Transcript Highlights from the Global Evidence Base PEPFAR Orphans and Vulnerable Children’ Program: Taking Programming to the Next Level for an AIDS Free Generation Neil Boothby,

Highlights from the Global
Evidence Base
PEPFAR Orphans and Vulnerable Children’ Program:
Taking Programming to the Next Level for an AIDS Free
Generation
Neil Boothby, EdD
United States Special Advisor for Public Law 109-95 and Senior Coordinator
to the USAID Administrator on Children in Adversity
AIDS 2012 - Turning the Tide Together
Strategic Directions &
The Global Evidence Base
I. Start young
II. Rebuild Fragile Families
III. Protect women and children from
violence and exploitation
I. Start Young
• Use Early Child Development platform to establish linkages
across clinic and community in order to achieve
comprehensive outcomes for children –
a)
b)
c)
d)
Ensure survival of
young children
Eliminate mother
to child
transmission
Promote secure
attachment and
bonding
Protect children
from lifelong
impacts of “toxic
stress”
Toxic Stress Derails Healthy Development
The Biology of Adversity:
Three Levels of Stress
Positive
Brief increases in heart rate,
mild elevations in stress hormone levels.
Tolerable
Serious, temporary stress responses,
buffered by supportive relationships.
Toxic
Prolonged activation of stress response systems
in the absence of protective relationships.
Protection from Toxic Stress Leads
to Lifelong Health and Well-being
Increased adverse childhood experiences (ACE) correlate with greater HIV risk
http://www.cdc.gov/ace
II. Rebuild Fragile Families
• Economic stability
• Emotional stability and social
connectedness
• Parenting skills
Evidence: HES & Social Protection
• Cash transfers (well established evidence)
– Enhance child health, nutrition, growth
– Improve school attendance, especially for girls
– Increase family consumption, assets, income
Adato & Basset 2008. Hagen-Zanker, McCord, & Holmes 2011. DFID 2011.
• Savings and money management (emerging evidence)
– Reduce erratic/seasonal spending
– Stimulate family investment in nutrition, health, education
and asset accumulation
– Promote goal-setting, planning, future-oriented behavior
Rutherford 1999. Collins, Morduch, Rutherford, & Ruthven 2009.
Duflo, Kremer, & Robinson 2010. Dupas & Robinson 2011a. Dupas & Robinson 2011b. Barber 2011.
Savings + Parenting Discussion Groups
Randomized Controlled Trial in Burundi | Midterm Findings
Savings had significant impact on economic wellbeing but did
not translate (yet) into better child outcomes:
• 4% reduction in poverty
• Improved food security
• Increased assets (equivalent to 1 cow/family)
Savings + parenting showed significant improvements for
children:
•
•
•
•
Substantial reductions in harsh discipline
Improvements in child mental health
Reduced family problems (reported by children)
Improved child wellbeing (reported by children)
Bundervoet, Annan & Armstrong 2011.
III. Protect Women and Children from
violence and exploitation
• Strengthen Child Welfare & Protection Systems
• Promote child protection models that encompass both
informal and formal systems
High rates of violence against women
and children with particular concern for
adolescent girls
Weak Formal Protection Systems
High Vacancy/High Turnover Rates
• South Africa – 50% of social work posts vacant and 50% leave
their jobs within 5 years
• Malawi – 66% vacancy rate in Department of Social Welfare;
47% vacancy rate in Ministry of Women and Child
Development
• Lesotho – on average, social workers leave their jobs within 5
years compared to 7 years in the health sector
Davis, Rebecca; “Opportunities and Constraints in Human Capacity within
Child Welfare Systems: The Social Work Workforce in Africa,” GH TECH, USAID 2010
Poor linkages Between Formal and Informal
(Community) Protection Systems
• Stark, et. al., “A qualitative study of community-based child
protection mechanisms in Aceh, Indonesia”, forthcoming in
Vulnerable Children and Youth Studies
• Wessells, et. al. “The disconnect between community-based
child protection mechanisms and the formal child protection
system in rural Sierra Leone: Challenges to building an
effective national child protection system”, forthcoming in
Vulnerable Children and Youth Studies
Thank You