Deborah L. Caselton
Date of Defense:
May 26, 2009
Objectives: In 2007, there was an estimated 86,000 to 110,000 children living with HIV in Zambia. However, only a small percentage of these HIV+ children are supported medically. Without antiretroviral therapy a child will most likely die before the age of five. A process evaluation was conducted of Tiny Tim and Friends (TT&F), a program in Lusaka, Zambia that provides HIV+ orphans and other vulnerable children with medical and nutritional support. Programs are often only evaluated on outcome measures. However, programs also need to be evaluated in order to identify strengths, weaknesses, and gaps in the program implementation. A process evaluation can provide insight into the program’s areas of operational capacity and implementation that are essential for programmatic modification and enhancement. This study aims to explore two research questions: 1) How is TT&F being implemented? And 2) What are the factors that have facilitated or hindered the operational capacity of TT&F?
Methods: Semi-structured interviews were conducted with staff members, patients, and guardians and a content analysis was conducted.
Results: The following themes that emerged from the interviews and content analysis are explored: recruitment of HIV+ children, services offered, lack of resources, partnerships, and staff values. Evidence of how the TT&F program is being implemented is presented through the themes of recruitment of HIV+ children and services offered. Evidence that some inputs of TT&F are beneficial while others are hindering are also presented through the themes of partnerships as well as the staff’s dedication and compassion are key factors in driving the program. Other resources such as money, space, staff capacity, and transportation are factors that hinder TT&F’s operational capacity. However, because of TT&F staff’s dedication, teamwork and innovation, the program is able to overcome these barriers. After completion of the process evaluation, recommendations for TT&F include: installation of a staff monitoring/progress and rewards system, installation of a simple program monitoring system, and a better utilization of volunteers.
Conclusions: After completion of the process evaluation, recommendations for TT&F include: installation of a staff monitoring/progress and rewards system, installation of a simple program monitoring system, and a better utilization of volunteers.