Publications & learning agenda

Community REACH Publications  |  Learning Agenda  |  Focus on Orphans and Vulnerable Children (OVC)

Community REACH Publications

Learning Agenda

Working through a collaborative process to identify gaps and underserved areas in the fight against HIV/AIDS, Pact's Community REACH program works to address these through themed RFAs that facilitate efficient identification of and award to local partners best positioned to fill gaps and meet the underserved needs in their communities.

In addition, to supporting the United States Agency for International Development's (USAID) goal of "increased use of improved, effective and sustainable responses to reduce HIV transmission and to mitigate the impact of the HIV/AIDS pandemic," Community REACH is engaged in an active, integrated and far-reaching effort to identify and document key policy and operational barriers, lessons learned and model programs. To do so, the program has developed a learning agenda. In the past year, Community REACH has channeled resources to organizations providing vital HIV/AIDS services. Community REACH has issued three requests for applications (RFAs) with the following themes:

• Care and Support-Community/Home-Based Networks including Orphans and Vulnerable Children (OVC)
• Youth Voluntary Counseling and Testing (VCT) Linkages and Referrals
• Community-Based Interventions that Target Stigma and Discrimination

Three critical elements are being examined in collaboration with grantees to synthesize the lessons learned across all Community REACH subgrants. These areas and several key related issues are:

Policy and/or operational barriers

• What standards of care exist in communities for care and support services? What obstacles have projects faced in implementing these standards of care?
• Are there policy and operational barriers to adolescent access to VCT and referral services such as adult consent policies and lack of confidentiality?
• Which existing local policies have a positive or negative impact on stigma and/or discrimination in the community?

Referrals/linkages/service delivery models

• What components have been missing in referral networks? What economic, logistic, psychosocial (including issues relating to stigma/discrimination) and other obstacles have PLWA and their families faced in obtaining referrals and accessing care and support services?
• Does exposure to targeted interventions reduce the difference between OVC and other children in the community with respect to emotional well-being, food intake, school attendance, personal possessions and risky behavior? Is the effect of the OVC intervention different for male and female OVCs, for OVCs of different ages, for OVCs from different types of households and different caregiver types?
• How effective are referral systems for HIV negative and HIV positive youth - both between reproductive health (RH) and VCT services, and from VCT to post-test support groups? How well can integrated RH/VCT programs meet the reproductive health and care and support needs of youth?
• What is the biggest challenge to changing stigmatizing attitudes and discriminatory behaviors? What strategies have been successful in improving the supply of services for PLWHAs and their families?

Target population participation

• In what ways have PLWHAs been involved in care and support programs, in what roles, with what effects? What are the obstacles to using volunteers successfully? What are the limitations of volunteers in providing services? What types of support and/or training do these caregivers need to be more effective in helping PLWHAs?
• To what extent are youth clients of VCT services engaged in high risk behaviors? What are the most effective ways to involve youth in VCT service delivery?
• How have capacity building and training efforts for PLWHAs improved GIPA? How have capacity building and training efforts for PLWHAs reduced stigma and/or discrimination?

Approaches

Four main approaches are being used to inform Community REACH's Learning Agenda. These are:

• Periodic Reporting - Grantees provide regular reporting on key lessons learned questions.
• Technical assistance site visits - Community REACH staff conduct technical assistance site visits to improve grantee capacity in monitoring and evaluation, provide suggestions to elicit case studies and stories of beneficiaries, lead interviews, and conduct field observation.
• Focused investigations of key issues - Community REACH is collaborating with a subset of grantees, USAID's Office of HIV/AIDS and the YouthNet project to design and implement research studies to improve understanding of the impact, and operational and policy barriers to the delivery of effective OVC and adolescent VCT programs.
• Grantee lessons learned workshops - Community REACH grantees will meet to strengthen documentation of lessons learned and promote sharing lessons both among grantees as well as with other NGOs and stakeholders in the community.

Focus on Orphans and Vulnerable Children (OVC)

A Costing Analysis of Community-Based Programs for Children Affected by HIV/AIDS: Results from Zambia and Rwanda [PDF | 284k]

The Well-Being of Children Affected by HIV/AIDS in Lusaka, Zambia and Gitarama Province, Rwanda: Findings from a Study [PDF | 416k]

Research Summary: The Well-Being of Children Affected by HIV/AIDS in Lusaka, Zambia and Gitarama Province, Rwanda: Findings from a Study [PDF | 316k]

Worldwide there are more than 13 million children under the age of 15 who have lost one or both parents to AIDS, and many others living with one or more terminally ill parent. As a result providing adequate, effective support has become increasingly difficult. Despite the recognition of the significant consequences of this problem, and increasing resources devoted to this population, there is limited research on the programmatic needs of NGOs working with OVC and how to meet them.

Pact's Community REACH program is funded through USAID's Global Bureau for Health's Office of HIV/AIDS and is designed to facilitate the efficient flow of grant funds to organizations playing valuable roles in the struggle against HIV/AIDS. One area where Community REACH has made a significant contribution is through the support of organizations working with orphans and vulnerable children (OVC). Four of Community REACH's grantees – HAPCSO, Ethiopia, ICROSS, Kenya, PCI Zambia, and CARE Rwanda – have OVC components to their programs.

Community REACH team has capitalized on its experience working with OVC programs to undertake a series of research activities that will begin to address issues related to OVC.

I. Rwanda and Zambia Research

The Community REACH team has implemented a study to determine a) the differences between orphans and vulnerable children (OVCs) and non-OVCs and b) markers of vulnerability. Community REACH completed this research in collaboration with two of its grantees, CARE Rwanda and Project Concern International (PCI) Zambia/Bwafwano over a two-year period from June 2003 to September 2004. An integral part of this process was to build the capacity of CARE Rwanda and PCI Zambia/Bwafwano in the areas of monitoring, evaluation, and research.

CARE Rwanda and PCI Zambia collected baseline data with funding and technical assistance from Community REACH. Two groups of households were surveyed: 1) households with orphans or vulnerable children receiving interventions (selected from project registers), and 2) A control or "comparison" group of households, selected using a "nearest neighbor" approach. In Rwanda, the team is examining OVC and non-OVC in Gitarama province, a post-conflict rural setting in the Lakes region. Community REACH is also assessing OVC and non-OVC in peri-urban areas in Zambia, a stable Southern African country that is in an advanced stage of the HIV/AIDS epidemic. Community REACH used the same research design and survey instruments to examine the differences between OVCs and non-OVCs and markers of vulnerability in these two contrasting contexts in order to identify and compare those characteristics that appear within the specific context of one country or across two diverse settings.

Results from the data collection allow for the comparison of children in a range of different household types, receiving a range of services. Specifically, the research compares households' socioeconomic and individuals' nutritional and psychosocial status for OVC and non-OVC.

The Community REACH team has developed a research protocol, survey instruments, interviewer guide, and data collection systems. Sampling and data collection methods are described in the Research Protocol and Interviewer Manual. These instruments are available as follows (please note that these are PDF files and require the Adobe Acrobat PDF Reader to access):

1. Research Protocol
2. Survey Instruments
   1. Parent/Guardian Questionnaire
   2. Children Heading Households Questionnaire
   3. Parent/Guardian Regarding Children 6-12 Questionnaire
   4. Children (6-12) Questionnaire
   5. Adolescent (13-19) Questionnaire
3. Interviewer Guide
4. Acknowledgements

II. Costing Guidelines for OVC programs

In collaboration with FHI/IMPACT, Community REACH assisted in the preparation of OVC costing guidelines which were pilot-tested with the aforementioned grantees in Rwanda and Zambia. The Community REACH project has supported FHI/IMPACT in the development of OVC costing guidelines by providing feedback to FHI on the development of costing guidelines and cost capture tools for OVC interventions. Based on the results of the pilot test, a report that analyses the costs of providing OVC services has been prepared.