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Key Findings & Programmatic Implications. Tonya Renee Thurman, MPH, PhD Tulane University School of Public Health & Tropical Medicine/ MEASURE Evaluation Dissemination Meeting, September 3 rd , 2009 Washington, DC. OVC Program Evaluations in Kenya & Tanzania.

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Key Findings & Programmatic Implications

Tonya Renee Thurman, MPH, PhD

Tulane University School of Public Health & Tropical Medicine/ MEASURE Evaluation Dissemination Meeting, September 3rd, 2009

Washington, DC

OVC Program Evaluations in Kenya & Tanzania

Tulane University School of Public

Health and Tropical Medicine

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What is the level of program coverage?

What influence are interventions having on the well-being of children and guardians?

Are there any unintended consequences?

What does it all mean?

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Program Coverage

A small number of beneficiaries confirmed that they received key interventions employed

For example, while TSA sample were drawn from the Kids Club Registry:

Only 27% reported attending

57% indicated they had never heard of Kids Clubs

Prevalence and frequency of home visits was also less than expected

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Key Outcomes & Interventions

Key Interventions

School-based HIV education

Kids clubs

Home visits

Guardian support groups

Distribution of goods: school supplies & food

Income-generating activities

Community education: OVC care & support

Key Outcomes

HIV knowledge

Psychosocial well-being of children & guardians

Care & treatment of children

Physical health of children & guardians

Legal protection

Children’s education

Household food security

Community support

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Hypotheses Tested

School-based HIV programs: Child HIV knowledge

Kids clubs: Children’s HIV knowledge & psychosocial well-being

Home visits: Children & guardians psychosocial wellbeing & physical health, child’s care and treatment, educational outcomes & legal protection

Guardian support groups:Children & guardian’s psychosocial well-being, child care and treatment & legal protection

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Hypotheses Tested

Distribution of goods: School supplies & children’s educational & psychosocial outcomes; food provision & food security

Income-generating activities: Food security

Community education, OVC Care & Support: Community support & child’s legal protection

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HIV Knowledge


Heard of AIDS

Number of known prevention methods

Mistaken beliefs

Key Interventions

School-based programs

Kids Clubs

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HIV Knowledge

  • Two programs offered school-based HIV education (CRS & IAP)

  • Both were associated with increased number of HIV prevention methods known by child participants

  • However, gaps in knowledge remained

    • Few mentioned sexually-related protective behaviors

    • No difference in prevalence of children’s mistaken beliefs

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HIV Knowledge

Two programs offered Kids Clubs (Allamano & TSA)

Better awareness of HIV among participants in one of the two Kids Clubs (TSA)

But only one-third knew at least 1 prevention method

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Children’s Psychosocial Well-being


Self esteem

Pro-social behavior

Emotional problems

Total difficulties

Adult support

Social isolation

Key Interventions

Kids Clubs

Home Visiting

Guardian Support Groups

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Children’s Psychosocial Well-being

Kids Clubs

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Children’s Psychosocial Well-being

Three Programs offered Home Visiting & Two offered Guardian Support Groups

  • Effects not consistent across programs– only one outcome affected by two programs

  • No more than two outcomes per program

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Care and Treatment of Children & Guardian Psychosocial Well-being


Child Care & Treatment

Feelings Towards Child

Family Functioning

Child Abuse

Guardian Psychosocial


Negative Feelings

Positive Feelings

Key Interventions

Home Visiting

Support groups

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Child Care and Treatment & Guardian Psychosocial Well-being

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Support Groups & Home Visiting?

One study demonstrated the added benefit of exposure to multiple interventions (CRS)

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Guardian Psychological Health

How did they fare?

Average scores of 2.3 -2.8 in Kenya and Tanzania

Relative data from healthy adults in Zimbabwe: > 3.5

Preliminary analyses also suggest it’s importance

Between OVC to non-OVC guardians

Impact of guardian psychological health on children’s psychological health

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Children & Guardian’s Physical Health


Reported Health Status

Use of needed health services

Key Interventions

Home Visiting

Referralsfor Free Health Services

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Home Visiting & Physical Health

None of the programs were associated with an improvement in the reported physical health status of guardians

Only one program demonstrated an association between home visiting and better reported health status for children

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Health Referrals

Frequency of Referral Use for Free Healthcare among program participants at one study site (CRS)

Uptake of referrals was fairly poor even if the service was free

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Legal Protection


Identity documents

Succession planning

Key Interventions

Home Visiting

Support Groups

Community education: OVC Care & Support

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Legal Protection

  • No effect of Home Visiting or Support Groups

  • No effects on Succession Planning

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Legal Protection

High prevalence of OVC lacking identity documents

About 65% in Tanzania and nearly half in Kenya

OVC found less likely to have such documents than non-OVC

60% of maternal orphans relative to 84% of other children; similar among other OVC groups

Succession Planning was very low

Less than 20% even among ill caregivers

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Children’s Educational Outcomes




Key Interventions

Provision of School Supplies

Home Visiting

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Educational Outcomes

  • Enrollment fairly high (> 95%) across each site

  • Provision of school supplies not associated with enrollment or attendance

  • Cross-cutting: Possession of school supplies was associated with better self-esteem across two program sites (Allamano & PACT)

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Household Food Security


Food Security

Key Interventions

Income generating

Food parcels

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Food Insecurity

Two programs aimed to enhance food security

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Community Support


Perceived Stigma

In-kind support

Key Intervention

Community education: OVC Care & Support

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Community Support

Two programs had Community Education regarding OVC Care & Support (IAP & PACT)

Guardians living in communities with a high concentration of OVC Care & Support Mtgs reported more receipt of in-kind support (PACT)

Attendance at an OVC Care & Support Mtg associated with marginal effects on participants stigma concerning OVC and HIV affected families (IAP)

Notably, children living in high stigma communities were found to be worse off (IAP)

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Unintended Consequences?

In one study, guardians of Kids Club participants reported more negative feelings towards the child

In another study, worse perceived stigma found among Kids Club participants and those with a home visitor

High levels of perceived jealousy reported across almost all sites

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Jealousy of service provision

For PACT, perceived jealousy was significantly higher in the Intervention Group

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Who is responsible for orphans?

Significant difference (p < .05)

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Summary: Service Provision

Program exposure was lower than anticipated

Beneficiaries may not always capitalize on services available to them

Services targeting one domain of well-being may affect another domain

Exposure to multiple interventions has additive effects

Emerging unintended consequences of program engagement

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Summary: Key Interventions

Kids Clubs and distribution of school supplies can have a positive influence on children’s psychosocial wellbeing

Home visiting had more effects on children’s outcomes than guardian outcomes and inconsistent effects across programs

Support groups for guardians associated with positive child, guardian and family outcomes

Meeting basic needs consistently can be effective

But are they sustainable?

Income generating can build the family’s capacity to support themselves

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Summary: Unmet Needs

Comprehensive HIV education remains necessary for youth

Stigma is powerful influence on child outcomes and remains largely unaddressed

Guardian’s psychological health unaffected across each of the interventions

No effects on child & guardian’s physical health

Limited influence on children’s legal protection, particularly succession planning

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Programmatic Implications

What does it all mean for the

improvement of OVC programs?

Drawing upon quantitative results & case studies

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Programmatic Implications

Reliance on volunteers:

Standardized volunteer training on OVC care is absent

Volunteers possess limited skills to address psychological and legal issues

Caseloads may be to high to expect anticipated coverage and outcomes

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Programmatic Implications

Service Provision:

Barriers to accessing services, beyond cost, need to be addressed

Additional interventions required to address unmet needs

Combination of interventions can have the greatest influence

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Programmatic Implications

Child focused interventions:

Adolescent needs are largely unaddressed

Ensure a comprehensive and age appropriate curriculum along with routine technical guidance

Inclusion of community children in recreational interventions

Engage guardians in interventions addressing OVC needs

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Program Implications

Guardian focused interventions:

Supporting guardians can translate into benefits for children under their care

Home visiting needs to move beyond an emphasis on children to include guardians

Beyond training, supplemental resources & support may be needed to ensure effectiveness of IGA

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Program Implications

Community interventions

Efforts to reduce community stigma holds promise if intensified

Unintended consequences should be anticipated with initiatives in place to reduce them

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Programmatic Implications

Program Monitoring

Regular assessments of program coverage and client participation are needed

Tracking referral uptake

Ongoing monitoring systems to register and track beneficiaries are needed

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Other Implications?


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Thank You

We ultimately hope that this study benefits

the adults & children in need across SSA