PEPFAR Implementation Progress and Promise (2007) / Chapter Skim
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7 PEPFAR's Orphans and Other Vulnerable Children Category
7 PEPFAR's Orphans and Other Vulnerable Children Category
Pages 205-240
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From page 205... ...
• PEPFAR has adopted the international approach for core services for orphans and other vulnerable children and supported activities corresponding to those services. However, scale-up efforts for the provision of these services are hampered by several challenges, including a lack of social service systems to address the social and mental health support needs of children and a lack of systems with which countries can track and report vital statistics, such as birth registration, to facilitate determination of eligibility for both PEPFAR and non-PEPFAR services.
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From page 206... ...
To ensure adequate focus on and accountability for addressing the needs of orphans and other vulnerable children, the U.S. Global AIDS Coordinator should work with Congress to set a distinct and meaningful performance target for this population.
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From page 207... ...
Global AIDS Coordinator (OGAC) has previously defined vulnerable children as "those affected by HIV though the illness of a parent or principal caretaker" (OGAC, 2005f)
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From page 208... ...
Although targets for the total number of orphans and other vulnerable children served directly for Country Operational Plans for fiscal year 2007 will be set as in previous years, use of the revised reporting indicator will be effective as of the fiscal year 2007 mid and annual reporting periods, with allowance made if the country's monitoring system is not yet able to provide the new breakdown (OGAC, 2006c,d)
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From page 209... ...
. Reporting of supplemental direct support is defined as follows: "count orphans and other vulnerable children who are periodically monitored in all six core areas and who are receiving PEPFAR funded or leveraged support in one or two areas, in the relevant reporting period, that are appropriate for that child's needs and context" (OGAC, 2006i, p.
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From page 210... ...
BACKGROUND Estimates of Numbers of Orphans and Other Vulnerable Children In its 00 Report on the Global AIDS Epidemic, the Joint United Nations Programme on HIV/AIDS (UNAIDS) estimated the numbers of children orphaned as a result of HIV/AIDS by region and country, using age 18 as the delimiter.
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From page 211... ...
The rankings of the focus countries are shown in Table 7-2. As of 2005, South Africa, Kenya, Uganda, and Tanzania had each reported orphan populations of just over 1,000,000.
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From page 212... ...
was instrumental in spearheading the formation of the Global Partners Forum for Children Affected by HIV/AIDS (GPFC) as a focal point for advocacy, dialogue, and prioritizing of action items.
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From page 213... ...
2003: UNAIDS and UNICEF convened the first Global Partners Forum in Geneva. The Framework for the Protection, Care, and Support of Orphans and Vulnerable Children Living in a World with HIV and AIDS was endorsed.
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From page 214... ...
While palliative and preventive care guidance are important, they are not, however, equivalent to official guidance on meeting the needs of orphans and other vulnerable children who are HIV-negative or asymptomatic children living with HIV/AIDS, which was not disseminated until after the publication of OGAC's second annual 1 According to the World Bank, poverty reduction strategy papers describe a country's mac roeconomic, structural, and social policies and programs to promote growth and reduce poverty, as well as associated external financing needs. The papers are prepared by governments through a participatory process involving civil society and development partners, including the World Bank and the International Monetary Fund (World Bank, 2006)
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From page 215... ...
The Country Operational Plans provide examples of PEPFAR-supported activities aimed at meeting the needs of orphans and other vulnerable children. These examples are presented in the next section, organized according to the five key strategies listed above.
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From page 216... ...
PEPFAR IMPLEMENTATION: PROGRESS AND PROMISE BOX 7-2 Key Strategies of UNICEF's The Framework for the Protection, Care, and Support of Orphans and Vulnerable Children Living in a World with HIV and AIDS Strengthen the Capacity of Families • Improve household economic capacity • Provide psychosocial support to affected children and their caregivers • Strengthen and support child care capacities • Support succession planning • Prolong the lives of parents • Strengthen young people's life skills Mobilize and Support Community-Based Responses • Engage local leaders in responding to the needs of vulnerable community members • Organize and support activities that enable community members to talk more openly about HIV/AIDS • Organize cooperative support activities • Promote and support community care for children without family support Ensure Access to Essential Services • Increase school enrollment and attendance • Ensure birth registration for all children • Provide basic health and nutrition services • Improve access to safe water and sanitation • Ensure that judicial systems protect vulnerable children • Ensure placement services for family care for children • Strengthen local planning and action Ensure That Governments Protect the Most Vulnerable Children • Adopt national policies, strategies, and action plans • Enhance government capacity • Ensure that resources reach communities • Develop and enforce a supportive legislative framework • Establish mechanisms for ensuring information exchange and collaborative efforts Raise Awareness to Create a Supportive Environment • Conduct a collaborative situation analysis • Mobilize influential leaders to reduce stigma, silence, and discrimination • Strengthen and support social mobilization activities at the community level SOURCE: UNICEF and UNAIDS, 2004.
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From page 217... ...
REVIEW OF PROGRESS TO DATE Strategies of the Framework Strategy #: Strengthen the Capacity of Families Some of the strategies of The Framework prescribe specific services children need, while others describe the catalysts for action necessary in communities, governments, and legislative and judicial frameworks and institutions. Strategy #1 is aimed at strengthening the capacity of families to protect and care for orphans and other vulnerable children by prolonging the lives of parents and providing economic, psychosocial, and other support.
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From page 218... ...
. Based on the Committee's review of Country Operational Plans and documents from the Orphan and Vulnerable Children Technical Working Group, it appears that the majority of the allocation of PEPFAR funds for orphans and other vulnerable children services is mostly channeled through a limited number of agencies, mostly large, international non-profit, nongovernmental organizations.
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From page 219... ...
. Strategy #: Mobilize and Support Community-Based Responses As noted in Chapter 6, OGAC concurs with UNICEF's assessment that the community is the safety net after the family, and intends to provide direct support for building the capacity of community-based and nongovernmental organizations to support a greater number of community initiatives.
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From page 220... ...
. In addition, UNICEF and UNAIDS have stated that faith-based and nongovernmental organizations have an instrumental role in galvanizing and supporting community efforts (UNICEF and UNAIDS, 2004)
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From page 221... ...
Several of these activities involved partnering with either U.S. government programs such as the Peace Corps or working closely with large interna BOX 7-4 Selected Examples of PEPFAR-Supported Activities Intended to Mobilize and Support Community-Based Responses for Orphans and Other Vulnerable Children Botswana: support for selected community-based organizations for grant making and program promotion in the areas of volunteer management, equipment, materials development, service delivery, vocational training, and other income generating projects to teach small-business skills for sustainable income Kenya: technical support to conduct needs assessments, write proposals, manage programs, establish eligibility criteria, train community groups and providers to understand the rights and health needs of children, and develop training materials Guyana: support for equity in access to educational, nutritional, and physical and social health opportunities for girls Mozambique: collaboration with Peace Corps volunteers to support community mobilization and training to implement modest rehabilitation projects and support training for caregivers Namibia: collaboration with national interfaith organizations to develop and sustain grassroots support programs focused on training providers, improving program management, mobilizing the involvement of community groups and their leaders, and providing small start-up grants for community projects SOURCE: OGAC, 2005a,d, 2006b,g.
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From page 222... ...
Of particular concern under this strategy are the issues of birth registration and education. One component of an effective national child welfare policy is a vital statistics program that registers births and deaths.
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From page 223... ...
. BOX 7-5 Selected Examples of PEPFAR-Supported Activities Intended to Ensure Access to Essential Services for Orphans and Other Vulnerable Children Ethiopia: linkage with USAID agricultural programs to improve food security by expanding the program coverage to focus on the needs of orphans and vulnerable children, with particular emphasis on female- and orphan-headed households.
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From page 224... ...
Where these policies are most effective, they articulate the rights of children and provide a culturally appropriate background for the development of services for orphans and other vulnerable children. Challenges related to the provision of such services, identified at PEPFAR's third annual meeting, include the need for linkages to care and psychosocial support services for HIV-positive children, educational interventions, and linkages to child protective services -- a particular challenge in countries with nascent or nonexistent social welfare systems.
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From page 225... ...
. See Table 7-2 for Index scores of the PEPFAR focus countries.
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From page 226... ...
Faith- and community-based organizations, the media, and nongovernmental organizations can play significant roles along with governmental organizations in raising awareness and promoting acceptance of community responsibility for caring for these children. Examples of PEPFAR-supported activities intended to create supportive environments for orphans and other vulnerable children are listed in Box 7-7.
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From page 227... ...
The fiscal year 2006 Country Operational Plans provide a number of examples of prevention interventions being funded by PEPFAR that target orphans and other vulnerable children, many of which are linked to other services being provided by PEPFAR (see Box 7-8)
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From page 228... ...
In Uganda, a community-based organization promotes HIV prevention beyond abstinence and being faithful by imparting comprehensive information and skills to the most at-risk populations and making environments safer for women, youths, and people living with HIV. A portion of the programs funding is used to work directly with older orphans and other vulnerable children to promote positive behaviors, such as delay in sexual debut and avoidance of early marriage and exchange of sex for money and gifts.
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From page 229... ...
Prevention programs in the school environment often will not reach this critical population. A number of out-of-school prevention programs exist in many of the focus countries, including community mobilization efforts that often include outreach to peers, adults, and outof-school youths to expand access to prevention (OGAC, 2005d, 2006g)
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From page 230... ...
. As discussed previously, OGAC released guidance for preventive care services for children aged 0–14 born to mothers who are HIV-positive, which was produced through the collaboration of several of the Technical Working Groups -- Palliative Care, Food and Nutrition, and Orphans and Vulnerable Children.
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From page 231... ...
Scale-up of PEPFAR's secondary preventive care services for both children and adults has the potential to help keep parents and families healthier longer, decrease the numbers of children who may become orphaned or otherwise made vulnerable as a result of HIV/AIDS, decrease stigma and discrimination against children and their family members, and improve a household's ability to positively cope with being affected by HIV/AIDS. Progress in Addressing the Vulnerability of Young Girls OGAC has articulated a commitment to focusing on the special vulnerability of girls to HIV/AIDS and its effects (OGAC, 2005a, 2006a)
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From page 232... ...
The UNAIDS and UNICEF (2003) Report on the Technical Consultation on Indicators Deelopment for Children Orphaned and Made Vulnerable by HIV/AIDS defined an orphan or otherwise vulnerable child as " a child below the age of 18 who has lost one or both parents or lives in a household with an adult death (age 18–59 years)
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From page 233... ...
. After the publication of its second annual report to Congress and as the program evolved, OGAC disseminated its "Orphans and Other Vulnerable Children Programming Guidance for United States Government In-Country Staff and Implementing Partners." The guidance includes updated definitions for children orphaned or otherwise made vulnerable as a result of HIV/AIDS (OGAC, 2006i, p.
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From page 234... ...
To ensure adequate focus on and accountability for addressing the needs of orphans and other vulnerable children, the U.S. Global AIDS Coordinator should work with Congress to set a distinct and meaningful performance target for this population.
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From page 235... ...
As mentioned in Chapter 2, however, increasing deaths among teachers and parents or adult caregivers who can pay school fees have affected the quality of education (through interruptions in education; classroom overcrowding, which may be exacerbated by the desire to decrease the vulnerability of orphans and other vulnerable children by increasing school attendance; inadequate teacher training; and closures of schools)
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From page 236... ...
Bundy (2003) has summed it well with the "HIV/AIDS education paradox," in which "education is seen as the one of the most effective ‘social vaccines' to prevent HIV/AIDS, but HIV/AIDS destroys education systems." Child Welfare In August 2006, UNICEF published a companion paper to The Framework entitled Child Protection and Children Affected by AIDS, with the primary purpose of articulating the need to recognize social welfare as a basic part of social services and identify strategies for strengthening this sector to better address vulnerability, abuse, and exploitation.
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From page 237... ...
The training curricula may also vary considerably if caring for children involves awareness campaigns for birth registration; skills needed to navigate systems that provide or certify eligibility for services; and other issues related to child survival, such as immunizations and increased use of cotrimaxozole and other preventive care services. The Committee would also like to see more active monitoring of providers and services that include emotional and nutritional support for children.
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From page 238... ...
2006. Technical consultation of global partners forum on children affected by HIV/AIDS.
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From page 239... ...
2005. Birth registration: Technical consultation of global partners forum on children affected by HIV and AIDS.
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From page 240... ...
2004. Conducting a situational analysis of orphans and ulnerable children affected by HIV/AIDS: A framework and resource guide.
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