Lessons Lessons learned from OVC programs have revealed the need to improve service quality and to strengthen harmonization across partners around the questions: How can our programs make a measurable difference in children’s well-being? What are the essential actions that we all agree need to be part of a service to best to mitigate the impact of HIV/AIDS on children and families, in the pursuit of efficiency, effectiveness, equity, reach, and scale and sustainability? In response to the observed need to improve the quality of services provided to orphans and vulnerable children, in 2007, PEPFAR, through the United States Agency for International Development (USAID), sought to create a regional initiative to support countries and implementing partners in improving the quality of OVC programming. With support from the USAID Health Care Improvement Project (HCI), a regional OVC quality improvement initiative was organized. The initiative, which has come to be known as Care that Counts, has engaged national stakeholders, program implementers, and donor agencies throughout sub-Saharan Africa in improving the quality of OVC programming. 

This short report describes the efforts of the Care that Counts Initiative to support to implementers at the country level to:
1) Build constituencies and commitment for quality in OVC programming,
2) Develop OVC service standards through consensus processes involving key stakeholders, including children and their families,
3) Undertake quality improvement activities at the point of service delivery with community-based volunteers and organizations, and
4) Gather evidence that standards and other quality improvement approaches have a measurable impact.

Lessons learned from programs serving orphans and vulnerable children (OVC) affected by HIV/AIDS have revealed the need to improve quality in OVC services and to strengthen harmonization across partners around the questions: How can our programs make a measurable difference in children’s well-being? What are the range of essential actions that we all agree need to be part of a service to best to mitigate the impact of HIV/AIDS on children and families, in the pursuit of efficiency, effectiveness and sustainability?

Several countries in sub-Saharan Africa have joined together in the quest for improving quality of services, through the USAID-funded Care that Counts Initiative, implemented by the USAID Health Care Improvement Project. These countries are engaged in applying the “science of improvement” to OVC services by 1) defining quality using service standards, 2) organizing for improvement at the point of service delivery; 3) and gathering evidence on the draft service standards that can be shared across countries. This case study highlights how Save the Children, as the leading organization of the USAID-funded Positive Change, Children, Communities and Care Program, together with local non-governmental organizations, and community-based organizations in Dire Dawa, Ethiopia, applied the science of improvement to pilot test the draft service standards.  The case study describes the design and organization of the pilot of draft service standards and the tools used to document and measure results from community level improvement activities. This case study has a “sister” case study developed by Save the Children that concretely details the actual results of implementing the standards, entitled "Communities in Action: Improving Quality in Service Delivery for Enhanced Wellbeing of Children in Ethiopia."

Lessons learned from programs serving orphans and vulnerable children (OVC) affected by HIV/AIDS have revealed the need to improve quality in OVC services and to strengthen harmonization across partners around the questions: How can our programs make a measurable difference in children’s well-being? What are the range of essential actions that we all agree need to be part of a service to best to mitigate the impact of HIV/AIDS on children and families, in the pursuit of efficiency, effectiveness and sustainability?

OVCsupport.net is a global hub for the exchange of experience, practice and tools on policy and programming around children and HIV funded by USAID.   The web site was originally developed by the International HIV/AIDS Alliance and Family Health International to serve as an an electronic library of resources about support to orphans and vulnerable children that have been collated by the Alliance and FHI from a wide range of organizations, based on the understanding that there are many good approaches to supporting orphans and vulnerable children.  Known as the "OVC Toolkit", the site addressed a wide range of themes related to support for orphans and vulnerable children– for example: situation assessments, access to education, psychosocial support, children’s participation, and monitoring and evaluation. In addition to over 500 downloadable resources, the site highlights key issues to consider for orphans and vulnerable children support programming.  Most of the resources contained on the site are in English.

The Quality Improvement Initiative for OVC Programs, funded by the United States Agency for International Development through the USAID Health Care Improvement (HCI) Project, brings together U.S. Government, other national government, and civil society partners with both OVC program and quality improvement expertise. Together these partners discuss, share and reflect on quality improvement processes for OVC services, especially at the point of service delivery and during contact with the children.

Key to the QI Initiative is sharing of experiences.  Monthly Quality in Focus Calls provide an opportunity for OVC program implementers to share and learn more about QI processes for OVC services. To join in on the Quality in Focus monthly conference calls, contact Louis Camara at lcamara@urc-chs.com to receive email announcements of upcoming calls.

Minutes of previous Quality in Focus Calls are linked below.

The Child Status Index (with its accompanying Child Status Record) is a tool that can be helpful in assessing and tracking priority services a vulnerable child needs. Equally useful for initial assessment and follow-up monitoring, the tool focuses on essential actions and is flexible enough that users can adapt criteria to the local context. Data from the Child Status Index and community mapping of services can be used together to inform coordination of care.