Improving the growth and development outcomes for young children affected by HIV and AIDS in East and Southern Africa.

Young Children Affected by HIV and AIDS Strategy

Phase Two: 2017–2021

An estimated 250 million children between 0-5 years, living in low- and middle-income countries, are at risk of poor development — and children living in communities affected by HIV and AIDS are particularly vulnerable. Early childhood development (ECD) interventions provide a powerful opportunity to level the playing field for these children.

The global Sustainable Development Goals (SDGs) target 4.2 includes early childhood development to “ensure that all girls and boys have access to quality ECD.” Further, the 2016 Lancet series “From Science to Scale” highlighted the importance of supporting children and families during the first 1,000 days of life when development is most rapid and when nurturing care (including responsive caregiving, stimulation and early learning, health, nutrition, and security and safety) by parents and other caregivers is among the most decisive factors for healthy child growth and development. The series further highlighted the need for multi-sectoral interventions, particularly the role of the health sector given its reach to families and children in the early years.

Building on increasing evidence and global momentum as well as our learning and achievements in Phase One , the Foundation’s 2017-2021 strategy focuses on advancing proven and promising approaches to improve caregiving and early learning, strengthening systems through integration and collaboration, and building and disseminating credible evidence to improve practice and policy.

Target Countries for Children Affected by HIV and AIDS

While we work to leverage the growing commitment and political will on ECD at the global level, our emphasis is on the first 1,000 days and health systems in high HIV prevalence communities in Kenya, Malawi, Mozambique, Tanzania and Zambia. The Foundation board of directors has pledged $55 million toward the five-year strategy and, together with our partners, we aim to demonstrate effective, scalable approaches to improve growth and development outcomes for young children.

One key tool for this work is the Nurturing Care Framework. Launched in May 2018 at the World Health Assembly, The Framework provides an evidence-based road map for action and outlines how policies and services can support parents, families, other caregivers and communities in providing nurturing care for young children. It calls for attention to be paid to communities where children are most at risk of being left behind.

In line with increased global political momentum and the priorities of the Nurturing Care Framework, the Foundation is investing in three inter-related focus areas in Phase Two:

1) Advancing proven and promising approaches to improve caregiving and early learning

The Foundation seeks to improve the quality and effectiveness of programs that benefit young children living in high HIV prevalence communities — with emphasis on the first 1,000 days (pregnancy through age 2) and responsive caregiving. Foundation investments will include integrating caregiver coaching and support as part of existing service delivery platforms, reaching the most vulnerable and raising awareness among community members.

2) Strengthening systems through integration and collaboration

To reach caregivers and children, Foundation investments will strengthen civil society organizations, government system and networks — including community-based organizations, faith-based entities and capacities of service providers, and government authorities at all levels (local, district and national). In addition, investments will support scale-up of ECD services at the district/county level in several countries.

3) Building and disseminating credible evidence to improve practice and policy

To influence practice, policy and investments, the Foundation will address key gaps in learning and best practice. Investments will strengthen research and technical capacity — including for advancing measurement of child development outcomes. Field-testing approaches and reaching decision-makers with evidence on what works will facilitate replication, scale-up and increased funding for quality early childhood services.

The Foundation’s Phase Two Strategy is an opportunity to lay the groundwork for achieving the SDGs. The Foundation is eager to contribute progress on the SDGs, while ensuring that the most vulnerable children affected by HIV and AIDS are not left behind. Building on a successful initial Phase One, our current strategy aims to support a more focused, evidence-based approach to high-quality interventions. This approach targets pregnant women and caregivers of the youngest children over the first 1,000 days, working through civil society and government systems and networks.

Young Children Affected by HIV and AIDS Strategy

Phase One: 2012-2016

Children have been a priority for the Foundation for many years. In 2011, the Board of Directors commissioned a landscape on children affected by HIV and AIDS, which indicated progress in decreasing rates of vertical transmission. Although a treatment gap for children persists and testing of children is inadequate, research indicates that even if a child is not infected with the HIV virus, being exposed to HIV in utero (being born to a mother living with HIV) poses risks to healthy development. Further, as more women are initiated on treatment, greater numbers of children are growing up in families impacted by HIV, with a host of additional stresses that HIV presents for caregiving.

Despite this, our landscaping revealed a gap in services for children age 0-5 and indicated that early childhood development (ECD) was not part of the mainstream HIV response. Based on these findings — and the evidence that ECD interventions provide a powerful opportunity to level the playing field for these vulnerable children, families, and communities — the Foundation’s Board of Directors approved a five-year strategy in 2011 to address ECD for young children affected by HIV and AIDS — with a focus on improving cognitive, social and physical development outcomes.

Between 2012-2016, the Foundation’s Children Affected by HIV and AIDS Strategy focused on three inter-related focus areas: 1) building the capacity of parents and caregivers to meet the developmental needs of their young children; 2) strengthening the capacity of community-based organizations; and 3) improving practice and policy via knowledge sharing. The Board approved $51 million in investments focused on five countries in East and Southern Africa: Kenya, Malawi, Mozambique, Tanzania and Zambia. All five countries have high HIV prevalence rates and large numbers of HIV-affected children and families.

In Phase One, a major lesson learned was the need for greater emphasis on reaching pregnant women and caregivers of very young children from birth through age 2 during the first 1,000 days when brain development is most rapid and when stable, responsive caregiving is most critical. Our Phase Two Strategy incorporates these and other key learnings to address the key challenges to delivering high-quality interventions that are effective, scalable, and sustainable.

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