Technical Guidance for Global Fund HIV Proposals

Transcription

1 Technical Guidance for Global Fund HIV Proposals Broad Area Intervention Area CARE ANS SUPPORT Protection, care and support of children orphaned and made vulnerable by HIV and AIDS Working Document Updated - February 2009 A. Objective of this Technical Guide The objective of this technical guide is to provide key considerations for the development of quality proposals to the Global Fund related to the protection, care and support of children orphaned and made vulnerable by AIDS (OVC). B. Documents used to inform this guide These documents are also additional resources to further guide content of proposals: Global Partners Forum on children affected by AIDS 2008 Communiqué Enhanced Protection for Children affected by AIDS framework, 2007 The Aidspan Guide to Developing Global Fund Proposals to Benefit Children Affected by HIV/AIDS, 2006 RAAAP methodology in sub-saharan Africa, 2004 UNAIDS (2006) Three Ones key principles- Coordination of National Responses to HIV/AIDS. Guiding principles for national authorities and their partners. Geneva, Switzerland: UNAIDS Guide to Monitoring and Evaluation of the National Response for Children Orphaned and made Vulnerable by AIDS, 2005 Guidance Document for the Development and Operationalisation of a Monitoring and Evaluation System for the National Response for the Protection, Care and Support of Orphans and Vulnerable Children Living in a World with HIV and AIDS, 2008 (Draft) Manual for the Measurement of Indicators for Children in Formal Care, UNICEF/BCN (2009) C. Justification for the inclusion of children affected by HIV and AIDS within Global Fund requests The global situation of children and HIV and AIDS Globally, according to the most recent estimates from UNAIDS, there are 2.1 million children with HIV. There were 420,000 new infections in children in 2007 (almost 17% of all new infections globally). Worldwide there were an estimated 15 million children who had lost one or both parents to AIDS of which 11.6 million in sub-saharan Africa. Sub-Saharan Africa remains the region most affected, representing approximately 90% of all cases, followed by Asia. 1

2 290,000 infants and children died in 2007 of HIV/AIDS-related causes (the majority of whom live in sub-saharan Africa) It is estimated that about 690,000 infants and children are in need of ART; at the end of 2007, there were approximately 200,000 infants and children receiving ART. Millions more children are orphaned and/or made vulnerable by other causes. Data from 47 countries worldwide shows that orphanhood exceeds 5% in most countries. High levels of orphaning are not always due to AIDS. In some countries, orphanhood is caused by armed conflict. AIDS has been a focus of international concern for more than two decades. Yet its impact on children has been little considered until recently. D. Process considerations within the proposal: 1/ Assessing the situation 1 A sound local knowledge base is essential to understanding the factors that influence the vulnerability of children. The situational analysis is an important component of the proposal and will guide the response to OVC. The principal objectives of the situational analysis are: Define the extent of the epidemic with respect to women and children and include factors that define children s vulnerability Describe the level of implementation and scale up of the children orphaned and made vulnerable by HIV and AIDS programme including development of supportive policies and guidelines and other aspects related to service delivery, including an analysis what different partners are supporting (Effort Index as a tool might be useful here). Identify programming and financial levels and gaps. Guide the process of proposal development, including assisting in defining goals, objectives, and strategies to be included in the proposal. 2/ Assessing the response 2 When developing a proposal for children orphaned and made vulnerable by HIV and AIDS it is important to have an understanding of what the national response currently is so that additional activities can help strengthen already existing programmes. The national response includes at all levels such as families and communities, decentralized agencies, NGO s and FBO s and government. 1 Taken in part from the UNICEF (2008) Guidance Document for the Development and Operationalisation of a Monitoring and Evaluation System for the National Response for the Protection, Care and Support of Orphans and Vulnerable Children Living in a World with HIV and AIDS. DRAFT 2 Reproduced in part from the First Edition of The Aidspan Guide to Developing Global Fund Proposals to Benefit Children Affected by HIV/AIDS, available at 2

3 In addition to assessing the response there needs to be further emphasis on children living outside of family care who may be the hardest to reach e.g. children on the streets, children living in institutions and children living in household settings without family. 3/ Monitoring and Evaluation Monitoring and evaluation (M&E) has a triple benefit: as a management tool for planning and implementing a response, as an accountability tool for performance monitoring, and as an advocacy tool. Because of this M&E must be shown to play an integral part of proposal. Orphans and vulnerable children National Monitoring and Evaluation Guidelines While ownership of the monitoring process for OVC programs must be assumed by the mandated government ministry, it is important and in keeping with the Three Ones Principle, 3 that the development and operationalisation of a system to monitor and evaluate the national response for the protection, care and support of children affected by HIV and AIDS is an integral part of the broader national monitoring and evaluation plan at country level. E. Programmatic and Strategic Considerations to Include in the Proposal 4 1. Supporting children and families living with HIV Support and expand access to anti-retroviral treatment and prevention and treatment of opportunistic infections for children, parents and caregivers, using family centred approaches and improve access to early infant HIV diagnosis as well as nutritional support, including in emergency settings; Accelerate scaling up prevention of parent to child transmission programmes. Improve linkages between clinic based and community based care. 2. Strengthen families and communities as units for prevention, care and support Scale up and link programming on care, prevention, treatment and support, including promoting integrated family-centred programming. Encourage the use of different entry points to identify vulnerable families (e.g., community children s care groups, NGO supported programmes, schooling, PMTCT, prenatal and postnatal services, family care and treatment, microfinance, drug prevention and harm reduction programmes, cash transfers, social transfer distribution sites, programmes encouraging active engagement of men, etc.) Scale up access to primary prevention within families, including HIV status awareness through couple counselling and testing and age appropriate messaging; Use the resources and programmes focused on children affected by HIV and AIDS to reach communities and families and build/strengthen systems for strengthening overall child wellbeing. In areas of widespread poverty and high HIV prevalence, there is high 3 UNAIDS (2006) Three Ones key principles- Coordination of National Responses to HIV/AIDS. Guiding principles for national authorities and their partners. Geneva, Switzerland: UNAIDS 4 Taken from the Global Partners Forum 2008 Communiqué 3

4 convergence of these sources of vulnerability. In this regard, promote and advocate for AIDS sensitive, rather than AIDS exclusive programming. 3. Strengthen social welfare systems to increase effectiveness of programmes, services and funding Strengthen the leadership and capacity of government, including at decentralized structures, to deliver effective and sustainable programmes. Develop professional human resources for social welfare; Support the development and implementation of comprehensive national social protection programmes including cash and other social transfers, family support services, early childhood care, alternative care; hold African governments accountable to the Kampala commitment of 2% of GDP allocated for social protection. Promote and advocate for child friendly legal protection accompanied by legal aid. Address domestic violence and abuse Sharpen operational guidance and standardise definitions and strengthen regional bodies and fora to support country level implementation. Promote and advocate for evidence based planning, including establishing clear targets, scaling up implementation and monitoring and evaluation; Improve the effective use of existing resources through better harmonisation and coordination and alignment to national responses, including those directed at economic security or supported by NGOs, FBOs and CBOs. Mobilise more and predictable funding from donor and domestic sources. Ensure existing resources reach the most vulnerable communities, households and children, including review of the incentives for community providers; Encourage partnerships between civil society, and Government, including parliamentarians by building civil society capacity to participate in national responses. Support civil society engagement and accountability in channelling funds to communities; Strengthen care options such as kinship care, foster care and domestic adoption so that institutional care is the last resort for children and a temporary solution; Strengthen the monitoring and evaluation of national responses by supporting development of national routine data collection systems and evaluations such as Demographic and Health Surveys (DHS), AIDS Indicator Surveys (AIS) and Multiple Indicator Cluster Survey (MICS), disaggregated by age, gender and locality; Accelerate integration of children and HIV/AIDS issues in national sectoral and development plans to advance sustainability and national ownership. 4. Ensure human rights for vulnerable children Support the development and implementation of comprehensive national and community strategies and actions that will combat violence, stigma and discrimination directed at children and young people living with and affected by HIV and their households; Support development of mechanisms and institutions for active participation of children and young people in prevention programmes and services that support orphans and children 4

5 who are made vulnerable by HIV and AIDS, including development of appropriate measurements for effective partnerships; Increase access to youth friendly services and quality education, especially for girls. Insist that governments ensure education for all. Where school attendance is low, implement mechanisms to improve access by children orphaned and vulnerable (such as abolishment of school fees and local charges); Advocate for legal protection of human rights of children, particularly children of marginalised populations and children infected with HIV, and work to remove legal barriers. F. Indicators by strategic area, age of target group, key thematic domains and measurement tool. 5 In 2005, under the direction of the UNAIDS monitoring and evaluation reference group, an OVC monitoring and evaluation guide was developed. The indicators recommended in the guide were based on a special technical consultation meeting on development of indicators that was hosted by UNAIDS, UNICEF and the Government of Botswana in Gaborone, from 2 4 April They were field tested in Kingston (Jamaica) and Blantyre (Malawi) in 2004 (see Methodological Report, forthcoming). Despite the field-testing, the indicators are still being refined based on new and emerging evidence. These represent a list of possible measurable indicators to help monitor the situation of children affected by HIV and AIDS at the national level. Strategic approach Age Key Domains Measurement tool Strengthening the capacity of families to protect and care for children Core indicators Basic material needs Malnutrition/underweight prevalence Sex before age 15 Additional indicators Food security Psychological health Connection with an adult caregiver Succession planning NA NA Mobilizing and strengthening community-based responses Core indicators Children outside of family care External support for orphaned and vulnerable children Family capacity Food security and nutrition Health Food security and nutrition Psychosocial Psychosocial Protection Institutional care and shelter Community capacity Population based surveys Population based surveys Population based surveys Household survey Household survey Street children survey and institution survey Household survey 5 Taken from the Guide to Monitoring and Evaluation of the National Response for Children Orphaned and made Vulnerable by AIDS,

6 Additional indicator Orphans living with siblings 0-17 Community and family capacity Ensuring access to essential services Core indicators Orphan school attendance ratio Education Birth registration 0-4 Protection Ensuring that governments protect the most vulnerable children Core indicator Orphaned and Vulnerable Children Policy and Planning Effort Index NA Policies/strategies, resources and resource mobilization Key informant interviews Additional indicator Property dispossession Protection Household survey Raising awareness to create a supportive environment Core indicators Percentage of children who are orphans Percentage of children who are vulnerable Policies/strategies Policies/strategies Additional indicator Stigma and discrimination Protection Indicators for children in formal care In 2009, 15 indicators for monitoring children in formal care were developed. These include: Indicator Description Quantitative indicators 1 Core Children entering formal care # children entering formal care during a 12-month period per 100,000 child population 2 Core Children living in formal care # children living in formal care ona given date per 3 Core Children leaving residential care for a family placement 4 Core Ratio of children in residential versus family-based care 5 Number of child deaths in formal care 100,000 child population Proportion of all children < 15 years leaving residential care for a family placement, including reunification, in a 12 month period Proportion of all children in formal care who are currently accommodated in non-family based care settings # of child deaths in formal care during a 12-month period per 100,000 children in formal care 6

7 6 Contact with parents and family Percentage of children in formal care who have been visited by or visited their parents, a guardian or an adult family member within the last 3 months 7 Existence of individual care plans Percentage of children in formal care who have an individual care plan 8 Use of assessment on entry to formal care (gatekeeping) Percentage of children placed in formal care through an established assessment system 9 Review of placement Percentage of children in formal care whose placement 10 Children in residential care attending local school has been reviewed within the last 3 months Percentage of children of school age in residential care who are attending school within the local community with other children who are not in residential care 11 Staff qualifications Percentage of senior management and staff/carers working with children in formal care with minimum qualifications in childcare and development 12 Adoption rates Rate of adoptions per 100,000 child population Policy/Implementation indicators 13 Existence of legal and policy framework for formal care 14 Existence of complaints mechanisms for children in formal care 15 Existence of system for registration and regulation The existence of a legal and policy framework for formal care that specifies: Steps to prevent separation Preference for placement of children in family-based care The use of institutionalization as a last resort and temporary measure, especially for young children Involvement of children, especially adolescents, in decisions about their placement Existence of mechanisms for formal complaints that allow children in formal care to safely report abuse and exploitation Existence of a system of registration and regulation for those providers of formal care for children G. Costing of activities Costs will be based on the specific estimates for the country and region. Consideration can be made for the following categories of costs: Costs for direct services to children orphaned and made vulnerable by HIV and AIDS and households including: o Health care support o Nutritional support o Family/home support o Economic support (including microfinance, income generating activities, and seeds for food crops) o Educational o Cash grants to households 7

8 o Psychosocial support (including prevention of sexual abuse) o Legal support (including help with birth registration and succession planning) o Community support (such as support for street children and child care centers). Programme support costs to ensure an enabling environment for the protection care and support of children orphaned and made vulnerable by HIV and AIDS including: o Training of social work professionals, government and non-government o Material support to Government and non-government organisation to ensure direct services to children orphaned and made vulnerable by HIV and AIDS o Support to legislative review, new legislation and operationalisation/enforcement o Support to media campaign or other advocacy related programmes o Support to improving coordinating mechanisms between key implementing actors e.g. Government, NGO s and CBO s o Support to establish or strengthen monitoring and evaluation systems o Operational research H. Additional Information For more detailed information on programming for orphans and children made vulnerable by HIV and AIDS please refer to UNICEF For more information on the global Inter-Agency Task Team on children and HIV and AIDS, please refer to For more detailed information on children affected by HIV and AIDS, orphans and vulnerable children and child protection issues please see the Better Care Network at For more detailed information on any of the points above, please contact Patricia Lim Ah Ken at UNICEF at plimahken@unicef.org 8