Final Draft

Review of
Children Affected By AIDS
UNICEF Supported Interventions

In Syangja and Accham Districts

Conducted by
Irada Parajuli Gautam
Consultant
15th July 2009
I. ACKNOWLEDGEMENT

I would like to extend my heartfelt gratitude to UNICEF for supporting in undertaking

this review of Children Affected by AIDS (CABA). I want to mention especially Sara
Beysolow Nyanti, Chief HIV / AIDS, by giving critical comments while designing tools
and finalizing the draft report. Also Ms Pragya Shah Karki, Project Officer CABA in
Kathmandu for her comments in draft report.

I am grateful to colleagues of UNICEF and its partner’s for providing accompany and
were supportive in various ways during review of CABA. My especial thanks to Ms
Shraswati Khanal Achham, Mr Anirudra Sharma Nepalgunj UNICEF and Mr. Laxman
Khand of SSS in Syangja for their supportive role in the field and drivers for safe driving.
This review would not be possible without their support.

My sincere gratitude to all the stakeholders who expressed their feelings openly about
CABA and made it possible to produce this report. Special thanks go to the children,
parents for giving their valuable time and contributed their ideas in Achham and Syangja
districts and have contributed immensely to the field study.

Thank you!

Irada Parajuli Gautam

Consultant
II. ABBREVIATIONS

AIDS: Acquired Immuno Deficiency Syndrome

AWP; Annual Work Plan
ANC: Antenatal Care
CCWB : Central Child Welfare Board
CABA : Children Affected By AIDSs
CPAP: Country Program Action Plan
DACC: District AIDS Coordination Committee
DDC: District Development Committee
DP: Development Partners (INGOs, Donors)
DEO: District Education Office
DOE: Department of Education
DCWB: District Child Welfare Board
DCPC District Child Protection Committee
ECD Early Childhood Development
EFA: Education for All
FGD: Focus Group Discussion
GN Government of Nepal
MACC Municipal Aids co-ordination Committee
MOE: Ministry of Education
MDG Millennium Development Goal
INGO: International Non Government Organization
IG Income generating
IDU Injecting Drug User
HIV Human Immunodeficiency Virus
NCASC National Centre for AIDS and STD Control
NRCS Nepal Red Cross Society
NKP Nava kiran Plus
NGO Non-Government Organization
PMCTC Prevention of Mother to Child Transmission
PE Peer Education or Educator
PLHIV People Living with HIV/AIDS
RPs: Resource Persons
SSS Sankalpa Sahayog Samuha
SMC: School Management Committee
UNICEF: United Nation Children Fund
SC Save the Children
STI Sexually Transmitted Infections
UNAIDS Joint United Nations Programme on HIV/AIDS
UNGASS United Nations General Assembly Special Session on HIV/AIDS
VCT Voluntary Counseling and Testing
VDC Village Development Committee
VEC Village Education Committee
VCPC Village Child Protection Committee
 Table of Contents

I. ACKNOWLEDGEMENT

II. ABBREVIATIONS
III. EXECUTIVE SUMMARY

1 INTRODUCTION ...................................................................................................... 7

1.1 Background ........................................................................................................ 6

1.2 Review Districts................................................................................................. 7

2. METHODOLOGY ..................................................................................................... 8

2.1 Tools and Techniques ........................................................................................ 8

2.3 Limitations of the Review................................................................................ 10

2.4 Ethical Consideration....................................................................................... 10

3. FINDINGS................................................................................................................ 11

3.1 Relevance of The Project To The Country Context......................................... 12

3.2 Review of the Project Strategies and Partners’ Capacity................................. 14

3.3 Results Achieved In the Project....................................................................... 16

3.4 Unintended Consequences ............................................................................... 25

3.5 Sustainability Of The Project........................................................................... 29

3.6 Lessons Learned and Gaps Of Existing Program ............................................ 32

3.7 Challenges........................................................................................................ 37

4. FUTURE RECOMMENDATIONS ......................................................................... 40

5. CONCLUSIONS....................................................................................................... 51

ANNEX......................................................................................................................... 54
 EXECUTIVE SUMMARY

UNICEF is a lead agency for providing protection, care and support to the children
affected by AIDS (CABA) in Achham and Syangja district. Based on an agreement
reached by the CABA taskforce, UNICEF implemented basic social support program for
children affected by AIDS in Achham and Syangja districts. UNICEF also conducted a
pilot program for income generation activities as a part of developing economic capacity
of CABA households in Syangja districts. Both districts were visited for the purpose of
review. The objective of this external review was to assess the effectiveness and make
recommendations to develop future strategy and guidelines.

The program has helped 415 CABA to protect survival and development rights through
food, health and education support. All the stakeholders participated in the review
realized that the program has increased the openness in reporting of CABA which were
hidden before, and has created the demand to access services by CABA and families.
Positive changes are observed among CABA that has motivated many other CABA’s to
use the services from this program. It was a great relief for children and families who
were extremely suffering from poverty, hunger and health. The food support to CABA
not only helped to relieve the hunger of children and families, but also helped to improve
the health condition, and to increase access to educational services.

As child headed household is emerging, it poses a new challenge making children more
vulnerable in accessing the opportunities. A need of psycho-social support is viewed as
primitive need. Based on the findings of this review, the recommendations have been
prioritized and categorized into different headings. UNICEF should fulfill its
commitment to protect CABA through working in partnership, networking with existing
Government, I/NGOs and UN, and initiating the dialogues with relevant stakeholders.
 CHAPTER ONE

INTRODUCTION

1.1 Background

UNICEF is a lead agency for providing protection, care and support to the children
affected by AIDS (CABA) as per the UN division of labor in Nepal. UNICEF supports
for coordination among CABA through CABA taskforce. Based on an agreement reached
by the CABA taskforce, UNICEF has implemented basic social support program (food,
education, health, and income generation activities) in partnership with NKP in Achham,
SSS and MCDS in Syangja from June to Dec 2008 to help children affected by AIDS.

In the year 2008, a total of 415 CABA received nutritional, educational and medical
support under protection, care and support in two districts above. Along with basic social
support, CABA households were provided with various income generations training in
Syangja. It is interesting to find that 50% of the households have started their own
business.

Estimated number of CABA in Achham is in the range of 1200–1500 and about 800 in
Syangja (based on NGO’s contact). Sankalpa (the local NGO) has regular contact with 90
to 95 individuals (adult and children) overall, which was 126 previously. Out of 126
persons, 10 to 12 adult has died. Although there are no concrete data on the size of the
CABA, it is assumed that there are many more children affected by AIDS in various parts
of Nepal who need such protection mechanisms. It is estimated that only 25% CABA in
Achham and 12 % in Syangja have been benefited from the services under protection and
care.

The National HIV/AIDS Strategy 2006 – 2011 has been endorsed by the government of
Nepal. A National HIV/AIDS Action Plan 2008 – 20011 was subsequently developed
and endorsed as a subset of the national strategy. In both documents, the agenda of
children was not properly captured and taken forward. Prior to this pilot, there were no
interventions for protection, care, treatment and support for CABA in both districts.

Although Nepal has made some progress towards incorporating children’s issues in the
National Action Plan, the National HIV and AIDS strategy does not explicitly address the
issue of children affected by AIDS. In addition, there are no national or district child
protection systems, which can cater to the needs of CABA. Hence, there is a strong need
for developing strategies and guidelines for protection, care and support for CABA. In
order to develop practical strategies and guidelines for improving the services for CABA
and to prioritize their needs, the review of CABA interventions in Syangja and Achham
districts was very much a need.

1.2 Review Districts

Two districts were visited under CABA review process and national stakeholders were
consulted in Kathmandu.

Table 1: Districts and Date for Stakeholder’s Consultation

CABA Districts Date of Field visit Including Travel Time

Achham June 9th to 14th 2009

Syangja June 16th to 21st 2009
Kathmandu May 25th to 30th 2009
 CHAPTER TWO

2 METHODOLOGY

2.1 Tools and Techniques

The methods primarily included the review of the documents, and participatory research
techniques such as focus group discussions and key informant interviews. Participatory
tools (FGD and KII in particular) were used not just to extract the information but to
initiate interactive discussions, so that two ways learning was possible. The review
process itself was a learning strategy for both group i.e. evaluators and stakeholders at the
district and central level. Techniques used in this review were as follows;

1. Documents Review (program documents, reports, monitoring reports, meeting

minutes etc)- Following documents were reviewed;
¾ UNICEF Country Programme Action Plan/Country Programme Document
¾ Project Document
¾ AWP
¾ Coping Mechanisms of CABA
¾ Project Progress reports by partners
¾ Monitoring reports by HIV and AIDS Section and other colleagues
¾ National HIV/AIDS strategy and National Plan of Action

2. Key Informant interview with different stakeholders ( KII )

3. Focus Group Discussion with parents, children, and school teachers in 2 districts

Standard Check list was developed for the Focus Group Discussion (FGD) and individual
interview. Observations of CABA’s participation in focus group discussion were noticed.
Individual interviews and FGD’s were conducted represented by Parents and children
from the program area.
 Table 2-Categorization of stakeholders Consulted During Review of CABA

Individual Interactive Meeting Achham Shyanja Kathmandu Total

Ministry of women and child social welfare - - 1 1

HSCB 1 1
NCASC 1 1
Central child welfare Board - - 2 2
Save the Children (Norway) - - 1 1
Navakiran Plus - 2 2
Unicef field office 2 - - 2
Naya Health service 1 - - 1
District child welfare Board - 1 1
District Education Office 2 1 - 3
Women development Office 2 1 - 3
LDO / DACC chairperson - 1 1
Municipal Aids coordination committee members - 4 - 4
DHO / DPHO / DACC secretary 1 1 2
Number of FGD 4 3 7
NGOs group
Navakiran Plus Representative 8 - - 5
Gangotri Representative 2 - - 11
OCWAC Representative 2 - 2
NGOCC Representative 1 - 1
Sankalpa Shayog Group ( SSS) - 5 5
Multi purpose community development service - 2 2
Sakriya Sewa Samaj - 2 2
Parents 10 26
Children 18 6
School teachers 20 - 20
Total 45 55 8 108
 Altogether 108 people were consulted that provided a good representation of the
district situation.

2.3 Limitations of the Review

The limitations encountered during review process are as follows;

• A Frequent Road Strike (Banda) made much difficult to meet stakeholders,
• During the review, the project was already completed before 7 months and it was
difficult to verify the effectiveness with stakeholders. Few stakeholders didn’t
even know about the program,
• Within a limited time, it was a long distance travel to reach district (Achham)
which affected the amount of information collected. Hence, the quality and
precision of data collected had to be balanced against the time constraints,
• Short duration of the assignment made least possibility to visit the villages; most
of the participants met were from nearer to the district headquarters. Therefore
certain influenced by access to information and proximity of district headquarters,
• Limited amount of information as consultant could meet only with certain number
of beneficiaries due to short time spent for review in field,
• The DACC co-ordinator, DHO, DCPC Officer, HIV/AIDS consultant of UNICEF
in Achham were out of place.
• Sensitive subject and limited time to allow children to feel comfortable enough to
discuss CABA issues to obtain information due to fear and lack of confidence.
• The political instability in country which may have affected people’s perception
of the current security situation.

2.4 Ethical Consideration

During FGD and individual interactive session, extreme care was taken to respect
individual views, ethnic characteristics and gender differences. Individuals were clearly
explained about the purpose of the review (FGD and interactive discussion) beforehand.
 CHAPTER THREE
3. FINDINGS

3.1 Relevance of the Project to the Country Context

As of 2008, the adult HIV prevalence in Nepal stands at 0.49% with nearly 70,000 adults
and children living with HIV.1 The national action plan on HIV and AIDS 2008 to 2011
serves as a blueprint for articulating the necessary actions to achieve universal access to
prevention, treatment, care and support over the next three years.

Although Nepal has made progress towards incorporating children’s issues in the
National Action Plan, (2008 – 2011) the National HIV and AIDS strategy does not
explicitly address the issue of children affected by AIDS. In addition, there are no
national or district child protection systems which can cater the needs of CABA.

On August 2007, the government of Nepal created the national HIV/AIDS and STI
control board mandated primarily to formulate policies, monitor the trend of the epidemic
and oversee the country’s multi-sectoral response to HIV and AIDS.1

The country’s program of cooperation for HIV and AIDS program has outlined four
projects which are: PMTCT, Pediatric AIDS Treatment, Adolescent Prevention and
Protection, Care and Support for Children Affected by AIDS. The four projects are
invariably interlinked albeit they have stand alone objectives and results.2

Nepal has concentrated HIV epidemic with prevalence estimated as high as 50% among
certain most-at-risk populations. It is estimated that almost 1,857 children under 15 are
living with HIV and as the infection spreads, the number of children who have lost
parents due to AIDS will begin to grow. Though the actual number is not available, it is
widely known and accepted that a larger number of children are in vulnerable situation

1
National HIV and AIDS Action Plan ( 2008 to 2011), Govt of Nepal HIV, AIDS and STI control board
March 2009
2 Country Programme Action Plan 2008 -2010 Between the Government of Nepal and UNICEF
due to the impact of HIV and AIDS. This vulnerability has increased due to poverty,
hunger, conflict, and deep rooted traditional practices. Many children are living with sick
and dying parents or in poor households, which take in orphans. In addition, when the
parents are infected with HIV, they fall sick or die, and their children are the first ones to
be affected. The children are often used as child labors, taken to child centers or sent off
for labor migration. They stand at risk to lose their inheritance. In some cases, they
become heads of the households and are left to care for themselves and their siblings.
This has become an emerging trend in the far western region Nepal.

More than two decade of national response with support from national and international
agencies, it has indicated that the response lacks child focus especially on protection,
treatment, care and support for CABA in the country.

The country has accorded high priority to HIV/AIDS as one of the cross cutting issue
providing a clear mandate to all line agencies to initiate sector specific programming.
However, most line agencies do not have sector specific HIV/AIDS’ plan and program
for protection of CABA.

The organizations (both government and non government) working for care, treatment,
and support for people living with HIV and AIDS are located mostly in urban and city
areas. After an agreement reached by the CABA taskforce UNICEF implemented basic
social support program for children affected by AIDS in Achham and Syangja districts.
This program was indeed a real need and relevance in present context. In Syangja, there
were no organizations focused on care, support and treatment on HIV / AIDS at the time
of review. Both districts were heavily influenced by labor migration to India that existed
since long. Similarly, looking at the poverty faced by CABA families, the income
generation activities focusing on CABA households in Syangja district was a greater need
to address for their sustainable livelihood.

The current political situation under which, much of the national resources are being
diverted to peace building process and the constitutional making, the government
capacity to allocate adequate resources for HIV/AIDS programming especially for
CABA’s protection, care and support is very weak. Hence, donors’ assistance will
remain to be crucial factor for the protection of CABA in future. Providing access to
health, education and food to CABA ensured survival and development rights, which is
the fundamental needs of every child. It is highly critical to CABA and families who have
suffered acutely from hunger and poverty. The NGOs, volunteers, parents, children and
staff expressed their appreciation for these actions and requested to have access of these
services for larger numbers of CABA.

3.2 Review of the Project Strategies and Partners’ Capacity

The project has able to provide access to health, education and food for CABA as per the
target. The program has enabled to increase the openness of CABA for reporting their
problems which were hidden before, and to create the demand to access services.

Moreover, the intervention was primarily focused to access services for limited number
of CABA in two districts. The program had given a least attention to promote the
strategies to create an enabling environment in the community for children affected by
AIDS and making their group to unite for strengthening their capacity to access the
services. Reaching to community was not been inbuilt within the program structure to the
extent anticipated in the project document. Reaching community beyond access to
services to targeted CABA was difficult task due to low number of outreach workers and
scattered community. Access to services to 300 CABA was possible due to referral of
other organization to NKP in Achham, which was incredible. There are social movement
program on HIV/AIDS, which is implemented by Gangotri and OCWAC that also helped
NKP to access services in Achham. In Syangja, SSS had started initiating group of
CABA families with mix up of men and women. Due to their own network of about 100
members; they have easy access to reach more number of CABA than targeted. CABA
families used to come on monthly basis in SSS office in Syangja Walling. However, no
groups were formed at the community level. No strategies were designed to access
services for all CABA in districts with mobilization and support of existing structure of
local government and other NGOs.

Due to UNICEF support program, both partners realized the experiences gained from
implementing program on CABA. Rajiv Kafle; a chief of NKP who had long history of
working with PLHA’s care, support and treatment also felt that this program gives a
sense of realizing why we need to focus on children? The positive experience in Achham
encouraged the authorities to expand the program in six more districts of mid and far
western region with different donors.

The CABA program in Achham and Syangja in such rural context has further
strengthened the image and credibility of NKP, SSS at the district and national level.
Both organization are dedicated and committed in action for PLHA / CABA care, support
and treatment. Staffs are mostly from HIV positive group in both organizations and they
also perform advocacy for the rights of PLHA and CABA. The staffs appeared to be
motivated and caring, also demonstrated strong commitment to the project.

SSS has learned management skills and expand their contact with district authorities over
the period, though it was a preliminary contact. In other words, this program has played a
catalytic role in expanding their contact with schools, DEO, DHO, DACC, DCWB,
VDCs. SSS and NKP experienced that their own knowledge, attitude and capacity have
improved substantially regarding CABA issues. There is a realization that understanding
of CABA should not just limit on relief, but needs to be seen from rights perspectives.

UNICEF field staff and DPHO in Achham mentioned that NKP needs to improve
communication and coordination skills with different district stakeholders in district in
order to get better support from them. Also monitoring mechanism of organization needs
to be strengthened. There needs to be a balance of institutional care vs. community
approach for the CABA and ensure the child protection policy within the institutional
care of NKP. Though project is called community based package for care, support and
treatment for CABA; it is still observed to be more on institutional care. Participants in
FGD expressed more about the Gangotri, and OCWAC when asking about the providers
for care and support at community for CABA. NKP identity was not highly expressed.

Although there are great opportunity and scope for partner organizations, the district
authorities expect a certain degree of professionalism in local monitoring, coordination
and in sharing the experiences. In terms of gender, almost all the staff are men except one
woman support staff in NKP Achham and might be difficult for girls /women to talk
openly. There is a lack of gender disaggregated data on access to services of NKP.

The strength of SSS is, they have network with CABA families mostly women members.
They are committed and dedicated for action at community level. They are in regular
contact with CABA households on a monthly basis. This is the only organization in
Syangja district working on protection, care and support on HIV/AIDS in Walling. The
coordination of Sankalpa with PHC Walling in Syangja found functioning well. All the
CABA and families were sending with referral slip to PHC to get prompt response.

The weakness of this organization is, it depends only on one donor, which is UNICEF
and lack linkages, networking with other donors and private sectors. There is also a need
to develop the human skills on report writing and proposal writing in order to build the
capacity of organization. Most of the board members of SSS are just literate.

3.3 Results Achieved In the Project

As per the planned results mentioned in agreement documents in terms of accessing

services to CABA in both districts, the results were achieved monitoring the services to
CABA that encouraged other NGOs, VDC to support CABA who were not partner of
UNICEF for this program. The following table shows money spent by UNICEF in each
district with different partners and its achievement to access services.
 Table 3 Cost spent for the program by UNICEF June to Dec 08

NGO / Budget per District Total Budget Nrs

NKP Achham 3961496

MCDS Syangja 1851340

SSS Syangja 1166300

As per the document reviewed, 93% of the budget in each district has been spent for
program activities and 7 % was spent for program support cost, which is fairly beneficial
to the target population.
Table 4 Support of NKP in Achham
Indicator Target Achievement
Educational Support 300 300

Medical Support 50 52

Food Support 300 301

Source: NKP annual report May 09

Table 5 - Support of SSS in Syangja

Gender Educational Support Medical facilities Nutritional support

Target 100 Target 50 Target 100
Infected Affected Total Infected Affected Total Infected Affected Total

Boys 8 61 66 8 22 30 8 45 53

Girls 4 63 70 4 24 28 4 58 62

Total 12 124 136 12 46 58 12 103 115

Source: SSS annual report May 09

The above table shows that SSS and NKP have provided access to the services to more
children than targeted. In terms of food Nava Kiran Plus (NKP) provides 6kg of satupitho
for children per month. However, NKP staff suggests that this satupitho is good only for
young children who were below 10 years. It is suggested to provide Rice, Dal, and
Cereals for children who were above 10 years. Sankalpa provides Rice, Dal, and Cereals
to all age group of CABA in Syangja. In the year 2008, with support of UNICEF a total
of 436 CABA received food, education and medical support through Nava Kiran Plus
(NKP) in Achham and Sankalpa Sahayog Samuha (SSS) in Syangja districts. It was
found that the support program has taken positively by all stakeholders and children
affected from AIDS are speaking up (who were not targeted) and demanding to get
services from NGOs, VDC, DHO and DEO.

This program has really helped in our education and also in our treatment. This program
is very effective, for the children like us who don’t have both of the parents living. It also
has supported in meeting our daily needs such as food and clothing. If this program
continues then it will be very beneficial to the children like us. – A girl in FGD Achham

In both district treatment of CABA and families are available in the district hospitals and
primary health care centers through the national logistics system. The Dr of PHC center
in Syangja mentioned that they are happy for their services and have capacity to receive
more children. The linkages and referral mechanism of NGOs to access health services
for the treatment of opportunistic infection to CABA are well functioning.

Medical care and follow up is well covered as the treatment for opportunistic infections is
ongoing in both districts. Essential drugs are covered and are accessed through the
government, and specific OI drugs are accessed through the national logistics system.

A 15 month old boy who was brought with her mother during FGD in Walling Syangja
was severely malnourished and more than 60% wasted. He is under DOTs treatment and
ART. These type of children require high density foods frequently with micronutrient
supplementation in close observation but couldn’t not be addressed those needs of CABA
who were severely malnourished. Mother told she doesn’t have enough food to feed him.
In Achham there is good coverage of VCT through CB-PMTCT. VCT has planned to
expand its services in future; total 17 expected including the VCT plan of Naya health
service and OCWAC. Rapid testing is available in the VCT sites and within ANC. This is
facilitated through the national logistics system. So far 52 children identified HIV +ve
and 4 children are taking ART from Achham hospital.

In Syangja there are 2 VCT centers now and plan to open one more in district hospital. 17
children are identified HIV +ve and 7 children are taking ART. In the beginning, SSS
sent client to Pokhara Gandkai hospital and after that the SSS managed to distribute ART
in their office for CABA and adults to minimize the resources to travel to Pokhara.

Though there was no any baseline survey to compare the schooling of CABA before and
after the program, the NGOs group mentioned that in the past, parents just admitted their
children in the school and didn’t send regularly due to not having financial resources to
buy stationery, shoes, and uniform but now CABA are going to school regularly.

“Earlier it was quite difficult to send children in school and now because of education
support our children are studying better. ---------- FGD parents in Achham and Syangja.

Meeting with parents in both districts revealed that they are regularly sending their
children at school except when they get sick. In Syangja, net enrollment rate of children
was 98% in 2008 and the focus was to bring 100% enrollment despite the status of
children. During the review in both districts the DEO’s expression was very positive for
education support to CABA children and they suggested needs to reflect in policy unlike
other categories and should be reflected in EMIS to know CABA information.

The NGOs and district authorities mentioned that there is no discrimination in school and
public spaces in both districts. Almost all children who participated in FGDs said that
they are happy and like to go to school, though they experienced beating by teachers if
they did not complete the school work. The children are not facing any discrimination
and misbehaviors in school due to their status. Nevertheless, a mother in Syangja during
FGD mentioned that her daughter was unhappy recently when she heard of her friend
shared among friends that her father was died from AIDS.

I am very happy by this program as it has given opportunity to many people and children
of our village who are deprived of resources. This program has given space for poor,
destitute and supported in their health and education through which an arena to bright
future is safeguarded. The people infected from HIV and AIDS were discriminated but
creating awareness among the people and now slowly people are accepting them. I wish
this program will continue and future too and support many other people who are in real
need. – A 15 years old girl study in Grade 10.

The quality of education was a big concern. NKP staff in Achham mentioned that the
children who are in 5 grades couldn’t write their name properly. It was also observed in
FGD that the children’s handwriting was very poor even while writing their own name.

Certain VDCs have started to allocate fund Nrs 5000 to 15000 or provide materials for
children and families affected from AIDS. For instance, Jalpadevi, Ganjara, Kalika,
Mastamando, Bhageswor and Ridikot VDCs are some of them in Achham. The school
teachers during FGDs mentioned that the VDCs have allocated fund due to SOVAA
movement in Achham, which is very popular and well known to everyone in Achhami
community. Allocated fund was basically for food, education, and IG activities for
CABA households, though it was one off support rather gave continuity to allocate fund
in systematic way. There is no record and report at neither DACC nor DCWB indicating
the distribution of funds for which children and families, and how the money has spent.

In Syangja, a single woman mentioned during FGD that when she went to ask support
from VDC, she was provided with one sack of Rice. For additional support, she was
asked to bring recommendation letter from Sankalpa and thus she plans to go again with
recommendation letter. LDO in Syangja who is also a coordinator of DACC suggested
that it is necessary to strengthen the capacity of VDC to reach at lowest level, so that they
can identify CABA issues and support accordingly. If VDC people are sensitized, they
can allocate budget from 5 to 15%.

In Achham, DACC has developed local guidelines for support to CABA’s and single
women but they are only limited in paper. Recently, DACC has also developed baseline
survey form to identify HIV infected and affected household, which is in draft form.

The municipal AIDS co-ordination committee was formed with representation of 15

members in Syangja Walling is encouraging. It is also found out that there is one regional
network of 4 districts (Palpa, Arghankahnchi, Syangja, and Rupandehi). The task of this
network is to identify the issues on CABA households and advocacy for policy making.

Social Support for CABA and Families has been provided by Navakiran Plus, Sneha
Samaj, Gangotri, Naya Health, Achham Hospital, VDCs and DEO in Achham. In
Syangja the SSS, Sahara Samuha, Shyangja support group, Surodaya youth club, children
club, DCWB, Sakriya sewa samaj, MCDS, primary health care center, district hospital,
NRCS, MACC are providing one off social support. When talking with parents and
NGOs, it was found that the social support for CABA and families from own relative
especially from husband’s family side was very weak. In Syangja it is found relatively
good from families compare to Achham. One of the woman staff in SSS mentioned that
when she was with her husband, they were separated with family members but after the
husband’s death the in laws came to live together and take care of her children.

The impact of HIV and AIDS and issues of Livelihood among CABA Household is most
profoundly reflected in the lives of CABA whose survival and development rights are at
stake. The following table indicates the number of benefits for CABA household from
different training to improve economic capacity.

Table 6 - Improving economic Capacity of CABA household Achievement

Micro-Enterprises Group (MEG) and Saving Credit Group Mobilization 2 groups with
56 members
Micro-Enterprises Creation and Development Training for 5 days 24 members
Tailoring, Embroidery and hand loom Jari Training for 3.5 months 9 Participants
Handicraft Training- Bamboo craft Training for 15 days 4 participants
Basket Weaving Training (Dhaki) for 7 days 10 participants
Candle Production Training for 4 days 9 participants
MEG Management and book keeping Training for 4 days 21 participants
Source: MCDS annual report May 09

Total Participants benefited by the different vocational training were 77 in Walling,

Syangja. Out of this number, 55 were women and 22 were men. The above table shows
that all the partners had achieved the results and accessed the services, which is more
than the target as mentioned in agreement document. Actually the project was
implemented by joint venture of Sankalpa and MCDS in Syangja. Sankalpa has identified
CABA families for the training, who can take vocational training and micro credit.

The CABA families who participated in FGD shared their very lively experiences with
us. Following points were highlighted during the review.

The families were very happy to receive the training, which they completed with a deep
interest. They also explored the market and contact person, who take their product
regularly and sell in the market. One of the man in FGDs said that he took training of
Candle making and the profit he made after selling the Candle helped him to connect
electricity at his home. In the past, there was no electricity at his home, which caused
difficulty for his children to study in the night. Likewise, other women expressed that the
income that comes from selling candle has been very helpful to improve their daily lives.

The families who have received vocational training also started monthly saving (10 Rs.
/month) so that they can initiate micro credit for small income generation activities. The
group of families involved in saving program also enjoyed sharing each other experiences
of their business. The group who meet every month for saving and micro credit also
collected the ART from Sankalpa office and at the same time went for regular health
screening in PHC, Walling Shyanja with referral slip of Sankalpa. Sankalpa’s work is
very much appreciated, who has good network with all those CABA families and they
keep regular contact on monthly basis. Till now, there are 2 groups for saving and credit
and 50 % credit that has taken by one group is already repaid.

The trainees in the initial days were not able to talk with MCDS staff confidently, as
they felt shy and could not raise their voice. Now they felt that they have got new life as
they can earn money and sees the positive hopes to carry on their life.

Their self confidence and strength has also increased due to group solidarity. They can
look after their household chores and at the same time do the business at home when they
have free time. The participants indicated that when they came in the training they have a
chance to share their family problems, issues they faced that also helped them in solving
their problems through sharing and discussions. The trainees have committed that they
will use their skills to earn their livelihood and continue their business.

In the similar way, it has helped to increase their contact in market as they enter into the
business unlike before they were staying at home with a feeling that they can’t do
anything productive in their life. As they have a good network and monthly meeting they
can expand the members. They demonstrated their capacity with strong resilient and can
manage their lives. They can identify and refer the CABA household to different
organizations to receive the services. The trainees stated that they have to listen to the
children, and also to meet income needs to support for their children as per condition.

The CABA families’ shares their experiences in this way; “Previously, we have negative
feeling “to get rid of this world and wanted to die” but now we have felt that if we die
others will take advantage of our children. So now we move ahead and develop
confidence to look after our children and secure their future”. The trainees also shared
that, in the initial days of training, the community people looked down on them and even
commented on them being affected from CABA households, but now situation have
changed. Those people who were against them now support and pay a good respect.
In the beginning, the participants did not talk with each other but now they have started to
trust each other and create a positive environment for building their strength. They
developed confidence, self respect, and learned to solve their problems by themselves. As
they were worried about their children and themselves, they mentioned that children have
to be loved and cared which has helped in making their life comfortable.

In order to build the confidence, to make them self-dependent, and to raise their
economic status, the skill development program and vocational training was very useful.
Another good motive of this program was also to come together on monthly basis for
micro credit and saving. This project has been proved very effective in terms of changing
gender roles as well. The prevailing concept of the work division is that women generally
work at home whereas men work outside the house. Nevertheless, if provided the
opportunity, no matter of HIV AIDS status, women can also work like men. This
program can be considered as a unique project to change the stereotypical role.

The participants expressed that they are independent now as they started to earn and
become economically stable. Thus the society started to look at them positively. They
have started to earn about 2000-8000/- Nrs per month.

While staying alone, the participants used to think that they were the only one who faced
the problem. However, being in the group they have realized that they are not alone and
there are many CABA households who have similar problems. This has given them hopes
and courage among each other.

The participants now have started to believe that they can also be independent as they
earn on their own. They have now realized that no one can cheat them with the label of
HIV/AIDS. They were victimized and started to believe that they can get loan and live
with dignity like other human being. The participants got this opportunity to be stress free
and concentrated on the training, which made the training enjoyable and shorter for them.
The participants have shown the commitment that they will advocate and spread the
messages against HIV/AIDS and also committed that whenever they see CABA will
report to the concerning agencies for the support.

The Womenfolk during FGD mentioned that “Earlier we really used to feel shy and
scared, for this reason our problems used to get unheard but now we are confident and
enough to express our problems in simple manner.” MCDS and Sankalpa have provided
us the training, while we were helpless, but now we feel confident and independent, we
feel that our better days are here.”

Regarding Psychosocial Support to CABA, some NGOs, through care and support, peers
support program is providing support. However, this is on adhoc basis and has no
continuation. Gangottri has trained CHBC workers and counselors in Achham and in
Syangja. Although there are few trained counselors, they have not practically worked in
field. This remains a gap in both districts.

3.4 Unintended Consequences

As per the experiences of NGOs, there are increasing demands of the services by many
CABA families. The parents during FGD mentioned that all CABA children need to be
benefited continuously from the program rather than only limited number of children.
There were many CABA that were left out to access the services from the program.

Looking at the demand of care and support, there are other NGOs like Gangotri,
OCWAC in Achham who supported education, food, and also economic support to
CABA families based on their needs. A staff of Gangotri mentioned that about 600
CABA had received care and support from the organization till last year, which was a
greater target than from NKP and they proposed DEO Achham to get educational support
for 800 more children.

The modality of combinations of vocational, micro credit and savings trainings in

Syangja brought positive results not only at economic level but also at psycho-social
level. This project provided resilient to CABA households within short period of time.
Almost all the stakeholders expressed the demand for IG support to CABA families.

Some VDCs have started to allocate the funds for CABA looking for external support. It
is often the case that own family members and relatives are not supportive to CABA
households. Single women during FGDs mentioned that in Achham and Syanga their
relatives are not supportive to them and degree of sensitivity to CABA households from
neighbors are less compared to outsiders.

The NGOs staff at Achham mentioned that due to frequent transfer of government
authorities, it created a problem to understand the issues and they have a low sensitivity
towards the problems. A need was felt by the staff of UNICEF and NGOs to give
orientation on HIV/AIDS and CABA to new authorities in Achham. The commitment of
DACC in Achham to support 350 children has not reflected in action and no budget is
allocated so far. DACC in both district under the leadership of LDO is not well
functioning at present and they do not have meeting since long time.

Likewise, there are no cases of marriage among boys and girls who has HIV +ve. In
Achham, a single woman said that both her brother in laws left house when her husband
died from AIDS and she didn’t get any family support at the time of difficulties. It was
also expressed that the support of NGOs to CABA households was not even easier as the
family members show a very jealous attitude towards such support. A staff of Gangotri
mentioned that when the children lost their parents due to AIDS, Gangotri went to repair
the roof of the house and family members didn’t support to repair their roof.

In Syangja district the LDO and DHO strongly mentioned that they don’t have any
budget to coordinate, monitor, and plan the HIV/AIDS activities. The officers were really
concerned on the budgetary aspect, without which nothing was possible. One of the DHO
staff in Syangja revealed that services were provided without any preparation in
community that failed their own community and family to support for such programs.
There were invisible stigma and discrimination in Achham and Syangja. At private level,
especially the single mothers were faced with a lot of emotional tortures expressed by
their own relatives for their children. The problems faced by the CABA families are
attributed to absence of male members at home, hand to mouth problem, increased
women headed households, and child headed households especially in Achham and
double burden of social and economic responsibilities and lack of father’s love and
affection.
Likewise in Syangja a single woman expressed that her daughter is not infected from
HIV +ve but her mother in law and younger sister in law doesn’t believe it. They always
used sickle after putting in fire to kill the HIV virus to sterilize once her daughter used
the sickle in cutting fodder for the livestock.

If people are infected from HIV/AIDS even the family members looks with suspicion and
they even hate the infected member. The community people also do not want to come in
contact with those families whose members are infected. The children of the local
community are not allowed to play together. The provision for fooding, clothing and
shelter should be provided to the CABA-- A woman in FGD, Achham

It was found that the single women who lost their husbands due to AIDS feel more
restrictions in participating in social and economic opportunities. For example, a single
woman during FGD in Achham mentioned that when she went to Dhanghadi for
HIV/AIDS workshop was accused as “bad character” by her mother in law. Her mother
in law also blamed her “in the name of HIV/AIDS after death of husband you are
misusing my son”. It was a big trauma for her than creating a supportive environment to
improve their situation. Another woman also expressed that her mother-in-law always
said to her child “don’t touch my utensils and don’t play with other children of younger
daughter in law, though she was not infected from HIV +ve.

A child in Achham came to parents’ discussion with her mother and expressed repeatedly
that he doesn’t have HIV positive status without asking question though his father died
from AIDS and mother is HIV +ve status. He wants to ensure and express his happiness
of not having HIV +ve. From this situation it is found that many CABA might have fear,
anxiety, confusion but lack to listen children’s feeling and didn’t address the need of
psychosocial needs of children in systematic way.

In Achham, it was quite stunning that children did not talk much. It seemed their
confident level is very low to talk on the HIV/AIDS issues. HIV is affecting the dalit
community more than the non-dalit in Achham whereas in Syangja it is not the same. In
Syangja it was found that Brahmin, Magar, Chhetri are more affected compared to Dalit.

During focus group discussion with parents, it was found that all CABA children have not
gone through VCT, and they give priority to younger son. Two women participated in
FGD in Achham mentioned that they did not send their daughters for HIV testing but for
the son they tested. They did not send their elder daughters to school as well. The elder
sons who crossed the age of 16 mostly went to India for the job, and the elder daughters
remained in the house with their mothers to support for household chores and to look
after the younger siblings.

There are government structures, NGOs, international agencies working in the district but
it was found that there is very little collaborative work in the area of HIV/AIDS at
institutional level. According to NKP coordinator, there is very little coordination among
the institutions and the stakeholders at action level but exists more of the lips services.
One of his experiences he shared, how difficult was it to support transportation cost to
send the children affected from AIDS to Kathmandu. He did telephone many times to
government offices and other NGOs for the transportation support but that didn’t work
out. Finally, he needed to visit the offices in person to arrange the transportation.

There is a competition among various NGOs to highlight their own work than providing
coordinated services in the community. On the other hand, the NGO partners were not
satisfied with the bureaucratic process of government. They mentioned that the
government body most of the time show off their bureaucratic power and only asked for
information on NGO’s activities and is less concerned on the successful implementation
of the program. This creates a barrier for coordination and collaboration at program level.
The DCWB/WDO in Achham mentioned that none of the NGOs are giving report on
CABA situation in district and their respond towards CABA families. And they were
concerned that how WDO/DCWB can plan, protect and monitor children rights in this
situation? The DCWB in Syangja is better coordinating to protect children rights. The
DCPC officer in Syangja mentioned that there should be an orientation program to all
stakeholders on CABA issues for their commitment and responsibilities spelled out.

3.5 Sustainability of the Project

Sustainability needs to be seen from the viewpoint of ownership from the community
rather than merely focusing on the continuation of the program. It is critical to see
whether or not benefits are going to be sustained in the longer term among the CABA to
whom the programme is targeted. Altogether, there were 436 CABA who received the
support services from the program. The care, support and treatment were very helpful to
protect their survival, and development rights. These children have access to health,
education and food that helped to sustain their life. There is a huge demand for
protection, care and support for other CABA and families who are not included in the
program at present. Currently, as per the NGOs, the program covers only 25% in Achham
and 12 % in Syangja. There are still 75 - 90 % of CABA who are marginalized from care
support program in two districts. The challenges remain at how to increase access to
services for remaining CABA beyond the 436 and how to sustain the services?

During the review, the NGOs staff mentioned that dependency of CABA household has
increased towards NGOs and the service providers. According to the staff, the children
outside CABA also claimed for the services. The services which were provided were only
a short term relief rather than being a strategic solution to the problems. The CABA and
families were demanding the services continuously and thus there is a need to identify
alternative options especially to meet the demand for food, shelter, and cloth (Ganns,
Bass, and Kapass) and to access health and education in the long run.
It was found that the social mobilization at community level to access services of care
and support is very weak. The project has not properly worked on the strategies to
mobilize community involvement. The existing structure of UNICEF in Achham on
CABA program has not mobilized sufficiently. The different structures at present such as
COs, PEs, child club, CBPMTCT, DACAW committee, CAP, paralegal committee do
not play significant roles in CABA program and are very passive. This is perhaps due to
the lack of orientation, sensitization on CABA issues and lack integration. The CABA
program couldn’t be linked well with other program of UNICEF that ignores CABA’s
participation in the program activities such as PEs, children’s club, SOVAA and extra
activities organized in school which would be beneficial for sustainable mechanism.

As per the discussion with NGOCC in Achham, the program can be sustained if it
mobilizes existing groups of UNICEF, other NGOs and government as there are already
children and women related program being implemented in many VDCs. The MACC
representative in Walling Syangja (who engaged in politics and different social sectors)
mentioned that if UNICEF initiates social dialogue among different stakeholders they
feel responsible, can support CABA / families such as allocating fund in school, access
food from business group, give credit in low interest from bank that can be sustained.

In order to reach the services to all CABA, UNICEF needs to cooperate and coordinate
with government and plan to start care and support program through out the country or at
least in the areas, where UNICEF has been implemented other program activities. It
might be needed to use different models or a shift to access services by DEO and DHO
for education and health. Looking at the benefit of accessing services, UNICEF needs to
focus into strengthening the capacity of district authorities, who have good structure at
lowest level especially DHO-Health, Psychosocial; WDO-economic empowerment,
Psychosocial, DCWB-overall child protection, social, legal and DEO- to access education
services. Also in relation to nutrition support, the UNICEF should explore the role of
child health division and its capacity to access the nutritional services in the long run.
The Nepal Government has already made an agreement on the provision of free health
services, which include the treatment for opportunistic infection. The present structure of
UNICEF needs to be mobilized such as VF in all VDCs where CAP process has been
implemented in DACAW districts for its wider expansion. Likewise, training and
workshop is also necessary to sensitize on CABA issues to all VDCs in Achham and
Synagja so that they can establish a system to allocate fund (5 to 15%) continuously for
the economic support, education and food for CABA. They can also monitor the benefits
in their VDCs and own the program. If VDC people understand the issues, they give
priority for their needy people and program can be sustained in the long run.

UNICEF and partners should develop a plan for making greater use of existing community
groups (e.g. Mothers Groups, Youth Groups, children CLUB, SOVAA) and other existing
structures. Greater community involvement has two main benefits. The first is that more
people are empowered to get involved in issues of CABA, increasing the positive impact of
program that brings a bigger difference to the lives of CABA. This includes reaching all
CABA. The second is that community attitudes towards CABA are changing at large. These
two factors have very significant contribution to the program sustainability as the ownership
and acceptance increases. For instance, if UNICEF and partners ceased to function as things
stand now, most of its benefits would be lost completely. With greater community
involvement, much more work could be continued smoothly, even if UNICEF and partners
organization no longer support the community.

The different stakeholders also emphasized that along with short term support for food
and shelter; there should be nationwide program for CABA households to improve the
economic capacity and sustainable livelihood. This needs to work in collaboration with
NGOs, private organization, WDO and small cottage industries for enhancing IG
activities. The government has good structure to access education, health, and child
protection, women empowerment services up to grassroots level through DEO, DHO,
DCWB, WDO, DDC, and VDC. These all structures needs to be mobilized, strengthened
and should be functional and monitored from CABA perspectives. Also DEO staff
mentioned that there should be a clear policy in regard to education support for CABA
same like in case of Dalit, other ethnic group, Madeshi and girl child, which can be
sustainable in the long run.

The present partners of UNICEF need to work in collaboration with other NGOs and
mobilize all the existing structure to access care and support services for all CABA for
extensive coverage, fast expansion, community ownership, sustainability, and to
minimize the cost. UNICEF should focus on building a long term partnership and long
term investment for achieving results on a sustainable way. For instance, if the project
will be discontinued after 1st phase, all the past efforts will be at zero level and it needs to
restart as from the original phase, which is in fact, waste of resources.

Obviously, financial sustainability is important in the district level, and absence of

external support does not guarantee much scope for sustaining the programme. Although
DACC, DCWB, DHO, WDO in both districts expressed their willingness and
commitment to protect CABA’s rights, no solid actions or decisions have been taken in
this regard. Moreover HIV/AIDS and CABA has not yet received a high priority due to
insufficient financial resources.

Sustainability of any long term project will depend on the extent to which communities
own the program, and have a real commitment to its continuation. External support is
needed to enhance the capacity of CABA families in order to access resources when
necessary, and resources should not be introduced that cannot be sustained.

3.6 Lessons Learned and Gaps of Existing Program

Even when the access to education, food and health services was for short term, it helped
to increase the demand for services from the poorest CABA and families and they were
benefited as compared to the cost for the programs.

When the CABA families are united and economically empowered, it gave them strength
in recovering their life in a dignified manner that encouraged new CABA families to join
the group. It also helped CABA and families to sustain their lives and become less
dependent to NGO partners.

Practices of welcoming all children and those out of school is good way of access
education in school including CABA regardless of their status.

It is important that the services have to be targeted to cover all the families without any
discrimination. It creates conflict and resentment among the CABA, if some CABA
receive the services while others do not in the same village. Those families who are not
getting support and not involved in the process might not be interested to support CABA,
which is against the rights based approach.

It is important to have formal and informal dialogues and interactions between the
government service providers, NGOs and service receivers regularly in order to reduce
the gap between them. It helps to strengthen the relationship, and to provide immediate
access of services in friendly manner rather than blaming each other.

It is particularly encouraging that almost staff team members are from HIV +ve group in NKP
and SSS which is a good example of inclusion and putting into in practice. Good teamwork
needs to be continually nurtured. The capacity of NKP and SSS has to be strengthened to
start care and support program for CABA in other districts and they need to be
encouraged to maintain the quality of services.

While organizing any programs, if all the stakeholders are collaborated, it will develop an
attitude to take and share the responsibilities resulting in the efficient and effective
delivery of the services in sustained way.

The NGOs need to give spaces to CABA and families in order to express their feelings
regularly and to create positive environment in community by mobilizing all
stakeholders. It is critical to bring up and review the updated issues regarding CABA in
their regular discussion and to take corrective action immediately.
There is an urgent need for integration, collaboration and coordination among number of
projects intervention in order to provide access to services and to impact positively on
CABA and families and to ensure better results of organizations. Exploring opportunities
to build linkages for getting support for CABA families should be a priority.

The coordinator/staff needs to be responsive on the situation rather than moving in with
a pre-conceived plan of action. The appropriate position to assume is that of catalyst,
and facilitators but not as an expert.

There are still invisible stigma and discrimination due to HIV/AIDS and gender
discrimination to access services and opportunities among boys and girls. Thus when
replicating the program in other areas, UNICEF should consider and integrate the gender
perspective in the program in order to address the attitude of male staff in NKP in dealing
with women and girl’s issues, and to ensure that the boys and girls are equally benefited
from all services. It is also critical to think on how CABA participation can be increased
in other development activities implemented by UNICEF or other organizations.

The identification and monitoring of CABA who are in real need of services could be
identified if the responsibilities of selection and monitoring are given to the community
members that will also ensure the involvement of community to increase their
ownership. Community ownership can assure the effectiveness of the programs when
they are involved from the beginning to the end as that benefit the community.

Any kind of problems and misconceptions or confusions related to CABA could be

solved through social dialogue. If there can be a regular coordination and frequent
sharing between stakeholders, it can help to ensure the community ownership.

Planning process of implementing agencies needs to be strengthened especially the

planning exercise should start from the community prioritizing their needs. When dealing
with CABA problems it is necessary to identify the challenges, the alternative solutions to
the problems. It is necessary to analyze whether the problem is genuine or not from their
perspectives.

The GAPS in the Program That Should Be Addressed In Future.

All the children should get this service. In the same village when one gets service and
the other does not the feeling of anger is created between the one receiving service and
not receiving service- Ngo staff in Achham

A care taker should be provided while conducting IG program with a large number of
women that can help effectiveness of the IG activities.

Nutrition supplementation is almost 100% gap in both districts for CABA. All the
CABA hasn’t gone through VCT screening, especially the elder girls.

There is lack of systematic updating of information, the exact number of CABA, its
magnitude and the precise extent of their sufferings, nature of the problems, recording
and reporting are not available at country level, nor in implementing districts, which is
the most priority area before implementing the program.

There is a structure of DDC, VDC, WDO, DCWB under the CCWB throughout the
country to protect rights of all children including CABA, but none of them are mobilizing
or functioning in the area of CABA. The CCWB made a draft of child protection policy
so far and few lines on CABA are included.

There is no real leadership or coordinating role of DCWB in Achham and Syangja neither
do they have any sustainable mechanisms for collecting, collating, entering, processing or
analyzing data on children. The DCWB and DACC only entertain their power to ask for
information to NGOs on what they are doing on CABA, however do not provide any
support for the protection of children.
The existing government structures from district to VDC level were not sensitized on
CABA issues. Due to lack of sensitivity of local authorities on the issues, there existed
problems of coordination and collaboration.

There were lack of coordination with private sector, district chamber of commerce and
district authorities in Syangja about economic support program to CABA families. Many
district authorities were not aware about this program even DACC do not know this.

There is a huge gap in terms of a structured program approach for ensuring psychosocial
support for those CABA and families. In both districts, the psychosocial needs of CABA
and families has not explored and not analyzed to prioritize their needs.

Economic support for families affected by AIDS such as to meet the survival needs of
children and women was an issue, which was raised by many stakeholders in both
districts. The lack of economic support makes it difficult for children and families to
participate in any activities and needs to be replicated of Syangja model in Achham.

There is a lack of monitoring mechanism for the CABA going to school to see their
participation in extra activities, their school performance and their regular attendance.

Though there are early childhood education program operated by DEO, the parents in
FGD in both districts mentioned that their young children are not in ECD. As ECD was
not focused and not targeted for the CABA they were excluded from the benefit of ECD.
This is an example to indicate how the government programs fail to coordinate with local
NGOs that excluded the services for the needy ones like CABA.

The protection of CABA property hasn’t given much attention by all stakeholders. There
are no any legal organizations working in this area to protect children and to ensure the
access of property rights. In fact, they couldn’t approach the legal justice for the property
and no any legal awareness on CABA and families to get justice if their rights are
violated. There is no birth registration of children in Achham. In Achham, there are
paralegal committees, women’s right forum; however, none of them had addressed these
issues in action. In Syangja, one of the women mentioned that when she asked for the
property to her children, her husband’s family responded “your husband died from AIDS
and how long you survive”? Your life is also short so why do you need property rather
we will support for your children’s education.” Likewise a man in Syangja (who has
AIDS and taking ART) expressed during FGD “even I am surviving but I couldn’t get
property to my families and if there is no husband how much more difficult for the
children and women, you can’t imagine? He also said “even taking loan is difficult as no
one believes what to do”?

Issues of Confidentiality: In Syangja, there is a lack of broad understanding about

confidentiality. The CABA families frequently expressed that if they identify CABA to
access services they are afraid that CABA and their families might face more stigma and
discrimination. The question is how CABA and families could access services like others
and live with dignity in their society. The service provider needs to know to whom they
are providing services and also the information needs to be recorded and reported for the
future planning and management of resources.

There is a lack of monitoring mechanism to monitor the status of CABA such as which
children, how many, from which VDC, what support for how long, (food, cloth,
education, shelter, medicine). There are no such records, neither in DCWB nor in DACC.

Looking at the care home of NKP at rural settings, there was lack child friendly setting,
such as child friendly activities and play materials, reading books for the children. Also,
it is critical to engage children in different creative activities while they stay at care
home, so that CABA could be creative. There is a need to maintain minimum standard in
the centre as per the child protection policy, which is virtually non existent.

3.7 Challenges

There is an increasing demand of access to services by all CABA; however, it is difficult

to achieve it with the limited budget. As the services could not reach all CABA, it was
targeted in low number and poverty faced by CABA families remained so huge. It was a
great challenge to select the limited number of children to receive the support from
UNICEF as the services was demanded by all CABA. The NKP staff in Achham
mentioned that not only the CABA but also non CABA families claimed to receive the
services. Likewise in Syangja when people knew that Sankalpa Sahayog Samuha (SSS)
was providing support to CABA, a man with HIV/AIDS from retired Indian Army
holding 2 pensions came to Sankalpa office. He told to staff that “I spent more than 16
lakhs for the treatment and why are you not providing me any support”? You people are
misusing money in the name of HIV/AIDS. The Sankalpa chairperson Tuka has to be very
direct to him by saying that “our support is for those poor CABA households but not for
the people like you with a good income”. Due to his ways of questioning, she also said
that you went to India to earn money but not to earn HIV/AIDS. Later he was convinced.

The challenge of economic support program to CABA household was that they couldn’t
continue their business, when they become sick. It took about one to two months for them
to recover from such sickness. At this time, it was difficult for them to manage the
household expenses as they could not make income.

As the CABA households lack sufficient financial resources, it was hard for them to start any
kind of business even after receiving the training for vocational skills. Thus they were in
dilemmatic situation on how to make the products after the training, as all CABA households
could not take risk for borrowing loan with interest.

Due to the limited number of target, other children who didn’t get support in same family
and community are not supportive and shown jealous attitude; which is one of the major
challenges on how to create supportive environment for CABA household.

Among CABA family, there is a continuous expectation to get support, which is one of
the great challenges for the program. The families sometimes put a lot burden for letting
all the responsibilities of the CABA to the organization. The local NGOS have a great
difficulty to provide access to the services in absence of external support.
Another challenge identified by NGO partners is to find ways to deal with the resistance,
pressure or harassment they sometimes receive from the people who demand services
without being CABA, while the resources were not sufficient to reach all CABA families.

Child headed households are emerging as a new challenge. Many CABA in Achham are
sent to orphanages or encouraged to go to India for labor migration. In both districts, the
CABA without parents are mostly living in their own homes, some are living in mother’s
home with grand parents, or with sisters and nephew. According to NGOs staff, their
relatives also felt burden to take responsibilities for CABA. From the focus group
discussion with NGOs representatives, it was found that there are 3 to 5 child headed
households in each VDC in Achham based on their field visit. However, there are no
formal studies or record of these numbers in DACC, DCWB or in NGOs. As per NKP
staff, there might be 20% child headed households out of 1500 CABA. In Syangja, their
observations identified 3 child headed households.

The stigma, discrimination based on HIV status and gender is still deep rooted in the
communities. Though CABA received services from NKP, SSS, MCDS, and government
authorities, the community looked at them with suspicions for the services they received
as the community was not involved in the process of CABA’s development.

Due to geographical features, the community was so scattered and there was no
motorable roads, it was too challenging to monitor the status of CABA after they
received the support. This was even harder with limited number of outreach workers
especially in Achham, which is a very remote area as compared to Syangja.

The CABA who traveled from the remote village sometimes far beyond working
districts to receive the services in the district experienced the problem as they need extra
cost for accommodation, food and transportation. It was especially a problem in
Syangja, as there was no short term care home for the CABA who travel from distance.
 CHAPTER FOUR

4. FUTURE RECOMMENDATIONS
CABA are often voice less and powerless, they are neglected within and outside the
family. Hence, it is a real need to empower CABA so as to provide a space for them in
family, society, and community. The program for care, support and protection to CABA
will be implemented through holistic and multi-sectoral approach. It will especially be
integrated in those areas, where UNICEF’s other sectoral activities have been launched.
These recommendations are based on the review in two districts and consultation with
national stakeholders. It is the responsibilities of all sectoral team for the protection of
CABA and their families. The interventions on policy program and activities under
prevention, protection, prosecution need strong commitment and action from decision
makers (government, donors) for its adequate resource allocation, and effective
coordination among the implementers and effective monitoring mechanism.

Looking the benefit of program, there is an urgent need for expansion of protection, care
and support program for other CABA and families through out the district. UNICEF
should meet its commitment to protect children through the following means:

Awareness: Ensuring that all UNICEF staff and its local partners are aware of
the problem of CABA, its magnitude and its risks to CABA;
Prevention: Ensuring, through awareness, training and good practice, that staff
and partners understand how to minimize the risk to CABA;
Reporting: Ensuring that UNICEF and its local partners know what steps to
take whenever concerns arise regarding the protection of CABA;
Responding: Ensuring that appropriate action is taken to support and protect
children, whenever concerns arise regarding access services.

Based on the findings, the recommendations have been prioritized into different
headings).
 1. Addressing Economic Impact

Poverty is seen as the major problem of CABA households. Hence, possible IG

activities or employment areas should be explored and provisions for vocational
trainings based on market assessment at local level and raised the income of families.

1.1 UNICEF should support income-generating activities with vocational skills,

micro credit and savings programs, life skills that are able to empower especially
single women so that they are able to take care of (food, shelter, livelihood,
education) themselves and their families in the long-term. The modality of
Syangja can be replicated in other districts as per context of CABA families.

1.2 UNICEF should build working relations with private sectors such as FNCCI,
banking sectors, WDO, small cottage industry and other NGOs for the IG support.

1.3 There should be some provision regarding seed money to start self business, as
CABA families come from the background of poverty and problematic situations.

1.4 There should be an environment where CABA families get continuation of the
support both moral and technical follow up and encouragement on IG activities.

1.5 There should be provision of taking care of young children so that vulnerable
CABA families’ especially single women can participate on IG activities.

2. Addressing Psychosocial Impact: UNICEF should facilitate to provide psycho-

social support to CABA and their families.

It was observed that there was a complete lack of psychosocial support mechanisms among
families who are affected from AIDS. UNICEF needs to facilitate existing support
mechanisms through DHO, WDO- DCWB or NGOs as per the context.
 2.1 Establish good psychosocial counseling to the CABA and families and facilitate
CABAs to discover meaning in life, build self-esteem and sense of humor.
Develop skills and feeling of having some control over what happens in life.

2.2 Identify existing local facilitators, local youth and volunteers who are interested to
work on child protection and psychosocial area, or who had involved in any
developmental activities, and build the capacities of those facilitators through
training so that they can identify CABA, their families and support accordingly.

2.3 Establish safe child friendly spaces cum tuition center and set up some structure
and activities for CABA where all vulnerable children will join and play different
games, read child friendly books, comics, and dance, sing a song or any activities
based on their interest. Child friendly activities need to reflect at care home too.

3. Addressing Access to Education

3.1 Regarding ECD, UNICEF needs to discuss and follow up in order to ensure CABA
children included in existing ECD run by DEO in both districts. In addition, if CABA
children live in care home run by NGOs, then DEO can establish ECD center near by
care home so that those children living outside of family will have access to ECD.

3.2 There should be training to parents and caregivers of CABA on early childhood
education, nutrition requirements, treatment adherence and other emerging needs.

3.3 UNICEF needs to address tutoring class for 1 to 2 hour for those CABA who don’t
have parents, weak students either through support of extra school teacher or identify
teacher who is eligible to teach and build up their confidence in friendly ways.

3.4 To ensure sustainability, there needs to coordinate with DOE in national level and
DEO in the district to integrate into the government system by providing a possible
 matching grant to the government funds to cover materials and supplies required to
CABA enrollment and retention all children in school through out the district.

3.5 Explore with PABSON to increase quota or allocate fund to support CABA.

3.6 UNICEF should re-emphasize to its counterparts the importance of not taking any
kinds of fees from CABA in schools and Initiate a dialogue between MOE, and DEO
in order to stop this practice. MOE should make a specific policy for CABA to
provide education support unlike other category enforce to implement.

3.7 There should be a better communication and sensitization among VEC, parents and
teachers so that parents and teachers could make proper arrangements for CABA’s
education. With support of DEO it can provide non-formal education classes for the
children who are not attending school or have dropped out who like to go in school.

3.8 The global campaign of “Welcome to School” should be used to design for the
targeting of non enrolled children focused on CABA.

3.9 Apart from the systematic targeting of CABA in government schools, UNICEF
should influence to other working districts where CABA’s enrolment rate in primary
schools are comparatively low.

4. Multi-Sectoral Recommendations:

4.1 Creating environment for specific issues such as emerging child headed
households, which requires full district integrated CABA program.

4.2 UNICEF can facilitate to access services by implementing integrated program for
the betterment of CABA, vulnerable families through networking among various groups.
Support services provided by government, private sectors and NGOs should be explored.
4.3 DHO might need to run mobile camp, where there are more CABA and
vulnerable families that can provide free health check up and free treatment for poor
families and make linkages with other organization for the prompt medical treatment.

4.4 UNICEF should create social environment through dialogue to access quality of
health services for OI and ART. Presently patients in need of CD4 count are sent to
Kailali district from Achham and send to Pokhara from Shyanja. Likewise focus should:
a) Address the issues of hygiene sanitation and the impact on AIDS affected
households and home based care to prevent opportunistic infections,
b) CABA and nutritional value of the food, ECD and CABA, Caring of children,
child development,
c) Ensure that family planning for prevention of unintended pregnancies, safe
abortion if there is unwanted pregnancies amongst HIV positive women needs to be
integrated into program especially through CB-PMTCT,
d) Facilitate establishment of positive mothers groups and positive adolescent peer
support linked,
e) Facilitate to identify positive individuals from civil society, business sector who
are interested to support CABA and families.

5. Addressing Overall Child Protection Issues through Mobilizing communities,

District Child Welfare Board, District Education Office and district health office,
women development office and other NGOs with linkages to child protection team

5.1 UNICEF should work with central child welfare board in national level, district
education office, DACC and district child welfare board in district level and ensure that
all stakeholders will fulfill their responsibilities to protect CABA and families.

5.2 Conduct training to child facilitators, volunteers, teachers, parents, NGOs, and
community leaders about basic principles and practices of protection and care. Establish
Child protection committee in program area to monitor, and report immediately and
manage if child’s right is violated including CABA’s.

5.3 UNICEF should facilitate clear referral mechanisms for legal issues related to CABA,
especially of child headed households working closely with legal organization, Lawyers,
DCPC, and women development office. VCPC to take immediate action and follow-up
on inheritance property with concerned government bodies. Likewise the process of law
enforcement needs to be improved in aspect to corporal punishment. Social and legal
awareness especially CABA’s property rights on children should be widely recognized.

5.4 A birth registration campaign needs to be launched for the protection of CABA; this
can be done around Vitamin A distribution day or in national polio day.

5.5 The review has revealed that the girl-child is especially vulnerable, not all girls have
gone through VCT and more often has had to forgo education to take on extra domestic
responsibilities. UNICEF should focus on advocacy to recognize the special status of the
girl-child and to reinforce the obligation to ensure that CABA (girls and boys) receive
same level of protections and opportunities.

6. MANAGEMENT ISSUES: (Capacity building, management, referral

mechanisms, Coordination, Leadership and data management)

Monitoring and Strengthening the Capacity of DCWB / DCPC / VCPC / DACC

The roles and responsibilities of the DCWB have not been fulfilled in line with the child
protection and CABA. There is a lack of awareness on CABA issues, roles and
responsibilities among the DCWB, DACC members, on the capacity (to keep records of
CABA for instance) is questionable. During the review, it was also found that the
commitment of DACC in Achham to allocate resources for 350 CABA has not reflected
in action and also to monitor the CABA’s situation of access service is weak.
6.1 There should be need assessment on CABA’s situation: its magnitude, nature of
problem, more data on child headed households as a result of HIV and AIDS.
6.2 Consequently, in order to ensure the regular monitoring, UNICEF and partners
should jointly assess the possibility of alternative mechanisms for monitoring
measures to improve the DCWB and DACC management capacity.

6.3 There should be an additional information on DOE, EMIS section to monitor the
CABA‘s record and should strongly reinforce the DEO and the RPs for the
regular monitoring of the CABA and to ensure that the CABA’s are regular in
school and figures reported are correct.

6.4 It is urgent to effectively activate and mobilize the DCWB / DCPC / VCPC /
DACC members with good orientation on CABA issues, and their roles and
responsibilities. Sensitization training should be planned to strengthen the
capacity of VCPC to DCPC on CABA issues.

6.5 The reporting of disaggregated information on CABA, record keeping, periodic

assessment of progress and establish regular feedback mechanism between
DCWB / DCPC / VCPC / DACC / DEO / DHO / and PHC.

6.6 UNICEF along with UCAAN should develop form to identify CABA’s
information at the household level in a more systematic way and introducing
alternative monitoring mechanism from VDC to district to see the support and
progress made for CABA and their families.

6.7 UNICEF must do collaborative work with different team within UNICEF in order
to ensure the child protection issues has integrated and cross fertilized in all work,
and monitor constantly to know what is going on related issues of CABA.

6.8 Referral mechanism for CABA should be established through network of NGOs,
government services at grass root level such as through CB-PMTCT.
6.9 Develop collaborative mechanism in UNICEF working area among stakeholders,
to monitor which children including CABA are not coming to school and why.

6.10 UNICEF should support DCWB and DACC for continuing their work and
strengthening their coordination role for being able to coordinate service delivery
and referrals for CABA (social service system development), database
management and the secretariat support.

7. PARTNERSHIP AND NETWORKING

There are fewer examples of practical partnerships in which partners has benefited from
the input or resources of other organizations. There appear to be opportunities for greater
networking within government, particularly within health and education but also within
local government generally. For example, the VDCs have fund to allocate 5 to 15 %, for
children and women, District Education Office (DEO) has funds to pay for schooling.

7.1 Explore partnership with other NGOs to focus on most at risk and who can provide
appropriate vocational training and support IG activities in Achham. Implementing
partners’ capacity requires strengthening overall programmatic management capacity
and needs to be built into agreements as required.

7.2 Network building among service providers at the local level needs to be strengthened
for better referral and for lasting benefit to CABA. Therefore, coordination meeting
and partnership building should be an integral part of the program in the districts.

7.3 A common coordination forum with the representation from the all concerned
agencies should be established for advocacy purposes as well as for increasing
efficiency of the activities being implemented especially for CABA.
7.4 NKP should hire more female staff to work at community. Having men staff to deal with
girls and women might not be sensitive.

7.5 UNICEF along with UCAAN agencies should advocate with the government and
main donors in order to ensure the minimum standard in the care home and schools.
Also UNICEF should do a mapping of “who is doing what” to address the protection
of CABA and do collaborative work with different agencies. At the same time, it is
necessary to seek strong commitment from all donors and government to address the
issues through out the country.

7.6 MWCSW and its district (DCWB and DACC) should take the lead role in organizing
regular forums/meetings among concerned government authorities to share and foster
understanding on practical issues related on CABA.

7.7 Also in relation to nutrition support UNICEF should explore the role of national child
health division and its capacity to access nutrition in the long run.

7.8 UNICEF must ensure additional and/or continued resources in collaboration with
development partners for the program and inform UN Joint Team on AIDS regarding
district plans to develop multi-year strategic plan. Need to coordinate with UCAAN,
other UNAIDS Co-sponsor agencies to scale up CABA support to reach all CABA.

8. Operational level

8.1 PE selection should be done in more inclusive way with the full participation of
CABA. In doing so, representation of deprived (Dalit for example) and marginalized
should be ensured especially in Achham. For instance, a representation of CABA
among PE can be made a mandatory with a view of consolidating efforts to focus on
high risks and vulnerabilities.

8.2 Organize regular sharing program among NGOs, DCWB, DEO, DHO, WDO and
DACC within the districts, to enhance understanding on practical issues related to
 CABA and updating their knowledge base. Such sharing mechanism can be expanded
to other stakeholders at the district, regional and national level as appropriate.

8.3 Continue assessment of CABA situation should also be integral part of CABA
programming to contribute in experiential sharing and advocacy to wider community.

8.4 While designing and implementation of the program, the need of children as per age,
gender, caste ethnic group and other status needs to be addressed. For e.g. access
super flour (Lito pitho) would be good for below 5 yrs.

8.5 Enhance the capacity of CABAs and families to create conducive environment
and increase the role of CABAs to confront with the social environment:

This review revealed that most of the CABA are seen as passive beneficiaries and are
excluded in existing development activities and under valued of their participation.
Therefore, listening, creating a climate of confidence, and discovering new values and
collecting their strength are highly recommended. Active participation of CABA and
families may help to enhance the self-esteem and to develop a sense of identity in the
society. It may also give CABA a collective strength in the society.

• The rights and hopes of CABA and their achievement should be constantly on the
agenda at all levels especially in the family, VDC, DACC, DCWB, schools,
women’s groups, NGOs, children’s groups and user committee at local levels.

• UNICEF needs to promote participation of CABA in existing children’s group,

PEs, other extra activities in school, strengthen and support CABA to access
resources and opportunities equally for both gender

• Involve CABAs in the decision making process and include them as full and
active partners in identifying their own issues and in designing, planning,
implementing and assessing programs which will have more sustainable impact.
8.6 Establish community support systems at local level

• Organize orientation, training, and awareness activities on CABA’s issues and

community support systems for CABAs and family need to be developed in every
village to enable CABAs potential. It helps to protect the rights of CABA.

• A wide spread campaign through posters, TV, radio and other media should be
organized to aware on the CABA’s right to get services and promote this theme
inside and outside the family.

8.7 Movement to change the society for equality and justice

• Need to sensitize district authorities, service providers, family and society on the
dignity and rights of CABAs so that there is friendly environment to get services.

• Since the harassment has been found in private places by own relatives, provision
of the law is required to punish the people who discriminate and harass CABA,

• Mechanism of regular monitoring of service sites and referral institutions would

be beneficial to maintain optimum care and support for CABA and families and
for the compliance of standards, manuals, and protocols by service providers.

• Advocacy to protect CABA’s rights is virtually missing or very weak especially

for those who don’t have parents and not been able to raise the voice of CABA’s
by organizations. All the combined efforts of state and different stakeholders
would be able to protect the rights of CABA. Explore the possibility of fostering
parents to take care CABA at local level who don’t have parents.
 CHAPTER FIVE
5. CONCLUSIONS

Protection, care, supports and treatment to CABA was implemented in two districts of
Far western-Achham and western region-Syangja. Program is highly demanded by all
stakeholders and has been an effective means of providing basic rights of education,
access to health and rights to survival to the CABA.

Food, shelter, economic support to CABA families was a major area of concern of all
stakeholders and access to free health and education services was seen as a priority. The
effectiveness of improving the economic capacity of CABA household in Syangja can be
replicated in Achham and in other districts as per the context. Creation of employment
opportunities, skill oriented training, and income generation activities for long term
support are highly demanded to improve the living condition of the families and children,
which is the sustained way rather than only one off support for affected children.

There is a lack of resources. The Children cannot learn effectively if they are hungry, do
not have access to stationeries and are not in good health condition. Although, the
government has free education policy till grade eight, but this doesn’t reflect in action.
The quality aspect is undermined. For instance, CABA students experience beating from
teachers though child friendly teaching methodology training is going on in both districts.

The existing structure of UNICEF in Achham on CABA program has not mobilized
sufficiently. The CABA program couldn’t be linked up well with other program of
UNICEF and ignoring the CABA’s participation in the program activities such as PEs,
children’s club, SOVAA and extra activities organized in school.

The local government especially VDC has social security budget, which can be used for
CABA’s protection and care, if the VDC people are sensitized on the issues of CABA.
However, there is delay in timely release of budget from central to district and from
district to VDC’s. Families, Teachers, NGOs, district authorities, and MACC expressed
the need to allocate more resources for CABA and families also to reach the services in
remote areas. In addition, the real action is very much important than only on paper.

No attempt is initiated to monitor and analyze the nutrition and health status of CABA
after the program. There is virtually no monitoring or any concerns on the attendance of
those children in school, and to track their immediate records and performance. Likewise,
other CABA who were deprived of services from the program, it is necessary to explore
their status on access to food, health, and education. Because, it was found that other
NGOs and VDCs in the district have also implemented activities for care and support.

The initiation of social dialogue on CABA issues among all district stakeholders
including private sectors in both districts is in shadow and there has not been true
interaction between partners and district authorities. In Walling Syangja, the private
sectors representatives mentioned that they are ready to provide support at any cost to
CABA households, if a meeting can be organized with stakeholders to plan the support
mechanism. Actually, the person from private sector is very clear on the concept and
action on HIV/AIDS’ issues as he is engaged in PHC, Banking sector, schools and many
more. He has many ideas on community approaches to deal with CABA, economic
empowerment of families, free education at local level and its sustainability.

The psychosocial effect on children was widely felt to be one of the most serious
problems. All the NGOs/district authorities are aware that CABA especially those
without parents live in a society of fear. CABA in Achham has a very low confident due
to their feelings of loss, confusion and the insecurity.

Many CABA now lack the traditional family support structure that is essential for health,
psychological and emotional development. Often CABA have no one to help them to
cope with extreme situations, and these experiences have severe long-term implications
for the sound development of these children. Studies need to be conducted about the
situation of CABA and their issues, who don’t have parents to address their needs.
Legal protection is required for the children affected by AIDS, especially those who have
become child headed households. There is a need to coordinate with paralegal
committees, Women’s federation, Village Child Protection Committee, district bar
association, or any national legal organization to deal with rights to inheritance.

There is lack of co-ordination among NGOs and Government to monitor on activities

“who is doing what?” Often there is a duplication of activities by different agencies
without being aware of each other’s support programs. At present other NGOs, VDC has
also involved in care and support of CABA, but there are no tracking system to monitor
those information neither in DACC nor DCWB. This will provide partners’ more
information on how we can further link services to other CABA, who don’t have access
to services and at the same time avoid duplications.
ANNEX I: List of Stakeholders

Syangja District stakeholders:

SN Name Org. Name Gender Position Telephone E-mail

1. Mukti Ram Acharya Waling M Executive 9856027927 Acharyamukt
Municipality officer i2005@yaho
o.com
2. Top Bahadur SPO, Shyanja M S.D.O 063-440103
Reshami
3. Dr. Prem Raj Pageni PHC, Waling M Medical 9846071671 prpageni@ya
officer 9856024644 hoo.com
4. Mani Prasad Par PHC M A.H.O 9846085840
5. Kamal Acharya M.C.D.C M P.A 9841961699 Rubenpb200
3@yahoo.
6. Kamala Sharma M.C.D.C F B.D.M 9846096080
7. Chandra Rana Sakrya Sewa M 9846020592 Rana99aries
Samaj @yahoo.com
8. Tuku Regmi Sankalpa F Chairman 9846047909
9. Jamuna Sankalpa F Member 9846035605
10. Dhulmaya Sankalpa F
11. Maina Thapa Sankalpa F Accountan 9846096327 Manthapa20
t @yahoo
12. Tuku Bika Sankalpa F O.A 9846338183
13. Laxman Khand Sankalpa M Co- 9846070663 Laxman555
ordinator 063-440070 @yahoo
14. Krishna Khand MACC M Chairman 9846115177
15. Dilip P Khand M 9846043755
16. Badri Prasad Wagle DCWB F Child 9846030094 alonebadri@
Rights yahoo.com
officer
17. Bishnu Prasad D.E.O, Shyanja M Section 9846052333
Koirala Officer
18. Shobha Shah WDO F W.D.O 063-420107
Officer
19. Dr. Tara Nath DHO M D.H.O 9856026904
Paudel
20. Mitra Prasad Aryal DHO M F.P.S.O 9846036907
21. Neeta Gurung DHO F P.H.M 9846054197
22. Durga Paudel DHO M 9846206221
23. Himlal Subedi DHO M C.C.S 9856024371
24. Krishna Prasad DHO, Shyanja M H.E.T 9746003773
Aryal
25. Kamal Pandey DHO, Shyanja M 9856027932
26. Govinda Bhattrai Field Co-ordinator, M 9747002375 apalpali@gm
Sakriya sewa ail.com
samaj

SN Name of Children Participants Grades Boys Girls Age Status

Syangja

1. Bishnu Syanjali 10 √ 15 Both parents +ve

2. Krishna Osti 7 √ 12 single parent +ve
3. Bikash Bhattrai 2 √ 7 Single parent +ve
4. Bhagwati Bhattrai 3 √ 9 Single parent +ve
5. Bibek Regmi 1 √ 6 Single parent +ve
6. Bipin Regmi - √ 3 Both parent +ve
Sankalpa Sahayog Samuha Waling, Syangja

SN Name of parents’ participants Age Caste Gender Status Child

1 Pitamber Basnet 44 Chhetri M ART 2
2 Tara bahadur 42 magar M 2
3 Kamala sen 25 Thakuri F ART 1
4 Dil maya thapa 35 magar F 3
5 Pabisra gaha 34 magar F 3
6 Reyoti Thapa 35 magar F 1
7 Tuka b.k. 29 Dalit F 2
8 Kopila syangjali 33 magar F ART 5
9 Laxmi bhattarai 37 braman F ART 3
10 Maya rana 25 magar F 3
11 Maina s.k. 30 Dalit F ART 0
12 Jaisara ale 30 magar F 2
13 Sumitra bhattarai 40 braman F ART 3
14 Jamuna khadka 32 Chhatri F ART 1
15 Kasi Ram regmi 37 braman M ART 2
16 Dhansing thapa 42 Magar m ART 2
17 Purva rana 29 magar f 5
18 Harmoti thapa 58 magar F ART 4
19 Lek kumari Rana 27 magar F 3
20 Krishna gaha 43 magar m ART 0
21 Rada gaha 35 magar F ART 0
22 Raj kumar thapa 28 magar m ART 1
23 Santi Ragmi 27 Barman F 2
24 Yam kumari G.T 29 Chhetri F 1
25 Dhani sara ale 40 magar F ART 3
26 Jamuna osti 37 braman F ART 1
Achham Districts:

SN Name of Parents’ Participants Age Caste Sex Status (Single +ve or -ve
or not)
1. Tulsi Maharjan 29 F Both +ve
2. Maina bhool 32 F Both +ve
3. Radha B.Ka 45 F Both +ve
4. Madhura Pariyar 46 F Single +ve
5. Ganga Pariyar 43 F Single +ve
6. Parvati Nepali 50 F Single +ve
7. Paru 30 F Single -ve
8. Devu Maat 28 F Single -ve
9. Setu Saud 28 F Single +ve
10. Lalu Bhool 30 F Single +ve

SN Name of Children Participants Grades Boys Girls Age Status

1. Chandra Bista 2 √ 11 No parents +ve
2. Mahendra Thapa 1 √ 8 Single parent +ve
3. Prabitra Tiruwa 1 √ 7 Single parent +ve
4. Anu Adhikari Nursery √ 4 Both Parents
5. Siru Maharjan L.K.G √ 6 Both parents +ve
6. Saroj Kamal 1 √ 8 Both Parents
7. Motikala Nepali 6 √ 12 Single parent
8. Siddhi Nepali 2 √ 8 Single parent
9. Jaumani Saud 10 √ 17 Single parent
10. Lalita Bhaat 7 √ 14 Single parent
11. Karna Bhaat 5 √ 11 Single parent
 12. Bhojraj Bhaat L.K.G √ 7 Single parent
13. Kamal Tamaha 1 √ 7 Both Parents
14. Shova Bhool 3 √ 10 Both parents
15. Rajesh khadka 5 √ 11 Single parent
16. Shankar Tamaha 4 √ 12 Single parent
17. Bhepa Tamaha 1 √ 5 Both Parents
18. Thamma kala Tamaha 4 √ 12 Both Parents

SN Name of District Org. Name Gender Position Telephone E-mail

stakeholders Achham

1. Khem Prasad Bhattrai OCWAC - M Program 9749013142 bhattraikhem

Co- @gmail.com
ordinator
2. Krishna Singh OCWAC - M Supervisor 9749009785 Krishna_sing
h@gmail.
3. Keshev Ramal NGOCC M P.C 974107224 Ramal_kes6
@yahoo.com
4. Hiudal K.C Gangotri, M P.C 9749007988 hiudalkc@g
mail.com
5. Sanjiv Kumar Gangotri M R. Co- 9841518801 Rajak.sanjiv
ordinator @gmail.com
6. Krishna Sapkota N.K.P M Volunteer 097-620056 Ksapkota09
@yahoo.com
7. Durgam Adhikari N.K.P, M P. Co- 9848435621 Durgam15@
ordinator yahoo.com
8. Shyam Rawal N.K.P, M C.M.A 9848457818
9. Dhambar Rawal N.K.P, M 9749004562
10. Lal.Bahadur. Budha N.K.P, M Outreach 9749010142
work
11. Mohan Thapa N.K.P, M Outreach 9848435222
work
12. Dilip Bista N.K.P, M Volunteer 097-620056
13. Sher Bahadur B.Ka N.K.P, M Volunteer
14. Shailendra Shrestha D.P.H.O, M D.P.H.O
15. Suresh Kumar Joshi D.E.O, M D.E.O
16. Dr. J.B.Thapa Naya Health M Medical
Service Doctor

Kathmandu

SN Name Org. Name Gender Position

1. Dr Sharad Onta HSCB M Vice Chair
2. Dr Laxmi Raj Pathak NCASC M Director
3. Mr. Laxmi Tripathi MWCSW M Joint secretary
4. Mr. Dharma Shrestha CCWB M Executive Director
5. Mr. Nur Panta Save the Children M Team Leader
6. Mr. Rakiv Kafle Navakiran PLus M Executive Director
7. Ms Manu Devkota Navakiran PLus M Program Officer
 ANNEX II Terms of Reference
for
Conducting review of UNICEF supported CABA interventions in Syangja and
Accham Districts

1. Background and Country Context

The first case of HIV was reported in Nepal in 1988, and according to NCASC's recent estimation
69,790 people are living with HIV and AIDS. Nepal has a concentrated HIV epidemic, with
prevalence estimated as high as 50% among certain most-at-risk populations. It is estimated that
almost 1,857 children under 15 are living with HIV and as the infection spreads, the number of
children who have lost parents to AIDS will begin to grow. Though the actual number is not
available, it is widely known and accepted that a much larger number of children have been made
vulnerable by the impact of HIV and AIDS. This vulnerability is due to poverty, hunger, conflict,
and deep rooted traditional practices. Many children are living with sick and dying parents or in
poor households which take in orphans. Also when the parents are infected with HIV, fall sick or
die, children are the first one to be affected. They are often used as child laborers, taken to child
centres or sent off for labor migration. They stand at risk to lose their inheritance. In some cases
which are now emerging as a trend in the far western region, they are heads of households and are
left to care for themselves and their siblings.

UNICEF is a lead agency for providing protection, care and support to the children affected by
AIDS (CABA) as per the UN division of labor in Nepal. UNICEF supports coordination on
CABA through CABA taskforce. Based on an agreement reached by the CABA taskforce,
UNICEF implemented basic social support programme for children affected by AIDS in Accham
and Syangja districts. Similarly, UNICEF piloted income generation activities with CABA
households in Syangja districts as a part of developing economic capacity of CABA households
in Syangja districts.

In the year 2008, a total of 401 CABA from Syangja and Accham districts received nutritional,
educational and medical support through community based support groups. The programme was
implemented in close coordination with District AIDS Coordinating Committee (DACC) in both
districts. Along with the basic social support, 38 CABA households were provided various
income generation training and 50% have started micro enterprises for improving their economic
conditions. Although there are no concrete data on the size of the CABA burden, it is assumed
that there are many more children affected by AIDS in various parts of Nepal in need of such
protection mechanisms.

2. Rationale and Baseline

The National HIV/AIDS Strategy 2006 – 2011 has been endorsed by the government of Nepal. A
National HIV/AIDS Action Plan 2006 – 2008 was subsequently developed and endorsed as a
subset of the national strategy. As comprehensive as both documents are, the agenda of children
was not captured or taken forward. Prior to this pilot, there were no interventions for protection,
care and support for CABA.

Although Nepal has made progress towards incorporating children’s issues in the National Action
Plan, the National HIV and AIDS strategy does not address the issue of children affected by
AIDS. In addition, there are no national or district child protection systems which can cater to the
needs of CABA. Therefore, there is a strong need for developing a strategy and guidelines for
protection, care and support for CABA.

Government and organizations working for care and treatment support for people living with HIV
and AIDS are coming up with strong recommendations for scaling up basic social support and
other capacity building responses to CABA and their households. In order to develop the CABA
strategy and guidelines and to scale up evidence based CABA interventions, there is a need for
conducting the review of ongoing CABA interventions of Syangja and Accham districts. The
results of the review will be used for developing national CABA strategy and guidelines and scale
up plan.

3. Objectives

The objectives of the review are to

1. Review the project in light of their relevance to the country context, UNICEF’s CPAP
with government, MDGs and other commitments
2. Review the effectiveness of the project strategies in relation to the expected results
3. Explore the possibility of sustaining the projects in the absence of UNICEF support
4. Identify unintended consequences (both negative and positive of the project)
5. Evaluate the outcome of basic social support programme to CABA in Syangja and
Accham districts
6. Identify gaps on ongoing CABA interventions and recommend interventions for
establishing a sustainable social protection system for all children affected by AIDS; with
linkage to using such a system for developing a wider child protection system for all
children in need of basic social services.

4. Evaluation Questions

o Are the expected results of the project in line with the CPAP objectives?
o Is the project design effective in achieving the planned results?
o Is the project sustainable as it is currently designed?
o What are the negative and positive consequences (unintended outcomes or results) from
the project?
o How can the current project design be improved on to ensure better results and
sustainability?
o Which lessons learned or best practices were identified to be shared with stakeholders
and partners?

5. Methodology

The evaluation will be guided by six OECD DAC evaluation criteria; Human right based
Approach to Programming and gender assessment and will use all the relevant and available
sources of information (primary and secondary sources). The consultant has to apply qualitative
approaches for information collection from right holders, and duty bearers such as district AIDS
coordinating committee members of Accham and Syangja districts using the following
methodologies:

• in-depth interview questionnaire for implementing partners (Nava Kiran Plus, Sankalpa
Sahog Samuha, and Multipurpose Community Development Services), District AIDS
Coordinating Committee Members and targeted beneficiaries
• interviews and focus group discussions with duty bearers such as Government, UNICEF
staff, Implementing and partners; also conduct interviews with rights holders such as project
beneficiaries and others for primary information on ongoing CABA intervention
• field visit to collect information from the project partners, DACC members and target
beneficiaries
• Consultation with CABA taskforce to share findings and recommendations

6. Work Schedule

Task Time (days)

1 Desk review of relevant materials 2
2 Development of work plan and submission to 1
UNICEF
3 Develop review questionnaire 2
4 Conduct interview with key implementing partners 3
representatives
5 Conduct field visit for data collection 14
6 Prepare and submit draft report 5
7 Discuss findings with CABA Taskforce 1
8 Incorporate feedback and submit final report 2
30 days

7. Expected Deliverables

The study organization will deliver the following as per the agreed time schedule

1. Work plan
2. Questionnaire for interviews and focus group
3. Draft report for review by taskforce and UNICEF and feedback
4. Final report including:

• Executive Summary
• Background
• Methodology
• Findings of the review
• Discussions and Conclusions
• Recommendations;
• Annexes
The evaluator should ensure to respect of ethics in terms of interviewing children (consent should
be provided by parent (s) or caregivers with clear limitations on what can or can not be
discussed).

Note: UNICEF has a final report format and guides to development of very good evaluation
reports. This will be shared with the selected consultant at the time of awarding the contract. It is
expected that the consultant would use this guide.

8. Programme Documents
The evaluator will be provided with the following documents related to this project:

• UNICEF Country Programme Action Plan/Country Programme Document

 • Project Document
• AWP
• Coping Mechanisms of CABA
• Project Progress reports by partners
• Monitoring reports by HIV and AIDS Section and other colleagues
• National HIV/AIDS strategy and National Plan of Action

9. Composition and qualification of the study team

UNICEF is seeking an individual with experience in conducting evaluations. The individual or

organization will be expected to carry out the detailed planning and implementation of the
assignment and to report on the results and will need the following requirements:

a) Expertise in conducting external evaluations with good knowledge of review

methodologies.
b) Contextual understanding of social economics including its links with poverty, exclusion
and other social issues including the current financial and fuel crisis and its impact on
families
c) Knowledge on HIV and AIDS especially as it relates to families which are affected by
AIDS.
d) Experience with implementation or review of community-based interventions
e) Understanding of the Nepal and children issues especially child rights
f) Sensitivity to socio-cultural and religious issues.
g) Familiarity with the local situation and issues related with people living with HIV and
AIDS
h) Ability to analyze and write a coherent report in English.
ANNEX III Check List

¾ How are the government, Donors, NGOs and I/NGOs dealing with CABA in
Nepal?
¾ Does the CABA programme fit within the national HIV and AIDS policy?
¾ Is support to CABA effective and relevant in the current country context?
¾ What type of work is being done for CABA and what approach is being used?
¾ What type of policies or social protection systems are available for vulnerable
children in Nepal?
¾ What kind of systems is needed to protect the rights of CABA in Nepal?
¾ What are the gaps in ongoing CABA intervention?
¾ What are some of the issues related to institutional development – potentials and
gaps?
¾ Are there local policies and practices developed for CABA program?
¾ How have legal issues of inheritance and rights to property of CABA been
addressed in national policies? What about in district level programmes and
projects?
¾ What are the mechanisms to respond and deal with psychosocial distress for
CABA and their families?
¾ How can the current project design be improved on to ensure better results and
sustainability? Any suggestions for the future program?

¾ What are the things you liked in the projects/activities? Are there things that you
did not like in the projects/activities?
¾ What are the strength / and weakness and the reasons of strength / weakness in
projects activities
¾ Ask why and how these are important strength / weakness to them.
¾ Are there any unintended or unexpected results of the programme? How did it
happen? If they are positive, how do you plan to build on them and integrate
them in future work?
¾ Are there any negative results of the programmes? Why did it occur? Is there
anything you could do to mitigate them, e.g. to reduce the harm on children?
What can be done to avoid them in the future?
¾ What are the lessons learned in this programme and how can these be built upon
in future work?
¾ What are the basic social support program to CABA?
¾ What are the changes in CABA lives that the projects/activities bring about
(personally, in their families, schools, and communities)? Can you give examples
[as much as possible]
¾ Timeframe: How long did it take for you to start seeing results for children
affected by AIDS?
¾ How do people interact with CABA and how are they treated in the village?
¾ How is the participation of CABA in daily life?
¾ How does the program address the poverty and gender dimension?
¾ Are there child headed households? Are they most often headed by boys or girls?
¾ What about legal property of children affected by AIDS if there are no parents, or
only single parents? Are there local norms or customs which lead to children
affected by AIDS or their single mothers or fathers losing their property rights?
¾ How do you see the level of stigma in terms of CABA equally participating in
social activities, having access to education, food and health services?
¾ What are the psychosocial problems observed among CABA group and how can
it be addressed?
¾ How is the attitude and behaviors of service delivery organizations and
communities towards CABA in terms of caste, age, gender, and poverty?
¾ What roles are different stakeholders playing to support CABA?

¾ What interventions would you suggest for establishing a sustainable social

protection system for all vulnerable children, including children affected by AIDS