How can schools help African children cope with the impacts of disease and poverty? An investigation of 'AIDS competent' schools in rural Zimbabwe

Lead Research Organisation: London School of Economics & Pol Sci
Department Name: Social Psychology

Abstract

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Description We explored the feasibility of international policy recommendations that schools should 'substitute for families' of African HIV/AIDS-affected children in extreme poverty, given declining welfare and international development support.

Our extensive multi-method study was conducted in rural Zimbabwe, framed by our conceptualisation of the 'HIV competent community' (a context where communities and support agencies collaborate effectively in HIV/AIDS prevention, care and impact mitigation).

Quantitative data included population-based surveys of 4,577 children, and parallel HIV-service-facility surveys in 46 schools, exploring school success in supporting pupil well-being (school inclusion, nutrition, physical, mental and sexual health, perceived self-efficacy, social participation).

Qualitative data included 131 interviews, focus groups with 120 participants, ethnographic observation, 277 draw-and-writes and 255 photo-essays -- with teachers, community members, primary and secondary school children associated with 3 primary and 3 secondary schools.

1. Surveys found:
i) Orphans and vulnerable children (OVC) in schools with higher HIV-competence scores were less likely to be behind in school.
ii) Children attending primary schools with higher HIV-competence had improved wellbeing. Not the case in secondary schools.
iii) Schools with most OVCs and in communities with high HIV-prevalence were least successful at including and supporting vulnerable children.

2. Qualitative research found most teachers lacked training, motivation and/or confidence to go beyond their traditional roles (imparting book knowledge and discipline) to take on the additional role of ensuring the protection, health and welfare of extremely vulnerable pupils. Many teachers felt powerless to assist children with HIV/AIDS and poverty-related problems they weren't coping with in their own lives. They received little or no institutional training or support from schools, who received little or no support from government in caring for children. In a harsh authoritarian environment, children feared teachers rather than seeing them as sources of support regarding deeply painful issues. Strong stigma deterred children and families from disclosing HIV-related problems, with teachers reluctant to stigmatise children by singling them out for special care, even where children were plainly very ill or traumatised. Schools received little or no support from surrounding communities, NGOs or education and health ministries.

3. A fine-grained analysis compared 2 primary schools, the rural school significantly more successful in supporting pupil health and inclusion than the small-town one. The latter had superior facilities, more teachers with higher morale, more HIV/AIDS activities, and a religious ethos. The relatively impoverished rural school was in a more cohesive community with a more critically conscious, dynamic and networking headmaster. The research emphasis on HIV/AIDS-related teacher training and specialist school-based activities neglects the impacts of school leadership and the quality of the school-community interface on the HIV-competence of schools.

4. The extreme suffering of HIV-affected children continues, yet support is dwindling as donors turn away from HIV/AIDS. Whilst some individual schools (who scored higher on HIV competence measures) were slightly better at supporting children than others, overall we found little evidence to support the optimistic policy assumption that schools could 'substitute for families' in the absence of significant further resources, training and support in generating vital enabling links with local communities and the public sector. Secondary school pupils are even more neglected than primary. Widely regarded as old enough not to need special help and support, many are particularly vulnerable, especially boys. Girls are better able to draw on school as a coping resource than boys.

5. Our research has contributed new insights to academic debates about children's agency and resilience, and developed an evidence-based conceptualisation of the 'HIV/AIDS competent school' as a tool for policy and intervention.
Exploitation Route Non-academic pathways to impact

The project's location at the interface of LSE, Imperial College and Zimbabwean Biomedical Research and Training Institute enabled dissemination to (i) health and education agencies in our research province, (ii) Zimbabwean education ministries and the National AIDS Council and (iii) London-based workshops with international child agency staff. This was done over three months in 2014, by outgoing project researchers and fieldworkers, using 'dissemination as intervention' approach. We produced several leaflets and reports - distributed to these agencies. Further details on our engagement website: http://supportiveschools.weebly.com/public-engagement.html.

Extremely positive feedback especially regarding our role in (i) breaking the silence on a pressing taboo social problem historically neglected in these groups; (ii) providing education ministries and policy makers with evidence-based guidelines for best practice for creating 'HIV/AIDS Competent Schools'.

Academic pathways to impact

Academic publications provide novel (i) understandings of children's agency, 'ethic of care' in schools and spatial nature of resilience, (ii) multi-method evidence for pathways between school characteristics and child health and inclusion; (iii) evidence-based critiques of current best practice, (iii) policy recommendations based on our conceptualisation of 'HIV/AIDS competent school' emphasising school-community interface and quality of school leadership, and how to strengthen teachers' caring capacities; (iv) pointing to the emotional support of secondary school boys as a priority area for intervention.

The project has also constituted 'schools in extreme settings' as a problem space for future research through international workshop followed by a journal special issue highlighting the potential for schools to support children in various extreme settings around the world.
Sectors Communities and Social Services/Policy,Education

URL http://supportiveschools.weebly.com/
 
Description SUMMARY OF SOCIETAL IMPACTS The project has generated a comprehensive understanding of how community members, teachers and children themselves experience the possibilities and challenges associated with the role allocated to schools in supporting children affected by HIV and poverty. The study has identified pathways through which schools can be strengthened to facilitate a supportive and inclusive environment, helping children and young people to cope with adverse circumstances. The research has had three main societal impacts: i) Informing international policy-making and key Zimbabwean Ministries linked to education, child welfare and health about the challenges and realities on the ground when addressing prevention and impact-mitigation of HIV and AIDS within the school context. ii) Facilitating platforms at district, national and international levels - bringing together relevant stakeholders including policy makers, aid organizations and academics for debate and knowledge sharing to further understandings of supportive school contexts. iii) Facilitating community platforms in Zimbabwe for community members, school leaders and teachers to come together and discuss ways of creating supportive community environments, improving children's access to care within school environments, and strengthening school-community collaborations. KEY FINDINGS THAT HAVE GENERATED SOCIETAL IMPACTS • Complex analysis of the school-community interfaces in three rural Zimbabwean communities. Incorporating both in-depth qualitative data and large scale quantitative survey data, the findings unpack ways in which the different and multi-layered interactions amongst teachers, learners, guardians and other community members - as well as contextual factors - facilitate or hinder HIV competence in schools. • Nuanced understandings of the implications and challenges for teachers to take on additional caring role during the daily functions of schools. • Children's own understandings of supportive school environments (including supportive peer relations and pupil-teacher relations). • Possibilities and implications for schools to play a role in scaling up HIV testing and ARV adherence among children in Zimbabwe Outputs include: • Research findings have been presented at invited talks and international conferences in countries including Zimbabwe, UK, Spain, France, Australia and South Africa, targeting policy makers, educationalists and public health experts working with HIV/AIDS, children and poverty. • National level dissemination workshop, co-hosted with the Zimbabwe Ministry of Primary and Secondary Education, at Cresta Lodge Harare. • Sharing research findings at the yearly provisional stakeholder meetings in Mutare hosted by the National AIDS Council, Zimbabwe. • District level dissemination workshop, at Professor Chandiwana Public Health Centre in Mutasa DC, Manicaland • 3 community dissemination workshops the study locations in Manicaland • 3 youth dissemination workshops in the study locations in Manicaland • An extensive stakeholder report presenting guidelines for promoting supportive school contexts. This has been shared with academics, NGO representatives, policy-makers and government departments concerned with the education, health and welfare of children. • An illustrated booklet on supportive school contexts, which has been distributed in study locations in order to help community members, school leaders and teachers facilitate more supportive environments. HOW WERE THESE IMPACTS ACHIEVED In Zimbabwe, the project has engaged in extensive dissemination activities facilitating a total of 8 dissemination events and sharing research findings at community, district, provisional and national levels. See our project website for full details of the events, attendance lists and materials. At national level, the dissemination workshop was a co-hosted event between Ministry of Primary and Secondary. We invited stakeholders linked to child welfare, health and education representing a wide range of organisations to bring forward their input to our research findings, and to debate the implications for schools to play a role in the protection and support of children affected by HIV. After this workshop, the National AIDS Council, Zimbabwe invited the research team to their yearly stakeholder meeting to share the research findings. For the district level dissemination workshop, we invited stakeholders linked to child welfare, health and education at a district level, together with head teachers from the study schools. Stakeholders were encouraged to bring forward their input to our research findings, and express their views on how these resonated with their realities and experiences in the district. Dissemination workshops were carried out in each of the three study communities to feedback research findings to the community, and give study participants the possibility of commenting and elaborating on these. Dissemination workshops were carried out with groups of 15 youth (aged 12-17, mixed m/f) in each of the three study communities. Research findings were presented in Shona by colleagues from the BRTI, and participants were invited to share their views and elaborate on the findings. The study team has produced an extensive stakeholder report capturing all research findings, presenting guidelines for promoting supportive school contexts and including a summary of feedback received at the dissemination workshops listed above. This has been shared with academics, NGO representatives, policy-makers and government departments concerned with the education, health and welfare of children. The study team has produced an illustrated booklet on supportive school contexts, based on the study participants' own ideas of ways in which schools could be strengthened to support for children affected by HIV. This booklet has been distributed in study locations in order to help community members, school leaders and teachers facilitate more supportive environments. PROJECT WEBSITE The following website serves as a publically available platform to disseminate research findings: http://supportiveschools.weebly.com/ The website presents the objectives, activities and events associated with the study - and provides links to all of its outputs. It also serves as a network for academics and stakeholders in the health and education sectors working on areas linked to the role of schools as supportive institutions for children and youth in adverse circumstances. WHO DID THE FINDINGS HAVE AN IMPACT UPON The research findings provide a comprehensive understanding of challenges and realties on the ground - useful for stakeholders engaging with schools as resources to help children cope with adversity - which can be applied in rural Zimbabwe - as well as in similar socio-economic contexts around Sub-Saharan Africa. The research findings and outputs are relevant to a wide range of stakeholders including: • International organisations promoting and working with schools as protective environments supporting the health, well-being and inclusion of vulnerable children affected by adverse circumstances such as UNESCO, UNICEF, REPSSI and Save the Children. • Community based organisations, local health personals, child protection committees and other local institutions working to improve the health and well-being of children. • School leaders and teachers to help facilitating more supportive environments. • Policy makers and governmental representatives from the Zimbabwe National AIDS Council and Zimbabwean Ministries linked to education, HIV/AIDS, health, children and youth. The research findings have been particularly useful for informing policy makers of realities on the ground in relation to implementing the 'Life Skills, Sexuality, HIV and AIDS Education Strategic Plan' launched by the Zimbabwe Ministry of Primary and Secondary Education. • Researchers have been invited to take on roles as advisors using the research findings to inform an International engagement Award, Wellcome Trust application in collaboration with Rashida Ferrand (Clinical Epidemiology, London School of Hygiene and Tropical Medicine), Nicola Willis (Africaid), Lovemore Magwere (Unicef), Astrid Jane Treffry-Goatley (African Center for Health and Population studies). Informed by the key findings from our research, the objectives of this upcoming project in Zimbabwe include engaging in dialogue with families and healthcare workers, initiatives to facilitating a breaking of the silence around HIV, and facilitation of communication between schools and the community, to strengthen the wider supportive context of schools.
First Year Of Impact 2012
Sector Education,Healthcare
Impact Types Societal,Policy & public services

 
Description Dissemination to policy makers and child protection researchers at Children's Institute, University of Cape Town: (Using a Zimbabwean case study to think about children's agency in extreme settings.) 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Talk sparked very heated debate amongst the presenter and UCT researchers with very different views of children's agency and how best to conceptualise it in generating research-led practice in the fields of child protection and social protection.

Discussion of the possibility of future research collaboration between project researchers and those in the Institute.
Year(s) Of Engagement Activity 2014
 
Description Dissemination to teacher training specialists at Institute of Education, London (School support for HIV affected children in Zimbabwe) 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Talk sparked questions and discussion. Useful discussion comparing potential for teacher responses to highly vulnerable children in South Africa and the UK.

Heightened awareness of problems facing teachers in an unfamiliar context. Participation by IoE's Dr Sarah Crafter in an LSE-based workshop on schools in extreme settings.
Year(s) Of Engagement Activity 2014
 
Description In-country Community dissemination workshops: 5th, 6th and 7th of March 2014 in three research locations in rural eastern Zimbabwe. (What role can schools play in the support and protection of children?) 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Participants in your research and patient groups
Results and Impact Dissemination workshops were carried out in each of the three study communities in order to feedback research findings to the community, and give study participants the possibility of commenting and elaborating on these. Participants were selected on their roles in the community as linked to HIV/AIDS, the welfare of children and youths. The workshops used our 'dissemination as intervention' methodology, designed to facilitate participant brainstorming about the actionable implications of the findings in their own lives, and in the context of their local leadership roles - in the interests of facilitating more health-enabling social norms and community responses to the challenges facing HIV/AIDS affected children.

Based on the workshops, leaflets were produced and made publicly available. See the leaflets here:
http://supportiveschools.weebly.com/leaflets.html

See full summary of input received at these workshops in the stakeholder report: http://supportiveschools.weebly.com/uploads/4/7/1/9/4719905/stakeholderreport_acs_2014.pdf

Photographs of the events are also included on our event website.

The workshops were an outstanding success in relation to our goal of empowering local leadership to think about how they might more effectively respond to the challenges of supporting HIV/AIDS-affected children. Workshop participants included a wide range of people engaged in various forms of formal or informal local leadership - including teachers, home based care leaders, shopkeepers, nurses, village health workers, School Development Committee representatives, church leaders, post-holders in community organisations including burial societies, local NGO staff, as well as local traditional leaders as well as elected local leaders representing the Ministry of Health and Child Care and Ministry of Primary and Secondary Education. Workshop participants were so exceptionally engaged in the discussions that they carried on, unexpectedly, for several extra hours longer than scheduled. All three workshops had high attendance turnout, very rich engaged discussions and participants expressing high appreciation of the events.
Year(s) Of Engagement Activity 2014
URL http://supportiveschools.weebly.com/community-level-workshops.html
 
Description In-country National AIDS Council, Manicaland Province, Stakeholder Meeting 5 of March, 2014 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Policymakers/politicians
Results and Impact The research team was invited to share research findings with the National AIDS Council of Zimbabwe's yearly stakeholder meeting. The presentation was well received and generated a rich discussion during the stakeholder meeting.

Several workshop participants requested further information from the research team after the presentation.
Year(s) Of Engagement Activity 2014
URL http://supportiveschools.weebly.com/talks-and-conference-presentations.html
 
Description In-country youth dissemination workshops - 22nd and 23rd of March 2014 in three research locations in rural eastern Zimbabwe 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Participants in your research and patient groups
Results and Impact Dissemination workshops were carried out with groups of 15 youth (aged 12-17, mixed m/f) in each of the three study communities. Using the 'dissemination as intervention' method, the workshops aimed to feed back findings in a format that encouraged youth to brainstorm how they might use the information to inform their individual and collective behaviour in their own lives, and also to increase health-enabling social norms in their own communities. The workshop participants were very engaged in the discussions and contributed with very useful comments and elaborations on the issues raised in the research findings.
Workshops were initiated with rapport building activities such as playing games and singing songs with the young people. Research findings were presented in Shona by colleagues from the BRTI, and participants were invited to share their views on the findings. Although a few remained shy, majority of them were very engaged in the discussions and contributed with very useful comments and elaborations on the issues raised in the research findings.

Based on the workshops, leaflets were produced and made publicly available. See the leaflets here:
http://supportiveschools.weebly.com/leaflets.html

See full summary of input received at these workshops in the stakeholder report: http://supportiveschools.weebly.com/uploads/4/7/1/9/4719905/stakeholderreport_acs_2014.pdf

The young workshop participants expressed their appreciation of being given the opportunity to discuss the issues and elaborate on the research findings.
Year(s) Of Engagement Activity 2014
URL http://supportiveschools.weebly.com/community-level-workshops.html
 
Description Presentation to teacher training specialists and policy makers at Dept Education, Univ Cape Town. (Supporting children in adversity?) 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Other academic audiences (collaborators, peers etc.)
Results and Impact This talk sparked in-depth discussion of potential implications of findings amongst colleagues lecturing on the teacher training diploma at the University of Cape Town. In particular there was engaged discussion about the impact of gender on teacher responses to vulnerable children. UCT colleagues said that they found the presentation useful and interesting, and the feedback from this presentation greatly strengthened the gender focus in two of the publications resulting from our research.

The impacts of this activity was a sharpening of the gender focus of the outputs of the grant.
Year(s) Of Engagement Activity 2014
 
Description Presentation to teacher training specialists in the region. Dept Educational Psychology, University of Stellenbosch. (How can schools support HIV affected children?) 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact This was a talk to teacher trainer specialists in educational psychology at the University of Stellenbosch in South Africa. It generated strong discussion about the implications of our findings for training of teachers.

The talk generated an invitation to the presenter to return next year and assist Stellenbosch academics in analysis and presentation of their own data on similar topics.
Year(s) Of Engagement Activity 2014
 
Description Workshop with Child Protection specialists at Save the Children UK. 4 Feb 2014. (Bridging child protection, social protection and education.) 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact This was an important workshop, allowing for discussion of the implications of our findings with child protection specialists working in a range of other low income settings around the world, in the context of different social challenges. Got very positive feedback from participants, and the discussion strengthened our own evolving focus on 'Schools in Extreme Settings', the focus of our forthcoming special issue of the International Journal of Educational Development.

On-going research collaboration between project researchers and Save the Children, UK.
Year(s) Of Engagement Activity 2014