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Coordination of OVC care

  • Care That Counts: Applying Quality Standards to OVC Services in Kenya | Publications

    This short film demonstrates how quality improvement (QI) methodology can be used to improve services for orphans and vulnerable children (OVC).  It tells the story of how implementing standards of care and improvement efforts made a difference in service delivery to orphans and vulnerable children by two organizations in Kenya: FHI-360’s Speak for the Child Project, through Okoka community-based organization (CBO) in Nyanza Province, and Maua Methodist Hospital ZOW Project in Eastern Province. These two organizations, along with five others, were selected to pilot OVC quality service standards in Kenya in order to improve services offered to orphans and vulnerable children. This QI initiative was implemented by the USAID Health Care Improvement Project (HCI) in partnership with the Department of Children’s Services of the Ministry of Gender, Children and Social Development with funding support from the U.S. President's Emergency Plan for AIDS Relief (PEPFAR).

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  • Implementing Standards-based Quality Improvement Processes at the Community Level for Orphans and Vulnerable Children: The Strengthening Community Safety Nets (SCSN) Project, Ethiopia | Publications

    The Strengthening Community Safety Nets (SCSN) project, managed by ChildFund International with its partners University Research Co., LLC (URC) and Christian Children’s Fund of Canada (CCFC), was a three-year (September 2008 – August 2011) project in Ethiopia. Its goal was to promote healthy child development for 50,000 orphans and vulnerable children (OVC) and to assist 8,500 primary and secondary caregivers through comprehensive, family-centered, and child-focused care and support services. The project served nine Ethiopian catchment areas with high HIV prevalence rates, poverty levels, and numbers of vulnerable children and with limited coverage of social and health services. The catchment areas served were five urban areas of Addis Ababa (Gulele, Kolfe Keranyo, Nefasilk Lafto, Arada, and Akaki Kality sub-cities) and four woredas (districts) of the Oromia region (Fentale, Dugda, Debre Zeit, and Shashemene).

    In order to improve care given to vulnerable children through SCSN initiatives, the science of quality improvement (QI) was used to ensure that the newly adopted standards were met at points of service delivery. QI uses quantitative and qualitative methods to improve the effectiveness, efficiency, and safety of service delivery processes and systems as well as the performance of human resources in delivering products and services. In order to determine how the standards could be practically and efficiently implemented in the context of the SCSN project, members of the community involved in coordinating the delivery of services to vulnerable children at four model sites, along with vulnerable children themselves and other beneficiaries, were engaged in a QI process. 
     
    This case study details QI efforts at the four sites, explains how communities were engaged, discusses how changes were tracked and what changes were seen, and presents specific lessons learned from the process.
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  • Amélioration des soins communautaires pour les orphelins et enfants vulnérables à Travers un Processus d’Amélioration de la Qualité | Publications

    Pour répondre à la problématique des Orphelins et Enfants Vulnérables (OEV) en Côte d’Ivoire, le Projet d’Amélioration des soins de santé (HCI) de l’USAID, le Ministère de la Femme, de la Famille et des Affaires Sociales (MFFAS), et le Programme National de prise en charge des OEV (PN-OEV) ont engagés le processus d’Amélioration de la Qualité des services pour découvrir les insuffisances des soins et soutiens offerts aux OEV et à leurs familles. Ce rapport décrit les interventions mis en œuvre par HCI et leurs partenaires pour améliorer la qualité des services offerts aux OEV qui a démarré en 2009.

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  • Implementation of standards of service delivery for orphans and vulnerable children in Kenya: A prospective evaluation of performance, costs and equity | Publications

    Due to an increase in the number of children affected by HIV and AIDS in Kenya, efforts to provide services for orphans and vulnerable children have expanded quickly in recent years. Lately, stakeholders have realized more attention should be given to outcomes and service quality. To address this, seven implementing organizations were identified to participate in the piloting of standards for services to vulnerable children in four districts. This study evaluates the effectiveness, efficiency and equity of implementation of standards of service to vulnerable children, which are of particular interest to USAID and the government of Kenya.

    For this prospective cohort study, quantitative data were collected on changes to children’s status as measured by the Child Status Index (CSI) from the baseline period immediately prior to initiation of the intervention to the end line following six months of application of the new standards. This part included an examination of whether there were differences between the performance of boys and girls and between younger and older children. Qualitative data were gathered from interviews with key implementing partners on the effects of using the new standards on performance of vulnerable children service delivery. Cost data from the perspective of the funders, USAID and the implementing partners, were collected from the accounting records of the USAID HCI Project and its partners.
     
    The main study questions were:
    1. 1) Was there a difference in the welfare of children receiving services from participating community-based organizations as measured by the difference between baseline and end line CSI scores?
    2. 2) What was the incremental cost to the implementing partners and USAID / HCI of implementing the new standards?
    3. 3) What was the proportion of girls and boys enrolled in vulnerable children care in the participating sites?
    4. 4) Were there differences in the effectiveness of the service delivery in improving child welfare between boys and girls and between younger and older children?
    5. 5) As reported by coaches and QI team members, what were key activities, the progress seen, the challenges and the role of stakeholders in implementing the new standards of vulnerable children care?
    Results
    There were 381 children from five service providers who had baseline and end line CSI scores (59.3% boys, 40.7% girls). The average CSI scores at baseline for all children for the twelve individual sub-domains of the CSI were between 2.8 for food security and 3.3 for emotional health. Girls tended to have slightly higher baseline CSI scores than boys in all sub-domains except for abuse / neglect however, none of the differences were statistically significant. The only statistically significant difference in improvement was in improvements in abuse / neglect in which girls where one and a half times as likely to improve by a score of 1 than boys (P=0.007). End line CSI scores all increased from the baseline by a range of an average 0.55 for care to 0.19 for wellness. Improvements seen in younger children were statistically significantly higher is shelter, care, wellness, health care services, emotional health, social behavior and education.
     
    Written reports from the four implementing partners showed substantive changes in activities of delivering vulnerable children’s services which they attributed to their participation in the new standards piloting. Chief among these were improved communication with and participation by children and their caregivers, improved coordination among the implementers and other governmental and NGO service delivery partners and more active problem solving to meet the specific needs of the children. Challenges to achieving better performance included a drought which increased food insecurity and decreased income in many regions, and the high expectations from service recipients.
     
    The cost to the implementing partners for the nine months attributable to the piloting program was 14.47 KSh per child receiving services (US$ 0.16 per child). The total cost to the USAID / Health Care Improvement Project was 4,180,000 KSh ($ 46,470).      
      
    Conclusions and Recommendations
    The qualitative data showed that significant positive changes were seen by the implementers in the overall quality of the services delivered to children affected by HIV/AIDS and their caregivers. By this measure, the standards piloting was a success. The improvement seen in the CSI scores was positive and encouraging, particularly given the fact that a drought was significantly affecting the welfare of the populations in the area where implementation took place. However, in the absence of a control group for a valid comparison, it is unknown how much of the improvement was due to the new standards.
     
    On the strength of the qualitative evaluation of the program and the low additional cost to the implementing partners, expansion of the program is recommended. If done on a regional basis so that travel expenses for the new standards workshop, learning sessions and coaching visits could be minimized, the overall efficiency of the program would be substantially enhanced. Further research is necessary to determine exactly what proportion of the CSI improvements were due to the new standards and such an evaluation should be part of any scaling up of the program.

     

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  • Strengthening Community Health Systems to Improve Health Care at the Community Level | Publications

    This short report summarizes the ways in which the USAID Health Care Improvement Project (HCI) is working with local groups and partners to apply quality improvement (QI) methods within the Community Health System in order to strengthen the impact of CHWs and other service providers at the community level, while at the same time increasing sustainability of programmatic impacts. Currently carrying out activities in more than 30 countries globally, HCI seeks to develop the capacity of health systems to apply modern QI approaches to make essential services better meet the needs of underserved populations; improve efficiency and outcomes; reduce costs from poor quality; and improve health worker capacity, engagement, and performance.

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  • Community driven initiatives for quality care of OVC | Improvement Report
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  • PEPFAR Care that Counts: Quality Improvement for OVC Programs | Page

    In response to the observed need to improve the quality of services provided to orphans and vulnerable children, in 2007, the United States Agency for International Development (USAID), with funding from PEPFAR, sought to create a regional initiative to support countries and implementing partners in improving the quality of OVC programming. With support from the Health Care Improvement Project (HCI), USAID’s global technical assistance mechanism for health care quality improvement, a regional OVC quality improvement initiative was organized.

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  • Using Collaborative Improvement to Achieve Quality Care for Vulnerable Children in Ethiopia | Collaborative Profile
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  • PEPFAR | Care that Counts: Improving the Quality of Programs for Orphans and Vulnerable Children | Publications

    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.

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  • Applying the Science of Improvement to Achieving Quality Care for Vulnerable Children in Ethiopia | Publications

    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."

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  • Communities in Action: Improving Quality in Service Delivery for Enhanced Wellbeing of Children in Ethiopia | Publications

    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. 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, applied the science of improvement to pilot test the draft service standards.   It highlights the key findings and lessons learned from the quality improvement pilot project implemented in Dire Dawa, Ethiopia from February 2008 to March 2009. The data provided in this case study provide insight into the way groups at the point of service delivery are able to internalize quality and utilize quality improvement methods to achieve results–results that are seen not only at the level of the organization, but also at that of the child. 
    A companion case study, Applying the Science of Improvement to Achieving Quality Care for Vulnerable Children in Ethiopia, also prepared by the USAID Health Care Improvement Project and Save the Children, 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.
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  • OVC Support Web Site | Publications

    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.

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  • Quality in Focus Conference Calls | Publications

    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.

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  • Child Status Index | Publications

    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.

    Developed by MEASURE Evaluation and Duke University with PEPFAR and USAID support, the Child Status Index (CSI) is based on six domains with 12 measurable goals related to the six core services that, taken together, approximate a standard for overall child health and well-being. The CSI measures attainment of goals in six domains of care: food and nutrition; shelter and care; protection; health; psychosocial; and education and skills. The index includes a four-point scale for each goal so that the child’s well-being can be assessed as good, fair, bad, or very bad.  A pictorial version of the index facilitates use with illiterate care providers.
     
    The goals themselves, as well as the rating guidance, are phrased in ways that allow for some local variation, yet the measures are still meaningful and specific. The accompanying Child Status Record, which records status over time, indicates services received and identifies critical events that have occurred in the life of the child. 
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