Saving a family - one person at a time

Deciding how to respond when people need help can be difficult at the best of times, but when resources are scarce and the needs great, it is easy to despair of getting things right, especially if you have no reliable means of measuring the outcome.

And it is not just that you want to spend your time and money wisely. Without an objective assessment, both before and after your intervention, it is also possible to be accused of unfair bias in the selection of recipients, and lose the vital cooperation of those you are trying to help.

In this example we show how the Haven Toolkit can be applied even to a single family unit, albeit a complex one, and to unravel the true priorities for aid on an individual basis. The family is in central district, near Namugongo.

The people

A single female carer is looking after eight children; five of her own and three of her deceased sister. The eight children are all enrolled at the same school, and are aged between 6 and 15 years. All of them are either single-or double- orphans. The age span of the group presents particular problems for the lady caring for them because of their very different demands in terms of adolescent behaviour, health and nutrition, and also the differing emotional support required. A further factor to consider, of course, is the demand on the time, energy and health of the carer herself.
Fortunately all of the children are free of Tuberculosis and are HIV negative, but as the older children are adolescents, they will increasingly be exposed to the risks associated with sexual behaviour and teenage pregnancy. None of them has any physical or neurological disability, but the younger children are at risk from malnutrition and poor growth.

The family lives in a single rented room. They have shared access to clean water and a ventilated pit latrine, but have no blankets or mosquito nets and have minimal clothing apart from school uniforms for the children.

Findings

It would be tempting to go for an umbrella solution on a family-wide basis (see total scores in red), but experience shows that by doing so we would probably miss the mark for all nine individuals: the children and the carer alike, and then the effectiveness of the service would be much diluted.

On closer examination of the data however, it is possible to tease out of the situation some key factors, which then lead to a more effective programme of assistance.

**In this and other tables in the report, the figures are important only in a relative sense.  For a fuller explanation of the origin of the figures, please contact Dr Kibirige.

Table 1  EDUMATRIX**

030/CA	914	105	65	HVNc	16.25	18.25	15.5	15
005/CA	915	105	64.5	HVNc	16.125	18.25	15.5	14.625
029/CA	916	105	65	HVNc	16.25	18.25	15.5	15
079/CA	917	105	66	HVNc	16	20	15.5	14.5
028/CA	918	105	64	HVNc	16	18.25	15.5	14.25
023/CA	919	105	64	HVNc	16	18.25	15.5	14.25
080/CA	920	105	67	HVNc	16.25	20	15.5	15.25
081/CA	921	105	67.5	HVNc	16.125	20.25	15.5	15.625

Highlighted in red are the priorities scores for education in the family. They all are in need of education, resources permitting, but if an organisation cannot afford to deal with all of them then prioritisation would help decide who gets help first.

Table 2  Education

030/CA	914	105	65	HVNc	16.25	18.25	15.5	15
029/CA	916	105	65	HVNc	16.25	18.25	15.5	15
080/CA	920	105	67	HVNc	16.25	20	15.5	15.25
005/CA	915	105	64.5	HVNc	16.125	18.25	15.5	14.625
081/CA	921	105	67.5	HVNc	16.125	20.25	15.5	15.625
079/CA	917	105	66	HVNc	16	20	15.5	14.5
028/CA	918	105	64	HVNc	16	18.25	15.5	14.25
023/CA	919	105	64	HVNc	16	18.25	15.5	14.25

Interpretation and recommendations/options for intervention

The toolkit was used to set priorities for each individual child and the carer, based on factors which included, amongst others:
·    age
·    gender
·    distance to school
·    family income
·    number of children
·    number of single and double orphans
·    relationship of children to carer
·    age and education level of the carer

Table 3 Education

ID/CA	Age	Gender	Orphan S/D	Carer(s)	Income	Priority
030/914	Yes	Yes	Single	Yes	Yes	1
029/916	Yes	Yes	Single	Yes	Yes	2
080/920	Yes	No	Double	Yes	Yes	3
005/915	No	Yes	Single	Yes	Yes	4
081/921	No	Yes	Double	Yes	Yes	5
079/917	No	No	Single	Yes	Yes	6
028/918	No	No	Single	Yes	Yes	7
023/919	No	No	Single	Yes	Yes	8

Although the raw output from the toolkit would be out of place here (contact me if you would like more details), it quickly identified the main options for support for this family. In particular, three of the children were regarded as in particular need and the toolkit showed this. It was considered inadvisable to move any of the children, however transport for the family to take them to age-appropriate self-support groups, education, food and nutrition would be invaluable.

A further option is a Children’s’ Community Centre to provide education (including health education for the carer and adolescent children), information and support programmes, possibly organised by social services. The advantage of this would be respite for the carer (and also opening up time for income generation).

A limiting factor in the family’s situation is that they spend most of their meagre income on rent for their single room. More appropriate accommodation would help, but would be more expensive, so perhaps providing support in terms of better sanitation, nets, blankets and clothing would seem more viable options, especially in the short term.

Further options suggested by the data include:

1.  Provide assistance in the form of:
·    transport
·    clothing (uniforms)
·    stationery
·    school meals
·    after school activities (in the home or at school itself)

2.  Facilitate an able member of the community to work with the children (for example with homework supervision).

3.  Assist the carer with income generation. Job opportunities identified include:
·    transport
·    purchase and sale of stationery
·    food provision
·    teaching and adult education

The toolkit in this instance focused on education-related options. This is not surprising, as the data gathered in earlier studies with the tool suggests a strong relationship between poverty and education and between education and health. What may seem merely intuitive is quantifiable as the figures below show. Poor income tends to lead to poor education (figure 1) and poor education correlates with delayed presentation for health care (figure 2).

Figure 1: Education vs disease stage at presentation

Y-axis Education, X-axis Stage of disease (a high score is bad. Poor education leads to delayed presentation).

Figure 2: Education Vs Income

Y-axis education and X-axis Income (high score is bad Poor education equates to poor income)

This example shows what the toolkit can do for one family unit. But it doesn’t matter whether you have 8 individuals or 8000. It works equally well on a regional, local or individual scale.

NGOs and their funders have different skills and priorities, and can be in education, healthcare, facilities or finance. With information from the Haven Toolkit not only can they can apply those skills exactly where they are needed, but work together with others who can fill in the gaps. Very often it is the right combination of skills which makes the difference. Healthcare is much more effective for example, when it is accompanied by education, nutrition and transport. The toolkit will help unravel complex aid issues and give NGOs the facts.

If you have questions or concerns about how this toolkit can help you, please let us know.