Monitoring and Evaluating National Responses for Children Orphaned and made Vulnerable by HIV/AIDS

Mary MahyUNICEF

Meeting on Results of Pilot SurveysWashington, DCJanuary 6, 2005

Overview of this presentation

• Definition of orphaned and vulnerable children

• Framework for developing indicators

• Definitions of indicators and results

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

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)

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

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

3. Ensure access to essential services

Core Indicators• Indicator 6: Orphan school attendance ratio• Indicator 7: Birth registration

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

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

Indicators and results from pilot surveys

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

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

Basic material needs – resultsincludes children outside of households

0

20

40

60

80

100

Blantyre Kingston

Vulnerable

OVC

Orphan

Non-OVC

Street

Percent of children ages 5-17 who have three basic material needs (blanket, shoes, two sets of clothing)

Ratio 0.69 0.95

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

Malnutrition (underweight prevalence)- results

-1.5

-1

-0.5

00-2 3-5 6-8

Flush/ventilatedPit latrine

ElectricityNo electricity

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

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.

Food security – results

0

10

20

30

40

50

Blantyre Kingston

HH with OVC

HH without OVC

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

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

Psychological health – resultsincludes children outside of households

0

10

20

30

40

50

60

Blantyre Kingston

Vulnerable

OVC

Orphan

Non-OVC

Street

Percent of children ages 12-17 scoring high levels on psychological test

Ratio 0.66 0.99

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

Connectedness to adult caregiver - results

0

10

20

30

40

50

Blantyre Kingston

Vulnerable

OVC

Orphan

Non-OVC

Percent of children ages 12-17 reporting strong connection tothe adult with whom he/she spend the most time living

Ratio 1.23 0.80

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

Children outside of family care - results

99.8

0.14 0.04

99.5

0.5 0.010

20

40

60

80

100

Blantyre Kingston

Household

Institution

Street

Percent of children ages 0-17 years by residence

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,

External support to households - results

0

5

10

15

20

25

Blantyre Kingston

Medical - 12 mosEmotional - 3 mosSchool - 12 mosSocial - 3 mosAny support

Any support - HH

Percent of orphans and vulnerable children ages 0-17 years receiving external support

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

Orphan school attendance ratio – resultsincludes 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

0

20

40

60

80

100

Blantyre Kingston

OVC

Non-OVC

Ratio 0.75 0.95

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

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

Percent of children who are vulnerable and who are orphaned - results

0

10

20

30

40

50

60

70

80

Blantyre Kingston

Household

Institutions

Street

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)

0

5

10

15

20

25

30

35

40

Blantyre Kingston

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

Thank you