and longitudinal data to follow children and families and the effects of the services they receive over time; and data on effectiveness and outcomes to help identify the most effective PEPFAR OVC programs and models. In addition, there is a lack of data about the total population of children “in need,” in part because of a lack of clarity and consistency both across countries and across programs within countries in how the population eligible for PEPFAR-supported services is defined (i.e., which children are defined as “vulnerable” or “affected by HIV”).

Recommendation Presented in This Chapter

Recommendation 7-1: To improve the implementation and assessment of nonclinical care and support programs for adults1 and children, including programs for orphans and vulnerable children, the Office of the U.S. Global AIDS Coordinator should shift its guidance from specifying allowable activities to instead specifying a limited number of key outcomes. The guidance should permit country programs to select prioritized outcomes to inform the selection, design, and implementation of their activities. The guidance should also specify how to measure and monitor the key outcomes.

Further considerations for implementing this recommendation:

•    For orphans and vulnerable children, the new OVC guidance and the ongoing developments for program evaluation already represent advances in addressing some of the challenges identified in this evaluation; this recommendation and the further considerations are intended to reinforce and further inform and support progress in achieving PEPFAR’s goals for children and adolescents.

•    Outcomes for consideration should be linked to the aims of OVC programs and therefore could include, for example, increased rates of staying in school, decreased excessive labor, reduced rates of exposure to further traumas, increased immunization completion, and increased coverage of HIV testing and treatment. With a continued focus on supporting developmentally informed programs, consideration should be given to identifying appropriate core outcomes for different age groups and for achieving developmental milestones. The program evaluation indicators currently being developed already offer a reasonable opportunity to link measures to core target outcomes for OVC programs.

•    The core key outcomes should also include quality of services and measures to reflect the potential sustainability of programs.

•    A shift to a more outcomes-oriented implementation model will re-


1 The discussion of nonclinical care and support for adults leading to this aspect of this recommendation can be found in Chapter 6.

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