BENUE STATE OFFICE
Dr. Kelechi Ngwoke
Head of Office APIN Benue State
APIN iCARES PROJECT: ENHANCING THE LIVES OF ORPHANS AND VULNERABLE CHILDREN (OVC) IN BENUE STATE.
Globally, Orphans and Vulnerable Children (OVC) are faced with a myriad of challenges ranging from hunger, exploitation, homelessness/displacement, physical, emotional and sexual abuse, school drop-out, child labour/trafficking and in some instances dehumanizing experiences. Of the estimated 17.5 million OVC in Nigeria, children infected and affected by HIV and AIDS or those who have lost one or both parents to HIV & AIDS are worst hit by these daunting challenges.
These children and their households face stigma and discrimination, health issues for HIV infected children, lack of access to basic necessities of life such as adequate food, clothing, shelter, education, protection, health services etc as a result of the loss of the breadwinners and societal perception of the HIV epidemic.
PEPFAR/ ICARES OVC INTERVENTIONS IN BENUE STATE
In response to the aforementioned and to mitigate the impact of HIV and AIDS to Vulnerable Children, the PEPFAR funded OVC program implemented under the Improving Comprehensive AIDS Response Enhanced for Sustainability (iCARES) Project – a facility and community based focused project, was designed to respond to and provide need based interventions to vulnerable households/beneficiaries.
In line with PEPFAR enrolment streams, the OVC Program is aimed at closing the existing gaps highlighted above and ensuring that HIV infected and affected children/households, HIV exposed infants, exploited adolescents at risk of HIV and children of Key Populations are targeted, enrolled into the OVC program and provided services to cushion the impact of HIV and AIDS, ensure adherence and retention in treatment programs and reduce their vulnerability. This is expected to ultimately contribute to the attainment of UNAIDS 90-90-90 goal and towards achieving epidemic control. In addition to attaining epidemic control, the services provided to these categories of OVC were proactively tailored towards improving their wellbeing, reducing disparities and systemic barriers and building their resilience to be able to cater for their basic needs.
To attain the overarching goal of the OVC program which is to ensure that beneficiaries are healthy, schooled, safe and stable, APIN engaged and partnered with 27 Civil Society Organizations (CSOs) in both Priority and Sustained Response LGAs in Benue State. The CSOs are AHP, ADDS, AGCOD, Caritas, CAGHADO, CLAP, CCRHSD, CLHEI, ECJP, EFFH, ETMLF, FSACI, GLOHAD, GDHCI, HCF, HIC/IHP, IHSD, ICDO, Jaspi-HGD, MIED, NHA, OsaFo, Otabo Caregivers, PHMI, SOWCHAN, SPRAD and WOCHAD.
The core services provided on the program through the CSO Partners include Education, Health, Psychosocial Support, Household Economic Strengthening (HES), Nutrition and food security, Protection (Child, Legal and Social Protection), Shelter and care, HIV Prevention, Life Skills and empowerment initiatives for Adolescents (Adolescent Girls and Young Women) in line with the National guidelines and the new PEPFAR OVC technical guidance. These services were provided both directly and through referrals and linkages to wrap-around services such as child welfare centres, agricultural/food schemes, and community health programs.
COMMUNITY AND STAKEHOLDERS ENGAGEMENT
APIN conducted community mapping to identify community structures, gatekeepers and Health Facilities utilized to enrol vulnerable children in line with PEPFAR approved enrolment streams. Advocacy and stakeholder engagement/sensitization meetings were held with critical stakeholders across supported LGAs. The engagement of these community gatekeepers and key opinion leaders (drawn from Government, Religious, Community/Traditional institutions and Health Facilities for referral and linkage of beneficiaries) was aimed at creating enabling environment, garner support and engender ownership of community based OVC program efforts.
CSO ENGAGEMENT AND CAPACITY BUILDING ACTIVITIES
Having signed contractual agreements with CSOs, APIN conducted start up meetings with these organizations which provided orientation on the Project goals, Scope of Work, targets and expected deliverables. APIN also assessed organizational and programming capacity of the CSOs, facilitated series of capacity building activities on core OVC thematic areas, provided SOPs and OVC guidance documents and the needed tools for documentation of program outcomes. With APIN’s presence in all LGAs of implementation, on-going real time on the job mentorship, monitoring and supervision are conducted to ensure quality interventions, documentation and entry into the NOMIS platform. The under listed trainings were conducted for staff and volunteers of all partner organizations.
- Comprehensive OVC training for CSO staff and Community Volunteers.
- OVC Case Management Training.
- Household Economic Strengthening Training.
- Psychosocial Support training.
- Better Parenting training.
SUMMARY ACHIEVEMENT IN CORE SERVICE AREAS
From inception of the iCARES project in Benue State, 281, 098 beneficiaries (children and caregivers) have been provided need-based services using the child focused and household-centred approach in line with the national guidelines, and the new PEPFAR OVC technical guidance. Below are summary and pictorials depicting achievement in core service areas.
ICARES provides a range of health support services to ensure the wellbeing and health of caregivers and children enrolled on the project. At the heart of health services is HIV prevention care and support services. These include HIV testing services, access to HIV treatment services including escort and accompaniment, adherence counseling and screening and referral for STIs and treatment of other opportunitic infections.
The project also provides reproductive health education targeting adolescents, health education and other preventive services including WASH.
The project provides nutritional support services which includes nutrition assessment, education and counselling support, growth monitoring, referral for management of undernourished children, training of caregivers on healthy food combinations and how to prepare them (food demonstration), infant and young child feeding interventions and the provision of food supplements to support undernourished children.
Educational support services were also provided to beneficiaries enrolled targeting children 0-17 years. ECDs in some communities’ also target children under 5 for early child stimulation. As a key strategy, block grants interventions were provided as substitute for school fees waivers and ensure retention in school. Education materials were also provided to schools as support. In the implementation of this program, there was great emphasis placed on the education of the girl child. Education performance assessments were conducted to monitor school attendance and progression.
PSYCHOSOCIAL SUPPORT SERVICES
The project has trained CSO staff, community volunteers and caregivers to provide psychosocial support that help both caregivers and their children to meet their emotional, mental and spiritual needs, both onsite and through referrals. Group activities such as kids and adolescent clubs are also organized for children and adolescents, taking into cognizance their ages. These activities are part of the case management approach to holistic care for vulnerable children.
The project strategy is to provide a range of child protection services, integrating community structures that are preventive and support children who are abused, at risk of violence, exploited or neglected. A key part of the child protection services is to ensure all children have a birth registration as the first and basic form of identify. Caregivers are also sensitized on the importance of birth registration and prompt reporting of child protection concerns.
SHELTER AND CARE
Through the resource mobilization efforts of CSOs in the communities, household items including clothing were secured for beneficiaries in dire need. Damaged roofs of beneficiaries were repaired; street children were re-integrated into their households for proper care by adult caregivers.
HOUSEHOLD ECONOMIC STRENGTHENING
iCARES Project provides a mix of Household Economic Strengthening services to enrolled beneficiaries. These interventions are aimed at facilitating the economic and financial empowerment of the beneficiaries. The services included the formation of savings groups, Cash Transfer, Vocational Training Acquisition and financial education.
CSOs commemorated the 16 days of gender activism across the project LGAs. They also conducted of community advocacy and mobilization to change harmful norms during community stakeholders/ leader’s forum and child protection committee meetings. During caregiver’s forum, adolescent clubs, kids club, caregivers sensitized on gender-related issues in their communities. Implications of harmful practices highlighted through drama and experience sharing by participants themselves.
The 10-hour gender norm interventions implemented across targeted LGAs continued with caregivers participating in gender norms sessions. Caregivers encouraged to provide equal opportunities for all children regardless of their sex.
ADOLESCENT GIRLS AND YOUNG WOMEN INTERVENTIONS
Adolescent’s forum and home visits were used as platforms to provide age appropriate HIV and Reproductive Health information including basic information on HIV transmission and prevention, sexual and reproductive health education by trained peer educators. One-on-one counselling sessions with adolescents with specific issues not addressed during the general session. Life skills such as negotiating skill, decision-making skills, refusal skills, time management skills, goal setting and assertive skills provided to the adolescent to help them cope with peer pressure.
APIN is engaging with relevant stakeholders within the community to establish youth friendly groups and camp meetings for teenagers to promote access to economic empowerment program, sexual and reproductive health services including HIV prevention/risk reduction and teenage pregnancy prevention.
NOMIS NATIONAL OVC MANAGEMENT INFORMATION SYSTEMS
CSO CIVIL SOCIETY ORGANIZATION
OVC ORPHANS AND VULNERABLE CHILDREN
HES HOUSEHOLD ECONOMIC STRENGTHENING
PSS PSYCHOSOCIAL SUPPORT
ECD EARLY CHILDHOOD DEVELOPMENT
ICARES IMPROVING COMPREHENSIVE AIDS RESPONSE ENHANCED FOR SUSTAINABILITY
AGYW ADOLESCENT GIRLS AND YOUNG WOMEN
IYCF INFANT & YOUNG CHILD FEEDING
CPC CHILD PROTECTION COMMITTEE
CPN CHILD PROTECTION NETWORK
NPoPC NATIONAL POPULATION COMMISSION
NDE NATIONAL DIRECTORATE OF EMPLOYMENT
N-POWER A YOUTH EMPOWERMENT SCHEME OF THE FEDERAL GOVERNMENT OF NIGERIA.
WRAPA WOMENS RIGHTS ADVANCEMENT AND PROTECTION ALTERNATIVE
FIDA INTERNATIONAL FEDERATION OF WOMEN LAWYERS
SMWASD STATE MINISTRY OF WOMEN AFFAIRS AND SOCIAL DEVELOPMENT
WASH WATER, SANITATION AND HYGIENE
STI SEXUALLY TRANSMITTED DISEASES
HIV HUMAN IMMUNODEFICIENCY VIRUS
AIDS ACQUIRED IMMUNE DEFICIENCY SYNDROME
CDC CENTER FOR DISEASE CONTROL AND PREVENTION
PEPFAR THE US PRESEDENT’S EMERGENCEY PLAN FOR AIDS RELIEF
LIST OF CSO PARTNERS
Community Life Advancement Project (CLAP)
CARITAS -Justice Development and Peace Commission, (JDPC) Gboko
Ecumenical Center for Justice & Peace (ECJP)
Gboko Diocesan Health Care initiative(GDHCI)Gboko
Society for Women and Children living with HIV/AIDS IN Nig (SOWCHAN)
Global Health & Development Initiative (GLOHAD)
Women Children Health and Community Development(WOCHAD)
Health Information Center (HIC)
Efa Eying Foundation for HIV/AIDS
Association for Grassroot Counsellors on Health and Development (AGCOD)
Society for the Preservation and Restoration of Women Honour & Dignity (SPRAD)
Emmanuel Teryila Memorial Liberty Foundation (ETMLF)
Initiative for Health & Social Development (IHSD)
Mimidoo Initiative for Empowerment and Development (MIED)
Hope and Care foundation (HCF)
African Health Project (AHP)
First Step Action for Children Initiative
New Hope Agency (NHA)
Anglican Diocesan Development Society (ADDS)
Foundation for Justice Development and Peace Commission, (FJDPC) Katsina Ala
Community Links & Human Empowerment Initiative (CLEI)
Positive Health Media Initiative (PHMI)
JASPI Health and Gender Initiative (JASPI-HGI)
Ipole Community Development Organization (ICDO)
Catholic Action Group on HIV/AIDS, Diocese of Otukpo (CAGHADO)
Center for Community Resources, Health and Social Development (CCRHSD)
EMR Implementation in Benue State:
Drawing from our over 10 years’ experience of deploying locally managed EMR set up with unique identifiers at over 40 comprehensive ART sites in 9 states of Nigeria, APIN deployed EMR to 270 APIN supported facilities in Benue State within the first year of iCARES project. A total of 143,617 active patients were on-boarded on National Data Repository (NDR) platform through the EMR. The roll-out of the EMR is supported via IT infrastructural donated with support from CDC.
Data room at FMC, Makurdi
Data room at Bishop Murray Medical Centre, Makurdi
Facility Health Informatics staff capturing patient’s biometrics
REMODELLING OF PCR LAB & GENEXPERT LABORATORIES
Achieving the UNAIDS 90: 90: 90 target require a viral load informed care to ensure optimal HIV clinical follow up and resistance monitoring which will in turn require significant mobilization of resources. However, early detection of treatment failure, adherence counseling and appropriate switching to second line therapy are key strength of a viral load monitored model. Thus investing and ensuring sustainability of a viral load informed care and monitoring model must be a priority. To this end, the remodeling and physical structure upgrade of the FMC PCR laboratory to a MEGA PCR laboratory is very essential to meet with the volume of work and ensuring the maintenance of standard PCR Laboratory.
The remodeling and physical upgrade of the FMC PCR laboratory into a MEGA PCR Laboratory by APIN Public Health Initiatives with funding support from CDC and in close collaboration with the hospital management to ensure sustainability and maintenance of the upgraded structure is aimed at improving access into achieving the 3rd 90 of UNAIDS target. The remodeling or upgrade clearly indicate the three distinct area in a standard PCR laboratory setting: Specimen preparation occurs in the first area, reagent preparation and PCR set-up in the second area, and amplification and detection in the third area.
The aged equipment were also replaced with a new equipment for faster sample turnaround time, better integration and lower maintenance cost. Summarily, viral load measurement is a critical tool to assess the impact of HIV treatment efforts.
With the advent of HIV/AIDS in Nigeria, TB has increasingly been posed as a challenge in the public health system in most resource limited country like Nigeria. Detection of acid-fast bacilli (AFB) by smear microscopy is a fast and cheap test for TB diagnosis, but it has low sensitivity and positive predictive value (PPV). Rapid diagnosis and detection of rifampicin (RIF) resistance is necessary for TB control, as transmission and emergence of multi-drug resistant tuberculosis (MDR-TB) cause serious health problems.
GeneXpert MTB/RIF was approved by the WHO in 2011 and recommended for diagnosis of TB in developing and high prevalence countries. GeneXpert MTB/RIF is a real time PCR (RT-PCR)-based molecular assay that amplifies a specific sequence of ‘rpoB’ gene in Mycobacterium tuberculosis (MTB) and detects ‘RIF’ resistance mutations as a marker for MDR-TB. The sensitivity of GX is closely related to the bacilli concentration in the specimen, and subsequently depends on sputum smear status. Some validation studies in adults described GX as a rapid, sensitive, and specific test for TB diagnosis and detection of RIF resistance. GeneXpert MTB/RIF could detect MTB in all smear-positive clinical samples and approximately 75% of smear-negative samples.
APIN Public Health Initiatives with the support of her funder – CDC is supporting 22 GeneXpert sites across 14 LGAs of the 23 LGAs of Benue state with each sites having 3.5KVA inverter batteries to support power supply and 1.0 & 1.5KVA air condition for effective functioning of the equipment; 10 supported facilities of the 22 sites/facilities also have solar power installed to support power supply at the sites/facilities.
Adolescent and Youth Friendly Program:
APIN supports 9 Adolescent and Youth Friendly Centers in Benue states- Logo (4), Tarka (2), Gwer West (2) and Otukpo (1). All centers are well equipped with computers and internet facilities and skill building equipment. They serve as centers where youth will get messages on adolescent reproductive health and HIV/AIDS, know their status and if positive linked to treatment.