Vulnerable Children & Families

School Children in Nigeria

Due to the long-term effects of HIV, AIDS and poverty, many countries are home to increasing numbers of vulnerable children requiring care and support beyond what can be provided by their families. Government, civil society, and the international donor community have attempted to fill those gaps in care and support through the provision of services to millions of at-risk children. Standardizing the delivery of child and family welfare services is a first step toward achieving a systemic and sustained response to the needs of vulnerable children and families. Improvement methods can help national coordinating bodies and implementing partners to develop and put in practice outcomes-oriented standards for vulnerable children and family services. Improvement methods can also test models to support and strengthen government capacity to protect most vulnerable children--those at risk of or living outside of family care.

USAID ASSIST Project Semi-Annual Performance Monitoring Report FY18

University Research Co., LLC (URC) and its partners have completed 5.5 years of implementation of the USAID Applying Science to Strengthen and Improve Systems (ASSIST) Project. This report is the eleventh Semi-Annual Performance Monitoring Report for ASSIST, summarizing the project’s accomplishments and results during the first two quarters (Q1-2) of Fiscal Year 2018 (FY18).  In late September 2017, the project was awarded a two-year costed extension with additional funding for Zika-related activities.  No further funding was provided for non-Zika work.  The project’s FY18 work plan thus focuses mainly on Zika-related support in eight countries and completion of previously funded work in other countries.

Overall goals
The USAID ASSIST Project fosters improvements in a range of health care processes through the application of modern improvement methods by host country providers and managers in USAID-assisted countries. The project’s central purpose is to build the capacity of host country health and social service systems to improve the effectiveness, efficiency, client-centeredness, safety, accessibility, and equity of the services they provide. In addition to supporting the implementation of improvement strategies, the project seeks to generate new knowledge to increase the effectiveness and efficiency of applying improvement methods in low- and middle-income countries.
USAID ASSIST country programs align with the goals of United States Government’s global initiatives and policies, including preventing child and maternal deaths, achieving HIV epidemic control, combating other public health threats, protecting life, and addressing gender inequalities.

Where we work
During the first half of FY18, USAID ASSIST provided technical support in 23 countries through field and core funding. USAID Mission funds supported work in nine countries: Cambodia, Côte d’Ivoire, India, Indonesia, Lesotho, Mali, Swaziland, Tanzania, and Uganda. USAID core funds from the Office of HIV/AIDS supported activities in seven countries: Kenya, Lesotho, Malawi, Mozambique, Namibia, Tanzania, and Zimbabwe.  Funds for Neglected Tropical Diseases supported improvement work to combat the Zika virus in the Dominican Republic, Ecuador, El Salvador, Guatemala, Honduras, Jamaica, Nicaragua, Paraguay, and Peru.  USAID cross-bureau-funded activities, through the Office of Health Systems, supported malaria prevention activities in Malawi and global and regional initiatives that contribute to local and global learning in improvement.

FY18 Q1-2 accomplishments and results:

  • Improvement in key indicators: As discussed in this report, ASSIST-supported programs demonstrated improved care and outcomes for a range of services, including antenatal and postnatal care, essential obstetric and newborn care, screening of pregnant women and newborns for Zika-related signs and symptoms, Zika care and support, PMTCT, and HIV prevention.
  • Research and evaluation studies: At of the end of the reporting period, the project had 29 research studies in planning, underway or completed in 14 countries. Three are multi-country studies.
  • Promoting the use of improvement methods: During the reporting period, project staff published nine peer-reviewed articles; seven case studies; four technical and research reports; and 10 guides, tools, and job aids. ASSIST staff led six sessions and made eight oral presentations at six regional and international conferences. ASSIST’s work continued to be promoted through the project’s website and social media engagement, with some 27,867 visitors viewing 61,572 pages within the ASSIST Knowledge Portal during the past two quarters.

Our “Best 9” stories in 2017

Vicky Ramirez

Consultant, USAID ASSIST Project/URC

Looking back, 2017 was a great year for us at ASSIST. In 2017, we were featured in USAID’s Exposure; we collaborated with a number of partners to publish ICHC Blog Series, which was cross-posted on The Huffington Post; and we ran a blog series in honor of Health Worker Week. After our resources page, our blog was the most visited page on our website. In case you missed some of these highlights, we’ve put together our “Best 9” stories. These posts illustrate the stories behind the great work employed by our country teams, partners, and individuals. Let us know which story you loved the most!

Strategies to Increase Identification of HIV Positive Children: A Compilation of Successfully Tested Changes in Communities and Health Facilities in Uganda

Identifying and diagnosing children as HIV-infected is the first step in the continuum of pediatric care and treatment. As part of its contribution to the UNAIDS first 90 goal to have 90% of all HIV infected people diagnosed, the USAID ASSIST, with support from the US President’s Emergency Plan for AIDS Relief (PEPFAR) works with the Ministry of Health (MOH) and implementing partners to test innovative approaches for increasing identification of HIV positive children and their caregivers. Following the HIV Continuum of Response (COR) model developed by ASSIST, all children and adults identified as HIV positive should be linked for HIV care and treatment. In October 2013, USAID ASSIST together with the regional implementing partners in East Central and South West regions identified eight health facilities and eight Civil Society Organizations that care for orphans and vulnerable children to test strategies to increase identification of HIV positive children. This change package highlights change ideas compiled by health facility and community QI teams to achieve two aims: 1) improve identification of HIV positive vulnerable children and their caregivers; and 2) improve enrolment of the vulnerable children and their caregivers identified as HIV positive. It provides detailed guidance that other health care providers and community organizations can use to improve identification and enrolment into care of HIV positive vulnerable children.

Improving household food security and economic status of vulnerable households in Mangochi District

With support from United States Agency for International Development (USAID), a multi-sectoral quality improvement (QI) team of extension workers and community members in Mangochi District, Malawi targeted a total of 587 vulnerable households to be linked to household economic strengthening activities. The QI team mobilized various stakeholders in Mpeya area to work together to reach vulnerable families in the catchment area with various services to improve their wellbeing. The CBO targeted 21 villages in four Group Village Heads in the district. In March 2014, Mpeya QI team conducted assessments on 25% of registered vulnerable children in selected communities. They identified food insecurity among vulnerable households as their priority problem. The QI team conducted root cause analyses on food insecurity among vulnerable households and discovered numerous root causes to the challenges. The QI team tested a number of possible solutions to improve household food security and diversity. Over the years, the QI team has recorded improvements in families being able to use modern methods of farming from 0% (April-June 2015) to 64% (July-September 2017) Similarly, vulnerable families involved in livestock production went from 13% (April-June 2015) to 64% (July-September 2017). The Mpeya team also recorded outstanding improvements (8% to 76%) in improving the number of vulnerable beneficiaries establishing kitchen gardens to help vulnerable beneficiaries diversify their diets.

Improving education performance in primary schools in Malawi

Community QI teams worked with 20 rural primary schools from Balaka and Mangochi districts to improve termly academic performance of vulnerable children attending primary schools. The teams found that vulnerable children face many barriers to academic success, ranging from food scarcity at the household level, lack of scholastic materials, limited parenting skills, and scarcity of positive role models in the communities for children to emulate. These barriers result in poor education outcomes among children who drop out of school, particularly girl children.  The community teams identified a number of changes that led to improvement in outcomes and these changes have been compiled in this change package, with detail on how teams tested the changes so others may replicate these efforts.

Improving linkages to livelihood interventions

In 2013, ASSIST began working with five community quality improvement (QI) teams in two districts, Mangochi and Balaka, to improve the quality of services delivered to orphans and vulnerable children and their families. ASSIST worked with 10 CBOs and helped form QI teams with key community volunteers from the executive committee and community extension workers from health, education, and agriculture sectors. After receiving QI training, teams assessed vulnerable children’s needs, finding food security was one of the biggest challenges they were facing. The QI teams began engaging vulnerable households in different household economic strengthening (HES) activities to improve household food security. By December 2016, the teams supported and linked 2607 of 3416 targeted households (76%) to different household economic and food security strengthening activities.

In order to systematically and effectively improve the services for vulnerable beneficiaries we recommend the following:

  • To ensure that households are supported appropriately, there is need to assess the level and type of vulnerability of the households to ensure targeted support for improving their food security and economic status. This was done with the Malawi vulnerability framework.
  • Agricultural extension workers are key to improving the household economic status of households as they are professionally trained to support communities. They, together with the community workers, are required to set goals and outline activities for the targeted households before beginning supporting households.
  • Data management is cross cutting for improving OVC services. It requires reinforcing quality data collection, accurate recording, quality data management systems, continuous data analysis, interpretation and use for further improvements. Improvement decisions should be made based on the evidence observed from the data collected.

This change package enumerates recommended activities for HES and best practices identified by QI teams implementing them.

USAID ASSIST Project Annual Performance Monitoring Report FY17

University Research Co., LLC (URC) and its partners have completed the fifth year of implementation of the USAID Applying Science to Strengthen and Improve Systems (ASSIST) Project. This report is the tenth Semi-Annual Performance Monitoring Report for the project and aims to summarize the accomplishments and results toward the program objectives of USAID ASSIST activities during quarter (Q) 1 through 4 of Fiscal Year 2017 (FY17).

Scale of USAID ASSIST work, FY17

FY17 Accomplishments and Results

  • Improvement in key indicators: As discussed in this report, ASSIST-supported programs demonstrated improved care and outcomes for a range of services, including antenatal and postnatal care, essential obstetric and newborn care, family planning, PMTCT, HIV care and treatment, HIV prevention, NACS, TB diagnosis and treatment, malaria diagnosis and case management, and services for vulnerable children and families.
  • Gender integration: Onsite gender training and technical support was provided to country teams in Burundi, Cote d’Ivoire, DRC, Lesotho, Mali, South Africa, and Uganda to integrate gender considerations into their improvement work. Ongoing gender support was provided to all field offices with improvement activities to collect and analyze sex-disaggregated indicators, identify gender-related gaps affecting outcomes, and respond to those gaps.
  • Research and evaluation studies: At of the end of the reporting period, the project had 37 studies underway or completed in 15 countries. Four are multi-country studies.
  • Promoting the use of improvement methods: In FY17, project staff published 14 peer-reviewed articles; 23 case studies; 11 technical and research reports; 42 guides and tools, six short reports; 29 annual reports, and seven multimedia products describing project-supported work and results as well as gender integration learning videos. ASSIST had an active presence at 16 international and national conferences. In all, project staff led 18 sessions and workshops and delivered 14 oral and 14 poster presentations. ASSIST’s work continued to be promoted through strategic engagement in Twitter chats, reaching close to 2,374 followers (26% increase from FY16) and an average of 26,500 unique Twitter users per month (impressions). We continued sharing resources via the ASSIST Facebook page (over 6,200 likes) as well as publishing engaging blog content (28 blogs in FY17).

Improving educational performance of children in Chilore Primary school using quality improvement approaches in Mangochi District, Malawi

A team of community volunteers and government extension workers, with support from USAID, from 16 villages in Namwera, Mangochi District used quality improvement (QI) methods to mobilise four primary schools and their 16 surrounding communities to improve the performance of vulnerable children in the four primary schools. In December 2013, the community QI team assessed the wellbeing of a sample of 132 vulnerable children. The Child Status Index (CSI) assessment revealed that 70% of the poor scores were on education performance, food insecurity, and shelter conditions. As a result, Chingwenya Community QI team prioritized improving education performance in four primary schools in their catchment area. Through root cause analysis, they found numerous challenges faced by vulnerable children ranging from poor performance, frequent absenteeism of learners, limited numbers of teachers, poor infrastructure, lack of school teaching, lack of learning materials, and cultural practices and norms that affected education calendars. The QI team developed and tested a number of changes to improve school attendance and performance in the four schools. From December 2013 to August 2016, the QI team gathered primary school sex-disaggregated performance data. All four targeted schools have demonstrated improvements in termly pass rates of children. One of the schools, Chilore Primary School, has demonstrated sustained improvements across the nine academic terms. The school observed achievements from 42% in term one (December 2013) to 81% in term nine (August 2016). Not only did the team achieve improvements in the pass rate, but also managed to close the gender difference in performance of boys and girls.

National Psychosocial Support Guidelines for Orphans and Vulnerable Children in Kenya

These guidelines were developed for use by front line child service providers to streamline psychosocial support services for children. The guidelines provide guidance for supporting caregivers, general guidance for children of all ages, and specific guidance by age range: 0-5, 6-13, and 14-18. An implementation framework is also included.