1. Highlights from the Global Evidence Base PEPFAR Orphans and Vulnerable Children’ Program: Taking Programming to the Next Level for an AIDS Free Generation Neil Boothby, EdD United States Special Advisor for Public Law 109-95 and Senior Coordinator to the USAID Administrator on Children in Adversity AIDS 2012 - Turning the Tide Together

2. Strategic Directions & The Global Evidence Base I. Start young II. Rebuild Fragile Families III. Protect women and children from violence and exploitation

3. I. Start Young Use Early Child Development platform to establish linkages across clinic and community in order to achieve comprehensive outcomes for children – a)Ensure survival of young children b)Eliminate mother to child transmission c)Promote secure attachment and bonding d)Protect children from lifelong impacts of “toxic stress”

4. Toxic Stress Derails Healthy Development

5. Toxic Prolonged activation of stress response systems in the absence of protective relationships. Toxic The Biology of Adversity: Three Levels of Stress Tolerable Serious, temporary stress responses, buffered by supportive relationships. Tolerable Positive Brief increases in heart rate, mild elevations in stress hormone levels. Positive

6. Protection from Toxic Stress Leads to Lifelong Health and Well-being http://www.cdc.gov/ace Increased adverse childhood experiences (ACE) correlate with greater HIV risk

7. II. Rebuild Fragile Families Economic stability Emotional stability and social connectedness Parenting skills

8. Evidence: HES & Social Protection Cash transfers (well established evidence) – Enhance child health, nutrition, growth – Improve school attendance, especially for girls – Increase family consumption, assets, income Adato & Basset 2008. Hagen-Zanker, McCord, & Holmes 2011. DFID 2011. Savings and money management (emerging evidence) – Reduce erratic/seasonal spending – Stimulate family investment in nutrition, health, education and asset accumulation – Promote goal-setting, planning, future-oriented behavior Rutherford 1999. Collins, Morduch, Rutherford, & Ruthven 2009. Duflo, Kremer, & Robinson 2010. Dupas & Robinson 2011a. Dupas & Robinson 2011b. Barber 2011.

9. Savings + Parenting Discussion Groups Savings had significant impact on economic wellbeing but did not translate (yet) into better child outcomes: 4% reduction in poverty Improved food security Increased assets (equivalent to 1 cow/family) Savings + parenting showed significant improvements for children: Substantial reductions in harsh discipline Improvements in child mental health Reduced family problems (reported by children) Improved child wellbeing (reported by children) Bundervoet, Annan & Armstrong 2011. Randomized Controlled Trial in Burundi | Midterm Findings

10. III. Protect Women and Children from violence and exploitation Strengthen Child Welfare & Protection Systems Promote child protection models that encompass both informal and formal systems

11. High rates of violence against women and children with particular concern for adolescent girls

12. Weak Formal Protection Systems High Vacancy/High Turnover Rates South Africa – 50% of social work posts vacant and 50% leave their jobs within 5 years Malawi – 66% vacancy rate in Department of Social Welfare; 47% vacancy rate in Ministry of Women and Child Development Lesotho – on average, social workers leave their jobs within 5 years compared to 7 years in the health sector Davis, Rebecca; “Opportunities and Constraints in Human Capacity within Child Welfare Systems: The Social Work Workforce in Africa,” GH TECH, USAID 2010

13. Poor linkages Between Formal and Informal (Community) Protection Systems Stark, et. al., “A qualitative study of community-based child protection mechanisms in Aceh, Indonesia”, forthcoming in Vulnerable Children and Youth Studies Wessells, et. al. “The disconnect between community-based child protection mechanisms and the formal child protection system in rural Sierra Leone: Challenges to building an effective national child protection system”, forthcoming in Vulnerable Children and Youth Studies

14. Thank You