Holistically Addressing the Needs of Young Children and their Caregivers Affected by
HIV and AIDS
What is Early Childhood Care and Development ?
what is happening within the child, but also the care that child requires in order to thrive.
Prenatal – 8 years old
Brain development is most rapid and vulnerable from conception to 5 years
During the early years a child develops all the basic brain and physiological structures upon which later growth, development, and learning are dependent.
Source: Slide by Flavlio Cunha based on Heckman and Masterov, 2004
0 Age
Rate of return to investm
ent in human capital
Preschool programs
Schooling
Job training
0-3 4-5Preschool School Post-school
Programs targeted towards the earliest years
Interventions are more cost effective than at other ages
Developmental Domains (Ages/Stages)
1. Physical
2. Socio-Emotional
3. Cognitive
4. Language
ECD is interdisciplinary
• Includes health, nutrition, education, social science, economics, child protection, social welfare and social protection
• Ensures young children’s overall wellbeing during the early years, thereby providing the foundation for the development of adults who are healthy, socially and environmentally responsible
What is the Essential Package?
• Provides a framework for action for addressing the needs of very young children impacted by HIV and AIDS
• May have broader application for other highly vulnerable children
• Particular attention paid to children from birth to age 8 and their caregivers (biological and other)
• It is meant to provide support to children who are not being reached by traditional ECD interventions, who are without appropriate care
• It is a complement to other supports for families and NOT meant to be implemented as a stand alone program
Why an Essential Package for Vulnerable Children?
• A review of orphans and vulnerable children programming indicated that– very young children were often left out of programmatic
responses– Emergency focus meant lost opportunities for integration into
other programming platforms (e.g. MCH, PMTCT)– Not accessing quality ECD interventions
• Literature review indicated that children impacted by HIV and AIDS are at risk of serious developmental delays, across all domains of development
• Investing early may stem the flow of orphaning, decrease HIV/AIDS rates and stop the intergenerational transfer of poverty
Components of the Essential Package
– An in-depth Literature Review: Distinct Disadvantage– A “Framework for Action” identifying age-appropriate
needs and actions for young children & their caregivers; – Tool Kit to support essential actions and decision making
for home visitors/program managers/policy makers;
Grounded in Evidence on the effects of HIV in early childhood on physical, cognitive and socio-emotional development of young children
Who is the end user of the EP?
• Program managers (CP/ECD/OVC programs)• Volunteers/home visitors
– Preliminary evidence shows that home visit is crucial to address issues of social isolation and helping to facilitate linkages to available care systems
• Policy makers
The Framework for Action
Eliminate
Barriers toCare &
Support
Support
Linkages to Broader
Systems of
Integrated Care
Foster Positive
Caregiver-Child
Interaction
Employ a Developmentally
Appropriate Approach ToEnhancing
Children’s Health& Development
The Essential Package Framework Two
Framework Two: Holistically Addressing the Needs of Young
Vulnerable Children
• A matrix of critical needs and essential actions across different
ages and domains (e.g., care and development, health, nutrition,
rights and protection)
• Example for child age 3-6 years
– Critical need: increased exposure to language
– Essential action: encourage caregivers to provide books and
read to their child
The Essential Package Framework Two
The Essential Package Framework Three
Framework Three: Key Actions for Caregivers of Young
Vulnerable Children
• Psychosocial support
• Health care
• Food and nutrition
• Legal protection
• Economic strengthening
• Plus key actions for specific types of caregivers
The Essential Package Framework Three
Tool Kit to Operationalize Frameworks
The 6 Essential Tools of the Essential Package
The 6 Essential Tools of the Essential Package
The 4 Complementary Tools of the Essential Package
Gathering Evidence on Use of the Essential Package
Research Questions
• How can we improve the effectiveness or efficiency of the Essential Package? – Achieving goals?– Innovative best practices?– Common challenges faced by organizations and their
volunteers?
• How can Save the Children scale-up the Essential Package nationally in Zambia and Malawi? – What are the options for scale-up?
– What options are politically and practically feasible?
Research methodology
• Qualitative research methods– literature review on home visitation programs and scaling– in-country research in Malawi and Zambia including 30 focus
groups of households and volunteers with 4 implementing organizations
– interviews with program managers, field officers, M+E etc
• Quantitative research methods – Baseline and post-intervention data for 138 households in
Malawi
Malawi Organizations
Local NGO in Manochi district in response to AIDS epidemic, 2004
HIV prevention, care and support 41 staff, 12,000 vulnerable children, 300
commuity cmtees, 101 CBCCs 2 EP CBCC sites, 20 EP promoters, training
May 2012
NACC Save the Children (Save)
Wide range of programs 4 EP CBCC sites, 76 ECD promoters,
August 2012 training
Zambia Organizations
Mulumbo
“Pioneer of early childhood programming" since 2001
4 staff, 49 volunteers, 7 ECD centers
1 EP site, 10 ECD promoters, May 2012 training
Faith based organization Health and development programs,
new to ECD (open 27 ECDs) 8 EP sites, 593 ECD promoters, May
2012 training
Zambia Anglican Council (ZAC)
Visible changes in communities
Visible changes in communities (II)
Best practices emerging from variation in EP implementation
Home Visits
• Dosage – How frequently households were visitedThe EP does not prescribe frequency or length of
home visitVariation
Dosage and length varied among implementing organizations
Frequency of visits depended on volunteers’ other commitments (once per week to once per month)
Best practicesFrequent visits important for relationship building between
the volunteer and primary caregiverDepending on needs of household, more frequent follow-up
to address the issues in due time are important
Home Visits
• Delivery – How EP messages are delivered – Demonstration of a home visit included in training – Variation
• Visual Guide Availability: One copy per person; sharing copies among volunteers
• Actual Copy: Laminated, bounded, printed in color, and translated in local language; black & white, English, stapled
– Best practices• Volunteers assess needs by being “very active and
observant”• Topics of discussion chosen based on observation, age of
children and type of caregiver • To be effective, each volunteer should have own copy of
visual guides with clear pictures
Comprehensive Checklist
• Purpose– Purpose is to measure impact of EP– Variation
• Purpose: Survey tool ~ discussion tool during home visits
• Measure EP impact ~ measure other program impact
– Innovative practices• Because of the integrated nature of the EP, the
comprehensive checklist may allow you to assess multiple areas of your program
• At some point we would like to get to attribution i.e. is it the addition of EP that is leading to the changes?
Comprehensive Checklist
• Data collection, entry and analysis– EP does not specify who should collect and enter data– Variation
• Collection: Some/All volunteers ~ external enumerators
• No allowances ~ Transport or lunch allowances ~ hourly wage• No training, no experience ~ 5 days training, data experience• Entry: Same day ~ Months later; On site ~ Mailed to capital city• Analysis: None ~ initial analysis
– Best practices• Training in tool essential, but whether volunteers or external
depends on volunteer skills, community context and organization’s resources
• Data entry proximate to data collection, both time and geography, improves accuracy, and address inconsistencies and error
High level recommendations
• Training– Refresher training: Revisit difficult lessons, deepen
knowledge– Invite local “experts” monthly reflection meetings to
focus on different lessons
• Monitoring & Evaluation– Simplification of Comprehensive Checklist
– Introduce monthly report – 1 per CBCC to Program Manager
• Ongoing advocacy
Common challenges across all sites
•How to provide key messages with no resources?
•How to continue to motivate volunteers?
Overall Findings
• Essential Package delivering promising ‘hard’ changes
• Longitudinal studies required to evaluate whether long term ‘soft’ changes in parent-child interaction and attitudes emerge and ‘stick’
Scale-up Goals in Phase II
1. Reach: 250,000 children and 125, 000 primary caregivers across Zambia, Malawi and Mozambique over 3 years
2. Capacity Building: Train community organizations and national governments
3. Sustainability: Advocate for inclusion of EP into national OVC and ECD policies and strategies
Scale-Up in Malawi
• Malawi government supported the development of the EP
• Adoption of the EP in line with other key programs for ECD/OVC critical to its sustainability
• Being used as a model for Mozambique and Zambia• A community of champions already exists, we will build
on it to make the EP more context specific • Holding National Level Training Next week for 50
Champions
Thank You