Tanzania | Bagamoyo Most Vulnerable Children Demonstration Collaborative
To improve the quality of services provided for orphans and vulnerable children in the Bagamoyo district of the Pwani region.
Before the initiation of this improvement collaborative, HCI had been working with the Department of Social Welfare (DSW) to make quality improvement one of the key programmatic areas of the Most Vulnerable Children program. In 2010, HCI assisted the DSW to finalize the QI Facilitator’s package and the QI team documentation tool for monitoring improvement processes at the community level. This training package has now been endorsed by the MOHSW. Together with the DSW and MEASURE Evaluation, HCI trained a total of 39 National facilitators from MOHSW and implementing partners: FHI/TUNAJALI, PACT Tanzania, Save the Children, Catholic Relief Services, Tanzania Red Cross Society, Walter Reed/Department of Defense (DOD), Africare, Salvation Army, World Religions for Peace (WRP), and Pathfinder International. The national facilitators and IPs working with vulnerable children are now able to communicate the QI guideline and standards for services provided to vulnerable children to various levels and use them as tools for planning and implementing MVC activities. HCI also worked with stakeholders to develop a draft QI job aid to provide direct service providers with reference materials, guidance in providing and tracking quality services to vulnerable children and their families.
To ensure vulnerable children have access to adequate, quality food and nutrition services, teams are testing the following changes: having most vulnerable children committee (QI teams) members conduct home visits, updating registers for vulnerable children, and preparing lists of vulnerable households which need food support; QI teams are mobilizing FBOs and community members to support vulnerable households with food; writing letters to request village authorities to provide pieces of land; and QI teams are involving Agriculture and nutrition extension workers in these efforts. To ensure vulnerable children have adequate and safe shelter, teams are verifying homes that need renovation and sensitizing community and family members to contribute resources for home renovations. To ensure adequate protection and prevent abuse of vulnerable children, teams are mapping vulnerable children without birth certificates; collecting and compiling necessary demographic data required for each child; teams presented estimates of resource requirements (passports photos, etc.) to village councils and are conducting community sensitization on the importance of birth certificates; teams submit MVC demographic information and pay required fee to district authority; sensitizing community members on issues related to abuse, neglect, discrimination and exploitation. To ensure all vulnerable children have access to medical services, teams mapped out MVC who are above 5 years of age; prepared and shared demographic information of vulnerable children with different stakeholders; mobilized resources at the community level to obtain child health funds and ITNs; and submitted demographic information and pay required fee to Health facilities. To ensure all vulnerable children have access to education services, teams have identified all vulnerable children who are eligible for school enrollment (primary, secondary and vocational training) and shared this information with different stakeholders; mobilized resources to support school attendance for vulnerable children; and followed up with vulnerable children enrolled in school in order to monitor their progress. To ensure all vulnerable children and their households have access to economic strengthening teams have conducted home visits to identify households that need economic strengthening and have linked households with stakeholders and programs involved in economic strengthening.
Teams track the following indicators monthly to determine improvement in the areas of nutrition, shelter, protection, health care, education, and household economic strengthening: percentage of most vulnerable children who get two or more meals a day; percentage of most vulnerable children ages 0-5 whose health cards/charts reflect normal growth for age; percentage of most vulnerable children household living in secure, dry and adequate shelter; percentage of most vulnerable children who have birth certificates; percentage of most vulnerable children reported to be abused in the last month; percentage of most vulnerable children who are sleeping under insecticide-treated mosquito nets; percentage of most vulnerable children who were sick and referred to a health facility; percentage of most vulnerable children above 5 years with community health fund cards; percentage of most vulnerable children in the program who are attending school regularly; and percentage of most vulnerable children’s caregivers who are able to meet their household’s basic needs as a result of economic strengthening interventions.
This collaborative was initially implemented in three wards out of 22 in Bagamoyo. These three wards are: Dunda (an urban setting with approximately 211 vulnerable children), Kiwangwa (a semi-urban setting with approximately 1554 vulnerable children) and Fukayosi (a rural setting with approximately 98 vulnerable children) were selected after the discussion with the Bagamoyo council authorities regarding the initiation of the collaborative. The criteria for selecting demonstration sites was based on the existing number of vulnerable children enrolled in registers and the geographical location of the wards (urban, semi urban and rural). In November 2011, the collaborative was scaled up to six new wards and by April 2012 the remaining 13 wards were involved.
The objective for coaching is to strengthen the capacity of most vulnerable children committees in implementing priority and essential actions. Coaching visits to teams were scheduled to be conducted after four or five weeks after each learning session and subsequently other two coaching in after 5 weeks from previous coaching. The first coaching was held in June 2011 whereby coaches at national, regional, district and ward levels visited teams to assess the functionality of these committees and provide support on identified quality gaps; review collected data on desired outcomes and essential actions implemented by most vulnerable children committees; assess quality of data collected for each priority essential action; and to review the ability of QI teams on carrying out system and process analysis in supporting vulnerable children.
Due to time and resources, two to three QI teams are meeting together during which, coaches have an opportunity to listen to teams’ achievements and challenges in implementing essential actions and QI action plans. Following that coaches are able to provide clarification, guidance and enlighten members on various policies, guidelines, programs and stakeholders whom are potential for addressing identified challenges and gaps.
Coaches also facilitate QI teams to interpret and utilize data for decision making. The national and regional coaches have a main role of equipping QI teams, district and ward coaches on policy guidance related to care, support and protection for MVC, and updating on the current national issues related to programming for vulnerable children. District coaches provide immediate technical support to QI teams by visiting and phone calling and to provide general guidance from the council in providing care and support for vulnerable children; also linking and referring QI team members to different stakeholders.
The first learning session was held in April 2011, for each ward, the objectives were: to build the capacity of QIT to be able to communicate and implement the National Guidelines for Improving Quality of Care, Support, and Protection for most vulnerable children in Tanzania; To discuss the roles and responsibilities of stakeholders involved in providing quality services to vulnerable children; To facilitate QI teams to be able to recognize and use the Essential Actions, Desired outcomes and the key principles of quality most vulnerable children services as outlined in the National QI Guidelines; to equip QI teams to organize and work together to improve services for vulnerable children; and to track and record improvement changes in services for vulnerable children.
At the second learning session which was held in November 2011, for each ward, the QI teams presented the results from changes implemented since the previous learning session and shared successful changes, challenges, and priorities. The objectives of the second learning session were: to engage QI teams in analyzing and implementing actions for change; to build the capacity of ward and district Coaches in providing regular TA to QI teams; and facilitate QI teams to share challenges and successes in aligning with their QI Action priorities. Teams were able to learn from each other ways of implementing and achieving changes as successes from one team motivated other teams to work hard.
While the activities are still underway, a number of improvements have already been seen. The percentage of children who receive two meals a day has increased from 62% at baseline in May 2011 to 100% in February 2012. The percentage of vulnerable children staying in proper shelter increased from 43% to 89%. At baseline, only 6% of vulnerable children in Dunda had birth certificates and in Kiwangwa, none had them. This has since increased to 45%. In August 2011, no vulnerable children had child health funds and by February 2012, 41% did. Access to and attendance in school and vocational training for vulnerable children was 76% at baseline in May 2011, and increased to 98% in February 2012.
It has been noted that before the implementation of the service standards, implementation of services for vulnerable children was fragmented. Since this activity began, teams have increased their coordination with stakeholders to provide services to children according to their priority needs. Community involvement and education has been crucial to the success of this activity as communities play a role in decision-making for vulnerable children. Their active involvement also supports sustainability of improvements achieved.