Innovations in HIV programming New research for assessing a child’s wellbeing Why more research? A common challenge for projects targeting orphans and vulnerable children (OVC) is the lack of data related to the impact on a child’s overall wellbeing. OVC programming is often multisectoral in nature and difficult to assess because it addresses so many facets of a child’s wellbeing. To help overcome this challenge, CRS developed the OVC Wellbeing Tool (OWT) to measure ten aspects of a child’s life: food and nutrition, education, shelter, economic opportunities, protection, mental health, family, health, spirituality, and community cohesion. The tool asks children to self-report on 36 questions using a three-point Likert scale, a psychometric scale commonly used in questionnaires. During a five-country pilot in 2006 and 2007, the OWT was deemed to have strong validity, yet there was no research on its effectiveness over long periods of time. CRS is therefore doing research to understand the tool’s usefulness in assessing longitudinal outcomes of OVC programming. The research is taking place in Kenya’s Nyanza Province, where the estimated HIV prevalence is 15.3 percent -- the highest in the country -- according to Kenya’s Ministry of Health. A study by the University of Boston and the University of Nairobi estimates that there are 500,000 orphans in Nyanza Province, or 25 percent of the country’s orphans.
About the Nyanza program The current program implemented by CRS for OVC in Nyanza province consists of three core program areas: education and vocational training, and health and psychosocial support. Educational support is provided in the form of school fees, uniforms, materials and school visits by community health workers. The program provides health support by paying for treatment of all beneficiaries who are in need as well as by carrying out HIV counseling and testing, and making referrals for antiretroviral treatment. Children are trained using “In Charge,” a curriculum for HIV prevention, and are guided in training their peers. Psychosocial support is delivered by a social worker or community health volunteer. Psychosocial support is also delivered by training caretakers who have formed support groups. Additional supplemental services include shelter renovation, protection, agricultural training, nutritional training and microfinance linkages.
Our approach To assess the impact the Nyanza project has had over long periods of time, CRS trained social workers to administer the tool to all children entering the OVC program in Nyanza Province in April 2008. The respondents were age 13 to 18. A mean score and an overall wellbeing score were calculated. The tool was re-administered to a subset of these same children in March of 2009.
What were the results? The loss to follow up of just over 50% was due to children being discharged from the project after they turned 18 years of age, dropping out of school, or moving out of the project area to attend secondary school. Data was obtained for a sub-sample of the original OVC who remained in the program one year after baseline. Figure 1: OWT domain scores before and after one year of OVC programming
3.0
2.5
r-
2.0
~
J~
jJ
J
J
1.5
At baseline, this sample had the lowest overall scores in the community, family, economic and protection domains. The highest scores were in the areas of education and faith. The overall average wellbeing score was 18.7 out of 30. One year later, all domains had improved. The lowest were protection and economic, the highest were education and faith, while the overall wellbeing score was 22.46 out of 30.
1.0
0.5
0.0
••
Nutrition Education
Shelter
Economic Protection
After 1 Year of intervention
Mental Health
Familly
Health Spirituality Community Overall wellbeing score
A comparison between the baseline and postintervention group revealed significant changes in the overall wellbeing score, along with significant changes in 8 of 10 domains. Only the protection and economic domains were not significantly changed, although there were positive increases in both domains. The targeted intervention areas of the program (education, psychosocial support and health) significantly increased from baseline after the oneyear intervention period.
Before Intervention
Looking ahead The OVC Wellbeing Tool is a low-cost rapid assessment measure that is easy to administer. It is innovative because it provides children’s perspectives of their wellbeing in a holistic, age-appropriate manner. Children are enthusiastic about the approach because they like to be asked their opinion. The tool can be used to assess the impact of OVC programming and should be used to monitor such programs to identify patterns of change in a child’s wellbeing over time. The results can be used by the program to focus interventions in the lowest scored domains. CRS will continue to use this tool to evaluate the effectiveness of its programs for orphans and other vulnerable children.
For more information, contact pqpublications@crs.org.