers with
community development committees, to assess the success and failures of the
programme.

Collaborations, with NGOs involved in HIV/AIDS work such as House of Hope, Total
Community Mobilization and People in Nature Trust, facilitate the referral process.
Challenges faced by the Ministry of Local Government are listed below:
Staff shortage: Due to shortages of human resources, officers end up doing assessments
from their offices instead of actually visiting homes. The officers are also not able to
provide effective counselling. There is a need for additional human resources to cater for
the growing number of orphans in the area.
Property grabbing: There have been some cases of property grabbing, where orphans’
inheritances have been taken from them by relatives, usually paternal relatives. There is
no policy in place governing inheritance and representing the needs of OVC. Officers
who may want to take up particular issues of inheritance with the relevant authorities feel
that there is no legal authority that can be used to protect them if families threaten them.
Lack of understanding of the programme by some community members: Some families in
the community take it for granted that they only need to register orphans if the orphans
in turn receive the food basket. In the case of well-off families that do not need the food
basket, families do not register their orphans, yet this is important for statistical purposes.
The department responsible for the registration of orphans continually engages in
dialogue with community members to encourage them to register all orphans, even when

they do not need the food basket.
Stigma: Regardless of how long HIV/AIDS has been in existence and how much
education has been done, stigma continues to be one of the main challenges that
handicaps progress. The community needs more education on issues of HIV/AIDS, to try
and decrease the extent to which people are stigmatised.
Transport: Shortage of transport limits the success and the expansion of the programme.
Some areas cannot be reached by officials using available cars, due to the poor road
conditions.
Ministry of Health
Palapye has one primary hospital, namely Palapye Primary hospital, and four clinics,
namely Kediretswe, Extension 3, Lotsane and Khurumela. All these health facilities
are supported through government structures. There is a referral hospital based in

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Francistown, which is two hours drive north of Palapye. The Ministry of Health and the
Ministry of Local Government administer the health systems and services. The Ministry
of Health is responsible for all hospitals (district and referral) while the Ministry of Local
Government is responsible for all the mobile posts, health posts and clinics. Healthcare
services are subsidised for all citizens. This includes the provision of antiretroviral drugs
for both adults and children, immunisation for all children and a feeding scheme for
malnourished children. The fact that there are mobile posts, health posts, clinics, district,
and referral hospitals makes healthcare fairly accessible throughout the country. The main
challenges in healthcare are staff shortages, especially nurses and doctors, and in some
cases access is a serious obstacle.
Botswana has two referral hospitals, with one in Francistown to cater for the needs of
the people in the northern part of the country (including Palapye), and one in Gaborone

catering for the needs of people in the southern part of the country. If, for example, a
child in Palapye needs specialised care and the case is not an emergency, the family is
expected to meet transport costs to take the child to Francistown. In cases where a family
is not able to meet such transport costs, the Ministry of Health has a system for awarding
transport warrants to families needing assistance. Families that are not aware that they can
receive such assistance often end up not taking their children for medical follow-up.
Residents of Palapye, both adults and children, access the antiretroviral therapy
programme from Sekgoma Memorial hospital, which is 45 kilometres from Palapye,
and from the Mahalapye hospital, 60 kilometres south of Palapye. Serowe was one of
the first four sites in the country to provide access to the national antiretroviral therapy
programme in January 2002, while the Mahalapye site started operating one and half
years later. Availability of public transport between Serowe, Palapye and Mahalapye is
excellent in the sense that there are buses leaving each area every 30 minutes. According
to the Masa1 antiretroviral programme, by the end of March 2004, there were 26 603
patients with CD4 cell counts less than 200 and/or AIDS defining illnesses. Of these,
14 400 patients were already on treatment, and 1 784 were treated in Serowe (there is
no specific information for Palapye alone, or for children).

NGO, FBO and CBO services
Home-based care
Home-based care volunteers care for orphans and vulnerable children, as well as those
who are ill. They care for orphans and vulnerable children in partnership with other
NGOs, CBOs, FBOs and government programmes. These caregivers work very closely
with the government orphan care programme and they assist with the identification of
orphans and provide psychosocial support to them. One of the strengths of the orphan
care programme, as identified by the caregivers, is the supply and availability of food,
which is always provided on time. However, items such as seasonal clothes take a long
time to reach those concerned, so that winter supplies for example may arrive after the
season. The caregivers identified the main needs of orphans as love, food, clothing,
shelter and protection from abuse.

Aside from the government’s involvement, some community members are supportive
towards those affected as well as towards the home-based care programme, and
hence the programme gets volunteers. The main problem that the volunteers face is
1

Masa means ‘new dawn’ in Setswana.

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transportation. There is a critical shortage of transport despite the fact that Palapye is a
big village. Lack of transportation limits the number of volunteers.
Most home-based caregivers have no knowledge of the HIV/AIDS policy. Even though
there is a Botswana national HIV/AIDS policy, it seems it is not integrated into either
the training or orientation for home-based care volunteers. As a result of this oversight,
the caregivers are not aware of the policy that is supposed to be guiding their actions.
However, they are aware of the antiretroviral (ARV) treatment programme and they
encourage their clients to test and enrol with the programme as and when appropriate.
The home-based care volunteers are aware of the programme and work with healthcare
professionals and communities in teaching people about the programme, as well as
making referrals.

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Itsoseng Banana
Itsoseng Banana is a voluntary youth organisation that started caring for OVC long before
the establishment of the House of Hope day care centre. Some of the other projects
that they started were poultry and gardening projects. These projects have not been as
successful as anticipated, due to financial constraints.
At the time of volunteering to care for orphans, Itsoseng Banana had discovered that

some children in the village stayed with their aging grandparents. Unfortunately, some of
these grandparents were visually challenged and could not provide adequate care. This
group therefore saw the need to establish a daycare centre, and so House of Hope was
born. Itsoseng Banana supports the building of orphanages, as they have realised that
most children are without proper care in the homes where they live. Once orphanages
are established, they will encourage home-based caregivers to assist at these centres.
Itsoseng Banana volunteers claimed not to have enough knowledge about HIV/AIDS, but
recognised that HIV/AIDS prevalence in the community is high. In response, they have
joined the HIV/AIDS fight through educating the community through song and drama.
Their activities are held in drinking bars and other public places. The main challenge to
what they do is transport, which they need to be able to visit different public places in
the community.
House of Hope
House of Hope was started in 1999 as a day-care centre for orphaned children. The
centre is currently housed in a building that can house 150–200 children. These numbers
are considered small, considering the current demand. House of Hope works very closely
with the Social and Community Development Social Workers. The social workers refer
OVC aged between 3–6 years to the centre. The centre also gets referrals through the
home-based care volunteers.
The centre has admitted children who come from both child- and grandparent-headed
households. As more and more grandparents die, the care of these OVC automatically
transfers to aunts and other living relatives. In some cases, aunts are burdened with
orphans from more than one household. Initially, caregivers were reluctant to take
their children to the centre, due to stigma associated with HIV/AIDS: some staff were
perceived to be HIV positive. This problem has now been addressed and the result has
been an influx of children, forcing the centre to introduce a process of screening.

18

House of Hope has received support from other governmental and non-governmental
organisations, as well as from the community of Palapye at large. The support has taken
the form of approval to set it up, and contributions of many kinds, including financial, to
assist in the day-to-day running of the place. Government has provided funding support
in the past but there is no guarantee that this support will come every year.
House of Hope faces a number of challenges. Some care-givers leave the responsibility
of caring for children entirely to the centre, and do not execute parental duties as and
when necessary, for example in cases of medical follow-up. Some children do not receive
adequate care from care-givers. The centre is faced with the challenge of referring such
children to social workers for appropriate placement. Some community members do not
understand the role of the centre, stigmatising people working at the centre as being
HIV-positive. The greatest challenges for House of Hope are staff shortages and financial
constraints.

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Total Community Mobilization programme
The Botswana National AIDS Coordinating Agency (NACA) and Humana People to People
(an international NGO working in the field of international development and cooperation)
started the Total Community Mobilization (TCM) programme in January 2001. The
programme started in Palapye in October 2001 and since then has been scaled up to
different parts of the country. Palapye was one of the areas that were targeted, especially
when the antiretroviral drug programme started.
The field officers visit, give lessons and provide information on HIV/AIDS to people in
the community. The TCM fieldworkers visit households more than once and assist people
to make decisions on safer sexual behavior, Voluntary Counselling and Testing (VCT),
the use of antiretroviral drugs (ARV), Prevention of Mother to Child Transmission of HIV
(PMTCT) and positive living.
In relation to orphans and vulnerable children, TCM assists with the identification of
orphans, referrals to the Social Welfare Department for registration, as well as providing

psychosocial support through counselling.
One of the major challenges in relation to orphan care has to do with being able to
identify orphans, especially those in need of care. It is also difficult to identify vulnerable
children and refer them for services, as most of them live on the streets and following
them up is not easy. It is also not easy to identify the needs of OVC, as these vary from
food to love, clothing, security, shelter, education and information. The field officers
realise that in some cases, the children’s rights are violated and the challenge for them is
in being able to know how to advocate for these children.
Churches
The church is also actively involved in the care of OVC. There were many churches
offering different community services. There were two churches that specifically had
programmes related to OVC, namely Bible Life and Divine Firm Foundation of Life
Healing. The services that the churches offer include feeding, recreation, rehabilitation,
counselling, transportation, and bible-sharing services. Divine Firm Foundation of Life
Healing church mentioned that it has a youth impact training programme, where youth
are trained to offer care and support to the elderly and underprivileged. Bible Life is
able to reach 60 OVC per month, providing them with food, counselling and transport.

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