Supporting Orphans and Vulnerable Children in Nigeria: A Conversation with Obialunamma (“Oby”) Onoh

{Photo credit: Jessica Charles/MSH, Nigeria.}Photo credit: Jessica Charles/MSH, Nigeria.

In Nigeria, 17.5 million children are orphans or vulnerable children; 2.5 million of these children are AIDS  orphans [PDF]. Although it is customary in Nigeria for extended family and community members to care for orphans and vulnerable children (OVC), the capacity and resources of these individuals and households have been overextended by the growing number of OVC and the complexity of their needs.

The Community-Based Support for Orphans and Vulnerable Children in Nigeria (CUBS) project, funded by the US President's Emergency Plan for AIDS Relief (PEPFAR) through the US Agency for International Development (USAID), and led by Management Sciences for Health (MSH), has provided care and support to children orphaned by HIV & AIDS and vulnerable children in 11 of Nigeria’s 36 states from October 2009 to October 2014.

Jessica Charles, a communications specialist for MSH, spoke with Obialunamma ("Oby") Onoh, associate director for monitoring and evaluation (M&E), about her work with the CUBS project. Oby also works on the PEPFAR-funded, USAID project, Prevention & Organizational Systems–AIDS Care & Treatment (ProACT).

[Oby Onoh (left) with her mother.] {Photo courtesy of Onoh.}Oby Onoh (left) with her mother.Photo courtesy of Onoh.

Please tell us more about CUBS: How did the project help save lives and improve the health of OVC?

Nigeria is a very resource-limited environment. One in ten households care for an orphan or vulnerable child [PDF]. Children’s health and well-being are dependent on the strength of the systems around them. We provided care and support to the OVC by intervening at multiple levels: directly with the child, with their caregivers, with their communities, and with ministries at the state and national levels.

At the child level, we provided services to OVC to meet their needs for health, education, nutrition, shelter and care, psychosocial support, and protection.

At the household level, we encountered widows with little or nothing to live on or to provide care for their children. We encountered families who were very poor and vulnerable. We’d enroll the caregivers into care programs at local civil society organizations (CSOs) where they would learn about child nutrition, basic health, hygiene, and psychosocial support. Some were also lucky enough to benefit from CUBS’ household economic strengthening activities, which equipped them with income-generating skills and capacity to care for their children. We stayed in touch with these caregivers and children and collected data on their well-being every six months to see how they improved. 

Many of the children CUBS supported were AIDS orphans. How did CUBS help the children and their caregivers protect themselves from HIV?

One of our strategies to help reduce the spread of HIV was to provide HIV prevention interventions to OVC and their caregivers.  We categorized the children into groups so we could give them age- and gender-appropriate information about HIV. We targeted adolescent vulnerable children between the ages of 10 and 17 by teaching them about HIV prevention through the peer education model. We established Girl Groups using HIV prevention and health information tailored for girls. The CSOs’ Kids Clubs and Girl Groups currently have over 40,000 members.

We also provided HIV prevention information to the OVC’s caregivers through reproductive health education–this was especially important for caregivers of reproductive age and those with adolescent children because they could reinforce this information when they went home.

My people say that knowledge is power. These children are able to face tomorrow and know that life will be better for them going forward. The girls, as they grow into young adults, they know they can say “no” to sex. They know they can negotiate sex. They know there are several ways of contracting the infection and, therefore, they know how best not to contract HIV–so definitely these empowerment activities need to go on. We hope this group of children will not only remain HIV-free, but also we expect that some of the trained children will be able to influence their peers. We estimate each child could share what they’ve learned with at least one peer per month--reach 12 in a year. 

As the information continues to expand, for me, it’s about saving a generation from HIV, and that’s exactly what we’ve been doing. 

Another thing that CUBS did well was establish child protection committees (CPC) at the community level.

What was the role of the CPC?

The CPC’s are tasked with protecting and improving the well-being of OVC in their communities. Each CSO recruited 10 to 15 leaders from traditional ruling councils, land-lord associations, religious groups, and market associations to form their committees. CUBS then trained these leaders in advocacy, leadership, community and resource mobilization, child protection, and OVC needs.

I saw the CPC members and they are very vibrant! Their members are as bold as lions! They go beyond just providing routine care for these children–they negotiate for reduced rent, tuition waivers, and free health care for OVC and their caregivers. 

What’s your most memorable story of a beneficiary whose life was improved?

Sheba, a young caregiver from Gombe state. Her parents had died, leaving her to care for six siblings. Sheba enrolled in CUBS’ household economic strengthening (HES) program, where she learned to make an income to support her family.  Through CUBS HES program, Sheba was empowered economically and became better able to care for her household.

One day we hosted a fair in Nigeria to showcase how MSH and partners are improving health in the country. We invited USAID, implementing partners, federal and state government officials, MSH staff, beneficiaries, and others from the community. 

Sheba came to the fair. She spoke in her native language about how CUBS helped her while someone translated. No one told her what to say--it blew my mind:

“CUBS has empowered me. Now I can make some money to take care of my siblings. And, beyond that, watching CUBS over time has also given me hope that I can go back home, I can be educated, and I can also do what CUBS is doing right now.”

Most young adults in their early 20s would be thinking about wanting to get married. But Sheba was thinking about how CUBS had helped her, and how she could do the same kind of job to help others.  It was touching.

CUBS has made a lot of remarkable impact in people–some in ways that that we are not able measure.

What’s the hardest part of this work?

Sometimes I get emotionally involved and am not able to stop—even though I know that one cannot solve all the problems. CUBS supported children under 18-years old—but what about when a project beneficiary turns 18 and needs to take an expensive exam so they can graduate from school and progress? Sometimes we pay for the exam from our own pockets, or help raise money for them, because  there’s a limit to what any one project can do. There’s a huge number of people who need support, but we’re working in a resource-limited environment.

With the CUBS project closing this year, how will the achievements be sustained?

Things are changing in Nigeria and there is increased vulnerability in the social welfare system and people don’t understand it or know how to stop it. We need to explain the current systems to people, the causes of vulnerability, and work with them to develop stronger support structures for OVC and their caregivers.

We cannot eliminate vulnerable populations, but vulnerability can be greatly reduced by supporting advocacy efforts, providing data to inform decisions, and reporting on results to inspire others to join efforts to help OVC.  We did as much as we could within the CUBS framework. But, as a people, I know we can do more. Sustainability is about involving all stakeholders. When all stakeholders, especially those in the community and at the government level, are committed—beyond external funding—their commitment can improve the systems that help reduce vulnerability and reach more people.

We should take every opportunity to disseminate the good work that CUBS has done and encourage people to help OVC.

A lot of our work is about communicating results—explaining to people what they can do to help vulnerable children and expand support structures in their communities. We will continue to do that.

Read CUBS final report

What was your role with the project? What will you do now?

I provided overall technical leadership on M&E for the project, including managing the project monitoring plan and all project data collection, collation, and reporting.  I recently also started providing M&E support to ProACT, another MSH-led project in Nigeria. ProACT also involves some forms of OVC services, but has a much bigger mandate and portfolio, including HIV & AIDS comprehensive care and treatment, and other forms of HIV care, such as preventing mother-to-child transmission (PMTCT), and HIV counseling and testing.  (Link to ProACT) I’m going to bring a lot of the community experience I’ve had in the CUBS project, as well as experience in HIV care and treatment I had before I joined MSH, to see how we can expand HIV care and services and link these to the community for sustainability and use available data for necessary decision making at all levels. Care at the facility is not complete without linking it to the community.

I’m using all of my experience with CUBS and before CUBS to add to what MSH is doing in Nigeria. MSH is a health system strengthening organization—and I’ve come to understand it better over the years. I’m focused now on the bigger picture of what MSH is doing, how it’s expanding, and using project data tell MSH’s a story in Nigeria.

What have you enjoyed most about being part of the CUBS team?

For me, the best part of CUBS was watching people who had lost hope, regain hope, and provide better care for their children over time.  We saw an overwhelming improvement and restoration of hope among the families that were supported over the years.