OVC Monitoring, Evaluation and Reporting Strategy (“the MER”) Feb 20-21, 2014 Pretoria, South Africa OVC HQ Technical Working Group ©USAID/ Tash McCarroll

OVC MER Strategy – Moving Towards Outcomes New OVC MER strategy is a critical and positive shift toward a comprehensive, outcomes based strategy for showing impact USG investments in OVC programs substantial, but impact mostly undocumented. Challenges to understanding impact: lack of standardized measures and tools tailored to OVC population & child well-being OVC TWG & Measure developed set of core quantitative child outcomes and caregiver/ household outcomes tools Toolkit formed strong foundation to build a new set of indicators and global strategy when OGAC commissioned a new MER strategy. Pilot-tested in Zambia and Nigeria; Translations to French in progress

Specific Shifts in Data Collected Emphasize program effectiveness & outcomes Reflects 2012 PEPFAR OVC Guidance- developmental milestones across ages/stages Track coverage: active beneficiaries for OVC Track contribution to Continuum of Response Elevate core indicators from OVC Survey toolkit Emphasize program effectiveness and outcomes—child, caregiver, household There are 3 output indicators and all the rest are outcome indicators Systems Indicators For workforce, social protection, finance)

OVC Indicators in the MER MER Code NGI Code Indicator Description Reporting Level FY 14 Targets and results FY 15 OVC_SERV New. Replacing C1.1.D <18 Number of active beneficiaries served by PEPFAR OVC programs for children and families affected by HIV/AIDS 1 √ OVC_ACC N/A –new indicator Number of active beneficiaries receiving support from PEPFAR OVC programs to access HIV services OVC Outcome Indicators Package (special studies) OVC_HIVST N/A- new indicators Percent of children whose primary caregiver knows the child’s HIV status 2 Budget and Plan No Targets required OVC_NUT Percent of children <5 years of age who are undernourished OVC_SICK Percent of children too sick to participate in daily activities OVC_BCERT Percent of children who have a birth certificate OVC_SCHATT Percent of children regularly attending school OVC_PRGS Percent of children who progressed in school during the last year OVC_STIM Percent of children <5 years of age who recently engage in stimulating activities with any household member over 15 years of age Child Protection Indicator OVC_CP % eligible households able to access money to meet important family needs

REPLACED C1.1.D- OVC_SERV Number of active beneficiaries served by PEPFAR OVC programs for children and families affected by HIV/AIDS Indicator REPLACES Umbrella CARE starting in FY14 Implications: Overall intent is comparable to old indicator: Measures coverage More specific: uniquely OVC-related vs. overlap with clinical care Defines “active beneficiary” as receiving quarterly contact-aligns with criteria needed to meet direct support definition Clarification of who is counted is anticipated to improve quality of data Targets will still be set at country level to ensure good coverage (i.e. there will be an expected consistency of numbers going forward) however they will not be tracked against a global number. -          New indicator is comparable to old - refined rather than retired fully. Will highlight - tracking coverage rather than looking for global number -          This is a positive shift for OVC programs since this allows for an emphasis on outcomes rather than ultimately meaningless outputs (numbers) as well as a shift toward systems strengthening and country ownership without concerns over achieving a target based only on head count.

OVC Level 1 Indicators-OVC_SERV Indicator code: OVC_SERV 1 Number of active beneficiaries served by PEPFAR OVC programs for children and families affected by HIV/AIDS NGI Mapping: C1.1.D <18 disaggregation continuing – significant modification in definition; trend analysis will be impacted PEPFAR Support Target/Result Type: Both Direct Service Delivery (DSD) and Technical Assistance-only (TA-only) targets and results should be reported to HQ Numerator: 1 Number of active beneficiaries served by PEPFAR programs for children and families affected by HIV/AIDS Denominator: N/A Disaggregation(s): Sex: Male, Female Age: <1, 1-4, 5-9, 10-14, 15-17, 18+ Data Source: Registers, organization records, or other program monitoring tools Data Collection Frequency: Data should be collected continuously as part of service delivery. Data analysis and review should be done semi-annually, in time for PEPFAR reporting cycles to monitor progress towards achieving the targets and to identify and correct any data quality issues. PEPFAR MER Introduction 2013_11_21

PEPFAR MER Introduction 2013_11_21 OVC Level 1 Indicators Indicator code: OVC_SERV 1 Number of active beneficiaries served by PEPFAR OVC programs for children and families affected by HIV/AIDS Method of Measurement:   The indicator is generated by counting the number of active beneficiaries (children or caregivers) who received at least one PEPFAR service from facilities and/or community -based organizations (see definition of an ‘active beneficiary’ below). To reduce the burden of counting on organizations providing services, registers with names of children who meet the criteria for “active beneficiary” are sufficient for generating the number included in this indicator. The types of OVC programs required to report on this indicator are outlined in the 2012 PEPFAR OVC Guidance and are those designed to address critical care needs. Explanation of Numerator: Active beneficiary is defined as an individual who has received program services in the last three months and who is scheduled to receive program services at least once every three months, as outlined in program guidelines or standards of practice. New beneficiaries who only registered in the last quarter will be counted as active even if they have not yet received services. Partners will report on the number of beneficiaries on their “active” registries. Partners will not be required to count the number of individuals receiving services at each reporting period. PEPFAR MER Introduction 2013_11_21

OVC Level 1 Indicator: OVC_ACC Number of active beneficiaries receiving support from PEPFAR OVC programs to access HIV services This is a direct output indicator that measures the number of children and/or caregivers who are referred to and enabled to access HIV-related services. The data obtained from this indicator can inform cross-program planning including PMTCT, pediatric and adult HIV testing, and treatment programs.  Learning year-2014; Report starting in FY15 PEPFAR OVC programs serve children who are at high risk of becoming HIV infected, either through mother-to-child transmission (MTCT) or sexual transmission. It is important for OVC programs to link potentially HIV-exposed infants and/or their caregivers to PMTCT programs and to connect those at risk of acquiring HIV, particularly adolescents, to HIV testing and counseling. Furthermore, it is critical for OVC programs to connect HIV-infected children with treatment, counseling and support services.   This is a direct output indicator that measures the number of children and/or caregivers who are referred to and enabled to access HIV-related services. The data obtained from this indicator can inform cross-program planning including PMTCT, pediatric and adult HIV testing, and treatment programs. This indicator will enable PEPFAR headquarters to: Gain a basic, but essential, understanding of the support OVC programs provide to their beneficiaries to enable them to access HIV-related services. Provide important information to stakeholders about the OVC contribution to the clinical goals of the PEPFAR continuum of response. Triangulate data with other OVC output indicators to track levels of OVC services provided across all PEPFAR countries over time. At the country level, this indicator will enable PEPFAR country teams, governments, implementing partners, and other in-country counterparts to: Help assess whether OVC support services are being delivered. Identify programmatic gaps by analyzing the number and ages of people receiving support to access clinical services, as well as the reach of services in particular geographic areas. Advocate for greater resources and technical assistance to enable OVC programs to contribute to the continuum of response.

PEPFAR MER Introduction 2013_11_21 Level 2 Indicators PEPFAR MER Introduction 2013_11_21

Reminder: Distilling core indicators Our starting point: 6+1 domains of PEPFAR OVC programming Step 1: Extensive literature search Step 2: Gaps (HES, PSS) filled through targeted research  Result: >600 child/HH wellbeing questions/indicators Step 3: Analysis against 8 criteria  Result: shorter list of questions for discussion

Biennial (every two years) Greater Age Disaggregation – all indicators Highlights of MER Outcomes Package: Data Collection for Improved Quality Biennial (every two years) Greater Age Disaggregation – all indicators Utilize trained data collections external to service delivery Relieve burden of front line service providers Build on capacity of local research institutions

OVC OUTCOMES PACKAGE – LEVEL 2 Outcomes Package- Quality* % <15 whose primary caregiver knows their HIV status % children <5 who are undernourished % children who are too sick to participate in daily activities % children who have a birth certificate % children regularly attending school % children who progressed in school during the last year % eligible children <5 years who engaged in stimulating activities with household members over 15 years of age Child Protection indicator (in development) % eligible households able to access money to meet important family needs * See Survey Toolkit: http://www.cpc.unc.edu/measure/our-work/ovc/ovc-program-evaluation-tool-kit

PEPFAR MER Introduction 2013_11_21 Added MER Level 2 indicators (not in current version of Survey Toolkit) Percent of children whose primary caregiver knows the child’s HIV status Child Protection Indicator (in development) PEPFAR MER Introduction 2013_11_21

STAY TUNED FOR… OVC SPECIFIC MER SUPPLEMENTAL: TECHNICAL GUIDANCE FOR PLANNING AND IMPLEMENTING SPECIAL STUDIES (Forthcoming, May 2014) * See Survey Toolkit: http://www.cpc.unc.edu/measure/our-work/ovc/ovc-program-evaluation-tool-kit

Indicator Reference Sheet (Level 2) Indicator: NC.1 Percent of < 15 whose primary caregiver knows their HIV status Indicator Type Outcome Numerator: Number of active beneficiaries <15 years of age whose primary caregiver knows the child’s HIV status Denominator: Number of active beneficiaries surveyed Disaggregation(s): Required: Sex: male, female Age group: <1, 1-4, 5-9, 10-14 years, 15-17 Data Source: Special Study Data Collection Frequency: Biennially

Indicator Reference Sheet (Level 2) Indicator: CW.1 Percent of children <5 years of age who are undernourished Indicator Type Outcome Numerator: Number of active beneficiaries <5 years of age with physical growth below international growth standards Denominator: Number of active beneficiaries <5 years of age surveyed Disaggregation(s): Required: Sex: male, female Age group: 6-11 months, 1-4 years of age Data Source: Special Study Data Collection Frequency: Biennially

Indicator Reference Sheet (Level 2) Indicator: CW.4 Percent of children too sick to participate in daily activities Indicator Type Outcome Purpose:   Numerator: Number of active beneficiaries who are too sick to participate in daily activities Denominator: Number of active beneficiaries surveyed Disaggregation(s): Required: Sex: male, female Age group: <5 years, 5-9 years, 10-14, 15-17 years Data Source: Special Study Data Collection Frequency: Biennially

Indicator Reference Sheet (Level 2) Indicator: CW.9 Percent of children who have a birth certificate Indicator Type Outcome Numerator: Number of active beneficiaries who have a birth certificate Denominator: Number of active beneficiaries surveyed Disaggregation(s): Required: Sex: male, female Age group: <1, 1-4, 5-9, 10-14, 15-17 Data Source: Special Study Data Collection Frequency: Biennially

Indicator Reference Sheet (Level 2) Indicator: CW.11 Percent of children regularly attending school Indicator Type Outcome Numerator: Number of active beneficiaries aged 5-17 years of age regularly attending school Denominator: Number of active beneficiaries aged 5-17 years surveyed Disaggregation(s): Required:   Sex: male, female Age group: 5-9 years, 10-14 years, 15-17 years Optional: Further disaggregation by age, particularly within the 5-9 age group may be useful at the national level as often children do not begin school until the age of 6 or 7. Data Source: Special Study Data Collection Frequency: Biennially

Indicator Reference Sheet (Level 2) Indicator: CW.12 Percent of children who progressed in school during the last year Indicator type Outcome Numerator: Number of active beneficiaries aged 5-17 years of age who progressed in school during the last year Denominator: Number of active beneficiaries surveyed who were enrolled in school during the previous year Disaggregation(s): Sex: male, female   Age group: 5-9 years, 10-14 years, 15-17 years Optional: Further disaggregation by age, particularly within the 5-9 age group may be useful at the national level as often children do not begin school until the age of 6 or 7. It may also be useful to disaggregate by primary and secondary school. Data Source: Special Study Data Collection Frequency: Biennially

Indicator Reference Sheet (Level 2) Indicator: CW.13 Percent of children <5 years of age who recently engage in stimulating activities with any household member over 15 years of age Indicator Type Outcome Numerator: Number of active beneficiaries <5 years who have engaged in stimulating activities with any household member over 15 years of age during the last 3 days, as reported by an adult Denominator: Number of active beneficiaries <5 surveyed Disaggregation(s): By sex: Male, Female By age group: 0-11 months, 12-23 months, 2-4 years Data Source: Special Study Data Collection Frequency: Biennially

Indicator Reference Sheet (Level 2) Indicator: HW.2 Percent of households able to access money to meet important family needs Indicator Type Outcome Numerator: Number of active beneficiary households able to access money to meet important family needs Denominator: Number of households surveyed that contain at least one active beneficiary Disaggregation(s): Optional: Location: urban, rural Data Source: Special Study Data Collection Frequency: Biennially

Indicator Reference Sheet (Level 2) Indicator: CW.14 Child Protection Indicator (to be defined) Indicator Type Outcome Numerator: Denominator: Disaggregation(s): Data Source: Special Study Data Collection Frequency: Biennially

LET’S KEEP DISCUSSING!