Defining Quality Care for Orphans and other Vulnerable Children in Ethiopia: A Standards-Based Process Ministry of Women, Children and Youth Affairs (MOWCYA) and Federal HIV/AIDS Prevention and Control Office (FHAPCO) ICASA, 2011 TESFAYE WOLDE December 8, 2011 Addis Ababa, Ethiopia

Background Ethiopia has over 5 million orphans (of which about 1 million are due to AIDS) however many more children are vulnerable and living in difficult circumstances. There are a multitude of service providers who provide care and support for OVC (e.g. GOs, CBOs, CSOs, NGOs, FBO, etc.) Traditionally, the services provided to OVC were Mostly focused on an “emergency responses” and were “commodity driven” Lacked effectiveness, accountability, equity and efficiency to reach OVC at scale The services provided were lacked standards and uniformity Thus, it was difficult to measure the impact and quality of services provided Ethiopia has over 5 million orphans (of which about 1 million are due to AIDS) however many more children are vulnerable and living in difficult circumstances. There are a multitude of service providers who provide care and support for OVC (e.g. GOs, CBOs, CSOs, NGOs, FBO, etc.) Traditionally, the services provided to OVC were Mostly focused on an “emergency responses” and were “commodity driven” Lacked effectiveness, accountability, equity and efficiency to reach OVC at scale The services provided were lacked standards and uniformity Thus, it was difficult to measure the impact and quality of services provided

Background, …cont’d Government, donors and implementing partners identified these gaps and developed draft guidelines to improve quality and standardize service for OVC in National OVC Task-Force had facilitated further enrichment and finalization of the guidelines. The guidelines were tested through a pilot exercise to answer questions such as  Are the standards doable at the point of services delivery?  Do they produce expected outcomes to improve the lives of children? The guidelines were launched in April 2010 by the MOWCYA The guidelines are now being translated into local languages and distributed at the grass-roots level. Government, donors and implementing partners identified these gaps and developed draft guidelines to improve quality and standardize service for OVC in National OVC Task-Force had facilitated further enrichment and finalization of the guidelines. The guidelines were tested through a pilot exercise to answer questions such as  Are the standards doable at the point of services delivery?  Do they produce expected outcomes to improve the lives of children? The guidelines were launched in April 2010 by the MOWCYA The guidelines are now being translated into local languages and distributed at the grass-roots level.

What is Quality Assurance? Desired Outcomes Desired Outcomes Defining Quality Improving Quality Measuring Quality

Defining Quality – at Different Levels Improving Quality Measuring Quality system Community Child/caregiver level Household

Dimensions of Quality Dimension of QualityQuality Characteristics Safety Are risks related to care removed? Access Are barriers to services removed? Effectiveness Are expected results being achieved? Technical performance Do tasks follow standards? Efficiency Are costs reasonable? Continuity Is there a continuum of care? Compassionate Relations Is there trust and confidentiality? Appropriateness Are services adapted to context? Participation Are community beneficiaries involved? Sustainability Can it be maintained by community?

Standards and basic services for OVC in Ethiopia I.In the guidelines Standards are set for: 1.dimensions of quality 2.desired outcome 3. major activities, and 4.critical minimum activities II.Basic services 1.Food & Nutrition 2.Shelter & Care 3.Protection 4.Health Care 5.Psychosocial Support 6.Education & Vocational Training 7.Economic Strengthening 8. Coordination of care I.In the guidelines Standards are set for: 1.dimensions of quality 2.desired outcome 3. major activities, and 4.critical minimum activities II.Basic services 1.Food & Nutrition 2.Shelter & Care 3.Protection 4.Health Care 5.Psychosocial Support 6.Education & Vocational Training 7.Economic Strengthening 8. Coordination of care 7

Results Preliminary evidences showed that the application of the guidelines has started contributing to the success of national programs and plans A.At Systems level a.Increased ownership, commitment and coordination of programs b.Increased M&E and data management c.Donors rely on the guidelines to support projects d.Increased child protection e.Increased capacity of CSOs to plan, implement, monitor and evaluate, manage and report on OVC programs f.More supportive environment for OVC and their households developed through strengthened coordination, networking, and advocacy B.At Community Level a.Increased ownership b.Increased participation in designing, planning and implementing programs c.Increased involvement in the M&E process d.Reduced stigma and discrimination e.Increased availability, equity, and consistency of CBOs to support OVC and families affected by HIV/AIDS Preliminary evidences showed that the application of the guidelines has started contributing to the success of national programs and plans A.At Systems level a.Increased ownership, commitment and coordination of programs b.Increased M&E and data management c.Donors rely on the guidelines to support projects d.Increased child protection e.Increased capacity of CSOs to plan, implement, monitor and evaluate, manage and report on OVC programs f.More supportive environment for OVC and their households developed through strengthened coordination, networking, and advocacy B.At Community Level a.Increased ownership b.Increased participation in designing, planning and implementing programs c.Increased involvement in the M&E process d.Reduced stigma and discrimination e.Increased availability, equity, and consistency of CBOs to support OVC and families affected by HIV/AIDS

Results... Cont’d C. At Household level a.Increased ownership and participation b.Improved living conditions D. Child/Caregiver level a.Living conditions are showing improvement b.Increased birth registration/certificate for OVC c.Education improved d.Health care improved e.Sexual violence reduced f.Improved collection, management and appreciation of data and use for decision making C. At Household level a.Increased ownership and participation b.Improved living conditions D. Child/Caregiver level a.Living conditions are showing improvement b.Increased birth registration/certificate for OVC c.Education improved d.Health care improved e.Sexual violence reduced f.Improved collection, management and appreciation of data and use for decision making

Conclusion Defining quality guidelines have led to great improvement in OVC coordinated care, with stronger referral pathways to community- based institutions such as schools, health centers, judicial services and the private sector. Applying quality guidelines has also led to a paradigm shift from commodity-driven to long term sustainable community-owned responses.

Recommendation Defining quality through a government-led collaborative process is key to harmonize and strengthen OVC services, towards greater efficiency, effectiveness, equity and accountability. Defining quality through a government-led collaborative process is key to harmonize and strengthen OVC services, towards greater efficiency, effectiveness, equity and accountability.

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