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Progress in Third Report

Click image above to read entire text of the third report to Congress

Brief Sketch of USAID Understanding of Orphans and Orphanhood

  • The UN and USG definition of “orphan” is a child whose mother or father, or both, has died. According to this definition, it is estimated that there are 163 million orphans worldwide.
  • Approximately 10.7 percent (17.5 million) of the world’s 163 million orphans have lost one or both parents due to AIDS.
  • Studies show that children who have lost their mother are more likely to have worse educational outcomes than children who have lost their father.
  • Some studies have found that girl orphans are at a greater risk for HIV infection and other threats to their reproductive health than boys.
  • Most orphaned children continue to live in families, typically with a surviving parent or sibling, or members of their extended family.
  • The relation of the adult caregiver to the orphan can affect the well-being of the child. Studies have shown that children living in households headed by non-relatives were worse off that those living with a parent, and children living in households headed by non-relatives were less likely to be enrolled in school.
  • An estimated 2 million children live in institutions, though the percentage of institutionalized children who are orphans is not known.
  • Some studies have found that, in comparison to children who are not orphans, orphans are at a disadvantage in terms of schooling, including enrollment, grade level, and dropping out.
  • Singling out specific children for special benefits based on their orphan status can lead to stigma, resentment, and harsh treatment from those in their households, schools, and communities.

Reliance on weak child welfare sector

Field experience and limited data show that the child welfare sector is often neglected, understaffed and under-resourced.

  • Fewer than one-third of the countries where laws have been passed to protect children from violence and exploitation have the resources to enforce those laws.
  • Child welfare departments and ministries are often week.

Goals for 2009-2010 and Beyond

  • Identify countries with complex U.S. Government assistance programs, determine the status of interagency coordination, identify and disseminate best coordination practices and assist countries to improve coordination.
  • Reach agreement on an improved monitoring and evaluation system and begin implementation.
  • Determine the feasibility and cost of filling key data gaps on children living outside of permanent family care

Click image above to read entire text of 2008 report.

Changes in Funding Levels from 2007-2008

  • U.S. President’s Emergency Plan for AIDS Relief increased funding for orphans and vulnerable children in 15 focus countries, serving an estimated 2.7 million children. In total, PEPFAR committed $278.3 million in FY 2007 toward OVC programs.
  • Department of Labor’s programs prevented or withdrew 229,000 children from exploitive child labor by providing them with education and/or training opportunities.
  • Department of State’s programs to prevent trafficking in persons provided guidance to help countries focus resources on prosecution, protection, and prevention programs and policies.
  • Department of States’ Bureau of Population, Refugees, and Migration developed programs to address gender-based violence against women and girls, including sexual exploitation and anti-trafficking initiatives.
  • Office of Food for Peace increased funding for food aid aimed at the most vulnerable populations, although increases in food and shipping costs erased the impact of these increases.
  • Displaced Children and Orphans Fund programmed $16 million in 16 countries to fund technical assistance for initiatives to benefit vulnerable children, especially children trapped by armed conflict, children on the streets, and children without family care.
  • Department of Health and Human Services’ Office of Refugee Resettlement provided resettlement services to adults, families and children unable to safely repatriate to their country of origin.

Challenges Affecting All Programming for Highly Vulnerable Children

  • Stigma: targeting vulnerable children can draw attention to their status and stigmatize them as “unclean,” “damaged,” or “violent”
    • To combat this, interventions should be available to all vulnerable children and not just a select subgroup
  • Global food crisis: rising food prices mean donors can afford less food and more families go hungry
    • Especially an issue in HIV-affected populations, who often cite food as one of their greatest needs
  • Finding and serving hard-to-reach children
  • Incorporating child protection into broader program

Improving Interagency Coordination of Programs for Highly Vulnerable Children

USAID accomplished three tasks in the reporting period:

  • Initiated data gathering and analysis for development of a strategic information system
  • Began developing country profiles for use by country-level interagency coordinating committees for highly vulnerable children
  • Continued analyzing the challenges and lessons learned to improve USG programming for highly vulnerable children.

Challenges to Improved Interagency Cooperation

  • Reaching vulnerable children who are not within the mandates of particular USG programs
    • Many funding programs are earmarked for a specific vulnerability (such as children affected by HIV/AIDS), making it challenging to ensure coverage of larger numbers of vulnerable children.
  • Restrictive funding streams and differing program mandates: different funding accounts can have different mandates. This effectively limits the scope of programs some USG personnel and partners can engage with for highly vulnerable children, and limits the type of communities within which they work.
  • The human resources cost of collaboration
  • Differing reporting and monitoring and evaluation requirements
  • Difficulties in making information easily accessible to agencies working with highly vulnerable children

Innovations for OVC Research

The following list includes several innovative activities, which are under way from individual USG agencies:

  • Mapping of services for vulnerable children: PEPFAR initiated a pilot program to map the services available from each PEPFAR-supported service provider. These maps match services to identified needs.
  • Identifying research priorities for HIV/AIDS-affected children: A 2008 research conference on children made vulnerable by HIV/AIDS identified several research needs, and discovered that:
    • Evaluation information is lacking on key topics for OVC programs in sub-Saharan Africa
    • Neglected research areas include:
      • Interventions focusing on the needs of adolescents and children under 5 years
      • Interventions for hard-to-reach youth
      • Interventions focusing on strengthening father-child relations as a protective factor
  • The Child Status Index: assists in the monitoring of the well-being of children and evaluating OVC programs that serve them.
  • Supporting Transformation by Reducing Insecurity and Vulnerability with Economic Strengthening (STRIVE): identifies and demonstrates effective means of improving the economic circumstances of vulnerable children and youth through economic development programs for their caregivers and/or youth themselves.

Click image above to read entire text of the 2007 report
  1. U.S. Government officials consulted with Field Missions to inform them of PL 109-95 legislation, proposed implementation steps, and the importance that the U.S. Government places on highly vulnerable children.
  2. Ethiopia, Uganda, and Indonesia were identified as “fast-track” countries that will serve as models for other countries.
  3. The Special Advisor for Assistance to Orphans and Vulnerable Children began coordinating activities with representatives of other government agencies. Representatives shared information about activities, budgets, target groups, results and potential challenges.
  4. Increased coordination with multilateral bodies, other donors, non-profits, and the private sector
  5. Initiated development of a strategic information system to compile pertinent U.S. Government programs focusing on orphan and vulnerable children.
  6. Appointment of Dr. Connie Carrino, the first Special Advisor for Assistance to Orphans and Vulnerable Children

USAID: PL 109-95’s Context

U.S. Agency for International Development 

This law, which was intended to respond to the global orphans and vulnerable children crisis, calls for the U.S. Government’s response to the crisis to be “comprehensive, coordinated, and effective.” Specifically, the legislation aims to improve the coordination, comprehensiveness, and effectiveness of U.S. Government assistance for highly vulnerable children.

The legislation calls for the submission of an annual report to Congress that provides legislators with updated information about orphan and vulnerable children research and action. Copies of the reports can be found below.

PL 109-95’s Context:

Click image to read entire PL 109-95 legislation

The 2006 Strategy for Implementation of PL 109-95 outlined seven parameters for programming assistance for highly vulnerable children:

  1. Focus on stressed communities
  2. Reliance on local institutions or communities to determine the most vulnerable children and to determine the most-needed services
  3. Preference for family/household care rather than institutional care
  4. Preference for a development approach that creates ownership and limits dependency
  5. Adherence to the five key strategies of the Framework for Protection, Care and Support of Orphans and Vulnerable Children Living in a World of HIV and AIDS (see below)
  6. Strengthening of partnerships and knowledge exchange between implementing organizations that are primarily child centered and those that focus on economic empowerment.
  7. Taking gender into consideration

 U.S. Government definition of highly vulnerable children: children under 18 whose safety, well-being, or development is at significant risk due to inadequate care, protection, or access to essential services, which are defined as globally agreed-upon inputs that children need to grow into contributing members of society. These include

  • Education
  • Food
  • Nutrition
  • Shelter
  • Protection
  • Health Care
  • Livelihood Opportunities
  • Psychosocial Support

Five Strategies from the Global Framework to Address Orphans, Children and HIV/AIDS:

  • Strengthen capacity of families to protect and care for highly vulnerable children by prolonging the lives of parents and providing economic, psychosocial and other support
  • Mobilize and support community-based responses
  • Ensure access for highly-vulnerable children to essential services
  • Ensure that governments protect the most vulnerable children through improved policy and legislation and by channeling resources to families and communities.
  • Raise awareness at all levels through advocacy and social mobilization to create a supportive environment for highly vulnerable children and families

U.S. Government agencies’ approach to reduce vulnerabilities:

  1. Direct delivery of essential services to large numbers of highly vulnerable children or highly vulnerable populations. This includes:
    1. Support for victims of natural disasters and emergencies
    2. Support for refugee resettlement
    3. HIV/AIDS-related care
    4. Reduction of exploitive child labor
  2. Capacity-building to foster sustainability
  3. Policy, Diplomacy, and Advocacy
  4. Demonstration Projects and Research to improve knowledge of the causes of vulnerability among children, understand how to develop strategies for preventing vulnerability, and testing interventions for those who are already vulnerable
  5. Documentation and Dissemination of Information
    1. PL 109-95 aims to expand information among USG agencies and partners about current work efforts and to encourage widespread dissemination of research results, policy analysis, and sound practices
  6. Integration with Broader Development Efforts
    1. Strive to integrate orphan and vulnerable children programs with broad-based programs (including education, child survival and health, enterprise and agriculture development, etc.)

In March 2011, USAID released a report titled Early Childhood Development for Orphans and Vulnerable Children: Key Considerations, providing an overview of important early childhood development (ECD) interventions and current evidence of ECD programs implemented to support orphans and vulnerable children (OVC). The report details critical elements of ECD programs as well as provides key findings from prior literature and evaluations. It also includes answers to common questions, resources on how to learn more about ECD, and examples of well-developed ECD programs that target OVC.

[button link=”http://documents.worldbank.org/curated/en/2012/12/17119686/kenya-kenya-cash-transfer-orphans-vulnerable-children-p111545-implementation-status-results-report-sequence-08″ color=”green” newwindow=”yes”] Read the Report[/button]

Overview: The Cash Transfer for Orphans and Vulnerable Children (CT-OVC) Project, approved in 2009, expanded the pilot CT-OVC Programme from 47,000 households caring for OVC in Kenya to around 83,000 households (increasing the coverage of OVC from around 140,000 to 250,000). Early evidence suggests that the program is having a significant impact on poverty reduction, school enrollment and birth registration for OVC. Using IDA resources, innovative technology is being introduced to transfer payments to beneficiaries in a faster and more secure way than was previously possible.

[button link=”http://web.worldbank.org/WBSITE/EXTERNAL/NEWS/0,,contentMDK:22887829~menuPK:141311~pagePK:34370~piPK:34424~theSitePK:4607,00.html” color=”orange” newwindow=”yes”] Learn More[/button]

[button link=”http://documents.worldbank.org/curated/en/2012/12/17119686/kenya-kenya-cash-transfer-orphans-vulnerable-children-p111545-implementation-status-results-report-sequence-08″ color=”green” newwindow=”yes”] View Online[/button]

 

Authors: Karen O’Donnell, Robert Murphy, Jan Ostermann, Max Masnick, Rachel A. Whetten, Elisabeth Madden, Nathan M. Thielman, Kathryn Whetten

10461Abstract: Assessment of children’s learning and performance in low and middle income countries has been critiqued as lacking a gold standard, an appropriate norm reference group, and demonstrated applicability of assessment tasks to the context. This study was designed to examine the performance of three nonverbal and one adapted verbal measure of children’s problem solving, memory, motivation, and attention across five culturally diverse sites. The goal was to evaluate the tests as indicators of individual differences affected by life events and care circumstances for vulnerable children. We conclude that the measures can be successfully employed with fidelity in non-standard settings in LMICs, and are associated with child age and educational experience across the settings. The tests can be useful in evaluating variability in vulnerable child outcomes.

Read full study here

Authors: Caroline Kuo & Don Operario

Abstract: In South Africa, an estimated 2.5 million children have been orphaned by AIDS and other causes of adult mortality. Although there is a growing body of research on the well-being of South African orphaned children, few research studies have examined the health of adult individuals caring for children in HIV-endemic communities. The cross-sectional survey assessed prevalence of general health and functioning (based on Short-Form 36 version 2 scale), depression (based on Center for Epidemiologic Studies-Depression scale), anxiety (using Kessler-10 scale), and post-traumatic stress (using the Harvard Trauma Questionnaire) among a representative community sample of adults caring for children in Umlazi Township, an HIV-endemic community in South Africa. Of 1599 respondents, 33% (n=530) were carers of orphaned children. Results showed that, overall, carers reported poor general health and functioning and elevated levels of depression, anxiety, and post-traumatic stress. Carers of orphaned children reported significantly poorer general health and functioning and higher rates of depression and post-traumatic stress compared with carers of non-orphaned children. In multivariate analyses, orphan carer and non-orphan carer differences in general health were accounted for by age, gender, education, economic assets, and source of income, but differences in depression were independent of these cofactors. Interventions are needed to address physical and mental health of carers in general. Greater health problems among orphan carers appeared to be fully explained by socioeconomic characteristics, which offer opportunities for targeting of programs. More research is needed to understand determinants of mental health disparities among orphan carers, which were not explained by socioeconomic characteristics.

Read full study here

Authors: Caroline Kuo, Don Operario & Lucie Cluver

Abstract: South Africa faces the challenge of supporting the well-being of adults caring for growing numbers of AIDS-orphaned children. These adults play a critical role in responses to the epidemic, but little information exists in regard to their mental health needs. This paper reports on findings from n=1599 adults, recruited through representative household sampling, who serve as primary carers for children in Umlazi Township, an HIV-endemic community. Overall, 22% of participants were carers of AIDS-orphaned children, 11% were carers of other-orphaned children and 67% were carers of non-orphaned children. Prevalence of depression was 30.3%. Orphan carers, regardless of whether they cared for AIDS-orphaned or other-orphaned children, were significantly more likely than carers of non-orphaned children to meet the clinical threshold for depression (35.2% vs. 27.9%, p < 0.01). In multivariate logistic regressions, food insecurity and being a female carer were identified as additional risk factors for greater depression. In contrast, households with access to running water and households dependent on salaries as the main source of income were identified as protective factors for disparities in depression. Mental health interventions are urgently needed to address an increased risk for depression among all orphan carers, not just those caring for AIDS-orphaned children.

Read full study here

Authors: Caroline Kuo, Jane Fitzgerald, Don Oerario, & Marisa Casale

Abstract: Drawing upon a sample of 1,599 adults caring for children in HIV-endemic Umlazi Township in South Africa, this cross-sectional survey investigated whether perceived social support varied among caregivers of AIDS-orphaned children (n=359) as compared to caregivers of children orphaned by other causes (n=171) and caregivers of non-orphaned children (n=1,069). Results of multivariate linear regressions indicate that caregivers of AIDS-orphaned children reported significantly lower levels of social support compared to caregivers of other-orphaned children and non-orphaned children independent of socio-demographic covariates. Caregivers of other-orphaned and non-orphaned children reported similar levels of social support. In terms of sources of support, all caregivers were more likely to draw support from family and significant others rather than friends. These findings indicate a need to develop interventions that can increase levels of social support for caregivers of AIDS-orphaned children, particularly networks that include friends and significant others.

Read full study here

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