February 10, 2006 Candace Miller, Sc.D. MHS

1. Using data to inform policies: Reducing Poverty by Supporting Caregivers, People Living With HIV/AIDS (PLWA) and Orphans and Vulnerable Children (OVC) February 10, 2006 Candace Miller, Sc.D. MHS

2. Fundamental Principles of Statistics… “Official statistics provide an indispensable element of the information system … serving the government, the economy, and the public with data about the economic, demographic, social and environmental situation.” United Nations Statistics Division, http://unstats.un.org/unsd/methods/statorg/FP-English.htm

3. How is data gathered at the national level? • Health surveys • Demographic Health (DHS) • Multiple Indicator Cluster (MICS) • AIDS Impact (AIS) • Behavioral Surveillance, Sexual Behavior (BSS, SBS) • Economic surveys • Core Welfare Indicators Questionnaire (CWIQ) • Income Expenditure Household (IEHS) • Living Standard Measurement Survey (LSMS) Find surveys at http://www.measuredhs.com/hivdata/ & http://www4.worldbank.org/afr/poverty/databank/survnav/default.cfm

4. Health Surveys Panel (age, gender, education) Relation to household head Parental survivorship 0-14 Housing characteristics and asset ownership Nutritional status (0-4 and 15-49 year olds) HIV prevalence (New!) Care indicators (New!) Economic surveys Household questionnaire Community questionnaire on available resources, social capital etc. Indicators of usage, satisfaction with public services Income and expenditure data Additional modules (impact of HIV/AIDS) What data is gathered

5. New Care and Support Indicators • External support for chronically ill persons • Medical, emotional, material, and social support • External support for orphan and vulnerable children care • Medical, emotional, material, social and school related assistance UNAIDS, et. al. Guide to monitoring and evaluation of the national response for children orphaned and made vulnerable by HIVAIDS. 2005. http://data.unaids.org/Topics/M-E/ME_NationalResponseOVC_guide_en.pdf

6. What we know: 40% are OVC Most children live with surviving parent and extended families Children’s relationship to household head >1 in 10 cares for chronically ill 40% receive support with OVC; 20% receive support with PLWA Child growth failure, health care access, schooling, psychosocial well being and basic material needs by OVC What we don’t know: What is the composition in OVC households? How many adults & older person households? What is SES of affected households? (assets vs. income) Health, basic needs, etc. by OVC status and by caregiver’s age, gender and SES? Who receives support by age, location, gender, SES? Is support adequate? Zimbabwe: Survey on Orphans and other Vulnerable Children in Rural and Urban High Density Zimbabwe UNICEF, Government of Zimbabwe, November 2005

7. How does data inform policy and programmes? • Demographic shifts in household composition, growing orphan population, HIV prevalence • Identifies existence of vulnerable families (e.g. growth failure in 0-4, women 15-49; lack of assets) However, • Data could identify vulnerable households, communities, regions Still, • Data does not tell us what families need to survive • Data does not tell us how families survive (coping mechanisms)

8. Gaps and challenges around data limitations • Disaggregation of key indicators • Age, gender, SES (wealth vs. income) • Lack of key indicators • Care and support • Income and expenditure • Relationship with public sector; receipt of resources • Lack of more frequent data collection in high prevalence areas and longitudinal data

9. What can be done now? • Disaggregate data • Household composition in homes of OVC and PLWA (dependency ratios, SES, # of working adults, older person households by age and gender) • Examine rate of child growth failure, schooling, etc. for OVC, by household (age, SES, household composition) • Use prevalence data • Identify/quantify vulnerable households (child and older person households with OVC and PLWA) • Identify vulnerable communities • Identify vulnerable children, caregivers for PLWA • Collect / present data on all ages • Use of and problems accessing health and other public services, frequency and presence of food, sexual activity,

10. Future surveys • Ideal survey • Household panel with parental survivorship for all children • HIV prevalence data on all ages (18 months+) • Caregiving and income-earning activities • Care and support indicators for OVC and PLWA • External sources of support (all types) • Income and expenditure data • Indicators of access and satisfaction with public services • Community-level indicators, such as social capital • Additional indicators of health and well-being for all • More analyses of new and existing data

11. With indicators of health and well being, use of, access and satisfaction with public services, and measures of income and support, we can better understand needs and target policies and assistance based on these needs at a level that reduces poverty and reduces and prevents poor health. For more information contact Help Age International at http://www.helpage.org or Candace Miller at candace_miller@post.harvard.edu