Title: Saving lives for a lifetime: supporting orphans and vulnerable children impacted by HIV/AIDS

Authors: Beverly Nyberg, Dee Dee Yates, Ronie Lovich, Djeneba Coulibaly-Traore, Lorraine Sherr, Renee Tonya, Anita Sampson, Brian Howard

Date: 2012

Abstract: President’s Emergency Plan for AIDS Relief (PEPFAR’s) response to the millions of children impacted by HIV/AIDS was to designate 10% of its budget to securing their futures, making it the leading supporter of programs reaching orphan and vulnerable children (OVC) programs globally. This article describes the evolution of PEPFAR’s OVC response based on programmatic lessons learned and an evergrowing understanding of the impacts of HIV/AIDS. In launching this international emergency effort and transitioning it toward sustainable local systems, PEPFAR helped establish both the technical content and the central importance of care and support for OVC as a necessary complement to biomedical efforts to end the HIV/AIDS epidemic. Critical services are reaching millions of HIV-affected children and families through vast networks of community-based responders and strengthened national systems of care. But rapid program scale-up has at times resulted in inconsistent responses, failure to match resources to properly assessed needs, and a dearth of rigorous program evaluations. Key investments should continue to be directed toward more sustainable and effective responses. These include greater attention to children’s most significant developmental stages, a focus on building the resilience of families and communities, a proper balance of government and civil society investments, and more rigorous evaluation and research to ensure evidence-based programming. Even as HIV prevalence declines and medical treatment improves and expands, the impacts of HIV/AIDS on children, families, communities, economies, and societies will continue to accumulate for generations. Protecting the full potential of children—and thus of societies—requires sustained and strategic global investments aligned with experience and science.

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Study Title: Child Status Index (CSI)

Context: In past, programs for orphaned and vulnerable children (OVC) have been evaluated by reporting the numbers of children and the services that they received (outputs.) To measure more appropriately the needs of OVC and the effectiveness of the support these programs provide (outcomes), the President’s Emergency Plan for AIDS Relief (PEPFAR) requested a tool to assess vulnerabilities, needs, and outcomes of OVC. To fill this gap, the Child Status Index was developed to provide a framework for identifying a child’s needs, creating service plans, and assessing intervention outcomes.

Study aims: As it is currently designed, the Child Status Index provides an assessment strategy that addresses the areas of a child’s life that are most indicative of the child’s relative well-being or vulnerability in low- and middle-income countries (LMIC). The CSI was developed based on twelve child centered factors, including food security, growth and nutrition, abuse and exploitation, legal protection, wellness, healthcare services, emotional health, social behavior, performance, and education. These factors are rated on a high inference scale following interviews and specific observations in a home/community visit. Each factor is rated as “good”, “fair,”, “bad”, and “very bad” relative to local norms by community volunteers who work for local organizations and who may have varying degrees of literacy.

Methods: The development of the CSI involved a community participatory process that included community workers, OVC caregivers, and village leaders in Kenya and Tanzania. To derive the domains and the factors that comprise the CSI, researchers conducted a series of informal discussions with community workers, guardians, and other service providers in Kenya and Tanzania. The CSI was then successfully tested to ensure its reliability and validity, and it has been utilized in trials in other countries, such as Ethiopia, Rwanda, India and Cambodia to raise ongoing feedback about its applicability.

Policy Implications:

  • CSI results can be used for targeting children with needs and factors in which those needs appear, not by aggregating total scores, but rather by developing algorithms at a community level, such as: any score in the “very bad” range or more than a pre-specified number of scores in the “bad” range, and so forth. The targeting strategies are developed by community organizations depending on their funding priorities and resources.
  • The CSI is often used in case management for child and households cared for by community based organizations.
  • CSI information, when aggregated by factor, can inform program planning for identified organizations in a defined setting.
  • The CSI can help identify benefits children receive from services, preferably used in conjunction with other outcome measures.

Principal Investigator: Karen O’Donnell (Duke University)

Contact: duke.ovcstudies@gmail.com