2. Defining PEPFAR's Approach

2. A. Defining "OVC"

Conceptually, a vulnerable child is one who is living in circumstances with high risks and whose prospects for continued growth and development are seriously impaired. In the international community, the term "Orphans and other Vulnerable Children," or "OVCs," sometimes refers only to children with increased vulnerabilities because of HIV/AIDS, and other times refers to all vulnerable children, regardless of the cause (e.g., chronic poverty, armed conflict, famine). Since the Emergency Plan focuses on those with increased vulnerabilities from HIV/AIDS, this guidance defines "OVC" in the following way:

A child, 0-17 years old, who is either orphaned or made more vulnerable because of HIV/AIDS.

Orphan: Has lost one or both parents to HIV/AIDS

Vulnerable: Is more vulnerable because of any or all of the following factors that result from HIV/AIDS:

• Is HIV-positive;
• Lives without adequate adult support (e.g., in a household with chronically ill parents, a household that has experienced a recent death from chronic illness, a household headed by a grandparent, and/or a household headed by a child);
• Lives outside of family care (e.g., in residential care or on the streets); or
• Is marginalized, stigmatized, or discriminated against.

The above operational definition identifies those who are potentially eligible for services, but does not identify those most in need of services. For programmatic decisions, each community will need to prioritize those children most vulnerable and in need of further care. Communities will also need to distinguish which core services each child needs to facilitate his or her age-appropriate development.

Because children develop at varying rates as they age, they can differ greatly in their needs, capacities, and individual vulnerabilities. It is important to address child-development issues through age-specific, child-focused programming that also aims to preserve family structures as much as possible. While there is some variation in how different organizations define these age categories,⁹, ¹⁰, ¹¹ the Emergency Plan recommends the following for programming purposes:

Age: Stage
Under 2 years: Infancy
2-4: Early Childhood/Toddler
5-11: Middle Childhood
12-17: Late Childhood/Adolescence

2. B. U.S. Government Priorities and OVC Program Planning

The mandate of the President?s Emergency Plan is to bring compassionate relief and support to countries, communities, families, and children affected by the HIV/AIDS epidemic. The Emergency Plan uses a three-pronged strategy of prevention, treatment, and care interventions to accomplish this goal, and OVC programs are among the HIV/AIDS care interventions it supports. The U.S. Government country teams make programming decisions for PEPFAR, and thus for OVC programs, which receive an approval in Washington through the Country Operational Plan and Reporting Systems (COPRS) reporting process.

OVC in-country programs need to be fully integrated into national strategies, as well as to function within the context of Emergency Plan policy through harmonized planning, operations and reporting systems. Specifically, Emergency Plan programs need to be planned in accordance with "The Three Ones" principles for HIV/AIDS assistance, promoted by the Joint United Nations Programme on HIV/AIDS and cosponsored by the U.S. Government, to ensure all international partners agree to support the following: (1) one national action framework; (2) one national AIDS coordinating authority; and (3) one, agreed-upon, country-level monitoring-and-evaluation system.

The U.S. Emergency Plan Five Year Global HIV/AIDS Strategy identifies several goals for developing OVC programs: to scale up rapidly compassionate care for OVCs; to build capacity for long-term sustainability of care; to advance policy initiatives with direct outcomes that support care for OVCs; and to collect strategic information to monitor and evaluate progress and ensure compliance with Emergency Plan policies and strategies.

Each OVC portfolio should be designed with consideration for the contributions of other Emergency Plan ongoing or planned prevention, care and treatment activities within the context of the network model of care to reach the targets and objectives. Leveraging and involving both the private sector and Government is an indispensable strategy to ensure the sustainability of programs over the long run, the expansion of coverage, and the achievement of Emergency Plan targets.

A multi-sectoral approach is necessary to address comprehensively the complex needs of orphans and other vulnerable children. The core interventions children need for their current well-being and for their development are food/nutrition, shelter, protection, health care, psychosocial support, and education. A community-based response to these needs that preserves and supports families as much as possible is the primary Emergency Plan strategy. Mapping of existing and planned programs, prevalence rates, and vulnerability profiles can help determine what and where support is most needed. The stage of the epidemic is another important consideration in identifying needed programs. It is also essential to weigh the priority of serving children most in need against the practical mandate to work in areas where the U.S. Government and its partners have an ability to respond effectively and quickly. Targeted evaluations can build on effective experience and lessons learned to identify sound practices and determine which methods of service delivery and programming are most effective and of the highest quality.

OVC activities directly provide support to OVCs, and their caregivers, families, and community members; build the capacity of local organizations; strengthen monitoring and quality-assurance systems; and advocate for sound strategies, policies and national programs that benefit OVCs. The following is a useful way of categorizing these varied types of interventions:

• Child Level ? Ensure provision of core interventions that create opportunities for vulnerable children to grow and develop appropriate to the norms in their community and cultural context;
• Caregiver/Family Level ? Train and provide direct support to caregivers (including adolescent heads of household) to improve their ability to care for vulnerable children; and
• Systems Level ? Build local, regional and national capacity to strengthen the structures and networks that support healthy child development, to gather and use information, and to develop policy and program responses that lead to comprehensive and effective care for OVCs.

Each level of programming has different implications for scale-up, reach/coverage, cost effectiveness, impact and sustainability - all elements that must be considered when developing a comprehensive OVC portfolio. In addition, OVC programs must balance these factors while ensuring the quality of each.

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