Key Findings and Programmatic Implications: OVC Program Evaluations in Kenya and Tanzania

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 Tulane University School of Public Health and Tropical Medicine

Overview
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?

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

Prevalence of Home Visiting

Frequency of Visits

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

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

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

HIV Knowledge
Outcomes
Heard of AIDS
Number of known prevention methods
Mistaken beliefs
Key Interventions
School-based programs
Kids Clubs

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

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

Children’s Psychosocial Well-being
Outcomes
Self esteem
Pro-social behavior
Emotional problems
Total difficulties
Adult support
Social isolation
Key Interventions
Kids Clubs
Home Visiting
Guardian Support Groups

Children ’ s Psychosocial Well-being Kids Clubs Allamano Effect Effect Effect No Effect No Effect Outcomes Emotional symptoms Pro-social behavior Adult support Global self-esteem Social isolation TSA No Effect No Effect No Effect No Effect No Effect

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
Child Outcomes Pro-social behavior Total Difficulties Adult support Global self-esteem Social isolation Support Group Effect Effect No Effect No Effect No Effect Home Visiting No Effect Effect Effect Effect Effect

Care and Treatment of Children & Guardian Psychosocial Well-being
Outcomes
Child Care & Treatment
Feelings Towards Child
Family Functioning
Child Abuse
Guardian Psychosocial
Marginalization
Negative Feelings
Positive Feelings
Key Interventions
Home Visiting
Support groups

Child Care and Treatment & Guardian Psychosocial Well-being Feelings re child Family Functioning Child abuse Negative Feelings Positive Feelings Marginalization Home Visiting (3 programs) No Effect Effect ( CRS ) No Effect No Effect No Effect No Effect CRS Support Group No Effect Effect Effect No Effect No Effect Effect IAP Support Group No Effect No Effect No Effect Effect No Effect No Effect

Support Groups & Home Visiting? One study demonstrated the added benefit of exposure to multiple interventions (CRS)

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

Children & Guardian’s Physical Health
Outcomes
Reported Health Status
Use of needed health services
Key Interventions
Home Visiting
Referrals for Free Health Services

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

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

Legal Protection
Outcomes
Identity documents
Succession planning
Key Interventions
Home Visiting
Support Groups
Community education: OVC Care & Support

Legal Protection
No effect of Home Visiting or Support Groups
No effects on Succession Planning
Home Visiting (3 programs) Support Groups (2 programs) Community Education (2 programs) Identity Documents NS NS Effect Succession Planning NS NS NS

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

Children’s Educational Outcomes
Outcomes
Enrollment
Attendance
Key Interventions
Provision of School Supplies
Home Visiting

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)
Home Visiting Allamano CRS TSA Enrollment Effect NS NS Attendance NS Effect NS

Household Food Security
Outcome
Food Security
Key Interventions
Income generating
Food parcels

Food Insecurity Two programs aimed to enhance food security

Household Food Insecurity Interventions: Food Parcels & IGA Inconsistent Food Parcels (CRS) Consistent Food Parcels (Allamano) IGA: Savings and Internal Lending Committees (CRS) IGA: Bio-intensive Gardening Training with Supply Provision (Allamano) Reduced food insecurity? No effect Effect Effect Effect

Community Support
Outcomes
Perceived Stigma
In-kind support
Key Intervention
Community education: OVC Care & Support

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)

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

Jealousy of service provision For PACT, perceived jealousy was significantly higher in the Intervention Group

Who is responsible for orphans?

Who is responsible for orphans? Significant difference (p < .05)

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

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

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

Programmatic Implications
What does it all mean for the
improvement of OVC programs?
Drawing upon quantitative results & case studies

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

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

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

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

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

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

Discussion
Other Implications?
Questions?

Thank You
We ultimately hope that this study benefits
the adults & children in need across SSA

Key Findings and Programmatic Implications: OVC Program Evaluations in Kenya and Tanzania

by MEASURE Evaluation on Oct 13, 2009

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Key Findings and Programmatic Implications: OVC Program Evaluations in Kenya and Tanzania — Presentation Transcript