The President's Emergency Plan for AIDS Relief What it Means for Vulnerable Children in Developing C

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The President's Emergency Plan for AIDS Relief -
What it Means for Vulnerable Children in
Developing Countries

• Colette Bottini
• Technical Advisor, Orphans Vulnerable Children
• USAID
• Global Health Mini-University - October 9, 2009

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Orphans Vulnerable Children Affected by HIV/AIDS

• Scale
• Duration
• Complexity

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Scale

• Nearly 12 million children in Africa have lost
  one or both parents to AIDS
• Over 2 million children currently living with HIV
• Almost 370,000 new infections among children
  under age 15 each year

UNAIDS 2008
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DurationAIDS impacts generations
2004
Epidemic curves for Sub-Saharan Africa
25,000,000
20,000,000
Adult mortality - AIDS
Adults living with HIV
15,000,000
Millions
18 million orphans due to AIDS in 2010
10,000,000
Orphans - AIDS
5,000,000
0
1985
1990
1995
2000
2005
2010
1980
The number of orphans will rise even after the
number of adults infected stagnates or declines.
Orphans may become the next generation at risk of
infection.

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Complexity - One size does not fit all

• Childrens needs span multiple domains shelter,
  health care, food, education, protection,
  psycho-social, economic stability
• Needs vary by age and developmental stage
• Vulnerability to risk is both individual and
  contextual

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The Presidents Emergency Plan for AIDS Relief
(PEPFAR) - Targets

• PEPFAR I (2003 2008)
• 2 7 10 Goals
• PEPFAR II (2008 2013)
• Treatment for at least 3 million
• Prevention of 12 million new infections
• Care for 12 million people, including 5 million
  OVC

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PEPFAR Financial Commitment

• PEPFAR (2003-2008) 18.3 billion
• Reauthorization Act (2009-2013) 48 billion
• 39 billion for PEPFAR bilateral AIDS programs
  the Global Fund to Fight AIDS, TB Malaria
• 5 billion for the Presidents Malaria Initiative
• 4 billion - to fight TB

10 of PEPFAR HIV/AIDS funding for orphans
vulnerable children
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Objectives

• Preserve families
• Empower communities and civil society to support
  most vulnerable
• Strengthen government systems capacity to
  deliver essential services

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Results for Children ( their Families)

• 2.1 million on life saving ARV treatment
  (increasing percentage of children)
• Prevention of mother-to-child transmission
  services during nearly 16 million pregnancies
• Supported care for over 10 million affected by
  HIV/AIDS, including more than 4 million OVC
• Significant training and capacity building
  investments
• As of September 30, 2008

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What limits coverage?

• Difficulty in targeting
• Limited data and ineffective use of available
  data
• Need for distinctive strategies for generalized
  and concentrated epidemics (including linkages
  with facility-based services)
• Complexity of programming needs
• Differing needs of children caretakers
• Involvement of multiple sectors (wraparounds
  necessary)
• Uneven quality of programs
• Inefficient service delivery
• Infancy in developing best practice and service
  delivery models
• Limited capacity
• All levelsfamily, community, government, USG

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Challenges Behind and Ahead

• Evolving program guidance misinterpretation and
  unintended consequences
• Quality data for program planning
• Workforce dependence on volunteers
• Sustainability and continuity of services

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Going Forward

• Focus on family-based care
• Targeting underserved age groups early childhood
  and older adolescents
• Improving ME and quality of OVC interventions
• Child Status Index (CSI) to evaluate child
  level wellbeing and impact of services
• Quality Assurance and Improvement (QAI) country
  level process
• Systems strengthening child protection/social
  welfare
• Expanding the evidence base on what is working
• Broader global context of vulnerable children

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THANK YOU!