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Monitoring and Evaluating National Responses for Children Orphaned and made Vulnerable by HIV/AIDS Mary Mahy UNICEF Meeting on Results of Pilot Surveys Washington, DC January 6, 2005
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Overview of this presentation Definition of orphaned and vulnerable children Framework for developing indicators Definitions of indicators and results
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Definition of orphaned and vulnerable children Vulnerable could be defined in many different ways: poverty, violence, abuse…. Specific to HIV/AIDS - adult mortality and adult morbidity For this guide, an orphaned or vulnerable child is a child under 18 who has: –Lost one or both parents –One or both of whose parents has been chronically ill in the prior 12 months –Lives in a household where an adult 18-59 has died in prior 12 months (and who was chronically ill prior to that death) –Lives in a household where an adult 18-59 was chronically ill in prior 12 months
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Framework for caring for children orphaned and made vulnerable by HIV/AIDS 1.Strengthen the capacity of families to protect and care for orphans and vulnerable children 2.Mobilize and strengthen community-based responses 3.Ensure access to essential services for orphans and vulnerable children 4.Ensure that governments protect the most vulnerable children 5.Raise awareness to create a supportive environment for children affected by HIV/AIDS Source: “The Framework for the protection, care and support of orphans and vulnerable children living in a world with HIV/AIDS.” July 2004 (www.unicef.org/aids/index_documents.html)
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1. Strengthen the capacity of families Core Indicators Indicator 1: Basic material needs Indicator 2: Malnutrition - underweight prevalence Indicator 3: Sex before the age of 15 Additional indicators Indicator A1: Food security Indicator A2: Psychological health Indicator A3: Connectedness to an adult caregiver Indicator A4: Succession planning
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2. Mobilize and strengthen community-based responses Core indicators Indicator 4: Children outside of family care Indicator 5: External support for households with orphans and vulnerable children Additional indicators Indicator A5: Orphans living with siblings
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3. Ensure access to essential services Core Indicators Indicator 6: Orphan school attendance ratio Indicator 7: Birth registration
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4. Ensure that governments protect the most vulnerable children Core Indicators Indicator 8: OVC Policy and Planning Effort index Additional indicators Indicator A6: Property transfer Indicator A7: Quality of Institutional Care
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5. Raise awareness to create a supportive environment Core Indicators Indicator 9: Percent of children who are orphans Indicator 10: Percent of children who are vulnerable Additional indicators Indicator A8: Stigma and discrimination
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Indicators and results from pilot surveys
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Basic material needs - definition Definition: Ratio of proportion of OVC to non-OVC ages 5-17 that have three minimum basic material needs for personal care (blanket, shoes, two sets of clothing) Issues: Blanket not necessary in warm climates => use sheet, mattress or other item if blanket is inappropriate Some items are shared
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Explanation of categories in following figures Vulnerable – All children who had a chronically ill parent or had an adult (18-59) in their households who was chronically ill or who died in the past 12 months Orphan – children who were not categorized as vulnerable, but who lost one or both parents (at any time in the past) OVC – all children who can be categorized as orphan or vulnerable Non-OVC – children who do not match either of the criteria above
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Basic material needs – results includes children outside of households Percent of children ages 5-17 who have three basic material needs (blanket, shoes, two sets of clothing) Ratio 0.69 0.95
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Malnutrition (underweight prevalence)- definition Definition: Ratio of proportion of OVC to non-OVC ages 0-4 who are underweight Issues: small sample sizes because of age => collected anthropometric data up to age 9 => Limited benefit. Only calculate when sample sizes are adequate Investigate other health indicators
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Malnutrition (underweight prevalence)- results Mean weight-for-age z-score in children ages 0-8, by age group and sanitation/SES variables, Blantyre, Malawi Source: Rivers, Silvestre and Mason. 2004. Nutritional and Food Security Status of Orphans and Vulnerable Children: Report for the UNICEF/IFPRI Research Project. Age in years
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Food security – definition Definition: Ratio of proportion of households with OVC versus households with children who are not OVC that are food insecure. Issues: Household-level, doesn’t show individual OVC’s food security. Not possible to ask of young children, biased responses from caretakers. Keep at household level.
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Food security – results Percent of households reporting severe food insecurity (children and adults in household forced to skip meal or food for entire day) Ratio 1.49 1.68
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Psychological health - definition Definition: Ratio of proportion of OVC to non-OVC ages 12-17 with a high score for psychological health Issues: Still in development. Translation problems, culturally specific wording/questions, Numerous questions, requires prior fieldwork, difficulty with rating scale
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Psychological health – results includes children outside of households Percent of children ages 12-17 scoring high levels on psychological test Ratio 0.66 0.99
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Connectedness to adult caregiver - definition Definition: Ratio of OVC to non-OVC ages 12-17 with positive connection to adult with whom they spend most time living Issues: Still in development, Might have strong connection to non-adult, Based on 15 questions, Problems with culturally specific words/questions, Difficulty with rating scale
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Connectedness to adult caregiver - results Percent of children ages 12-17 reporting strong connection to the adult with whom he/she spend the most time living Ratio 1.23 0.80
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Children outside of family care - definition Definition: Proportion of all children ages 0-17 living outside of family care Issues: Requires census (or representative survey) of all street children and all institutions
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Children outside of family care - results Percent of children ages 0-17 years by residence
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External support to households - definition Definition: The proportion of OVC whose households received free basic external support in caring for the child Issues: Do households receive support or individual OVC => if collected at household level all children are assumed to receive support Support might not be required, Might not capture support from neighbours,
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External support to households - results Percent of orphans and vulnerable children ages 0-17 years receiving external support
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Orphan school attendance ratio - definition Definition: The ratio of double orphaned children to non-orphaned children (who live with one parent) aged 10-14 years who are currently attending school (MDG indicator) Issues: small sample size => include vulnerable children 10-14 used to keep narrow age range, and avoid children who start school at older age
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Orphan school attendance ratio – results includes children outside of households Percent of children 10-14 currently attending school including vulnerable children and lifting restriction on non-orphans living with at least one parent Ratio 0.75 0.95
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Quality of institutional care - definition Definition: Percent of children ages 5-17 living in institutions that care for orphaned or vulnerable children who: attend mainstream school, have individual care plans regularly reviewed, have regular contact with family member Issues: Requires institutional survey, potential biased reporting from institution administrator, problems with age categories, often no care plan exists
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Percent of children who are vulnerable – definition Definition: Percent of children who are vulnerable (in past year parent has been chronically ill or an adult, aged 18-59 years, in household has died or has been chronically ill) Issue: countries might want different definition
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Percent of children who are vulnerable and who are orphaned - results Percent of children ages 0-17 years who have lost one or both parents, by residence Percent of children ages 0-17 years who are vulnerable (only those in households)
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Plans for inclusion in future surveys UNICEF’s Multiple Indicator Cluster Surveys will collect 5 of these indicators in about 15 countries MeasureDHS’s AIDS Indicator Surveys and AIDS module in DHS will collect 12 of these indicators Only in countries where more than 8% of children are orphaned
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Thank you
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