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