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Orphans and vulnerable children

  • 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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  • Amélioration de la Qualité des Soins et Services en Côte d'Ivoire | Publications

     

    Apres plus d’une décennie de soin et de traitement d’ARV, il semble très important pour le PNPEC de se concentrer sur la qualité des interventions. Pour répondre à ce besoin, le PNPEC à fait appel au support technique d’URC pour mettre en œuvre un processus d’amélioration de la qualité avec le soutien financier du PEPFAR. Les résultats de cet effort national à travers le Projet d’Amélioration des Soins de Santé de l'USAID (HCI) conduit par URC.  
     
    Ce rapport décrit les objectifs de quatre projets d’amélioration dirigés par HCI en Cote d’Ivoire :
    1.    ARV-PTME : Améliorer la qualité de la prise en charge des PVVIH par le traitement antirétroviral et celle des services de prévention de la transmission mère-enfant du VIH.
    2.    OEV : Améliorer la qualité des services offerts aux OEV et leurs familles à travers le développement des normes et bonnes pratiques.
    3.    Prévention : Développer la norme Nationale pour les programmes d’éducation par les pairs dans le domaine du VIH/sida.
    4.    Laboratoire : Renforcer les capacités techniques des laboratoires impliqués dans le programme d’accréditation selon le schéma OMS-AFRO.

     

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  • Quality Improvement of HIV and AIDS programs: experiences from South Africa (2007 - 2010) | Publications

    This presentation was given by Dr. Donna Jacobs, HCI Country Director for South Africa, at the 28th International Conference of the International Society for Quality in Health Care, Ltd. (ISQua), which took place in Hong Kong, China from September 14-17, 2011. The conference theme was, “Patient Safety: Sustaining the Global Momentum."

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  • Report on the Children's Workshop in Nigeria | Publications

     

    From March 18-19, 2011, in coordination with the Federal Ministry of Women Affairs and Social Development, the USAID Health Care Improvement Project (HCI), held a Children’s Workshop in Abuja, Nigeria. Also participating as facilitators were personnel from Save the Children and Hope Worldwide Nigeria. The purpose of the two-day workshop was to bring together youth who are recipients of programs providing services to Orphans and Vulnerable children (OVC) to provide them with an opportunity to share their thoughts on the services they are receiving, inform providers on what children’s real needs and concerns are, and to tell us what we can all do better to help them achieve their full potential. The document below is a report on the proceedings of the workshop including activities implemented and concerns expressed by the children.

     

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  • APHIA Plus OVC QI Workshop | Publications

    From March 23-24, 2011, the USAID Health Care Improvement Project (HCI) convened a two-day workshop in Nairobi, Kenya to orient AIDS Population and Health Integrated Assistance Plus (APHIA-Plus) implementing partners providing orphan and vulnerable children (OVC) services to Quality Improvement (QI) tools and how these tools can be implemented in their work to increase the impact of their efforts in improving children’s lives. The APHIA-Plus implementing partners also developed annual work plans that included QI techniques, receiving support and feedback from HCI and USAID personnel who were present. The report below summarizes the proceedings of this workshop.

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  • HEALTH CARE ON GIRL CHILD - INFORMAL SETTLEMENT | Improvement Report
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  • Meeting multiple needs of vulnerable children in Kenya | Improvement Report
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  • Improving the quality of care for adolescents living with HIV/AIDS by introducing Psychosocial Support services at Beatrice Road Infectious Disease Hospital (BRIDH) Opportunistic Infections and Antiretroviral Therapy (OI/ART) Clinic in Harare, Zimbabwe | Improvement Report
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  • Measuring engagement of community health workers to improve productivity, retention and quality of care | Publications

    Context: The health workforce crisis most African countries are facing is enormous, and many countries rely heavily on community health workers to provide basic essential services. However, shortages of community workers also exist in rural areas as most of the population tends to be concentrated in urban areas.

    Problem: Many CHWs are volunteers and receive little to no compensation, are often poorly trained and lack the materials and supplies necessary to perform basic services. CHWs are also overburdened by the number of households they must visit on a daily basis and the psychological impact of their work, which frequently leaves them feeling overwhelmed and sometimes unmotivated. As a result, the turnover rate for CHWs remains high.
     
    Assessment of problem and analysis of its causes: Improving motivation, productivity and retention of community health workers through incentives is challenging and many countries cannot sustain costly compensation plans for CHWs. Yet most community health workers perform well when they are engaged, feel respected by communities, and rewarded by the work improving the welfare of their clients. Addressing engagement of community workers by helping them solve the problems that discourage them can increase their standing in the community, improve their livelihood, and keep them more productive for longer periods.
     
    Strategy for change: To improve engagement with community workers in Ethiopia, HCI tested a new management approach, Employee Engagement, to increase worker motivation, self-efficacy and productivity at the community level. Through this engagement approach, community workers and their project officers/supervisors will develop and implement practicable and sustainable solutions to problems that discourage them.
     
    Measurement of improvement:  HCI has adapted private sector employee engagement instruments and developed a short questionnaire for community workers to complete confidentially and anonymously every four to six months. Based on the results of the questionnaire, community workers and their project officers develop action plans to improve areas where engagement is low. The engagement tool was recently adapted for community workers providing care to OVCs in Ethiopia. It was administered to 30 community workers, including both volunteers and project staff, in two project sites in Ethiopia as part of a baseline assessment.
     
    Effects of changes: Project officers and community workers developed action plans based on results. For example, in Ethiopia staff realized that communication between the different levels of staff i.e. between community workers and project officers and leadership needed improvement and planned an orientation for all staff. Other action items included a workshop on team-building skills and training for staff on communication skills. The participants also found the questionnaire to be a useful tool to facilitate team-building and conflict management. 
     
    Lessons learnt: The CHWs in Ethiopia were very enthusiastic about the tool and felt empowered to work in cooperation with their supervisors/project officers to find practical and sustainable solutions to the HR issues that affect them the most. CHWs found that another benefit of the tool was that it enabled them to look internally at their own performance, helping them to identify basic gaps in problem-solving skills.
     
    Message for others: Engaged workers are loyal to their organization, have a lower rate of absenteeism, have lower rates of accidents on the job and provide a higher quality of care than disengaged workers. The experience in Ethiopia proves that the employee engagement methodology can be successfully applied to CHWs working with OVCs.
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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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  • Improving the Quality of HIV and AIDS Care and Related Services in Cote d'Ivoire | Publications

    This short report describes assistance that the USAID Health Care Improvement Project is providing to the National Program for HIV Care and Treatment (PNPEC) of the Ministry of Health, implementing partners, the National Program for Orphans and Vulnerable Children (PN-OEV) and the Ministry of the Family, Women and Social Affairs (MFFAS) in Cote d'Ivoire to apply improvement methods to improve the quality of antiretroviral therapy services, PMTCT, OVC programs, and peer prevention of HIV.  The report also highlights results from 41 sites that have been engaged in an improvement collaborative on ART and PMTCT since 2008.

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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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  • Quality Improvement for OVC Services: Changing Youth Participation from a "Token Voice" to a Key Actor | Publications

    This short report describes three guiding principles for involving children and adolescents in improving the quality of services they receive. These principles hold that service providers should: 1) focus on the needs and desires of those being served; 2) recognize that children are part of a larger entity—a family and/or community; and 3) do no harm.  The report also briefly describes experiences from Ethiopia and Tanzania with engaging children and guardians in QI teams.

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  • Training materials from the Regional Training and Exchange Event, Ethiopia, November 2008 | Publications

    During the week of November 18-21, 2008, representatives from more than 16 countries came together to share experiences and enhance their understanding of Quality Improvement (QI) for programming and services targeting orphaned and vulnerable children (OVC). The African Regional Training and Exchange Event, “Care That Counts: Quality Improvement in OVC Programming” was held in Adama, Ethiopia. The team of 14 facilitators for the event included representatives from international organizations (INGOs), local non-governmental organizations (NGOs), and donors from the United States, Kenya, Tanzania, Zimbabwe, Namibia and Ethiopia. The training built upon concepts and priorities highlighted in the first meeting of OVC experts which was held in Tanzania in 2007.

    The centerpiece of the training was a proposed “Roadmap for Quality Improvement for OVC Programs,” a conceptual framework to guide the process of developing and implementing OVC standards. Facilitators highlighted the fact that the Roadmap is a work in progress and that this training would provide important opportunities for feedback from participants in an effort to improve the Roadmap. The Roadmap highlights the overall partnership and work of key stakeholders, including government, INGOs, NGOs, beneficiaries, etc. It also highlights processes and activities at the organizational level, frequently referred to as the “point of service delivery.”  To achieve a measurable difference when working on behalf of orphans and vulnerable children there needs to be a comprehensive understanding of their needs and providing services which are effective, efficient and equitable.

    The creation of service standards through consensus is a key element of the QI process. Stakeholders are involved in defining in operational terms what OVC services at the point of delivery should look like and what outcomes they should bring. The idea of “minimal essential actions” is a key component of a service standard; it is necessary to define what is “good enough.” Service standards are also developed incorporating evidence and best practice and consensus among stakeholders. Once service standards are developed they need to be communicated, piloted, evaluated, and improved.

    Other materials presented at the training event addressing principles of quality improvement, dimension of quality, developing consensus-based standards, steps to vetting and gathering evidence to refine draft standards, steps in communicating standards, and a vignette about measuring quality improvement based on experiences in Ethiopia.

    Link below to the final report about the Training and Exchange Event and to materials developed by the HCI Project for the event.

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