Highly Vulnerable Children Research Center

The Impact of Paraprofessional versus Volunteer-Driven Home Visiting Programs on the Wellbeing of Orphans and Vulnerable Children: Evidence from a Longitudinal Evaluation in KwaZulu-Natal, South Africa

This brief describes the findings and program implications from a study designed to develop critical knowledge on “what works” to improve the well-being of children affected by HIV and AIDS.  Community-based home visiting, in which care workers provide a range of support services during regular visits to the child’s home, is an increasingly popular service delivery approach in South Africa. However, there is enormous variation in how home visiting programs are implemented.  The aim of the study is to evaluate the relative impact on child wellbeing of a range of home visiting models. We hypothesized greater improvement among children enrolled in program models that are implemented by well-trained and compensated home visitors rather than lay volunteers. The findings in this report can be used to identify home visiting models that are likely to have the greatest impact on children’s wellbeing, and subsequently inform program improvement and resource allocation decisions.

The study is a two year longitudinal assessment of home visiting program models providing support to children who have been orphaned or otherwise affected by HIV in KwaZulu Natal, South Africa. It was conducted in partnership with 30 community-based organizations supported through several South African organizations— specifically, the National Association of Child Care Workers (NACCW), Heartbeat International, and the Children in Distress Network (CINDI). Information on children and their caregivers was collected in two survey rounds: at enrollment into the program in 2010 and at follow-up after approximately two years of program engagement.  Outcomes measured reflect families’ linkages to needed social services, obtainment of basic needs, the psychological health of children and their caregivers, child protection and HIV risk factors. Findings illustrate that programming models that engage trained, compensated paraprofessionals in home visiting have clear strengths over volunteer-reliant approaches; these include longer, more frequent home visits, greater tangible and emotional support, increased access to social grants as well as the fulfillment of children’s material needs.  Gaps remained even among enrollees of the paraprofessional models with respect to other outcomes measured reflecting psychological health, child protection and HIV risk.

Suggested Citation: Thurman TR, Kidman R, and TM Taylor (2013).  The impact of a paraprofessional versus volunteer-driven home visiting programs on the wellbeing of orphans and vulnerable children: Evidence from a longitudinal evaluation in KwaZulu-Natal, South Africa. New Orleans, Louisiana: Tulane University.

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