PEPFAR OVC Guiding Principles

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2. PEPFAR OVC PRINCIPLES AND APPROACH FOR PROGRAMMING

2.1 PEPFAR OVC Guiding Principles

This guidance mirrors principles found in the Framework for the Protection, Care and Support of Orphans and Vulnerable Children Living in a World with HIVAIDS The Global Framework as well as those found in the UNAIDS Investment Framework for HIVAIDS. The principles are also aligned with the objectives included in the U.S. Government USG National Action Plan for Children in Adversity: A Framework for U.S. Government Foreign Assistance, which was developed under the auspices of the USG Secretariat for Children in Adversity PL 109-95. Specifically, the following principles undergird all PEPFAR OVC programming: Strengthening families as primary caregivers of children Strengthening systems to support country ownership, including community ownership Ensuring prioritized and focused interventions that add ess hild e s ost critical care needs Working within the continuum of response to achieve an AIDS-free generation 2.1.1 Strengthening families as primary caregivers of children Within PEPFAR OVC programs, the family should be the primary unit of intervention. In fact, 95 percent of all children affected by HIVAIDS live in families, and interventions that support entire households to p o ide fo hild e s eeds a e e ou aged. Interventions that promote family involvement in hild e s de elop e t, uild pa e tal k o ledge a d skills, and improve family stability through, for e a ple, effo ts to a d e o o i se u it a d so ial i lusio fall u de the u i of fa il strengthening. 24 These efforts are foundational to programs addressing children affected by HIVAIDS. 25 Programs should not singularly target any child within the family without considering the needs of other siblingschildren as well as the needs of primary caregivers at the household level. 2.1.2 Strengthening systems to support country ownership, including community ownership All PEPFAR OVC programs should support country ownership and systems strengthening see Section 11 and remember that the USG is only one of many funders and implementers supporting the HIVAIDS response. Working with host-country governments as well as other key stakeholders, such as the Global Fund to Fight AIDS, Tuberculosis and Malaria, is a key facet of building country ownership. The principles and approaches within this guidance should inform collaboration and interaction with all players at the country level. Community ownership is a central but often overlooked element of country ownership at the micro level. It contributes to macro outcomes and is crucial for sustainable, positive outcomes for children in both the short and long terms. It is also a central and long-standing feature of OVC programming. Country ownership is central to the PEPFAR strategy and has been widely endorsed by both donor and recipient nations. The Paris Declaration, developed in 2005 and supported by the United States, outlines country ownership as one of five fundamental principles for aid effectiveness. 26 Without strong 24 Caspe M, Lopez M. 2006. Lessons from family-strengthening interventions: Learning from evidence-based practice. Cambridge, Mass.: Harvard Family Research Project. 25 Richter L, Sherr L, et al. 2009. Strengthening families to support children affected by HIV and AIDS, AIDS Care. 21 S1, 3-12. 26 Organization for Economic Co-operation and Development; Development Co-operation Directorate; [web site]. Accessible at: http:www.oecd.orgdocument180,3746,en_2649_3236398_35401554_1_1_1_1,00.html . Online. Internet. Accessed 2011 Sept. 7. 12 community ownership, government initiatives and services can ultimately be weak and ineffective at the point of delivery, where effectiveness matters most. 27 PEPFAR OVC programs also support country ownership at the national level through social welfare workforce strengthening to increase human resources that serve children and complement health systems strengthening. 2.1.3 Ensuring prioritized, focused interventions that address chil dre ’s ost riti al are eeds The number of intervention areas pursued by country programs, as well as the level of technical competence required to deliver different interventions, depends largely on country context and the budget and longevity of the program. There are thus no preset minimums for the number or range of i te e tio s e ui ed pa t e s, o is the e a o e size fits all pa kage fo ost ou t p og a s. When working with children with multiple needs, it is tempting to try to do everything. However, such attempts generally lead to poor quality programming with little depth or sustainable impact. In all p og a s, assess e ts should e do e to ide tif hild e s ost iti al a e eeds, prioritized based on urgency as well as proven effectiveness. In this guidance, the seven core areas have been reinterpreted to better acknowledge the important role of strengthening parents and caregivers so that the a p o ide fo thei hild e s basic needs. While all needs cannot be met through OVC programs, linkages can be made within and throughout a system of care to help cover the range of needs identified through household assessment. 2.1.4 Working within the continuum of response to achieve an AIDS-free generation When considering OVC interventions and program implementation, all actors should intentionally consider how the interventions planned fit into the HIVAIDS continuum of response CoR. The CoR approach addresses the lifetime needs of the target populations to ensure adequate access to a wide range of prevention, care, and treatment services based on the changing needs and circumstances of the families that are being served. HIV services, including OVC programming, are part of the larger CoR that add esses the e ti et of the populatio s eeds, i ludi g so ial a d e otio al eeds that esult from the effects of the epidemic. The CoR approach should be set within an organized and coordinated system of community- and facility-based services and providers. OVC programs find their place in the continuum by considering the ways in which HIV AIDS is a biosocial event and how the different interventions advance the goal of an AIDS-free generation see Section 2.3.

2.2 PEPFAR OVC Program Approach