1. 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

2. Overview of this presentation Definition of orphaned and vulnerable children Framework for developing indicators Definitions of indicators and results

3. 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

4. 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)

5. 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

6. 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

7. 3. Ensure access to essential services Core Indicators Indicator 6: Orphan school attendance ratio Indicator 7: Birth registration

8. 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

9. 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

10. Indicators and results from pilot surveys

11. 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

12. 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

13. 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

14. 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

15. 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

16. 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.

17. 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

18. 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

19. 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

20. 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

21. 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

22. 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

23. Children outside of family care - results Percent of children ages 0-17 years by residence

24. 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,

25. External support to households - results Percent of orphans and vulnerable children ages 0-17 years receiving external support

26. 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

27. 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

28. 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

29. 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

30. 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)

31. 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

32. Thank you