It’s been just over three years since the Sinovuyo Caring Families Project was piloted with 68 families in Khayalitsha, Cape Town. The programme, which recently completed a two year randomised control trial supported by Ilifa Labantwana, has attracted a great amount of international attention and is being implemented in Kenya, South Sudan, the DRC and the Philippines this year alone. We spoke to Dr Jamie Lachman about the project and the journey to scale.
Q: First things first, what is Sinovuyo Caring Families Project?
The Sinovuyo Caring Families Project for Young Children (we also have a programme for parents and teens) is a parenting programme developed in South Africa, focusing on the highest-risk families with children aged 2-9. These families are typically affected by HIV/Aids or intimate partner violence. Sinovuyo’s goal is to prevent child maltreatment and conduct problems, and to improve family dynamics.
Q: Tell me about the origin of the Sinovuyo.
Sinovuyo began as a collaboration between the Universities of Cape Town, Oxford, and Bangor. The focus was to develop and evaluate a parenting programme to reduce violence against children in South Africa and other low-resource settings. Many of the existing evidence-based programmes available were either too expensive to deliver in South Africa at scale or too restrictive to culturally adapt for local families. The team realised the need to develop a South African programme that was similar to these other programmes but appropriate for the local context and most importantly, economical to scale up. At the same time, I was working on a parenting programme at Clowns Without Borders SA (CWBSA) in KZN at the time and we jumped at the opportunity to expand our programme while also deepening our understanding of its impact on families and children. UCT and CWBSA teamed up and I went to study at Oxford University, where I met Professor Lucie Cluver, and the design of the Sinovuyo Caring Families Project began in earnest.
Q: What factors did you take into consideration for the design?
We started off by looking at the commonalities for effective family programmes globally and identifying the components. We wanted Sinovuyo to be culturally relevant for its context and we visited six Cape Flats communities, speaking to parents and service providers in focus groups and interviews about their needs from a parenting intervention. Finally, our goal from the very start, was to create a programme that is easily scalable at a minimal cost in low-resource countries. We knew that Sinovuyo needed to be widely available with no licensing fees and free for parents to attend.
Q: How did Sinovuyo evolve?
With initial funding from the World Health Organization, the programme manual was developed at the end of 2012. We had designed a 12-week, group-based programme, delivered by community workers trained to model parenting techniques. We then piloted the programme in the following year with 68 families in Khayelitsha, Cape Town. In 2014, Ilifa, along with the ApexHi Charitable Trust, funded a randomised controlled of trial (RCT) of the programme with 296 families in Khayelitsha and neighbouring Nyanga. The RCT, which ended in March this year, will provide robust evidence on whether Sinovuyo reduces abuse and harsh parenting, improves family relationships and reduces caregiver and child levels of depression and toxic stress.
Q: Towards the end of last year Sinovuyo started attracting a lot of attention. Were you ready?
We wanted the RCT to be complete before taking the programme overseas but it didn’t work out exactly like that. Our presentations at conferences and our journal articles caught the attention of various organisation. By the start of 2016, we were already working with AMPATH Kenya’s project for young mothers in Western Kenya.
Q: So, Kenya is Sinovuyo’s first international application?
Yes. It’s been highly rewarding to see community health workers delivering Sinovuyo in rural Kenya, which is an environment even more resource-poor than the Cape Flats. AMPATH Kenya had a first 1000 days programme for 600 new mothers. As the babies approached age 2, the moms had a lot of questions about parenting and dealing with challenging behaviour. This is why Sinovuyo was introduced. The moms come with their children and sit in a big circle under a tree. A lot of them have had new babies since the initial first 1000 days programme started, and they put them in the centre of the circle to sleep and play while they do the programme. It’s been almost surreal to see Sinovuyo applied to this wholly different context.
Q: Have you had any big problems in the roll-out?
The biggest challenge is to retain a degree of control on the quality as the programme moves further away from its source. It’s difficult for us to monitor and support quality delivery remotely. For example, we often have to conduct supervision via Skype with interpreters but many of the valuable nuances get lost in the translation.
Q: How you are dealing with it?
We have developed a certification process for the facilitators. This will include assessments from peer reviews, supervisors, and video recordings of the sessions. All these things should help strengthen competencies and quality of delivery. We are also learning to build support structures to help the programme fly. For example, we aren’t just training the facilitators, we are also training their supervisors and other supporting staff members.
Q: What’s the one thing you wish you had known before you started on this process?
One thing I still don’t know but I wish I did, is whether Sinovuyo is the most effective, economic and scalable programme, or intervention package, it can be. During discussion with scaling up partners, I am frequently asked “What will happen if we reduce the dosage by one session?” or “What will happen if we omit this part?” We just don’t know the answers to those questions. If I had to do this all again, I would do more innovative testing of the programme design, before embarking on the RCT.
Q: The growth of Sinovuyo is still very exciting though.
Yes, absolutely. It’s so difficult to visualise the end goal when you are in the thick of planning and designing a programme. We often felt that way with Sinovuyo. To see it go to scale over the past year has been quite amazing.
Q: What do you have planned next?
Later this month, we are going to be rolling out the programme in South Sudan, working with Catholic Relief Services, and funded by USAID. We are also busy adapting Sinovuyo in the Philippines to be rolled out with a conditional cash transfer system, which is really exciting. We have been working with the Philippine Ambulatory Paediatric Association on that since last year. Almost every week we get requests from more and more places – Egypt, Thailand, Syrian refugees, who knows what’s next!
Dr Jamie Lachman was interviewed by Ilifa Labantwana in September 2016. For more information on Sinovuyo check out Clowns Without Borders or email on Jamie at Jamie@cwbsa.org.
For more details on the Sinovuyo programme, take a look at this Lessons from the Field report.