Determining Program Beneficiaries Assembling a Portfolio

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3.2 Assembling a Portfolio

Based o a a al sis of e ide e gathe ed u de the Five K o s, programs must determine achievable objectives for the portfolio over for a three- to five-year timeframe. 40 Objectives of the portfolio include those required to achieve PEPFAR global goals and those that achieve the unique goals of the country program as articulated in country national plans of action and the Partnership Framework.

3.2.1 Determining Program Beneficiaries

By any estimate, the vast numbers of children who are potential beneficiaries for USG assistance far outstrip resources available. The intended beneficiaries of PEPFAR programs as defined in the Hyde- Lantos Act include Childre ho ha e lost a parent to HIVAIDS, who are otherwise directly affected by the disease, or who live in areas of high HIV prevalence and may be vulnerable to the disease or its socioeconomic effects . The legislation further states that PEPFAR strategies should be guided by an a al sis of… I fa to s o t i uti g to hild e s ul e a ilit to HIVAID“; a d II ul e a ilities aused the i pa t of HIVAID“ o hild e a d thei fa ilies. I additio the H de-Lantos Act stipulates the eed i areas of higher HIVAIDS prevalence, to promote a community-based approach to vulnerability, maximizing community input into determining which children participate . 41 In all epidemics, beneficiaries of direct services can be identified through several channels including: 1 HIV-specific services – PMTCT, voluntary counseling and testing, treatment, home-based care, support groups for people living with HIV, etc. 2 Social services – child welfare services, post-rape care centers, etc. 3 Key populations initiatives – including prevention programs for high-risk persons under age 18 In higher-prevalence areas where populations at large have been impacted by HIV and there is greater opportunity for broader-scale interventions, community identification of beneficiaries is also key. Aligned with the overarching principle of helping children by strengthening families, programs should e plo a child-focused, family-centered app oa h to ta geti g. One example of a child-focused, family-centered intervention is savings groups that work with adult caregivers but evaluate their success based on child outcomes such as increased school attendance. The child-focused, family-centered approach underlines the importance of avoiding situations that may foment family discord for example, providing school assistance for only one of several children out of school in the same household and stresses the value of interventions that support holistic family health. In addition, OVC programs should strive to be inclusive rather than exclusive in their delivery of services. This is especially critical in higher-prevalence settings where programs have the mandate and flexibility to oade thei effo ts to i lude hild e that may be vulnerable to the disease or its socioeconomic effects . An inclusive approach might entail special outreach efforts to ensure that children affected by 40 Timelines for portfolio strategies should, as is feasible, coincide with country national plans of action and take into account mission exit strategies. 41 Hyde-Lantos Act: http:www.govtrack.uscongressbills110hr5501 21 HIV benefit from certain services. However, it would not exclude other poor children in the same high- prevalence setting from benefiting as well. It is important to note that the distinction between inclusive and exclusive targeting relates as much to the choice of intervention as it does to the choice of beneficiary. Services that are more specific to persons affected by HIV, such as succession planning, disclosure and bereavement support, or support for treatment adherence, are not likely to cause stigma when given to the few who need it. However, handouts exclusively to HIV-affected households of foodstuffs, school uniforms, and other material goods are likely to cause stigma and should be avoided. Policy development and government-strengthening efforts should also employ an inclusive rather than exclusive approach. Many of the policy and national systems-level issues that specifically impact on the lives of children affected by HIVAIDS also have the potential to improve the lives of a larger group of children, including efforts related to inappropriate institutionalization of children and the availability of alternative family-based care and weak child protection capacity.

3.2.2 Programming for a Range of Ages and Stages