(OVC_SERV) Number of beneficiaries served by PEPFAR OVC programs for children and families affected by HIV
PEPFAR is mandated to care for children orphaned or made vulnerable by HIV. Mitigating the impact that HIV is having on children and the families that support them is integral to a comprehensive HIV response. It is important to note that the definition of “affected” children includes, but is not limited to, children living with HIV and children at risk of HIV infection. PEPFAR recognizes that individuals, families, and communities are affected by HIV in ways that may hinder the medical outcomes of HIV-positive persons as well as the emotional and physical development of children orphaned or made vulnerable by HIV/AIDS. A variety of services are supported through PEPFAR to mitigate these effects in order to improve health and well-being outcomes of children and adults to contribute to epidemic control. The goal of OVC programs is to build stability and resiliency in children and families who are exposed, living with, at risk of, or affected by HIV/AIDS. This is achieved through rigorous case management and provision of and access to health and socio-economic interventions.
This indicator is a direct (output) measure of the number of individuals receiving PEPFAR OVC program services for children and families affected by HIV/AIDS. The total numerator of this indicator is disaggregated by Program Participation Status: “active” to track the number of OVC and caregivers actively enrolled in an OVC program and receiving services, and “graduated” to track the number of OVC and caregivers graduating from PEPFAR OVC programs. Graduation requires that each child and caregiver in the household achieve a global set of minimum benchmarks. These graduation benchmarks purposefully set a high standard for children and caregivers to exit the program in a stable situation. Partners may include additional benchmarks based on local criteria for achieving stability, but all PEPFAR agencies and programs receiving HKID funding for OVC programs must adopt the eight minimum benchmarks. Exceptions to use of the benchmarks when counting OVC beneficiaries are outlined in the “Disaggregate descriptions and definitions” section below.
Additional disaggregates for “transferred out to a PEPFAR-supported partner”, “transferred out to a non-PEPFAR supported partner”, and “exited without graduation”, while not included in the total numerator, capture critical information on the differing situations of children who have left the program and track the movement of children and their caregivers between PEPFAR and host-country programs that provide a sustainable response to OVC needs. Transfers to host-government services for unstable households in geographic areas not prioritized by PEPFAR should be counted as transfers to non-PEPFAR supported programs.
Illustrative eligible interventions have been added to this guidance to ensure that children (and their caregivers) counted as “active” receive substantive, timely, and regular support based on a needs assessment after enrollment. See Appendix E.
Number of beneficiaries served by PEPFAR OVC programs for children and families affected by HIV.
How to calculate annual total:
To calculate data for annual results for OVC_SERV:
Sum the reported number of Q4 Active (children and caregivers who received services in each of the preceding two quarters (Q3 + Q4)) + Q4 Graduated (all OVC that graduated from the OVC program in the fiscal year).
Q4 OVC_SERV = (Active Q4) + (Graduated Q4)
Individuals should only be counted once by each partner at Q4 reporting, and the graduated, exited, and transferred disaggregates should be reported cumulatively at Q4. Program participation status at the end of Q4 should take precedence for where to count an individual (i.e., if a beneficiary was counted as exited without graduation at Q2 but had met the criteria to be counted as active at Q4, then they should be reported at Q4 only under the active category and not in the total reported for exited without graduation). The exits, graduations, and transfers are a snapshot for the entire fiscal year at the time of reporting (either Q2 or Q4).
How to collect:
Data sources include PEPFAR OVC program registers and other records of program data generated by implementing partners. Implementing partners’ registers need to record names of children and caregivers, likely requiring use of a unique ID system, who meet the criteria for “active beneficiary” or “graduated” to generate the numerator total and disaggregates included in this indicator. Each individual should be counted only once under OVC_SERV in the reporting period. In addition to counting active and graduated beneficiaries, implementing partners should record whether children or caregivers “transferred out to a PEPFAR-supported partner”, “transferred out to a non-PEPFAR supported partner”, or “exited without graduation.” The program participation status and transfer/exit disaggregate categories are mutually exclusive.
All agencies and programs receiving HKID funding are required to report on this indicator.
Please note that there is specific guidance related to graduation. PEPFAR guidance for graduation from an OVC project includes the following eight benchmarks that are required for all OVC programs (see Appendix F for additional details and definitions).
Reporting scenarios and frequently asked questions for OVC reporting are included in Appendix G.
How to review for data quality
Review PEPFAR OVC implementing partners’ results to ensure that there is no double counting. Review IP and site results for deviations from one period to the next which may indicate rapid exit and entry of beneficiaries or high sudden graduation rate in one, versus another period.
Age/sex disaggregates will auto-sum the total numerator.
Reporting Level: Facility and community
Disaggregate descriptions & definitions:
Program Participation Status Definitions:
- “Active beneficiary” is an individual, a child or caregiver, who has received at least one PEPFAR OVC program service in each of the preceding two quarters. New beneficiaries enrolled during the reporting period can be counted as active only if they have received at least one service in the last quarter. For OVC_SERV, a caregiver fulfills the role of parent or guardian, and there should be no more than two primary caregivers per household. In most cases, given the vulnerability status of the households PEPFAR serves, there is likely to be only one primary caregiver (i.e., parent/guardian). While adults or household members who are not caregivers fulfilling the role of parent or guardian may indirectly benefit from program support or access a one-time service, they should not be counted, as that does not meet the intention of increasing primary caregivers’ access to critical services and support.
Active OVC_SERV beneficiaries include several, potentially overlapping, categories of recipients with the following requirements:
- Child beneficiary (“OVC”) aged 0-17 (note: children aged 18 to 20 still completing secondary education or an approved economic intervention intended to secure the livelihood of an OVC aging out of the program may be included):
- Has a case plan that has been developed (or updated) in last 12 months
Continues to be monitored at least quarterly, but as often as is necessary according to the child’s safety, schooling, stability, and health status. Monitoring includes establishing contact in person, or virtually where needed, to ensure that the case plan is progressing, and documentation of this contact is recorded in the case plan.
Has received directly from the project, was facilitated to obtain, or has a completed referral for at least one intervention in each of the preceding two quarters (see Appendix E for illustrative eligible interventions; if a service is not included on this list, the partner must seek and receive approval from local USG funding agency and note this in the OVC_SERV narrative). Intake assessment, enrollment, subsequent assessments including HIV risk assessment, case plan development, and case plan monitoring are considered critical administrative processes rather than services but remain critical to ensuring provision of needs-based services in a timely manner.
Caregiver beneficiary (primarily aged 18+) of an OVC (child/adolescent aged 0-17 or 18-20 still completing secondary education or an approved economic intervention intended to secure the livelihood of an OVC aging out of the program) who has met the following criteria:
Has received directly from the project, was facilitated to obtain, or has a completed referral for at least one caregiver intervention in each of the preceding two quarters (see Appendix E for illustrative eligible interventions).
In addition, select services, including parenting, household economic strengthening, and food security interventions (specified in Appendix E in the caregiver and child column), qualify both the caregiver and OVC to be counted as active.
Active DREAMS beneficiary aged 10-17
An active DREAMS beneficiary who is not otherwise actively enrolled in an OVC program must receive a DREAMS service/intervention that is also included in the list of OVC_SERV illustrative services (Appendix E). They should be counted as “active” in the reporting period in which they received an eligible service. These individuals are not required to have an OVC case plan or to be monitored using the OVC graduation benchmarks, thus they will never be reported under the graduated, exited, or transferred disaggregates. Active DREAMS beneficiaries should also be counted under the AGYW_PREV indicator according to their layering status.
Active DREAMS beneficiaries aged 18+ who are not otherwise actively enrolled in an OVC program should NOT be counted under OVC_SERV.
Children aged 9-14 receiving only a primary prevention of HIV & sexual violence intervention Prevention of HIV and sexual violence are important services that fit under the core benchmarks of the OVC program. Delivery of these services may differ from the comprehensive OVC program.
A child (boy or girl) aged 9-14 who is not otherwise actively receiving services in the comprehensive OVC program, but who is receiving an approved primary prevention intervention through a community entry point should be counted as “active” in the fiscal year in which they complete the intervention. At Q2, report the number of beneficiaries who completed an approved primary prevention intervention in the past two quarters. At Q4, report the number of beneficiaries who completed an approved primary prevention intervention in the past four quarters and did not become enrolled in the comprehensive OVC program.
These individuals are not required to have an OVC case plan or to be monitored using the OVC graduation benchmarks, thus they will never be reported under the graduated, exited, or transferred disaggregates.
Approved primary prevention of sexual violence and HIV interventions are as follows: Families Matter Program, Sinovuyo Teen, Coaching Boys into Men, IMpower, and Stepping Stones. Countries are strongly encouraged to implement one of these five pre-approved curricula. All other curricula used for 9-14 primary prevention must be approved by S/GAC and the relevant agency HQ and must include the three S/GAC evidence-informed modules on healthy and unhealthy relationships, healthy choices about sex, and understanding non- consensual sex.
- “Graduation” is defined as the point at which a household enrolled in a PEPFAR OVC program is deemed to have become more stable and is no longer in need of project- provided services. For caregivers and children <18 (or aged 18- 20 and completing secondary education or an approved economic intervention intended to secure the livelihood of an OVC aging out of the program) to be counted as an individual graduated in DATIM, all child and all caregiver beneficiaries in a household must meet all applicable (age and HIV status specific) graduation benchmarks established by PEPFAR for improving stability in the household. For the purposes of graduation, a household is defined as all children in the household/family unit less than age 18 years and their caregiver(s) (not to exceed two people fulfilling the role of parent or guardian per household/family unit). PEPFAR guidance for graduation from an OVC project includes the following eight benchmarks (see Appendix F for additional details, definitions, and data sources), which align with the illustrative services in Appendix E. Countries may include additional benchmarks, but the eight global benchmarks are a minimum requirement.
- BENCHMARK 1.1.1: All children, adolescents, and caregivers in the household have known HIV status or a test is not required based on risk assessment
- BENCHMARK 1.2.1.
- (a) All HIV+ children, adolescents and caregivers in the household with a viral load result documented in the medical record and/or laboratory information systems (LIS) have been virally suppressed for the last 12 months OR if viral load testing or viral load testing results are unavailable at clinic treating HIV+ beneficiaries, then:
- (b) All HIV+ children, adolescents, and caregivers in the household have adhered to treatment for 12 months after initiation of antiretroviral therapy
- BENCHMARK 1.3.1.: All adolecents 10-17 years of age in the household have key knowledge about preventing HIV infection
- BENCHMARK 1.4.1.: No children <5 years in the household are undernourished
- BENCHMARK 2.1.: Caregivers are able to access money (without selling productive assets) to pay for school fees and medical costs for children aged 0-17
- BENCHMARK 3.1.1.: No children, adolescents, and caregivers in the household report experiences of violence (including physical violence, emotional violence, sexual violence, gender-based violence, and neglect) in the last 6 months
- BENCHMARK 3.1.2.: All children and adolescents in the household are under the care of a stable adult caregiver
- BENCHMARK 4.1.1.: All school-age children and adolescents in the household regularly attend school and progressed in school during the last year
Exited or Transferred Disaggregate Definitions:
- “Transferred out to a non-PEPFAR-supported partner” is defined as when a child or caregiver beneficiary has transitioned to programs that are not PEPFAR funded. These could include country-led services or other donor-funded programs.
“Transferred out to a PEPFAR-supported partner” is defined as when a child or caregiver beneficiary has transitioned from the support of one PEPFAR partner to another PEPFAR partner.
“Exited without graduation” is defined as when a child or caregiver has not received program services in each of the past two preceding quarters or is lost-to-follow up, re- located, died, or the child has aged-out of the program without the household meeting graduation benchmarks from the PEPFAR OVC program.
Program participation status categories (i.e., active, graduated, exited without graduation, transferred out to a non-PEPFAR-supported partner, and transferred out to a PEPFAR- supported partner) are mutually exclusive such that an individual should be counted under only one category per partner, per reporting period.
The numerator is the sum of the following Program Participation Status disaggregates:
- Active beneficiaries (children and caregivers)
- Graduated beneficiaries (children and caregivers graduated in the reporting period)
Indicator changes (MER 2.0 v2.3 to v2.4):
- Clarifying language added that exited, transferred, and graduation disaggregates should be reported cumulatively at Q4.
Expanded definition of “child” OVC beneficiary to include children aged 18 to 20 still completing secondary education or an approved economic intervention intended to secure the livelihood of an OVC aging out of the program.
Clarifying language added regarding counting active DREAMS beneficiaries who are not otherwise actively enrolled in the OVC program under OVC_SERV.
Clarifying language added regarding the definition and number of caregivers per household.
Clarifying language added to describe how to account for the OVC recipient category of children aged 9-14 receiving only an approved primary prevention of HIV and sexual violence intervention who are otherwise enrolled in the OVC comprehensive program.
PEPFAR Support definition:
Modifications to standard definition of DSD and TA-SDI related to eligible goods and services:
Provision of key staff or eligible goods/services for OVC beneficiaries receiving care and support services in the community includes: For beneficiaries of OVC services, this can include funding of salaries (partial or full) for staff of the organization delivering the individual, small group, or community level activity (e.g., psychosocial support, child protection services, education, etc.). Partial salary support may include stipends or incentives for volunteers/para-social workers or paying for transportation of those staff to the point of service delivery. For goods or services to be eligible, goods or services (e.g., bursaries, cash transfers, uniforms) can either be paid for out of the implementing partner’s budget or be provided as a result of the IPs efforts to leverage and mobilize non-project resources. For example, an IP may help beneficiaries fill out and file forms necessary for the receipt of government provided cash transfers, social grants, or bursaries for which they are eligible. Given the focus on long-term local ownership, IPs are encouraged to mobilize goods and services whenever possible.
For care and support services, ongoing support for OVC service delivery for improvement includes: the development of activity-related curricula, education materials, etc., supportive supervision of volunteers, support for setting quality standards and/or ethical guidelines, and monitoring visits to assess the quality of the activity, including a home visit, a visit to a school to verify a child’s attendance and progress in school or observation of a child’s participation in kids’ clubs.
Guiding narrative questions:
- Please explain reasons and context for highest/lowest performing partners’ performance (i.e., results/target) for OVC_SERV total numerator and OVC_SERV <18, including any programmatic shifts or monitoring updates.
- Please explain results by Program Participation Status:
- For active beneficiaries, were there any interventions that were provided and approved by local USG funding agency that were not included in the illustrative examples (Appendix E)?
- For active beneficiaries aged 10-14 and 15-17, how many individuals were active DREAMS beneficiaries aged 10-17 not otherwise enrolled in the OVC program?
- For active beneficiaries aged 5-9 and 10-14, how many individuals were children aged 9-14 who completed an approved primary prevention intervention and who were not otherwise enrolled in the OVC program?
- For active beneficiaries aged 18+, how many individuals are OVC beneficiaries aged 18 to 20 still completing secondary education? How many are OVC beneficiaries aged 18 to 20 receiving an approved economic intervention intended to secure their livelihood as they age out of the program?
- For graduation, were any of the benchmarks especially challenging to achieve or monitor? If so, which ones and why?
- Please explain results by exited/transferred:
- How many beneficiaries exited without graduation? Please explain the reasons for exiting without graduation and try to quantify with percentages if possible. Are there certain partners with higher rates of exiting without graduation? How are you managing this with the partner(s)?
- How many beneficiaries were transferred? To whom (e.g., other NGOs, government support, etc.) were they transferred? Where were beneficiaries transferred? Please provide disaggregates for beneficiaries transferred to specific sources of support.