AN ANALYSIS OF A COMMUNITY-

BASED CHILDREN’S CENTER IN

SOUTHERN KENYA

by

Jason Paltzer

A Master’s paper submitted in

partial fulfillment of the
requirements for the degree of

Master’s of Public Health

University of Minnesota – School

of Public Health

2003
 University of Minnesota

Executive Summary

An Analysis of a Community-Based Children’s Center in

Southern Kenya
by Jason Paltzer

Chairperson of the Supervisory Committee:Professor Dr. Leslie Lytle

Department of Epidemiology

The AIDS epidemic has resulted in a mass influx of orphans especially in Sub Sahara
Africa. Of the 13 million children displaced because of AIDS, 95% are in Sub Sahara
Africa. This places a heavy burden on the extended families with the majority of the deaths
taking place among the productive 15-49 year old population. The stigma of AIDS places
an added burden on these children and their ability to care for themselves. Kenya is among
the highest orphan populated country with the number over 1 million. With these numbers,
it is unrealistic to expect orphanages or the traditional family safety nets to absorb the
increase of these displaced children. The goal of this study was to identify the practicalities
of community-based children centers in southern Kenya and their successes in assisting
orphans and communities. Community-based centers are meant to provide the community
with the resources and knowledge to be able to take in and adopt these children as their own
thus aiding in comprehensive community development versus just child development
through orphanages. Using qualitative research methods, the Makindu Children’s Center
(MCC) in Makindu, Kenya was examined and compared with neighboring orphanages and
other community outreach programs. Twenty-nine key informant interviews were
conducted with Program Directors, Community Members, MCC Board of Directors, and
Past Volunteers of MCC. Key elements of success, challenges and barriers, and future steps
of development of a community-based children’s center were extracted from the interviews
using qualitative data analysis. Key elements include active community involvement,
leadership, and participation in the program at its conception; keeping the children in the
community and with guardians; a director with a heart for the children and commitment to
working with them; keeping the program grassroots resulting in decreased cost, increased
community involvement, and the possibility of local control; and lastly, supplying primary
education to the children through the local schools. Challenges and barriers include
increased community development, communication with Board of Directors in the U.S.,
stable funding base, AIDS prevention, and equality of children at the center and in the
village. Future steps resemble the collaboration of the first two categories: continued
community involvement and development, replication of program, building up current
children at the center, retaining basic needs and necessities for the children and community,
and continued AIDS prevention and education.
 TABLE OF CONTENTS

I. Introduction.....................................................................5
II. Background
a. Affect of AIDS and Its Numbers
1. AIDS in the World, Africa, Kenya...................7
2. AIDS in the Community................................8
b. Cultural Factors and Human Rights of Children in Kenya
1. Education of Orphans in Kenya....................9
2. Government Response and Inheritance Rights
11
c. Affect of Orphans on Communities
1. Traditional Safety Net Being Broken...........12
2. Crime and Prostitution................................13
d. Community-Based Solutions for AIDS Orphans
1. Successful Projects in Sub Sahara Africa....14
2. Community-Based Programs in Kenya.......14
3. Recommendations by UNAIDS....................15
e. Models of Orphan Centers in Africa and Kenya. . .16
II. Methods and Materials
a.....................................Identifying a Project in Kenya
.................................................................................19
b..............................................................Goal of Study
.................................................................................20
c..............................................................Study Design
.................................................................................20
d...........................................................Data Collection
.................................................................................22
e..............................................................Data Analysis
.................................................................................23
III. Results..........................................................................25
a...............................Infrastructure and Design of MCC
.................................................................................26
b........................................................The Start of MCC
.................................................................................27
c..............................................Function and Operation
.................................................................................30
1...........................................Program Operations
..........................................................................31
2.................................................Program Director
..........................................................................33
3...............................................Board of Directors
..........................................................................34

3
 4................................................Program Manager
..........................................................................34
5...........................................................Volunteers
..........................................................................35
c.........Key Elements of a Successful Children’s Center
.................................................................................35
1. Local Community Development......................36
2. Low Cost and Minimal Resources....................37
3. Education........................................................37
4. A Heart for Children........................................38
d..............................................Challenges and Barriers
.................................................................................38
1. Community Involvement.................................39
2. Communication...............................................39
3. Funding...........................................................40
4. AIDS................................................................40
5. Elitism.............................................................41
e.........................................Future Steps and Solutions
.................................................................................42
1. Community Involvement and Development....42
2. Replication of Program....................................43
3. Sustaining Current Children............................43
4. Developing Board of Directors........................43
5. Retaining Basic Needs and Resources.............44
6. AIDS Prevention and Education.......................44
IV. Discussion
a..................................................................Limitations
.................................................................................46
b.............Key Elements of MCC and Community-Based
Organizations...........................................................45
1..................................Local Leadership and Trust
..........................................................................46
2.................................................Grassroots Focus
..........................................................................47
3..................................Funding and Sustainability
..........................................................................49
4........................Keeping the Community Involved
..........................................................................49
5...............................Equality and Child Protection
..........................................................................50
c.Community-Based Organizations Versus Orphanages
1.. .Strengths of a Community-Based Organization
..........................................................................53
2.Weaknesses of a Community-Based Organization
..........................................................................54

4
 3.. .Summary of a Community-Based Organization
..........................................................................55
d................Future Steps and Development of Program
.................................................................................56
e....................................Global AIDS Orphan Programs
.................................................................................58
V. Conclusion and Implications for Research.....................60
VI. Appendix A 62
VII. References...................................................................64

5
 INTRODUCTION
“Ignorance is the crucial reason the epidemic has run out of control. They don’t
think it applies to them and their vague knowledge does not translate into changes
in their sexual behavior. And Africans are beset by so plentiful a roster of perils –
famine, war, the violence of desperation or ethnic hatred, the regular illness of
poverty, the changes inside mines or on the roads – that the delayed risk of AIDS
ranks low.” [1]
-McGeary, Johanna

22 million dead, 42 million infected, 1 new infection every 6 seconds. In 2000, 500,000

children died of AIDS while another 600,000 became infected. By 2010, 44 million children

will have lost one or both parents in 34 developing countries with Kenya’s numbers being 1.5

million from AIDS alone.

Table 1: The percentage of Orphans because of AIDS versus total orphans between 1990 and
2010. The percentage of Orphans because of AIDS increases from 2.9% to 73.4% of the total
orphans in Kenya. [2]

Distribution and Proportion of Non-AIDS Orphans

vs. AIDS Orphans in Kenya

2.5
Number of 2.0
1.5
orphans (in 1.0
Non-AIDS Orphans
millions) 0.5
0.0 AIDS Orphans
1990 1995 2001 2005 2010
Year

Thirteen million children displaced, 95% of these in Sub-Sahara Africa (SSA) and 890,000 in

Kenya alone. Five hundred people die every day because of AIDS in Kenya. [2-9] Among 15-

24 year olds, the prevalence rate doubles for females versus males (67% versus 33%,

respectively) [10].

6
 This tragedy is taking place in many villages, communities, and cities around the

developing world. It’s a story we are becoming familiar with but not fully understanding. The

children’s plight gets pushed aside by many local governments in Sub Sahara Africa. With the

traditional safety net of extended families breaking down, children are left unprotected by the

government, the community and also the people who love them most, their family [11]. They

are left with no education and no parents to bring them up. Instead they are forced to assume the

responsibility of mature adults at the age of 10 or even younger. The goal of this report is to

focus on the most affected and infected population of this epidemic, the youth and vulnerable

children, in one of the top ten AIDS impacted areas, Kenya. Vulnerable is defined as “those

living without the protection, care, or support of parents.” [8]. This report will describe elements

of a community-based children’s center, the Makindu Children’s Center, for vulnerable children

and orphans because of AIDS and the center’s effects on a village in rural Kenya.

7
 BACKGROUND

EFFECT OF AIDS AND ITS NUMBERS

AIDS in the World, Africa, and Kenya:

The ability of a disease to weave itself into the fabric of the community and every

country’s life is an amazing and frightening feat. AIDS has done just that despite the ongoing

efforts of health education and disease prevention strategies. Ignorance, silence, and apathy

allow AIDS to not only survive but also thrive. The numbers of AIDS cases in Sub Sahara

Africa are staggering in that over 29.4 million have AIDS with 90% of these being between the

ages of 15-49, the most productive years of an adult life [5]. Africa only holds 10% of the

world’s population yet is home to 70 % of all HIV infections [4]. About 3.5 million new

infections occurred in Sub Sahara Africa alone in 2002 despite increased efforts of HIV

prevention programs by private and volunteer organizations [4]. The new infections in Kenya

alone represent an increase of 0.4% in overall prevalence from the previous year. Three million

children in the world under age 15 are walking death sentences with HIV [5]. Approximately

220,000 children under age 15 in Kenya have the virus representing 11.4% of the 2.5 million

infections in Kenya and another 890,000 children orphaned because of AIDS [4]. This keeps

Kenya as one of the top ten HIV infected countries in the world. AIDS is one of the key

elements keeping families, communities, and children in a perpetual lifecycle of poverty. How

can this vicious cycle be stopped? How can efforts be mounted that equal the magnitude of this

epidemic and its ability to thrive?

8
Table 2: Comparison of HIV infections and number of orphans because of AIDS in the world,
Sub Sahara Africa and Kenya in 2002 [2-4, 6].

HIV HIV Infections HIV Infections AIDS

Infections age 15-49 age < 15 Orphans

World 42 million 37.8 million 3.2 million 13.2 million

Sub Sahara
Africa 29.4 million 26.5 million 2.5 million 12.5 million

Kenya 2.5 million 2.3 million 220,000 890,000

AIDS in the Community:

The children feel the effect of AIDS and the stigma it continues to carry in the

communities long before the infected parent dies. Before death, the child must care for the sick

parent and help keep them as healthy as possible. Without medication, nutrition is the only thing

available to fight off disease as long as possible. The child must drop out of school, one of the

few ways s/he is able to escape the vicious cycle of poverty, to become the main caretaker.

While at home, children work the fields or resort to prostitution for a source of any income to

purchase food for siblings and family to live. [6, 9, 11] Discrimination and resentment are felt

from other family and village members just by being associated with the disease. The parent

dies and the eldest sibling now becomes the main caretaker. The inheritance rights of the

children are rarely recognized and their house and land are taken or squatted on by family

members or neighbors right after or even before the death [8, 11]. Once homeless, the

temptation and benefits of street life become the only option left. Theft, robbery, and

prostitution become the norm; children doing whatever they must to get by day to day [3].

“The rights of children have been a missing piece of the AIDS crisis. If their
parents died in any other way, these children would have been at the top of the

9
 agenda. But because their parents died of AIDS, with all of the stigma that
implies, they’re at the bottom.” [5]
-Joanne Csete, Researcher for the Children’s Rights Division of HRW

Situations like this one have left communities with a break down in the traditional safety

net of extended family. They are no longer able, financially or emotionally, to care for their

children given their resources and knowledge. AIDS has taken away valuable life years of the

most productive members of the family leaving the elderly and young to care for each other.

Without basic education or tools to escape the streets for survival, the youth will be unable to

mend their safety nets and regain the strong family units that make African culture the surviving

force it once was. [3, 12]

CULTURAL FACTORS AND HUMAN RIGHTS OF CHILDREN IN KENYA

Education of Orphans in Kenya:

In Kenya, fifty-two percent of children with at least one parent dead are not receiving an

education while only 2% of non-orphan children are not receiving an education [2]. 1999, 4.2

million Kenyan children were out of school [5]. Education is one of the only resources available

to help these children break the cycle of poverty and discrimination. Ignorance and lack of

empowerment feed this epidemic and knowledge through education is a main target to aid

children and communities in their ability to stand on their own two feet. Young girls are

especially vulnerable to being pulled from school. They usually become the main caretakers and

work to try to send their siblings to school. This work usually ends in prostitution, a job that

keeps them suppressed and more vulnerable than before to not only AIDS, abuse, pregnancy, and

other STD’s but also the poverty than put them in this position [6].

10
 Increasing the capacity of children is one of USAID’s recommendations for “children on

the brink” [2]. This capacity encompasses basic education in schools that is also ensured by

Article 24 of the International Convention on Civil and Political Rights (ICCPR) – “Children

have the right to survival; physical, social and cultural development; health and education.” [5]

The USAID supported programs in 25 countries, including African countries that provided basic

education and focused access, quality, and equity through increased community involvement in

education, decision-making, and program planning. Higher school enrollments and lower

dropout rates were achieved as well as policy changes and provisions for local funding [8]. In

Uganda, teachers have been trained to integrate HIV education and sex behavior change

messages into curriculum. Women and youth caucuses were allowed to play an active role in the

Ugandan government and decision-making. Uganda also made school free up to 7th grade for

families with more than 4 children. This program increased enrollment in primary school from

2.9 million to 6.8 million from 1996-2000. [10] Zambia’s out of school youth broadcast of 30

minutes on health life skills messages and practical advice targets the most vulnerable youth on

the streets that do not have access to books and teachers [7, 8].

Not only is reading, writing, and arithmetic needed but also continued health and sex

education. The Kenyan national exams do not include health as part of the passing requirement,

giving schools no motivation for teaching the subject. These exams scores are needed for

national ranking that dictates the school’s prestige and national standing. This lack of education

supports a report by Human Rights Watch in which 80% of 15-19 year old feel invincible when

it comes to AIDS and that it will not infect them [5]. Without health education, these children

remain disempowered to change their sexual behavior and keep this mentality of invincibility.

The fact that more than half of the children that need health education most are not in school

11
makes it more difficult to get the information to them. This is yet another barrier to

implementing and supplying proper and appropriate knowledge to the future leaders of a nation.

Government Responses and Inheritance Rights:

The local Kenyan government has neglected the human rights of children since the

epidemic first surfaced. A number of policies have been written in support of the protection of

the youth and children but few, if any, have been observed. Kenya failed to ratify and sign the

International Labor Organization Convention Number 182 that classifies prostitution as among

the worst forms of child labor leading to “survival sex” for many young girls [5]. A number of

other articles from the Convention on Rights of the Child and Covenant of Civil and Political

Rights guarantee and protect the rights of a child from exploitation, hazardous work and

anything that interferes with or is harmful to the child’s physical, spiritual and mental health.

Kenya did ratify the International Convention on Civil and Political Rights (ICCPR) that

guarantees children the right to survival; physical, social, and cultural development; health and

education [5]. The past president of Kenya was called upon to end the “conspiracy of silence”,

the force behind the discrimination against children affected by AIDS. He passed legislation

aimed at reducing tariffs on imported condoms and cheaper, generic drugs but has done little to

protect and guarantee basic human rights to the affected and infected vulnerable children of

Kenya [5].

Inheritance rights of children are rarely granted [11]. This takes away any chance of a

sustainable source of livelihood. They are forced to look elsewhere for a home and

identification. AIDS leaves children with few surviving family members and relatives to seek

12
help in protecting their property and those that are living do not have the resources or knowledge

to help or want the property for themselves.

“Children actually face problems in the system adults don’t face. The law makes
it hard for children. They have no standing. They need someone to seek a letter
of administration on their behalf. For a letter of administration, there have to be
identification documents and birth certificates. What child will know how to
obtain a birth certificate? Sometimes by the time we obtain a letter of
administration, the movable property has already been taken away…the
mechanism that is in place, the public trustee, doesn’t do its work. The
bureaucracy takes forever-it takes years to settle a case with adults, and its worse
with children.” [5]
-Mille Odhiambo, director CRADLE, a non-governmental organization aimed at
protecting the rights of children.

EFFECT OF ORPHANS ON COMMUNITIES

Traditional Safety Net Being Broken:

AIDS is breaking the natural and traditional safety net of orphans and vulnerable

children. Extended family and community members used to be able to support the children and

give them the basic needs for survival. In Kenya, the death of the family head results in a 68%

loss in net value of farming output [6]. This safety net is tearing and unable to provide for the

mass influx of orphans being created because of AIDS (Table 1) [2]. The resources are no

longer available with the working, middle-aged men and women dying by the hundreds each

day. This leaves a loose fabric of grandparents and young children to care for each other in any

way possible. Remaining family members are being forced to place their grandchildren on the

street in hopes of an orphanage taking them in. [6]

Live-in homes and institutions are filled to the maximum, calling for a restructuring of

community-based programs.

13
 “Help for orphans should be targeted at supporting families and improving
capacity to cope, rather than setting up institutions for the children. Orphanages
may not be relevant to a long-term solution. Children sent away may lose their
rights to their parents’ land and other property as well as their sense of belonging
to a family.” [12]
-“Waking up to Devastation, UNAIDS Report, June 2000

Many youth leave their villages in hopes of finding a better life in the urban areas. Slums

abound and diseases are even more prominent in these close living quarters of the slums versus

the villages they came from. Crime is only more pervasive but the biggest downfall is the

villages are comprising more and more of elderly and children who must rely on each other and

the meager resources available for any chance at survival.

Crime and Prostitution:

Families not only feel this strain due to a break in the familial safety net but also the

community as a whole. As a result of being homeless, children look to streets for any type of

sustainability and survival [5]. Crime, theft, mugging, and rape by the boys become the way of

life while a main mode of survival for many girls is prostitution [5]. None of these behaviors

enhance a community or allow it to move forward in its battle with AIDS and poverty but bring

it further down making it that much harder to achieve any type of financial, emotional, or

physical relief. A community with a lot of street children makes it hard for businesses to come

in and make money which results in no jobs for the other community members. No jobs mean

no source of income forcing the men to travel and look elsewhere for work. Traveling opens

them up to more sexual encounters they bring back home and keep the disease spreading and

able it to continue its chaos and destruction.

14
COMMUNITY-BASED SOLUTIONS FOR AIDS ORPHANS
Successful Projects in Sub Sahara Africa:

Uganda with its comprehensive AIDS prevention movement starting in the early 90’s has

reduced its prevalence rate dramatically. Their rate dropped from 30% in 1991 to less than 10%

in 2000. [7, 10, 14] This success has come from political support with Non Governmental

Organizations (NGOs) and other private organizations, a decentralized implementation of

behavior change communication (billboards, radio, print materials and grassroots mobilization),

interventions addressing the stigma among women and youth, and mobilizing faith-based leaders

and organizations. Uganda was ahead of its time when they placed strict regulations and

guidelines on orphanages urging the communities to reunite the children with family members

with the government supporting families and communities to do so rather than building

institutions [10]. The number of children in orphanages in Uganda was 10 times less than that of

Kenya. There are 35,000 children in institutions and orphanages in Kenya representing about

0.3% of children under 15. Currently, Kenya has 64 registered and 164 unregistered orphanages

and institutions requiring a decrease of these live-in shelters to compare with the successful

programming used in Uganda [5].

Current Community-Based Programs in Kenya:

Many orphan programs remain unregistered in Kenya and make it hard to determine the

number of community-based organizations in Kenya. In Nairobi, an AIDS orphanage called

Nyumbani started a community outreach program using social workers as the main source of aid

to many families in the area with an AIDS infected orphan. The outreach program raised their

15
number of assisted orphans from 84 to over 500, the cost of which was negligible to the amount

used to run the actual orphanage. On the downside, these children who are part of the outreach

program do not receive anti-retrovirals as the live-in children but do get some food and medical

check-ups on a regular basis. This is enough for the child to be able to remain at home in a

stable environment and not have to turn to the streets. It is also helping break down the stigma

AIDS still carries in knowing that people are willing to help and assist them despite the disease.

A second program, Lalmba, located in Matoso, Kenya reaches out to nearly 1,000

orphans through their community outreach program providing education, clothes, food, and

medical care to the children and their guardians. [15]

COPHIA, a UNAIDS funded project in Kenya, used local partners, authorities,

community and religious leaders to sustain home-based care and support to persons living with

HIV. They have successfully started numerous orphans support programs, widow support

programs, and income generating activities. COPHIA is currently providing aid to 6,900

orphans through community-based practices. [16] UNAIDS also had five other community-

based funded projects in Kenya aimed at these same populations in different regions all showing

the importance and successes of community-based care and support for vulnerable children. [16]

Recommendations by UNAIDS:

In 2000, USAID’s Displaced Children and Orphan Fund benefited 365,000 children in

helping them reintegrate into their communities using partnerships with local NGOs [8]. This

alternative to institutions is using NGOs to supply the community with resources such as a

resource center, counseling, trainings on parenting, agriculture, and AIDS, as well as for business

and life-skills training for the older children. Five recommendations by the UNAIDS Committee

16
of Co-Sponsoring Organization recorded in Children on the Brink, 2002 to help HIV affected

children are as follows [2]:

1. Strengthen and support capacity of families to protect and care for their children.
2. Mobilize and strengthen community response as second safety net.
3. Target the perpetual cycle of poverty because of AIDS on orphans in that they must care
for themselves yet have no education or schooling to do so.
4. Ensure the discussion and development of appropriate governmental policies aimed at
essential services for vulnerable children.
5. Raise awareness in communities that enables support for children affected by HIV.

All of these are aimed at strengthening the traditional safety nets once used by the

communities to take care of their own orphan population. This is the long-term solution that

needs to be acted upon and utilized by more programs in Kenya. Efforts must focus strongly on

supporting families as suggested by a joint report headed by the UNAIDS:

“When solutions are weighed against the best interests of the child, it will become
even more apparent that the family remains the primary cradle of care for children
and their most cherished and valuable safety net.” [3]

MODELS OF ORPHAN CENTERS IN AFRICA AND KENYA

One type of model is the live-in, 24-hour care and monitoring of orphanages.

Orphanages do not provide a long-term solution for communities suffering under AIDS. A few

disadvantages include their high cost versus providing direct assistance to the families and

community (14 times higher than a community based program), a hard time readjusting to

society by the orphans after “graduation”, and the lack of attention and family support of the

children once they are part of the orphanage [2]. Institutions are best used as a temporary

placement for children during times of immediate crisis and the identification of more

appropriate placement. Susan Hunter and John Williamson of USAID sum up the basis for this

ideology in their statement:

17
 “It is difficult to overstate the trauma and hardships that the increase in AIDS
related morbidity and mortality has brought upon children. Denied the basic
closeness of family, children lack love, attention and affection, similar to children
living in war affected areas.” [2]
-Susan Hunter and John Williamson, USAID

Also, a report by Human Rights Watch on children in Kenya noted:

Orphanages and children’s homes run by the state and private organizations
which may in some cases be the best option for protecting children without caring
guardians, are few relative to the need for them. In addition, except the few state-
run children’s homes, the government does not provide inspection or support to
ensure that standards of care and protection are respected or oversight to ensure
an equitable process for admission of children. [9]

A second model found in Sub Sahara Africa for orphans is the set up of a crisis village

through a German organization called SOS Kinderdorf. Several house are constructed with a

“mother” in charge of each home consisting of 4-10 children. Education, meals, and medical

care are provided for them while they grow into a sharing community. SOS Kinderdorf

programs started after the end of WWII and have spread to many countries in the developing

world.

SOS Children's Villages are the main focus and point of departure for the
organisation's global activities. Every SOS Children's Village offers a permanent
home in a family-style environment to children who have lost their parents or can
no longer live with them. Four to ten boys and girls of different ages live together
with their SOS mother in a family house, and eight to fifteen SOS Children's
Village families form a village community. [17]

It is hard to replace the natural fabric that the natural family of an orphan provides to the

child, a fabric that cannot be bought through hired “mothers”.

A third type of model is a community-based model in which the children are placed

within their family units and cared for through a central resource center in the village. The

Makindu Children’s Center is of this type and is open to the children, family members and

guardians of the children throughout the day. The goal of this center is to provide orphan

18
children, birth-18+ years old, with the education, nutrition, and the environment they need for a

healthy and productive life in their communities. The uniqueness of this day-use facility lies in

its ability to keep the children integrated in their community by living with extended family and

guardians who receive extra food and practical living resources from the center so that they are

able to care for their children. This is the first step to rebuild the traditional safety nets of a

village community. AIDS and agricultural workshops are conducted for the community as well

as life skills and vocational trainings for the youth and guardians. The guardians also receive

assistance with food and healthcare to aid in their ability to care for the children. The children

attend school in the village through the aid of the center as well as have access to the local

medical clinics through the village. A major attribute to a center of this type is its ability to

empower not only the children but also the family units to realize they can help and make a

difference.

19
 METHODS AND MATERIALS

GOAL OF STUDY

The study had four goals attached to it. The first was to describe the basic infrastructure and

program design of MCC, the responsibilities of the staff and stakeholders involved with the

program. The second was to identify the practicalities and key elements of a community-based

children’s center versus other child support services. A third goal was to identify the effects,

possible successes, barriers, challenges, and future developments of MCC. The last goal was to

develop a field list of recommendations for current and future child support services in

developing counties.

STUDY DESIGN

The information was collected as part of a program evaluation for the Makindu Children’s

Center in Makindu, Kenya.

The Results section describes:

• Infrastructure and program design

• Program initiation
• Function and operation of the center
• Key Elements for success of a community-based center
• Challenges and barriers of development and sustainment of the center
• Future steps of development and solutions to barriers

My proposal called for doing interviews with key informants from three different stakeholders:

1. Board of Directors and Founders

2. Past Volunteers
3. Guardians of the children

20
 I chose not to interview children because of the vulnerable subjects clause in the

Institutional Review Board (IRB) application. Not familiar with the ways of life in Makindu,

Kenya, I was unsure if direct interviews of the guardians would be possible. Upon my arrival, I

found it would not be and had to rely on direct observations and informal conversations.

I chose to do key informant qualitative interviews versus other sources of data collection

because of the geographical location of the main stakeholders and the language barrier involved

in writing a culturally appropriate survey. According to the Program Director and Manager of

MCC, surveys are foreign and intimidating to Kenyans and not well received in Kenya

altogether. Also, given the small number of key stakeholders involved, I wanted to get as much

information from interviewees as possible with the ability to ask follow-up questions or

clarifications. This was needed given my lack of experience in developing countries and orphans

in Kenya. Only by being there could I get to the right questions and understand their answers.

Open-ended questions were asked in order to get the broadest picture of MCC and its ability to

affect a community. (See Appendix A for the list of interview questions.) Through the key

informant interviews, the beginning of the center, functions and operations of the center, key

elements and practices, challenges and barriers to achieving the key elements, and future steps of

development and sustainability of future community-based organizations were identified. These

can be used as a best practices guide for future directors and program implementers of such a

center.

Doing this type of qualitative research gave me the opportunity to find out the story

surrounding orphan centers from the people who use them and in their own culture. Qualitative

data analysis involving ethnographic research adds its own difficulties especially for an amateur

researcher. The great amount of data collected made it more difficult to extract the relevant

21
material especially given the passion and feeling the interviewees possessed and expressed in

their interviews.

A partial ethnography study was used to gain more of an understanding of the

surroundings and community-specific information needed to comprehend the challenges and

barriers to implementing a program that is culturally sensitive to the families. By living with a

Kenyan community member, social and cultural factors were learned to help recognize an

“intervention that better addresses the interests, values, concerns, and realities of community

members’ lives.” [18] Without this knowledge, it would have been more difficult to put together

the whole story of how MCC came into existence and what were the driving factors behind the

idea for a community-based center. Observing guardians and conducting home visits and school

visits for 10 weeks also gave me great insight into the cultural history and how it shapes the

values of the people in Makindu. Culture is a hidden and dynamic aspect of a community

usually staying undiscovered in research. These brief and partial ethnographical observations

made it possible to weave together individual community member perceptions with the cultural

values they live by.

DATA COLLECTION

In Makindu, I was able to interview a 4th population sample of key stakeholders, Kenyan

Community Members, ranging from business owners and doctors to chiefs and government

officials. The total interviews completed were as follows:

Board of Directors/Executive Directors 10

Program Directors 7
Community Members 7
Past Volunteers 5

22
Total 29 Key Informant Interviews

I conducted the volunteer interviews via telephone and I conducted in-person interviews

with the Board of Directors in Oregon upon my return. The past volunteers are scattered

throughout the United States making it most feasible to conduct phone interviews. The Board of

Directors live in Brownsville, Oregon and made it possible to interview them in person with one

visit. The Program Directors were found by visiting local children orphanages in Makindu and

Nairobi, Kenya. Community Members were selected on the criteria of having knowledge of

children’s centers or an affiliation with MCC.

Consent was received through interviewees’ willingness to be interviewed and

confidentiality was strictly enforced among all interviewers by not putting any identifying names

on the tapes or notes. My study required, and I obtained, approval of the Institutional Review

Board (IRB) of the University of Minnesota and the Board of Directors of the Makindu

Children’s Program.

DATA ANALYSIS

Data analysis and summary was achieved by following the qualitative research method

outlined by Miles and Huberman, 1994 [19]. This method includes three phases of data analysis:

data reduction, data display and coding, and drawing conclusions/verification. Data were

collected via taped interviews, notes from interviews, and field notes. The taped interviews;

Board of Directors, Founders, NGO Director, and Future MCC Director, were transcribed by a

third party in the Department of Epidemiology at the University of Minnesota to reduce bias.

The remaining interviews and direct observations were rewritten and typed from the journal

entry notes. Data reduction involved reviewing each transcript and highlighting relevant

23
responses to the questions asked as well as extraneous comments helpful to the broader research

questions. The transcripts were reviewed and passages from the texts relevant to the project’s

goals were identified by the Principal Investigator and Project Advisor, independently, to reduce

researcher bias.

Data display is the organizing of the relevant responses so that themes and main issues

may become clear. The highlighted responses were copied into a master template consisting of

the main topics in the interview questions. The copying was done with a word processing

program, Microsoft Word, with the result being a condensed report of all the coded information

under its corresponding category or theme. Each of the four stakeholder categories had its own

master template reflecting the difference of questions asked to each group. This retained the

perceptions and attitudes of each group and their responses. Interesting and relevant quotations

were kept complete in the copying process to ensure authenticity and accuracy. The written

notes taken during the interviews did not add any more information to the transcripts and were

discarded upon review with the transcripts.

The final step in qualitative data analysis is verification. The major themes of the

research were pulled apart and checked for validity, verifying their plausibility and

confirmability [19]. In the Results section, the major themes for the main questions can be

found. The themes were interpreted and generalized for new projects in developing countries.

Citations were connected with corresponding conclusions in the summary Discussion section. A

second reviewer, the project advisor, was used to, again, protect from researcher bias.

24
 RESULTS

I interviewed 29 individuals from four different groups of stakeholders:

Board Members 10
Program Directors 7
Past Volunteers 7
Community Members 5

My personal observations of MCC are also included in this results section. Taped

interviews were conducted with the Board Members and half of the Program Directors. Journal

notes were used to record the other half of the Program Directors, the Kenyan Program

Directors, and my direct observations. The Past Volunteer interviews were conducted over the

phone as the third method of data collection.

The results section is in broken up into six parts:

The Infrastructure and Design of MCC

The Start of MCC
Function and Operations
Key Elements of a Successful Children’s Center
Challenges and Barriers
Future Steps and Solutions to Barriers

The first two sections, The Background and Start MCC and Function and Operation,

give background on the center focusing on its creation, development, and the roles and

responsibilities involved in carrying out the mission of the center. Both of these sections contain

basic information taken mainly from the two MCC Program Directors and Board of Directors.

The last three sections contain the major themes and key findings extracted by qualitative data

analysis from the interviews of all four stakeholders groups and personal observations pertaining

to key elements, challenges, and future developments.

25
INFRASTRUCTURE AND DESIGN OF MCC
MCC started in 1998 and currently are assisting 104 children with the ages ranging from

1-20 years old. The younger ones are walked to the center by their siblings or guardians.

Eighty-five percent of the funding comes from the western world through private donors, grants,

newsletters, website, church donations, and one time events such as benefit concerts and quilt

sales. The remaining 15% comes from in-kind donations through the Kenyan community

members and guardians. Guardians bring firewood and baskets; local businesses donate eggs,

tomatoes, construction labor and materials; and local hospitals donate 50% of the medical costs.

The staff is mainly Makindu residents that include a cook, two farm aids, two nighttime security

guards, one cleaning woman, and the program manager. The program director is the only

western employee of MCC. Western volunteers are used on a need-by-need basis depending on

the projects being done such as organizing an AIDS prevention program or a construction

project. A center like MCC operates on a budget of about $50,000 a year that includes all

program operations and staff salaries.

MCC’s main role is physical and mental sustainment of the children through daily lunch,

clothes, access to education in the village, and access to medical care through the local hospitals

in Makindu. They also ensure homes for the children by identifying guardians to care for them

while they are not at school or the center. The center is open Tuesday-Sunday from 10am – 5pm

and includes a recreation room, a farm, cooking facilities, a wash area, and a soccer field. The

program director takes care of the relationship building, new program developments, and in-

country control. The program manager is in charge of day-to-day operations, coordinating

workshops, school and home visits, and identifying the children and possible guardians. A local

26
Kenyan in this position is key to obtaining trust from the community, decreasing suspicion of the

center, and increasing community buy-in of the center. The Board of Directors in the U.S. is

responsible for major program decisions and approvals and also for the fiscal integrity of the

program. All these responsibilities support their main mission of developing the community

through the children and building community empowerment, knowledge, and opportunities to

obtain sustainable resources. In doing this, they are also decreasing the negative perception of

AIDS orphans by the community and allowing the community to adopt the children as their own.

Makindu is a town in southern Kenya along the major truck route between Mombasa and

Nairobi. A high trucker population results in a high prostitution rate and thus a high prevalence

of AIDS and orphans. The population of Makindu is about 20,000 residents including the

surrounding villages. MCC utilizes six primary schools in the area along with the local

government hospital and Sikh Indian hospital also in the town of Makindu.

THE START OF MCC

The Makindu Children’s Center started out of the home of a Kenyan social worker whose

heart went out to the street children in her village of Makindu, Kenya. Dianah Nzomo is a single

mother with four children of her own and a village elder in every sense of the word; a title rarely

given to any woman in Kenyan culture. With no place to go, children would come and go out of

her home as a sort of reprieve from the daily struggle they faced. Somehow she found it possible

to take in a few more mouths here and there, not being able to bear to see these children die in

front of her. Dianah Nzomo is even unsure herself how she was able to do it with hardly enough

to feed her own family. Starting a program without initial financial support is impossible in any

country and especially Kenya. In the beginning there was no money for extra food or a place for

27
the orphans to gather other than the streets where they were not welcomed by business owners

and workers. All Dianah could provide for the few in the beginning was an ear to listen and her

home where they could sit without anyone running them out. The group of kids that needed help

was too large and she began seeking a larger area for them to congregate. A police officer

allowed them to meet in a cleared field near the railroad once a week to play. Dianah would

supervise the 200 plus children with help from a few friends of her women’s support group.

From this beginning grew a community resource center that now assists 104 children and their

54 guardian families through education, medical care, and nutrition, and also provides an entire

community with clean water and a clearinghouse of information and guidance.

How did Dianah go from her home to a field to a community resource center and a

budget of $50,000 per year? The answer lies in the sheer determination and will of two women.

Dianah Nzomo and Winnie Barron. Winnie, a physician assistant from Brownsville, Oregon, is

the key link in this transition along with a child named Madonna. While working at the

government hospital in Makindu as a Global Peace Corps volunteer, Winnie was introduced to

12 year-old Madonna who would take her through the village to help the sick street children. In

doing this, she got to listen to their stories that ultimately possessed her and brought her into

contact with Dianah. After many conversations with Dianah, Winnie made a promise that she

would return to Makindu to help her and the children. A promise in Kenyan culture is something

a person makes sure she follows through with and Winnie had every intention of doing so. She

returned to Brownsville, Oregon where she brought together 10 of her closest friends in the

living room of Paul and Diane Baxter. A compelling slide presentation and a naïve group of

friends created the first Board of Directors, many of who are still on the board. The thought was

some financial support and three years of guidance and they would be able to continue on with

28
their normal lives and turn the program over to Kenyan hands, a thought that has proven to be

not even close to the reality of what proceeded to take place. With the help of Sharing Hands, a

non-profit organization in Brownsville, Winnie was able to obtain short-term status as a non-

profit organization and be able to bring in donations and monetary gifts. Three years later,

Winnie obtained separate non-profit status for the Makindu Children’s Program.

Upon Winnie’s return to Makindu, she and Dianah discussed possible solutions to the

orphan situation with the first thought being a traditional orphanage. They soon realized this was

not the way to go after noticing mothers were purposefully leaving their children in their path in

hopes that Winnie or Dianah would take them in. Wanting to help as many as they could, they

decided to continue their path of basic care and crisis prevention, feeding them as much as they

could and giving them the love and attention they were not getting from their guardians or on the

streets. Many of the children were living with extended families, but these traditional safety nets

were slowly breaking down because of the AIDS crisis. Winnie and Dianah continued to

provide a temporary mend to these nets so the children could continue to stay with the people

who wanted to care for them. The two women soon started renting out a facility for the children

to come to and in September, 1998, MCC came into being. This move created the necessity to

develop selection criteria to decide which children needed the most resources to make them

equal with the other children in the village. Dianah, being a social worker, knew many of the

children and their life situations. She was able to pick out the true orphans and the ones who

needed the most assistance relative to the other children. The community trusted Dianah and

knew that she wanted the best for their children.

As the months went by and the daily crises were being taken care of, they decided to

pursue bigger dreams in giving these children a place they could come to get a regular reprieve

29
from their daily walks in the shadows of death. A local chief, Chief Kisilu, offered to help them

obtain the necessary permits for a piece of land. Obtaining land in Kenya takes much patience

and years of working the system. With Chief Kisilu on their side, this process was sped up and

they soon had their own plot of land near the main market. The center provided the children a

place to come during the day for the smaller children and for lunch and school breaks for the

older children. No sleeping quarters were built but a main basic resource center for the children,

their guardians, and ultimately the community.

Without going against the natural flow of Makindu culture, Dianah and Winnie were able

to create a program that not only helps children survive but is slowly mending the traditional

safety nets of the families in Makindu and allowing them to survive the AIDS epidemic through

a true community-based program and an extension of the natural responsibilities placed on

families within their culture. By allowing them to stay with guardians, the children are able to

retain inheritance rights of their land and take over the land after their guardians pass on when

they are older to do so. This is very important in that without land, a person is not only homeless

but also not respected and unable to start a livelihood in the community. Dianah and Winnie are

giving many kids this opportunity to start a livelihood and create a new generation of leaders in

the village of Makindu and the country of Kenya.

FUNCTION AND OPERATION

This section will start out discussing the overall program operations and concerns of

everyone involved at the center and the basic responsibilities of the staff. The parts following

program operations go into greater detail of the responsibilities of individuals and specific

30
groups. Information in this section was, again, taken from a few select interviews that described

these basic facts about MCC and its staff.

Program Operations:

“…children were living with their guardians in the community and just coming to
the center for services rather than being taken from their homes. Or offered to be
taken from their homes to be somewhere else. I like the fact that it was
community based and would keep them with their culture and with their people
and with their extended families.” –Past Volunteer

MCC’s main responsibility as a center involves the 104 children they are directly

assisting and the 54 guardian families that support these children. As explained by a Program

Director, Everyday is involved in “engendering and nurturing them so they trust you. Making a

‘No’ feel like a ‘Yes’ thus leading to empowerment, inspiration, and hope.” Medical care via

local clinics and hospitals; school fees, books, and supplies; lunch 6 days a week; HIV, health,

and agriculture workshops; life skills trainings and basic parental needs are the main services

given through the center to the children. The fundamental need for love, affection, and attention

by children are of utmost concern to the staff at MCC and possibly the most important aspect of

physical assistance they receive.

“If something is going wrong we listen to the cries of the kids and just find out
what is happening. So it’s just balancing a mother or a father. The problem is
huge, a big family. Sometimes they want more love and you have to give it to
them. They want attention. So it’s not really difficult but it’s just balancing each
child everyday.” Program Manager

They use existing school and facilities that are also accessible to the village children as to

aid in not creating an elite group of orphans. Being a community-based program, the ripple

effect occurs and the community benefits by being able to participate in the workshops and

trainings and also playing an active role in monitoring and adopting these orphans that remain

out in the community. A local headmaster commented “It’s good to give people awareness of

31
projects” to which he added the community knows of MCC, not CBM (a local orphanage). The

other two orphanages in Makindu mentioned not being known in the community and do not get

involved with the community. He also added, “its good that MCC goes into the community to

find out problems and helps correct the child.” This gentleman also is an advocate for

orphanages yet still appreciated and acknowledged the benefits of such a community-based

program.

Recently, MCC constructed two water tanks that provide clean water to 20,000 village

residents, a huge step towards preventing many diarrheal diseases. In addition to the workshops

and trainings, community members can also come and receive HIV counseling and testing.

People come from 2-3 hours away to get tested because of the lack of services in the rural parts

of Kenya. They also supply the surrounding six primary and secondary schools with materials to

pour concrete floors for the classrooms and build latrines as well as build and donate desks in

return for waiver of school fees. These donations not only help the MCC children but also the

other children at the schools preventing the spread of diseases prominent among children in the

“bush”.

School visits and home visits are done on a quarterly basis to make sure the children are

safe and performing well in school. Following the children through school and at their homes is

a key function to the operation of the center. This gives the children the realization that people

care about them and want them to succeed. Following through school and checking on scores

and conduct increases their confidence, acceptance, and performance given the fact that orphans

are usually older than their classmates and often objects of ridicule. A low self-esteem usually

accompanies an orphan until they become accepted and loved as required by a child.

32
The guardians also receive support through clothes and food give-a-ways when available. The

guardians are able to come to the center for counseling and advice, agriculture and health

workshops, and if they want to spend time with the children during the day.

Program Director:

The Program Director must balance this specific child focus with the broader

responsibilities of ensuring medical treatment with local clinics or at the center and building

external relations such as long-term sponsors in Kenya and local donors to ensure sustainability.

These two responsibilities require both administrative and public relations skills. Possessing

medical knowledge is an advantage but not a necessity in a Program Director. The local

relations include developing connections with headmasters of primary and secondary schools,

chiefs, sub-chiefs, government officials, doctors, local businesses and families. In addition to

these, partnerships with other local NGOs are also important for key funding and program

opportunities. MCC currently receives 15% of all funds from in-country donations ranging from

government grants to firewood for cooking by guardians who walk miles to deliver it.

“The amount of funding and gifts that we get here, numerically are smaller. But if
you look at somebody’s situation and know that they’ve just given you 5,000
shillings, you see it differently because you know their salary. And we’ve had
donations anywhere from the [name] family that gave us probably one of the most
gratifying donations, not a huge amount of money, but two years after we started
the program they had a successful harvest at their farm. These are five boys taking
care of themselves. They are their own guardians. They are living with no adults,
just five young boys. They had a successful harvest because of the seeds that we
gave them. And, by the way, these are kids that when they first came into the
program were so malnourished and so weak that the youngest three couldn’t walk
to the center to get the food that they needed. They just couldn’t make it. We had
to bike it out there until they got strong enough to come on their own. So these
guys had a harvest. And from that harvest they got some seeds and they
brought…corn. And they brought it to me and Dianah at the center and they
donated it. Now, you take something like that, you take a donation from [name]
when she knew she was really gonna die, and she donated probably ¾ of her
clothes, and she didn’t have a lot, to the center. Those are the kinds of donations

33
 that we get here. And those, in my mind, are the most valuable.” –Program
Director

Board of Directors:

The Board’s responsibilities have changed throughout the development of the program.

The main responsibility started as policy development and enforcement of the policies and

procedures. This has since changed to more responsibility on developing a stable, long-term

funding base which includes grants, individual donor relationships (“Thank You’s”, phone calls,

lunches with donors), churches, the use of a website and newsletter to keep donors and

supporters updated, and single, one-time events to reach a new donor base and bring in extra

funds for special projects. Also included in this is major program approvals and advice, “You

[The Board] make major program approvals, consultation advice, direction to the director, and

fiscal integrity of the program” as noted by a Board Member. The Board makes only major

program decisions with many daily program issues being decided by on-site field staff looking

for guidance from the Board if needed.

Currently, only a local Board is used for such responsibilities and decisions. An advisory

committee may be developed consisting of supporters throughout North America. This

committee would be used for developing future programs, projects, and goals.

Program Manager:

The current program manager is also the co-founder and main creator of the center.

Being a Kenyan social worker with the knowledge of many of the local families and culture

allows her the ability to play a vital role in child and guardian selection, a vital link and liaison

between the community and the center. Organizing deals and contracts with the schools and

34
providing a source of trust for local community members. This trust allows the guardians and

children the confidence to come out and identify themselves as part of their inherent sense of

responsibility to family. The responsibilities of the Program Manager include organizing meals,

trainings and workshops for the community, home and school visits, child counseling and

disbursement of school supplies.

Volunteers:

Being a non-profit organization, volunteers are an important aspect of the success of the

program. Volunteers are now selected on a need-by-need basis and come with a preconceived

task or goal while some may come to offer any services they can or that need to be done. These

tasks range from organizing and cleaning the center, to attending town meetings, and conducting

school and home visits, to delivering medicine and befriending children going through tough

times. The Board oversees the selection and logistics of volunteers including application

reviews, on-site interviews, and departure preparation. Reasons for having volunteers include:

• Free labor for special projects

• Infusion of passion among U.S. community and Board members
• Positive influence on MCC children

Some obstacles to having volunteers include the difficulty in firing them if a problem arises

in Makindu and the inability to separate them from the field. Volunteers from the United States

also add to the dependency of the Kenyan community on western influence.

KEY ELEMENTS OF A SUCCESSFUL CHILDREN’S CENTER

This section starts the main analysis of the interviews and data collected that continues in

the following two sections, Challenges and Barriers and Future Steps and Solutions to Barriers.

35
Key elements were extracted from all twenty-nine interviews and discuss the different

perspectives regarding MCC and children’s centers in general.

Local Community Development:

Every stakeholder group and the majority of all respondents mentioned increasing the

resources of the community and developing it as a key feature of a successful center.

“And I think one of the very unique things that we’re doing here is trying to not to
disenfranchise these kids from the community, but rather involve them in the
development of the community. And in fact, to empower them to have a very
strong impact, positive impact on the development of the community.” –Program
Director

“I would just say the center is a good model in Kenya or in Africa, where…the
poverty level is very low, and if really people want to help, this is a family-based
center. We are community-based and we can help so many kids with the little
that we have.” –Program Manager

These responses are part of a variety of topics with each directly related to the other around this

theme of local community development. The majority of these discussions centered on the

guardians and their role with the center. Having the children stay with guardians thus decreasing

the dependency on the center and keeping them off the street was talked about by a significant

number of interviewees, mainly Board Members. All four groups also mentioned the continual

need to develop and support the guardians in their ability to care for the children. Examples of

guardian development from the center and my observations include holding trainings and

workshops on AIDS, agriculture, and life skills; construction of water tanks; access to some

medical and health care; food and clothes give-a-ways when available; and just being a basic

community resource center for assistance and guidance. Also from my own observations and

from a few of the respondents it was noted that home and school visits aided in the development

of the guardians and the children. These home visits are done quarterly and mentioned by

36
Community Members to relieve suspicion of the center by the community as well as build a

more cohesive unit between the guardian and the children.

This concept of community development was the most discussed theme in all the

interviews. It was a key element that was agreed upon by all the respondents including directors

of non-community based children’s centers in Makindu and Nairobi. Among most Past

Volunteers, Board Members, and a few Program Directors the element of having a strong

Kenyan leader was essential, someone to bridge the political and cultural gaps that exist between

a foreign supported program. This also translated into an increased sense of family according to

some Board Members. Another element of community development involves building

partnerships between other local NGOs. All four groups said the reasoning for this is to increase

accountability, reduce community suspicion, and also be more efficient as a community-based

organization.

Low Cost and Minimal Resources:

The opportunity to produce offshoot or satellite centers was the next most mentioned

element by all stakeholders. Those respondents said this opportunity was there because of the

low amount of resources MCC uses and the ability to “do a lot with a little.” One Chief said that

it was a way for him to help his poor people.

Education:

Education in the form of both formal education for the children as well as trainings and

workshops for the community was the third most common key element of discussion among all

groups, about half of all interviewees. Indirect education also takes place by the children as they

37
interact in and with the community as stated by one program director. AIDS education in the

community was unanimously mentioned in conjunction with any education program.

A Heart for Children:

Having a heart for the children and administering patience, flexibility, commitment,

knowledge, and love as a director were key characteristics of a director expressed by a

significant number of interviewees, again, among all stakeholders.

“Diana, and about 15 of our kids sitting around this huge circle shelling peas,
singing, laughing and telling stories. And I just sat there transfixed for about ten
or fifteen minutes. And that was one of those moments that I said, ‘You know,
this is pretty cool.’ Something [is] up here. Because even though that was a
momentary flicker in these kids’ lives, I think that makes a difference. I have to
believe it does, or it would make it difficult to kind of get through the years.” –
Program Director

Through personal observation, I noted a key element in this love that the staff at the center

express toward the children. I found that the children display this same love as they interact with

each other and their guardians. The guardians seemed pleased with the set-up and philosophy of

MCC including the home visits and the support they were getting from the center. A number of

them would bring donations of firewood to the center and also come to get assistance and an ear

to talk to. Community members knew the center was a place they could go for help, assistance,

and knowledge. I noted that the medical aspect of having a medical professional at the center

helped relieve a lot of suspicion of the center by the community members.

CHALLENGES AND BARRIERS

38
 Five main challenges and barriers were stated throughout the interviews. In order of

most mentioned to least mentioned, the list is as follows:

1. Community involvement
2. Communication
3. Sustaining a stable funding base
4. AIDS education and prevention
5. Creating elitism among the children at MCC

Community Involvement:

All four groups, mostly Board Members, talked extensively about the difficulty in

obtaining local community involvement with the center.

“I believe probably the biggest challenge the center has had to get through is
acceptance by the community as a viable participant in that community. Africa is
a country and continent where lots of white people have come and done good, by
their standard, and then they leave. We tend to come in, Europeans and
Americans, and throw around a whole lot of money and then leave. Set up things
that then aren’t sustainable over time. And so, in a very healthy fashion I think
Kenyans are quite skeptical of us, and they should be. So getting to a place with
the community of Makindu actually believed we would be there and we would
continue to be there, and would continue to do what we said we were going to do
was probably the biggest challenge.” –Board Member

The discussion included the difficulty of obtaining community acceptance, identifying key

Kenyan leaders to eventually take over the program, establishing a Kenyan board of directors or

advisory committee, and decreasing suspicion while increasing trust of the community members.

On a similar level, the difficulty in retaining the knowledge, wisdom, and culture of Kenya in the

children at the center was expressed in a few of the interviews of Program Directors.

Communication:

Communication was mentioned exclusively among the Past Volunteers and Board

Members but in significant numbers to be the second most mentioned barrier. Communication

39
problems were found to be in two forms - language including meaning and cultural modes of

expression and also the distance and physical inability to communicate at will with those in the

other areas. Email has aided in solving this problem but communication remains a barrier

according to the majority of Board Members and Past Volunteers.

Funding:

Sustaining a stable funding base was stated by most Board Members and Program

Directors as an ongoing barrier to daily operation. This was noted to involve both in-country

(Kenyan) donations and U.S. donations. This money issue was mentioned as being the main

barrier in turning the program over completely to Kenyan leaders. Through interviews with

these two stakeholder groups and direct observation, poverty is too deep and underlies every

aspect of their lives thus preventing Kenyans from taking it over completely and still have it

function at its normal pace. Development in this area includes creating a database of past and

current donors, following-up with donors, establishing more relationships with Kenyan donors,

and developing Kenyan leaders to be the local face associated with MCC. These financial

barriers continue to be the main problem regarding the ability to turn the center over to local

control as stated by the Board Members and Program Directors.

AIDS:

Combating AIDS and its effect on the community was an overriding concern and reason

in everything done by the center as I saw in my own observations and conversations with people

throughout Kenya and Africa. This was also verbally mentioned in most interviews with Past

40
Volunteers, Board Members, and Program Directors. AIDS was not discussed in great detail

because its prevalence and results were well known among those interviewed.

Elitism:

Creating a sense of elitism or exclusivity among children at the center was a challenge

discussed in the same three stakeholder groups – Past Volunteers, Board Members, and Program

Directors.

“In the beginning, there were a lot of questions about why are you taking care of
the orphan children when everyone is hungry here. Almost like they were getting
special treatment – and they weren’t sure [why]. And a lot of projects have come
and gone and they didn’t think it would last.” –Past Volunteer

“Traditionally orphans are suppose to not eat, not to be clothed so well. But with
our kids, we have been able to balance because we give food, we give Christmas
gifts, we give sweets. We also pay home visits to keep better connection and
open heart to them and talk to them. We also sometimes give clothing to the
families. And free dinners.” –Program Manager

This issue of elitism was not sensed among the Community Members interviewed. Through my

observations, I noticed a sense of hope and happiness among the children at MCC versus the

other village children through their smiles and willingness to talk about their goals but found

they were not treated differently relative to the guardian’s natural children. They mixed in well

at the schools in spite of the fact they are a bit older and thus prone to a low self-esteem and self-

confidence. The Past Volunteers noticed a similar sense of happiness and fondness for the center

by the children. In speaking with Program Directors, these situations of neglect by guardians

have occurred only a few times and dealt with through village and clan meetings with the

families involved. This alienation and elitism was mentioned as a challenge when trying to

serve the children and the community at the same time.

41
FUTURE STEPS AND SOLUTIONS TO BARRIERS

The ongoing development of the center involves six different areas as identified through

the interviews:

1. Community involvement and development

2. Replication of programs
3. Sustaining current children
4. Retaining basic needs and resources
5. Developing U.S. Board of Directors
6. AIDS prevention and education

Community Involvement and Development:

Community development was the only future step mentioned overwhelmingly; the other

five steps were discussed equally among all the interviews. All interviewees expressed this

sense of continual community development in some way. Continued formal education, home

and school visits, expanded AIDS education and development of guardians were each noted by

several respondents. The reason many interviewees gave for this was to build Kenyan leadership

of MCC to eventually take control of the program, nurturing the community and adult mentor

roles, and letting the community be the resource of their educators. A program director noted the

need to be sensitive to the needs of the community without changing the social fabric of the

society. Developing partnerships with other local NGOs and developing the guardians with

medical care and food that trickle down to the community was observed by another Program

Director. Items briefly touched on by the interviewees regarding this development were a micro

or revolving loan program for guardians and graduates to develop a business or income

42
generating job and the start-up of a library to enhance the knowledge and empowerment of the

community.

Replication of Program:

The following five future steps were equally discussed among the respondents with one

third of them discussing to some degree on each of the issues. Replicating the program and

bringing in more kids was talked about among three of the four groups excluding Program

Directors. The key issue in replicating such a model is the importance of reaching out to more

children.

Sustaining Current Children:

On the other side of the spectrum, an equal number stated, including Program Directors,

the need to continue to help the current children being assisted by the center. Suggestions for

doing the latter were the micro loans as stated above, business trainings that would identify

interests and income generating work, as well as pursuing bursaries or scholarships for the ones

who do well in school. Developing relationships with nearby businesses that could take on

employees after the youth graduate high school was mentioned by a Community Member in

Nairobi. It was noted that businesses look favorably on orphans.

Developing the Board of Directors:

A common point of discussion exclusively among the Board of Directors was

development and expansion of the U.S. Board. This was suggested as coming through an

advisory committee with national representatives down to just growing internally into a working

43
board of directors versus a program committee. “I think if we’re going to be very effective with

AIDS education, if we’re going to be effective with replicating this program or helping anybody

to replicate the program, its got to be bigger. Because our group is to small, too local, and we’re

getting really tired” commented a Board Member regarding the current make-up of the Board.

“And if we stay small and tight like this, I think we will destroy the program” echoed another.

Retaining Basic Needs and Resources:

The desire to keep the basic necessities such as food, love, friendship, commitment,

Kenyan staff and leader, and patience as part of the center was expressed by members of all four

stakeholders. The mission statement would be sustained in offering things for the spirit and heart

first followed by the physical needs of food, clothing, and shelter. These were all talked about in

needing to be kept as the focus of the program. Reasons given for this was the ability to do a lot

with a little and thus keep it as a grassroots, community-based project that will be able to be

eventually taken over by the local community.

AIDS Prevention and Education:

About one quarter of the interviewees discussed the overriding effect of AIDS, excluding

Community Members. This does not correspond to my personal observations and informal

discussions where AIDS was more freely discussed with local community members. From

similar conservations, I heard that AIDS still carries a heavy stigma with it and though it can be

talked about more freely in public, the knowledge of having AIDS or being associated with

AIDS is not readily received or dealt with and could bring ostracism from family and

community. According to the Program Director, the workshops and trainings are providing the

44
community members with the knowledge they need to gain more understanding about AIDS and

its effects thus making it easier to talk about in public. I found that AIDS affects every aspect of

a villager’s livelihood and not one person was left unaffected by the disease. AIDS is the main

cause of 70% of the orphans in Makindu, Kenya and the rest of Sub Sahara Africa. Everything

that is done for these children and the community is mainly because of this disease and the

ability of it to travel given the lifestyle and culture of many tribes and villages in Kenya.

45
 DISCUSSION

LIMITATIONS

There are a number of limitations in this study. The potential for bias is particularly an

issue for qualitative research. Bias was minimized in analyzing the data by using a second

researcher to also review the data throughout the analysis process but was still possibly present

to some extent throughout the study. The potential for bias was present as I conducted the

interviews. My ability to be an objective and impartial interviewer was increasingly challenging

the longer I was in the community since being a part of the community made it difficult to

separate myself from their lives and stories. The low sample size adds a second limitation in not

being able to get a complete and accurate assessment of the center and community. The

inability to interview the guardians and some Kenyan community members was also a limitation

because I missed recording an important aspect of the community. According to the MCC

Program Director, the Kenyan guardians are suspicious of formal interviews and are not

comfortable with them. This led me to use informal conversations and observations to collect

data from them. Kenyan community members were also difficult to obtain accurate information

from given their inherent sense of telling you want you want to hear, especially when being

interviewed by an American. The interviews in this study also represent only one center at one

point in time creating a lack of generalizability to other regions and communities in Kenyan and

Africa.

46
KEY ELEMENTS OF MCC AND COMMUNITY-BASED ORGANIZATIONS

Local Leadership and Trust:

The importance behind having a cultural component connected to any project in a

developing village is the ability to provide political knowledge, local trust, support and

acceptance leading to local buy-in of the program. This support and buy-in should come from

the families as well as the schools and village leaders. A number of respondents stated the need

to attend town meetings, listen to locals with a closed mouth, and learn the language to form a

mutual respect between the program and those it is meant to help. One Board Member stated,

“But you can’t not have the Chief of your district involved in this. These are the people that live

there, they’re the ones who know what’s needed.” Through this community interaction, the

program will become community-based and nurture continual involvement by the community

with the program hopefully leading to eventual training, employment, and ownership of the

program by the local community members. When working with a children’s center, it is vital to

incorporate the local leaders and members in dealing with the children and letting the families

and their clan leaders take responsibility to solve any problems that may arise. Included in this

should be the guardians, sub-chiefs, chiefs, and extended family members.

The one element that has helped MCC’s success as an orphan center in rural Kenya was

its conception and start by community members of Makindu. The poverty among such a

community is extremely high and is almost impossible for such a community to start anything

structurally thus showing the importance of outside support and guidance. It is necessary for the

community leaders to be involved with the initial planning of any program paving the way for

continual involvement and immediate trust with the outside organization and staff. The poverty

level makes it difficult to transfer financial responsibilities to local staff and hinders it from

47
becoming 100% Kenyan run. The temptation to steal and borrow from the program is very high

given their current situation of barely being able to support themselves or their family. The

ultimate goal would be to turn the program completely over to local hands after the community

itself has been relieved of some of the deep lack of resources and poverty.

Grassroots Focus:

As a children’s center, the philosophy mentioned most in the interviews and observed at

the center dealt with intangible characteristics such as having a shoulder to lean on, creating

hope, “observing the things you can change without changing the fabric of society”, honesty and

openness with accountability, and doing what you can do with what you have – “So the trust is

not how much you are, the trust is in what you are doing.” This involves keeping the program as

a grassroots project initiated and started by the local community thus ensuring these community-

based and empowering aspects of the project. Keeping a community focus is extremely

important given the delicacy in these familial safety nets because of the AIDS epidemic. The

grassroots involvement ensures a program that is welcomed and takes into account the culture,

traditions, and daily living of the villagers. Attached to this is performing regular needs

assessments to be able to change and adapt with the village as stated by a Program Director:

“But I think with constant assessment and adjustment with a keen ear on what is
happening in the community and how the community is changing and developing,
then I think you are aware of these things, then you can help an organization like
this grow and serve the community and the children that are such a huge part of
that organization.” –Program Director

48
Funding and Sustainability:

A couple of suggestions concerning funding include marketing the successes and activities so

supporters and donors can visualize and see what they are supporting. A second suggestion

given was developing a medium and long term plan to help broaden the picture to approach

donors in different ways thus getting the maximum support and increasing sustainability and the

option to expand. With increased programming and success, opportunities for more grants

become available as mentioned by a program director:

“Because with every year that passes and you’re doing good things and you’re
doing things that are useful in the community, the more recognition that your
organization is going to get and then subsequently, the more funding you’re going
to get.” –Program Director

Equal funding development in-country and out of country is necessary to ensure a stable funding

base for the future. Follow-ups with past donors and pursuing relationships with nearby NGOs

thus obtaining a history of accountability and successful operations and programs allows for the

opportunity to apply for these larger governmental and non-governmental grants and funds.

Keeping the Community Involved:

Some of the more concrete comments regarding key elements of a community-based

center are having the children stay with families or community members, developing committees

that are unbiased and able to listen to the government officials and town leaders, making the

benefits of the center observable and marketing these successes to increase center supporters and

donors. Only by being in the community can the children have a true sense of belonging that

will ultimately sustain them beyond what a physical center can provide. Community

involvement requires making allies with the other institutions in the village – religious and

49
political leaders, social groups, and businesses and keeping the program grassroots enough to

allow the eventual absorption of the program into local hands.

MCC’s implementation of the UNAIDS recommendations for HIV prevention is being done

successfully in Makindu, Kenya based completely on a grassroots approach and start-up. Not

only does this model help prevent HIV through education and empowerment but also increases

the capacity of a community to cope with its current state and develops a greater pool of

resources to achieve a more sustainable future. This is the underlying problem of HIV and this

model provides a viable long-term solution to the epidemic’s devastating wake. Empowerment

of the community is achieved ensuring trust, acceptability and buy-in by the locals, again,

obtaining a sustainable program. MCC has been able to prove this and show the practical

realities of implementing these recommendations – a comprehensive program dealing with HIV,

orphans, and community development through the hands of the local leaders.

These solutions come down to being able to “give the kids a sense of their rights as humans

and empowerment and in the long run…what they’re getting is inside and that’s going to be with

them for as long as they’re going to be in Kenya and that can help them.”

“Empowerment. Public service. I mean there are so many things that we can do
at the center and extend from the center into the community to make the people
really see the center as a pillar of the community.” –Program Director

Equality and Child Protection:

A constant vigilance about community involvement and participation is necessary for the

success and sustainment of a community-based children’s program in rural Kenya and East

Africa. This prevents elitism and exclusion of the orphans. Assisting, educating, and developing

the guardians through agricultural and AIDS workshops, clothes and food give-a-ways, and some

50
access to healthcare to the guardians have helped break down the barrier of favoritism that may

have arisen if these were not in place. This also helps protect the child from an abusive guardian

and gets them to work together and help each other. The feeling of watching a grandmother

walking hand in hand with her grandson knowing that each are relying on the other for survival

is a feeling that leaves a person with the conviction that this relationship needs to be sustained

and strengthened.

The program director, program manager, and staff also closely monitor the children and

observe any changes in the demeanor, attitude, and appearance signifying a dangerous or abusive

situation. They talk to community members and local beggars to get any information about how

the families and children are doing. Kenyan staff is also a key link in being able to keep track of

family and child situations through the unique relationship they develop with the children.

Community members have adopted the orphans as their children and know what the children are

doing even if they have not come to the center for a few days according to the Program Manager.

Other solutions to protect the children from various troublesome problems are facilitation

of meetings with the police, pastors, chiefs, family, and friends to discuss and work out an

agreement. This gives the community the opportunity to work out their own problems without

being told what to do by a foreign organization thus increasing their sense of responsibility,

independence, and empowerment.

All the interviewees that were asked the question pertaining to the perception of the

children at MCC noted that the children seemed extremely happy to be at the center and see it as

their second home if not their first. One volunteer commented on the resiliency of the children in

the beginning stages of the program:

“What impressed me so much with those kids was that they were so resilient in
that you could feed them. They’d get their bellies full. They hadn’t perhaps eaten

51
 for several days, we didn’t know. We could feed them on Sunday and after they
ate they were up and dancing and playing and laughing. And I was just astounded
by the spirit of those children” –Past Volunteer on her visit in 1998

Others mention the children being enthusiastic, committed, mature, and wise with a strong sense

of family with the other children at the center. This is not what I observed upon my visits to the

other two local orphanages in Makindu. One had reports of rape and abuse while the other is

currently being investigated for starving children and diverting funds. A Community Member

stated her fondness for MCC and the friendships it has forged among the children:

“What I know is it is very nice for those children. They’re all friends. They
know each other. They eat a balanced diet. And once a day they get education
and at the moment I don’t think they need more.” -Community Member

The children at MCC exuded a sense of family and concern for each other. They had a

spark in their eyes different from any of the village children I came across. I have to

believe that this came not from the one meal a day they were getting but from the love

and attention given to them by the MCC staff, feeling part of a community, and the love

and attention that children need to grow and develop a sense of hope for the future.

Orphans and vulnerable children are the futures of a community and also provide the

weakest link in the unity of a village making it essential to focus on this population as the first

line of defense. When the orphan and village children are brought up to an equal level of

survival, education, and medical care opportunities then more focus can be shifted to community

development, raising their capacity and environment to a sustainable level and bringing them up

as a cohesive unit creating empowerment, confidence and an active movement toward a

sustainable future.

52
COMMUNITY-BASED ORGANIZATIONS VERSUS ORPHANAGES

Strengths of a Community-Based Organizations (CBOs):

With the anticipated continuation of the AIDS epidemic in Africa, orphan centers are

going to be in more demand (Table 1). The influx in AIDS orphans is expected to rise

exponentially over the next 10 years with the number of total orphans reaching 2 million in

Kenya alone [5]. Orphanages offer a short-term solution to the initial crisis of orphans but they

isolate the child from the family and have extremely limited community involvement instilling in

orphans a dependency on an outside organization that will not always be there for them.

Community-based centers like MCC offer a longer-term solution to communities with high

poverty, HIV, and orphan populations. The low cost and the ability to take in 3-10 times the

number of children are two of the main arguments to replicate and develop more CBOs. A third

key argument is their realistic ability to increase the capacity of the community to eventually

adopt these children as their own, thus requiring limited foreign aid. “The community really still

has these kids in their heart, they just don’t know how to have them in their homes” was

mentioned by a Program Director. The more that they learn to do for themselves, the less that

needs to be done for them. Just creating a sense of independence, empowerment, and knowledge

of rights and opportunities has a great impact on such a community. A few of the sentiments

concerning the need for more centers like MCC and its ability to create this independence are:

“There needs to be more centers like MCC.” –Headmaster

“Even if it does replicate itself, it does not have to be the same but the principle
has to be the same.” -Past Volunteer

“That is in all her research, about three years worth including South America, she
did not come across another [model] that was as comprehensive and community
based.” -Field notes from Past Volunteer phone interview

53
 Most of the interviewees thought a CBO was the most desired and successful. One village

chief just lowered his glasses, stared directly forward and said, “Oh, yes” affirming the benefits

of having the children stay with guardians versus an institution or orphanage. The Program

Manager of MCC summed up their philosophy with her statement:

“I would just say the center is a good model in Kenya or in Africa, where the
poverty level is very [high], and if people really want to help, this is a family-
based center. We are community-based and we can help so many kids with the
little that we have.” –Program Manager

MCC’s help with school fees is a needed logical step in helping these children mend their

safety nets. Primary school is free but administrators can charge fees for various things such as

chalk, uniforms, books, construction, and exams [7]. In combination with education and literacy,

improving health and nutrition can help the poorest families out of poverty [13]. “Education and

training are fundamental building blocks in our collective effort to reduce poverty, alleviate

hunger, improve health, develop economics, and defeat HIV/AIDS” says USAID Administrator

Andrew Natsios [13].

Weaknesses of a CBO:

Families and guardians of the children can be unstable or abusive requiring the children

to be moved from family to family. This family jumping may produce an even greater sense of

isolation and mental instability. A second problem that is faced is if the extended family cannot

be found or has completely abandoned the child due to the high stigma HIV continues to carry.

An AIDS orphan may be considered unclean and not be taken in by the family or a community

member. MCC has confronted this problem only a couple of times since 1998 and has found that

by talking with the clan leaders, the inherent sense of responsibility for the family prevails and

54
an extended family or community member volunteers or is chosen to take the child in. Another

possible weakness of community-based centers is the reality of guardians leaving young children

at home alone while looking for work in town. These children have been found dehydrated and

on one occasion, the child was extremely ill from drinking kerosene sitting next to the water jug.

Orphanages, being confined institutions, supply these children with a permanent home, constant

adult supervision, and some sense of immediate physical survival but do not guarantee a life free

from abuse or neglect and isolated from the natural love of family. A CBO also has to monitor

the children because of the influence other street youth can have on them. Orphanages are more

likely to keep the orphans within closed confines and buffered from the influences of the street

and crime.

CBO Summary:

The overall weaknesses are something to be aware of during implementation and

development of such a community-based children’s center. It must be noted that two of the three

orphanage directors interviewed had started a community-based program in addition to the

institutional care of the orphanage. This was done to reach more children and be more effective

in the community. One of the orphanages, Nyumbani, reached out to more than 500 orphans

through their community-based program in addition to their 84 live-in orphans. Another center,

Lalmba, in western Kenya reached out to over 1,000 orphans through their community-based

program offering medical assistance, education, and basic needs to the children and their

families. A community-based concept was automatic in Makindu because they did not have

anything else to start with. It was found through interviews with other program directors and

research that the cost of a CBO can be up to 14 times less than that of a live-in center and helps

55
3-10 times the number of children [2]. It is a model that can be adapted and adopted by other

rural villages in Kenya and East Africa.

Table 3: Pros and Cons of the Makindu Children’s Center:

PROS CONS
1. Keeps the children in the community via 1. Neglect and abuse by guardians.
guardians while supplying education and 2. Lack of extended family or want by
basic needs for survival. family.
Develops and educates the community through the 3. Do not provide 24 hour care and
children thus increasing empowerment monitoring.
and confidence of the community
members.
2. Serves as a community resource center –
water tank construction, workshops and
trainings, AIDS education, testing, and
counseling.
3. Gives children the love and sense of hope
they need to grow up strong mentally and
physically while feeling part of a family.
4. Ability to assist hundreds of children
because of low cost and offering the
possibility for complete control by
community or replication to other areas.
5. Changes community perception of orphans
and allows them to adopt the orphans as
their children.

FUTURE STEPS AND DEVELOPMENT OF PROGRAM

The two main directions brought up in the interviews related to either taking on more

children as older ones graduate secondary school (high school) or ensuring the graduates through

to an income generating job or work before taking on new orphans. The latter could happen in a

few ways as suggested from a variety of stakeholders:

56
 • Create relationships with businesses and companies as sources for future jobs.
• Offer business training with the following elements - skills identification tools,
accounting, and income generating possibilities.
• Micro and revolving loans for graduates to start their own businesses in the village.

It takes more than just offering the knowledge aspect of income generating opportunities

but also helping the youth identify something that they are going to be successful at and

want to do. A Program Director supported this with his comment:

“You really have to try to match your child or the youth with something that their
1-interested in, inspired by if at all possible, skilled at or have a natural ability for
and finally 2-something that is going to generate some kind of income to help
support him or her support their family and themselves.” –Program Director

It must be remembered that, “the more you do, the less they do.” The importance of this

statement lies in the fact that in order to build sustainability, the project cannot become

dependent on any specific entity but transfer that sense of responsibility to the ones that will

always be there thus bringing up the entire community even if the program runs out of funds.

There must be a balance between assistance and empowerment leading to a sense of

independency from foreign aid, responsibility and unity among the community.

Included with the first mentioned future direction for the center on taking on more children is

developing and assisting satellite centers in neighboring villages. This would require increased

funds or a third party to come along and take on the responsibility of replication using MCC as a

model and/or springboard to get started. “So I think the idea of this project being replicated

elsewhere is not only extremely doable but also absolutely necessary” was stated by one Board

Member and “So my desire now would be that if we’re going to grow is to expand and then do

the same thing there” as repeated by another.

A future step could incorporate one or both of these discussed solutions. The important thing

is that the decision be decided and agreed upon by the local staff, Board of Directors, and local

57
community to move ahead and continue increasing the capacity of the community to absorb the

influx of orphans due to AIDS. It was also noted through the interviews that a balance must be

found in the number of children they serve and the fostering of leadership of Kenyans to be able

to sustain the program. Building too big, too fast will throw this balance off requiring western

influence and support indefinitely.

GLOBAL AIDS ORPHAN PROGRAMS

In South Africa, the AIDS orphan population is just as severe as in Kenya and other Sub

Sahara African countries. Orphanages exist but receive little help from the national government

and the government social workers [20]. One foster home, Siyabulela, was caring for 57 orphans

without any governmental aid [20]. With South Africa having the highest AIDS prevalence in

Sub Sahara Africa, the AIDS orphan population is expected to double in the next ten years

increasing the need to reduce the stigma attached to these children and increase the opportunities

to education [20]. Save the Children is active on two fronts regarding AIDS orphans, the first

front being prevention and the second being care and support for the children and families

affected by AIDS. Both of these efforts operate on the community-based principle [21]. In South

Africa and the rest of Sub Sahara Africa, they work on empowering young women to say “No”

and organize workshops on AIDS education [21]. Similar programs are also being implemented

in Asia [21]. The Hope for African Children Initiative (HACI), organized by Save the Children,

aims to support vulnerable children through direct education, supporting the family to deal with

the death of a parent, building awareness of AIDS thus decreasing the stigma associated with the

disease, and increasing prevention and treatment services [22].

58
 India and China are two countries on the verge of experiencing similar effects of AIDS as

Sub Sahara Africa [6]. With AIDS cases and deaths rising in these countries so are the number

of orphans that need to be taken care of [6]. India is noted as having these same risk factors

concerning sexual practices as Sub Sahara Africa thus paving the way for its own severe AIDS

epidemic [6]. While not as many programs specifically focusing on AIDS orphans seem to be in

existence in India and Asia, the initial focus seems to be on these same community-based

strategies being used in Africa not wanting to repeat an African size epidemic. As India and

China experience the impact of increased AIDS orphans, the number of AIDS orphan programs

similar to MCC and HACI will only increase.

Across the globe, other community-based programs are also being implemented. The

Association François-Xavier Bagnoud (AFXB) has several programs around the globe covering

the community-based goals listed above [23]. UNICEF has a program in Eritrea that aids in the

reunification of displaced children with their families and also supports faith-based programs in

Thailand aimed at addressing the needs of AIDS orphans [24]. UNICEF also supports programs

in the Philippines trying to stop the trafficking of young girls [24]. While this last effort may not

directly affect AIDS orphans, it is necessary in the comprehensive approach to dealing with

AIDS and the parentless children it produces. One last community-based strategy supported by

UNICEF is in Brazil and the programs focusing on providing psychosocial assistance to AIDS

orphans [24].

These programs show that the reality of AIDS is similar no matter what country or

culture. The results seem to be the same requiring similar methods and strategies of prevention

and support for the communities affected.

59
 CONCLUSION AND IMPLICATIONS FOR FUTURE

PROGRAMMING

The environment these orphans live in each and every day is difficult to comprehend.

Nothing is an overstatement when the talk is about life or death. It takes a comprehensive

approach and cooperation on all sides of the problem including international organizations, local

governments, and the non-governmental/voluntary organizations that are directly impacting the

communities. In the report entitled, Young People and HIV/AIDS: Opportunity in Crisis by

UNAIDS, a motto is stated for the next decade of HIV focus and prevention, “Young people are

our greatest opportunity to defeat HIV/AIDS” [11].

The Makindu Children’s Center is a model program and my hope is that this research

helps inform other organizations so that they may replicate or adapt elements of MCC allowing

many other orphans the rights they deserve as children. Future objectives for research would be

identifying ways to transition from secondary school (high school) to a successful income

generating business for recent graduates and guardians. A major problem is the lack of jobs for

graduates from secondary school. Lack of currency flow in a community decreases the number

of jobs available and also the number of paths to pursue a sustainable economic living. Micro,

revolving or small business loans have been used in the past to develop a business for individuals

but more research needs to be done on using them to develop a community thus ensuring jobs for

future graduates on an on-going basis through the community itself, not an outside foreign

organization. By focusing on this, the next arm of such a model can be developed and bring

these communities up to a sustainable level through the children and orphans.

A second area of research would be to identify the differences among youth coming out

of an orphanage type model versus a community-based model such as MCC. Basic AIDS

60
understanding, health knowledge, economic resources, and general attitude toward community

development could be areas to determine any differences among the youth at different time

points. Due to the relatively new implementation of the community-based models, it has not

been possible to do a study such as this.

Table 4: Recommendations for other children support services:

Involve the community and local leaders at conception of program.

Facilitate meetings and develop partnerships with political and religious leaders, other
NGOs, chiefs, and families.
Keep the children in the community through guardians and schools.
• Develop guardians with extra food, clothes, and medical care.
Ensure education through secondary or vocational school.
Supply life skills training, health education, and income generating
workshops/opportunities (micro loans) for the youth after graduation from secondary
school and for the guardians and community members.
• Be open with the community and involve them in decision-making processes.
• Conduct frequent community development projects to build up traditional safety
nets.
• Listen to staff through regular assessments and staff meetings, not being afraid to
adjust.
• Conduct frequent home and school visits to monitor children.
• Be persistent and follow-up with donors to ensure a stable funding base.
• Build community through empowerment and knowledge.
• Market successes to decrease suspicion of community and build trust.
• Give only basic necessities so not to create an elite group of children.
• Maintain a local leader as a key player in the role of the program.
• Use volunteers on a need-by-need basis.
• AIDS education and possible Voluntary Counseling and Testing opportunities.
• Have a heart for children and their well-being.

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 APPENDIX A

INTERVIEW QUESTIONS

Questions for Initiators and Board Members:

Demographics of Board: age, sex, occupation, # years as board member
1. What are your current responsibilities? (program initiation, tasks)
2. What was needed to gain permission for the center in Makindu? Steps taken to start it?
(International and National steps needed to implement MCC)
3. How long did it take for the necessary components to be available? (Program initiation)
4. What were barriers to achieving these components? (Barriers)
5. How did you come up with the idea for this type of center and do you feel your goals are
being attained? (Background)
6. Where does your funding come from and how is it sustained? (Funding)
7. How are the children selected to be able to participate at the center? (recruitment)
8. How are the children matched with the guardians? How are guardians chosen?
9. How long are the children allowed to come and be cared for by the center?
10. How many children can the center accommodate? How much does it cost per child?
11. Is the children’s care by the guardians monitored?
12. Are there any safe guards in place to protect children from a bad guardian situation?
13. If you could change one thing about the center, what would it be? What would stay the
same?
14. What is the most difficult task in keeping the center running? Have there been times when
resources were needed but could not be obtained? (Barriers) If so, how did you get through
them?
15. What are any future problems you foresee and how do you plan to do deal with those?
16. What advice would you give to future center directors and board members of a similar
center? (Recommendations)
17. Have there been other approaches to aid the orphan population in Makindu? If so, what were
they?
18. Why did you become a Board Member or Program Director and what keeps you involved?
19. Do you report to anyone? What, if any, decisions are made higher up?

Questions for Volunteers:

1. What steps did you have to take to become involved in the program? (volunteer
initiation)
2. What were your responsibilities? (program sustainability)
3. What were any barriers that could have kept you from accomplishing your volunteer
tasks? (challenges)
4. What made you decide to want to be a volunteer at MCC versus another orphan center?
(uniqueness of MCC)
5. What change in the program would have added to your experience at MCC?
(Recommendations)
6. Is MCC a unique, successful and sustainable center? If so, what makes it unique?
(Uniqueness)

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 7. What would make MCC a better service center for the children and the community?
8. Would you advise other organizations to start a similar center? If so, what advice would
you give them? (Recommendations)
9. How has your life been different since you returned from MCC? What lessons did you
learn as a volunteer? (Long term outcomes)
10. How did you fund your volunteer work? (funding)
11. Do the children perceive to be satisfied when at the center?
12. Are there services the center should provide that they do not?

Observation of Guardians:
1. Observe age and demographics of guardians.
2. Treatment of children.
3. Perception of center and staff.
4. Demographics of the guardians

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 REFERENCES

1. McGeary, Johanna; Death Stalks a Continent. TIME, February 12, 2001.

2. USAIDS. 2003. Children on the Brink: A Joint Report on Orphan Estimates and
Program Strategies. Washington, DC: USAID.
3. Joint UN Programme on HIV/AIDS, UNICEF, BLCA. Call to Action for Children Left
Behind by AIDS. December 1, 1999.
4. UNAIDS. 2002. Epidemiology Fact Sheet. Update of Kenya. Geneva, Switzerland:
UNAIDS
5. Human Rights Watch. 2001. In the Shadow of Death: HIV/AIDS and Children’s Rights
in Kenya.
6. UNAIDS/WHO. December 2002. AIDS Epidemic Update. Geneva, Switzerland,
UNAIDS.
7. USAID. September 2001. Leading the Way: USAID Responds to HIV/AIDS.
Washington DC: USAID.
8. USAID. 2001. USAID Child Survival and Disease Programs Fund Progress Report.
Washington DC: USAID.
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11. Human Rights Watch Kenya. June 25, 2001. Government Neglects AIDS Orphans.
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Devastation. Geneva, Switzerland: UNAIDS.
13. Best Practices Compendium for Family Planning/Reproduction Health. Lessons Learned
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14. USAID. September 2002.What Happened in Uganda? Declining HIV Prevalence,
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15. CBS News Sunday Morning. Help for Africa’s Future. April 20, 2003.
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19. Miles, Matthew B., and Huberman, A. Michael. Qualitative Data Analysis; Second
Edition. California, Sage Publications, 1994.
20. Temkin, Sanchia. HIV/AIDS to Double Number of Orphans. Business Day, April 25,
2002.
21. Children Affected by HIV/AIDS. www.savethechildren.org.
22. Hope for African Children Initiative. www.savethechildren.org/hope.shtml.
23. Action for Orphans. AFXB’s Global Action for Orphans of HIV/AIDS and Other
Vulnerable Children. www.thebody.com/afxb/background.
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York: UNICEF.

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