This document provides an overview of an Essential Package for addressing the needs of young vulnerable children affected by HIV/AIDS. It discusses: 1) What early childhood care and development (ECD) entails and why the earliest years are most critical for development. 2) The components of the Essential Package framework, which provides age-appropriate support for children aged 0-8 and their caregivers. 3) Research conducted in Malawi and Zambia to evaluate implementation of the package and identify best practices, challenges, and recommendations to strengthen and scale up the program.

1. Holistically Addressing the
Needs of Young Children and
their Caregivers Affected by
HIV and AIDS

2. 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

3. 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.

4. Source: Slide by Flavlio Cunha based on Heckman and Masterov, 2004
0 Age
Rateofre
Preschool programs
Schooling
Job training
0-3 4-5
Preschool School Post-school
Programs targeted towards the earliest years
Interventions are more cost effective than at
other ages

5. Developmental Domains (Ages/Stages)
1. Physical
2. Socio-Emotional
3. Cognitive
4. Language

6. 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

7. 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

8. 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

9. 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

10. 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

11. The Framework for Action
Eliminate
Barriers to
Care &
Support
Support
Linkages to
Broader
Systems of
Integrated
Care
Foster Positive
Caregiver-
Child
Interaction
Employ a
Developmentally
Appropriate
Approach To
Enhancing
Children’s Health
& Development

12. 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

13. The Essential Package Framework
Two

14. 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

15. The Essential Package
Framework Three

16. Tool Kit to Operationalize
Frameworks

17. The 6 Essential Tools of the Essential
Package

18. The 6 Essential Tools of the Essential
Package

19. The 4 Complementary Tools of the
Essential Package

20. Gathering Evidence on Use
of the Essential Package

21. 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?

22. 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

23. 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

24. 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)

25. Visible changes in communities

26. Visible changes in communities
(II)

27. Best practices emerging from variation in EP
implementation

28. Home Visits
• Dosage – How frequently households were visited
The EP does not prescribe frequency or length of
home visit
Variation
Dosage and length varied among implementing
organizations
Frequency of visits depended on volunteers’ other
commitments (once per week to once per month)
Best practices
Frequent visits important for relationship building between
the volunteer and primary caregiver
Depending on needs of household, more frequent follow-up
to address the issues in due time are important

29. 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

30. 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?

31. 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

32. 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

33. Common challenges across all
sites
•How to provide key messages with no
resources?
•How to continue to motivate volunteers?

34. 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’

35. 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

36. 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

37. Thank You