Monitoring and Evaluating National Responses for Children Orphaned and made Vulnerable by HIVAIDS

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Monitoring and Evaluating National Responses for
Children Orphaned and made Vulnerable by HIV/AIDS
Mary Mahy UNICEF Meeting on Results of Pilot
Surveys Washington, DC January 6, 2005
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Overview of this presentation

• Definition of orphaned and vulnerable children
• Framework for developing indicators
• Definitions of indicators and results

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Definition of orphaned and vulnerable children

• Vulnerable could be defined in many different
  ways poverty, violence, abuse.
• Specific to HIV/AIDS - adult mortality and adult
  morbidity
• For this guide, an orphaned or vulnerable child
  is a child under 18 who has
• Lost one or both parents
• One or both of whose parents has been chronically
  ill in the prior 12 months
• Lives in a household where an adult 18-59 has
  died in prior 12 months (and who was chronically
  ill prior to that death)
• Lives in a household where an adult 18-59 was
  chronically ill in prior 12 months

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Framework for caring for children orphaned and
made vulnerable by HIV/AIDS

• Strengthen the capacity of families to protect
  and care for orphans and vulnerable children
• Mobilize and strengthen community-based responses
• Ensure access to essential services for orphans
  and vulnerable children
• Ensure that governments protect the most
  vulnerable children
• Raise awareness to create a supportive
  environment for children affected by HIV/AIDS
• Source The Framework for the protection, care
  and support of orphans and vulnerable children
  living in a world with HIV/AIDS. July 2004
  (www.unicef.org/aids/index_documents.html)

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1. Strengthen the capacity of families

• Core Indicators
• Indicator 1 Basic material needs
• Indicator 2 Malnutrition - underweight
  prevalence
• Indicator 3 Sex before the age of 15
•  Additional indicators
• Indicator A1 Food security
• Indicator A2 Psychological health
• Indicator A3 Connectedness to an adult caregiver
• Indicator A4 Succession planning

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2. Mobilize and strengthen community-based
responses

• Core indicators
• Indicator 4 Children outside of family care
• Indicator 5 External support for households with
  orphans and vulnerable children
•  Additional indicators
• Indicator A5 Orphans living with siblings

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3. Ensure access to essential services

• Core Indicators
• Indicator 6 Orphan school attendance ratio
• Indicator 7 Birth registration

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4. Ensure that governments protect the most
vulnerable children

• Core Indicators
• Indicator 8 OVC Policy and Planning Effort
  index
•  Additional indicators
• Indicator A6 Property transfer
• Indicator A7 Quality of Institutional Care

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5. Raise awareness to create a supportive
environment

• Core Indicators
• Indicator 9 Percent of children who are orphans
• Indicator 10 Percent of children who are
  vulnerable
•  Additional indicators
• Indicator A8 Stigma and discrimination

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• Indicators and results from pilot surveys

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Basic material needs - definition

• Definition Ratio of proportion of OVC to non-OVC
  ages 5-17 that have three minimum basic material
  needs for personal care (blanket, shoes, two sets
  of clothing)
• Issues Blanket not necessary in warm climates
  use sheet, mattress or other item if blanket is
  inappropriate
• Some items are shared

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Explanation of categories in following figures

• Vulnerable All children who had a chronically
  ill parent or had an adult (18-59) in their
  households who was chronically ill or who died in
  the past 12 months
• Orphan children who were not categorized as
  vulnerable, but who lost one or both parents (at
  any time in the past)
• OVC all children who can be categorized as
  orphan or vulnerable
• Non-OVC children who do not match either of the
  criteria above

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Basic material needs resultsincludes children
outside of households
Percent of children ages 5-17 who have three
basic material needs (blanket, shoes, two sets
of clothing)
Ratio 0.69 0.95
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Malnutrition (underweight prevalence)- definition

• Definition Ratio of proportion of OVC to non-OVC
  ages 0-4 who are underweight
• Issues small sample sizes because of age
  collected anthropometric data up to age 9
  Limited benefit.
• Only calculate when sample sizes are adequate
• Investigate other health indicators

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Malnutrition (underweight prevalence)- results
Mean weight-for-age z-score in children ages 0-8,
by age group and sanitation/SES variables,
Blantyre, Malawi
Age in years
Source Rivers, Silvestre and Mason. 2004.
Nutritional and Food Security Status of Orphans
and Vulnerable Children Report for the
UNICEF/IFPRI Research Project.
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Food security definition

• Definition Ratio of proportion of households
  with OVC versus households with children who are
  not OVC that are food insecure.
• Issues Household-level, doesnt show individual
  OVCs food security.
• Not possible to ask of young children, biased
  responses from caretakers. Keep at household
  level.

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Food security results
Percent of households reporting severe food
insecurity (children and adults in household
forced to skip meal or food for entire day)
Ratio 1.49 1.68
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Psychological health - definition

• Definition Ratio of proportion of OVC to non-OVC
  ages 12-17 with a high score for psychological
  health
• Issues Still in development.
• Translation problems, culturally specific
  wording/questions,
• Numerous questions, requires prior fieldwork,
• difficulty with rating scale

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Psychological health resultsincludes children
outside of households
Percent of children ages 12-17 scoring high
levels on psychological test
Ratio 0.66 0.99
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Connectedness to adult caregiver - definition

• Definition Ratio of OVC to non-OVC ages 12-17
  with positive connection to adult with whom they
  spend most time living
• Issues Still in development,
• Might have strong connection to non-adult,
• Based on 15 questions,
• Problems with culturally specific
  words/questions,
• Difficulty with rating scale

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Connectedness to adult caregiver - results
Percent of children ages 12-17 reporting strong
connection to the adult with whom he/she spend
the most time living
Ratio 1.23 0.80
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Children outside of family care - definition

• Definition Proportion of all children ages 0-17
  living outside of family care
• Issues Requires census (or representative
  survey) of all street children and all
  institutions

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Children outside of family care - results
Percent of children ages 0-17 years by residence
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External support to households - definition

• Definition The proportion of OVC whose
  households received free basic external support
  in caring for the child
• Issues Do households receive support or
  individual OVC if collected at household level
  all children are assumed to receive support
• Support might not be required,
• Might not capture support from neighbours,

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External support to households - results
Percent of orphans and vulnerable children ages
0-17 years receiving external support
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Orphan school attendance ratio - definition

• Definition The ratio of double orphaned children
  to non-orphaned children (who live with one
  parent) aged 10-14 years who are currently
  attending school (MDG indicator)
• Issues small sample size include vulnerable
  children
• 10-14 used to keep narrow age range, and avoid
  children who start school at older age

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Orphan school attendance ratio resultsincludes
children outside of households

• Percent of children 10-14 currently attending
  school including vulnerable children and lifting
  restriction on non-orphans living with at least
  one parent

Ratio 0.75 0.95
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Quality of institutional care - definition

• Definition Percent of children ages 5-17 living
  in institutions that care for orphaned or
  vulnerable children who attend mainstream
  school, have individual care plans regularly
  reviewed, have regular contact with family member
• Issues Requires institutional survey, potential
  biased reporting from institution administrator,
  problems with age categories, often no care plan
  exists

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Percent of children who are vulnerable
definition

• Definition Percent of children who are
  vulnerable (in past year parent has been
  chronically ill or an adult, aged 18-59 years, in
  household has died or has been chronically ill)
• Issue countries might want different definition

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Percent of children who are vulnerable and who
are orphaned - results
Percent of children ages 0-17 years who have lost
one or both parents, by residence
Percent of children ages 0-17 years who are
vulnerable (only those in households)
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Plans for inclusion in future surveys

• UNICEFs Multiple Indicator Cluster Surveys will
  collect 5 of these indicators in about 15
  countries
• MeasureDHSs AIDS Indicator Surveys and AIDS
  module in DHS will collect 12 of these indicators
• ?Only in countries where more than 8 of children
  are orphaned

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• Thank you