THE SISONKE PROJECT Partnering to empower grandmothers in rural South Africa

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1 AVERT LEARNING BRIEF THE SISONKE PROJECT Partnering to empower grandmothers in rural South Africa In 2005, Avert helped establish the Sisonke Project with the Diocese of Grahamstown s Department of Social Responsibility (the DSR) in the Eastern Cape of South Africa. Between 2005 and 2018 the project supported over 15,000 vulnerable elderly people and young children during the most challenging phase of the HIV epidemic. This learning brief presents key findings from the end of project evaluation conducted in partnership with Lifetime Consulting. Sisonke effectively reaches out to all people. Even though it was intended to be a project for the elderly, no one was left behind from its activities. Imbumba Elderly Network member SUMMARY EVALUATION FINDINGS Over the course of 13 years, the project built a strong network of elderly women who were well informed about HIV, had a voice to speak out in their communities and were able to access the support they needed to keep themselves and their families healthy. Sisonke is regarded as a genuinely community-driven project that belongs to the people it is intended to reach, which enhanced its sustainability over time. Evaluation findings suggest that the results achieved by the Sisonke Project will be sustained at community level long after Avert s funding has ended. This is largely attributed to the community-oriented nature of the project; the integration of elderly people into other DSR projects; and the extent to which elderly persons also receive support from several other agencies, including community groups, government departments and civil society organisations. While the project has undoubtedly had a positive impact on the local communities, monitoring, evaluation and learning systems in the project were weak implying that learning could have been missed over the years.

2 2 THE SISONKE PROJECT PARTNER Department of Social Responsibility (DSR) TIMEFRAME January 2005 March 2018 LOCATION Rural Eastern Cape, South Africa CUMULATIVE GRANT SIZE 482,812 SISONKE KEY INFORMATION THE SISONKE CONTEXT SOUTH AFRICA KEY FACTS Largest concentration of people living with HIV in the world 18.9% National prevalence (varies widely from region to region) 270,000 new infections in % of adults living with HIV on treatment SOURCE: UNAIDS 2017 South Africa was slow to respond to its HIV epidemic. As the country embraced democracy in 1994, the HIV epidemic was not recognised as a major public health issue and received very little attention. In 2002, Thabo Mbeki s government finally acknowledged the direct relationship between HIV and AIDS. This heralded change as the government took steps to affirm its commitment to respond to the epidemic. With support from international agencies and civil society, the South African government rolled out a nationwide antiretroviral treatment programme in 2004, and in 2009 embarked on a major national HIV testing campaign which saw 20 million people getting tested. The country also increased domestic resourcing for HIV and started to build stronger social security and pension schemes. As elderly people, we were so much used to over-relying on social grants. But with Sisonke, we realised the dangers of over dependence and we have been taught to be self-reliant. We have been taught to use available resources. Elderly woman, Madhakeni Village The impact of the HIV epidemic on the elderly has been particularly significant. Many grandparents became primary caregivers to their grandchildren due to the middle generation dying of AIDS, particularly at the height of the epidemic more than 2.3 million children have been orphaned by HIV and AIDS in South Africa. This extra burden in later life left the elderly feeling disempowered, abused, without economic support mechanisms, and many having lost their established roles in the community. The pressure on them was often psychologically and financially overwhelming in the absence of any other forms of support. It was against this backdrop that the Sisonke project was established in 2005, to empower elderly caregivers with knowledge and skills to deal with the impact of the HIV epidemic in their communities; and to enable them to access social security services and benefits. I am proud to say that when my grandchildren come back from school they find a proper cooked balanced meal waiting for them. l have Sisonke to thank for this. Sisonke elderly beneficiary

3 3 THE SISONKE PROJECT PHASES OF SISONKE In recognition of the shifting context both at project and national levels, Sisonke adapted to meet the changing needs of the elderly over time. SISONKE S DESIRED CHANGE Improve the living conditions and human dignity of elderly people through enabling them to be self-reliant, to understand their rights and supporting them to access essential services from relevant institutions HIV prevention, knowledge and awareness Social grants, livelihoods support and permaculture Responding to violence, abuse and substance abuse Elderly safe spaces and holistic response to emerging issues THE SISONKE APPROACH KEY PROJECT ACTIVITIES Increasing HIV knowledge and awareness among the elderly Supporting access to HIV-related treatment, care and support for old and young alike Reducing HIV stigma and the isolation of people living with HIV Helping grandmothers to provide care and support for their grandchildren Community trainings and demonstrations (e.g. organic farming, goat rearing) Sisonke is a Zulu word meaning we are all together. The Sisonke Project took a community-led approach to empower elderly caregivers by creating strong networks and building confidences, particularly among elderly women, to become more engaged in society. Recognising the important role of grandmothers, the project aimed to equip the elderly with skills and support through mentoring and capacity building to promote HIV awareness and take care of themselves and their grandchildren orphaned by AIDS. PROJECT AIMS Tackle HIV and AIDS-related challenges at community level Reduce social exclusion, stigma and isolation Address poor health outcomes related to ageing and associated conditions Reduce injustice and violence against the elderly, especially older women Increase knowledge about rights and available social services Address the low socio-economic status of elderly women and an over-reliance on social grants. Livelihoods activities to increase household incomes and food security (e.g. craft-making) Empowering elderly caregivers with parenting skills Community dialogues to bridge inter-generational gaps Social capital building through learning and sharing groups Creating safe spaces for the elderly to reduce isolation Sporting activities to improve the physical fitness and health outcomes of the elderly Paralegal support service and training for elderly to access their rights Facilitating referrals for the elderly to relevant social services Partnerships with government, civil society and agencies to support the elderly

4 4 THE SISONKE PROJECT SISONKE S IMPACT Over 13 years, the Sisonke Project built a network of elderly people across 20 rural communities around the King William s Town area of the Eastern Cape. Approximately, 15,000 people of all ages from these communities were supported both directly and indirectly by the project. Elderly groups established three drop-in centres in different communities to ensure the elderly had access to safe spaces to meet. The project has enabled elderly women to have a voice in their communities, with around 40 female elderly leaders mobilised to speak out as activists for their communities. IMPACT AREAS 1. People affected by HIV in the project areas, especially elderly women and their grandchildren, benefitted from improved HIV prevention, care, treatment and support services. The project improved awareness, knowledge and understanding of HIV, leading to greater acceptance of HIV and better support for grandparents left to care for their grandchildren, whose parents had died from HIV-related illnesses. Health outcomes improved as the elderly were able to access health services and general fitness activities through community sporting activities. 2. Local people in project areas became more inclusive of the elderly, and elderly people themselves gained confidence to participate in community activities. Sisonke created a safe space for elderly people from different socio-economic backgrounds to work together and put aside personal differences. Sharing and learning opportunities allowed them to meet regularly with their peers and provide mutual support. Older people are held in higher regard within the project s communities as a result of building stronger intergenerational, family and community relationships. ASSESSING SISONKE S IMPACT In September 2017, Lifetime Consulting led an evaluation process that was largely participatory and qualitative in nature. The process included the full participation of DSR staff, volunteers and various stakeholders involved with the project. The fieldwork employed qualitative approaches and methods: desk review, stakeholder consultations, key informant interviews, focus group discussions, and a collection of significant change stories. We are confident that outputs from the data gathering and content analysis processes reflect a true and representative picture of the contribution Sisonke has made in the lives of those most affected by the project. 3. Elderly people in the project areas had increased knowledge about their rights and improved access to social protection assistance (such as social grants and other essential services). As a result of the information received through the project, older people were empowered to represent their interests and access social benefits. The project s positive affirmation of the rights of older people increased their confidence to tackle issues affecting them, such as abuse. 4. Older people in project areas gained self-reliance as a result of participating in livelihood and economic empowerment activities. Elderly people gained greater independence through learning new skills to expand their livelihoods opportunities. Elderly people were in a better financial position to support their families and not solely rely on state pensions.

5 5 THE SISONKE PROJECT PROMISING PROJECT APPROACHES Upholding the rights, and ensuring safety for, older persons Facilitating space for active involvement and participation of the elderly Ensuring equitable access to social protection services Provision of integrated services that respond to emerging need LEARNING FROM THE PROJECT CHALLENGES AND CONSTRAINTS The evaluation process enabled staff, beneficiaries and volunteers to reflect on what worked well during the project, and what the underlying enabling factors were. WHAT WORKED WELL Elderly more able to deal with impact of HIV epidemic Responsive to emerging issues Community-led Elderly empowered to understand and demand their rights Established strong elderly networks Built confidence of elderly women Communities healthier and responsive to HIV Elderly more economically independent Elderly have their own safe spaces in the community Building inter-generational relationships ENABLING FACTORS Sisonke is regarded as a genuinely community-driven project that belongs to the people it is intended to reach, which enhanced its sustainability over time Effective use of a dedicated team of passionate and experienced staff Commitment and support from volunteers who are part of the communities where the project is implemented Positive developments and successes in the response to HIV and AIDS both nationally and internationally Strong partnerships and collaborative efforts with various agencies, both public and private The existence of an enabling environment for social and community initiatives in South Africa Flexibility of the project to respond to emerging issues and needs of the target population Several project approaches were flagged by the evaluation team as working effectively in tandem to respond to vulnerability issues experienced by the elderly (see infographic at the top of this page). Several internal and external constraining factors were identified by the evaluation, which impacted on the project s implementation and effectiveness: Livelihoods and economic empowerment activities were not supported by a clear strategy and project staff lacked the capacity to implement and manage profitable livelihoods support programmes. Although the activities had some success, this restricted their effectiveness. Weak monitoring, evaluation and learning systems documentation was activity-focused and rarely captured the changes happening in the life of people. No baseline studies or evaluations were carried out during the project s lifetime, implying that a lot of learning could have been missed over the years. The multi-faceted nature of the project makes it a challenge to define its overall impact over time. A few years into the project, it would have been beneficial to have a narrower set of outcomes aimed at specific measurable impact and a focus on fewer specific activities. Youth unemployment, alcohol and drug use and rise in crime posed a major threat to peace and security for older people. Generally, older women felt very unsafe and at a high risk of violence and abuse, restricting their independence and movement. Negative and harmful socio-cultural beliefs and practices relating to the elderly (such as the belief that sexual activity with a person over 60 will enhance healing following circumcision and that Alzheimer s is a sign of witchcraft) created a climate of fear and potential violation of elderly people s rights. The most significant of the changes is that elderly people now have more knowledge about their rights and that are better able to stand up for them due to the information they received from the Sisonke Project. Community Caregiver for the elderly, Border Post

6 6 THE SISONKE PROJECT EMERGING ISSUES FOR THE FUTURE Various issues emerged from the evaluation that may help to inform both the next phase of Sisonke and other similar programmes targeting the elderly. Male participation: An overwhelming proportion of Sisonke participants were female, a pattern that not only reflects the demographic structure of the population in which older women considerably outnumber men, but also the fact that often men have other competing interests and modes of social interaction. It is potentially also due to gender dynamics, where women in sub-saharan Africa are predominantly caregivers. Despite efforts to engage them, very few men had a sustained interest in the project, but could have played a pivotal role in changing mindsets. Social centres: The concept of having elderly centres was well received and having a safe space to meet had a considerable impact. However, there is a strong feeling that more centres are needed that are within reach of communities, that are better equipped (e.g. toilet facilities) and can accommodate larger numbers of people. Young people: A need emerged during the project to better engage young people in the community. Increasingly the elderly were experiencing violence and abuse perpetrated by young people, often from their own families. A more targeted approach to improving inter-generational dialogue could be beneficial for future interventions targeting the elderly. Sporting and fitness activities: There is a need to expand opportunities for elderly people to participate in a wide range of activities to improve knowledge and positive attitudes around physical activities and active lifestyles amongst the elderly. Sporting activities introduced by Sisonke were limited in their scope, hence there is a need to build local capacity or partner with other agencies who could help elderly people to enhance their physical fitness and health outcomes. THE NEXT PHASE OF SISONKE In light of the project s immense progress, the increased availability of domestic resourcing for HIV, and wider social development in South Africa, Avert began a two-year phase out of its grant to Sisonke in As part of this phase-out, Avert and the DSR worked with Lifetime Consulting to conduct an extensive review and documentation of the project s impact, summarised in this learning brief. Alongside this, an assessment was done of the current priorities and gaps for elderly caregivers in the context of a rapidly changing South Africa, to inform the future direction of the DSR s work with this group. The DSR will take the learning from this evaluation process to inform the next phase of Sisonke. Early indications suggest that tackling the growing fear of abuse and violence among elderly women perpetrated by young people in the community will be a priority. Although HIV will remain a cross-cutting issue addressed by the project, it is no longer relevant for it to be a central focus. The project has brought so much light to the people of our communities. Elderly persons were enlightened and educated on how to start up small projects for themselves and become self-dependent. Youth focus group discussion participant Avert, First Floor South, 6/7 Lovers Walk, Brighton, East Sussex, United Kingdom BN1 6AH General info@avert.org April 2018

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