This document introduces the Child Status Index (CSI), a tool developed to monitor outcomes for orphaned and vulnerable children (OVC) receiving support programs in sub-Saharan Africa. The CSI was created through participatory research with local communities to assess child well-being across 12 domains, including food, shelter, health, education and psychosocial support. It provides a standardized way for programs to evaluate how services are impacting children and to match children's needs with available support. The CSI is being implemented by various NGOs and national monitoring systems to improve outcomes for OVC.

1. Introduction to the Child Status Index
Florence Nyangara, Ph.D.
MEASURE Evaluation/Futures Group
March 17, 2009
Regional Conference
Kigali, Rwanda

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Background
 Estimated 12 million
children are orphans in
SSA (UNICEF ’06)
 Program support to 4
million orphans and other
vulnerable children
(PEPFAR report, 2008)
 How has the support
benefited the 4 million
OVC? This is the Question?
New York Academy Primary School for OVC,
Nyamira District, Kenya, receive school supplies,
2007: photo by F. Nyangara

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OVC Program Structure……
 Multidimensional – education, health, legal, PSS, etc.
 Multisectoral – Ministries of health, gender, women, etc
 Multilevel of interventions; Direct services to the child, indirect to
household or community
Child
Household
Community
BOTTOM-LINE: All OVC support (Direct or indirect services) are aimed at-
“IMPROVING CHILD OUTCOMES”

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Understanding the Situation!
In 2006, field assessment of M&E for OVC programs in several
countries revealed that;
Numbers of children/services were used to track progress
No outcome monitoring at all levels of OVC programming
Quality of services provided to children was compromised
Monitoring tools and indicators were not consistent
Community volunteers were doing most of the M&E work
Thus: USG requested MEASURE Evaluation to develop a
tool that would assist partners to monitor child well-being

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Rationale for Developing the CSI Tool
 To address gaps on existing measures/tools of child well-being that are;
 Modeled on Western Cultures/international standards - no local perspectives
 One-dimensional - when in reality child well-being is multidimensional
 Focused on outputs or process indicators – little on outcomes
 Costly – in terms of capacity and funds to train data collectors etc.
 To holistically capture the multiple benefits of OVC programs on children
 To help match OVC levels of needs with available support (child-focused)
 To provide a common approach to assess outcome progress across programs
 To help align quality of services with child outcomes
 To incorporate the perspectives of beneficiaries and service providers regarding
child well-being as defined in there local context (their community
interpretations)

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How CSI was Developed
 MEASURE Evaluation and Duke university partnerships with NGOs,
community leaders, workers, guardians, and children in Kenya and
Tanzania (PEPFAR Funds)
 Ground-up and participatory approaches used to get community buy-in,
provide their INDICATORS (end-user’s and local perspectives)
 Local program staff and community members in Kenya and Tanzania
participated in concept, design, content, and field testing of the tool
 Consultations with experts and use of existing OVC frameworks,
PEPFAR OVC guidance, and previous research on child development in
resource poor countries affected by HIV/AIDS guided its format
 Research team set selection criteria for identified outcome domains
 i.e. should be measurable and changeable by program interventions

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Sources of CSI Information

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What the CSI Tool Evaluates
 Twelve outcome areas included
 Food and Nutrition - (Food Security; and Nutrition & Growth)
 Shelter and Care - (Shelter and Care)
 Protection - (Abuse & Exploitation; and Legal Protection)
 Health - (Wellness; and Health Care Services)
 Psychosocial - (Emotional Health; and Social Behavior), and
 Education and Training - (Performance; and Education/Work)
 Rating: 4= No problem; 3=A little problem; 2= Bad problem;
1=Emergency situation)
(SEE TOOL)

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Characteristics of the Child Status Index
 Child focused
 Simple, reliable & intuitive
 Its domains are measurable, changeable by program interventions
 Many domains to reflect overall child well-being than one-
dimensional
 Captures all the key dimensions of child wellbeing
 Reflect both positive and negative outcomes/benefits of children
receiving services
 Constructs that can be measured or adapted across ages and
cultures
 NOT - A policing tool
 NOT – Promoting any type of service delivery method etc.

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Advantages of Child Status Index Tool
 Provides a consistent way to assess how close children are to the
desired outcomes or program goals.
 Puts focus on outcomes/child’s wellbeing rather than on just
number of services delivered.
 Can help field staff monitor and ensure appropriate responses to
actual child needs
 Program managements and improvements - evaluate the
effectiveness of services
 Support advocacy
 Raise awareness among frontline staff about all areas of a child
wellbeing
 Accountability - demonstrate program progress

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Learning to use the CSI - 5 Basic Steps
The Child Status Index dimensions and Record sheet
Conduct the CSI assessment visit
Score and complete the CSI Record Form
Plan necessary follow-up to address needs
Implement follow-up plan through appropriate service
delivery

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Guidelines for gathering CSI Data
• Rater should be known to household (no strangers!)
• Normal greetings (i.e. respect and compassion)
• Rater inquires about the overall well-being of entire family
i.e. “How are the children?” (normal in SSA)
• Rater proceeds with a brief, informal discussion with the
caregiver and child; and other adults such as teachers (as
needed) – be spontaneous/natural – not interrogations!
• Begin the conversation with general questions about the
child and his/her life, to encourage the person to talk
• The best method of discussion is informal, using open-
ended questions
• The information could be gathered from multiple persons,
as needed especially on issues of abuse if suspected
• Information for rating the CSI could also gathered through
observations
• Make sure you know both the goal and contents of each
domain
• Make sure to cover all 12 domains to rate child

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How often should CSI be used..
 As part of a home visit conducted by volunteers & frontline
staff (monthly in some areas, some OVC) to be used as a;
• Basis for an individual care plan for a child (service needs)
• Monitor changes in a child outcomes and needs over time
 Periodically as determined by program or service providers
and purposes (e.g. 6 months, annually) to;
• Establish a baseline of relative need (Who are neediest and
for what?)
• Determine aggregate impact of services delivered
• Knowledge – based practices (e.g. determine most effective
program models in improving wellbeing of children.)

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Training on the Use of the CSI
 Discuss with volunteers or other stakeholders – buy-in
 Work with partners to determine who would complete the evaluation,
frequency, and literacy demands
 Like any survey instrument ensure that volunteers understand the
importance and usefulness of collecting child outcomes
 Discuss how to conduct informal interviews to gather information from
various sources about the wellbeing and rating of each child
 Score the children and fill the summary form on the outcomes, services
received, important events that happened in the child’s life, etc; and
 Practice with a few children (PRACTICUM). Then discuss the results to
address any issues arising.

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Volunteer Training
 Volunteers must see
the usefulness of CSI
data
 Link what they are
already doing with CSI
use
 Make their work easy
 Provide evidence

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Who is implementing the CSI?
 Individual child level use – several NGOs have adapted
the CSI and are using it to collect baseline data, develop
case management types of plans for child etc
 Programs and National M&E systems- in progress:
Rwanda, PC3-Ethiopia, Tanzania,
 Several others in planning stages

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Group Exercises (Training AID)
An imaginary story of Maria (give hand out and ask
the participants to rate Maria)
Jeopardy Game (innovative training AID) by Africare

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Details of Training on the Use of CSI
Coming Up Soon!

19. MEASURE Evaluation is funded by the U.S. Agency for
International Development (USAID) through Cooperative
Agreement GPO-A-00-03-00003-00 and is implemented by
the Carolina Population Center at the University of North
Carolina in partnership with Constella Futures, John Snow,
Inc., ORC Macro International, and Tulane University.
Visit us online at http://www.cpc.unc.edu/measure.