Improving early childhood development outcomes for young children affected by HIV and AIDS.

Phase One (2012-2016)

Children have been a priority for the Foundation for many years. In 2011, the Board of Directors commissioned a survey of the landscape related to children affected by HIV and AIDS. The research and consultations revealed a gap in services for the youngest children age 0-5 years and indicated that early childhood development (ECD) was not part of the mainstream HIV response. On the other hand, ECD interventions provide a powerful opportunity to level the playing field for these vulnerable children, given the multiple ways in which HIV and AIDS negatively impact children, families and broader communities. Based on these findings, the Foundation’s Board of Directors approved a five-year grantmaking strategy in 2011 for beginning to address ECD for young children affected by HIV and AIDS – with a focus on improving cognitive, social and physical development outcomes. Over the initial five-year period from 2012-2016, the Foundation’s Children Affected by HIV and AIDS Strategy focused on three programmatic emphases: 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 a total of $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 thus large numbers of HIV-affected children and families. A major lesson learned was the need to place more emphasis on reaching pregnant women and caregivers of very young children from birth through age 2 – during the first thousand days when brain development is most rapid and when stable, responsive caregiving is critical. The Phase Two Strategy incorporates key learnings with the overall intention to address the key challenges to delivering high-quality interventions that are effective, scalable, and sustainable.

Landscape

The HIV epidemic is far from over, particularly when it comes to children and HIV. While there has been good progress in decreasing rates of vertical transmission (passed from mother to child during pregnancy, delivery or breastfeeding), a treatment gap for children persists. Testing of children is inadequate and only half of the estimated 1.8 million children under the age of 15 living with HIV have access to treatment. Without treatment, half of all children living with HIV will die before their second birthday. New research suggests 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, will all the stresses that HIV presents for caregiving.

The Sustainable Development Goals (SDGs) include early childhood development (target 4.2) and the World Bank has called for prioritization of ECD to enable countries to compete in the new global economy. The Foundation’s second phase strategy thus comes at an opportune time when the Foundation can join forces with a growing coalition of actors to contribute to reaching the SDGs by 2030 and specifically to demonstrate effective, scalable approaches to improve developmental outcomes for young children (0-5 years) affected by HIV and AIDS in Kenya, Malawi, Mozambique, Tanzania and Zambia. Our strategy seeks to leverage the increased commitment and political will that ECD is benefiting from, while addressing key challenges including a lack of evidence regarding effective ECD approaches in these African country settings. Therefore, over the next five years, we will focus on identifying and testing approaches that have the potential to improve cognitive, social and physical development.

Vision

To improve the developmental outcomes of all young children (0-5 years) affected by HIV and AIDS in Kenya, Malawi, Mozambique, Tanzania and Zambia by 2030 in line with SDG target 4.2.

Approach

Phase Two (2017 – 2021)

Very little attention has been given to developing scalable models for promoting responsive care and stimulation of the very young child, even though growing evidence identifies the first 1,000 days as most sensitive for socio-emotional, language, cognitive development and physical development. In the context of known detrimental effects of malnutrition—HIV and stress among others—on child development, ECD interventions become critical towards reducing long term consequences of these pervasive factors for millions of vulnerable children in the developing world. The health sector alone among government service delivery structures is well placed to reach caregivers of the youngest children at scale, by offering multiple regular contacts with both caregiver and child from pregnancy through the first years of life, during which time evidence-based interventions that support nurturing care in the home can be provided.

Through its grantmaking, the Foundation will focus on identifying and testing approaches that have the potential to improve cognitive, social and physical development by investing in three focus areas:

1) Strengthen Approaches to Improve Caregiving and Early Learning Opportunities:

The Foundation will support caregivers of young children in multiple contexts, including as part of health services and daycare programming. Our hypothesis is that, if we improve the quality and effectiveness of programs for parents and caregivers of vulnerable, young children living in high HIV prevalence communities (with emphasis on the first 1,000 days—conception through age 2), over time child developmental outcomes will improve.

2) Strengthen Civil Society and Government Systems and Networks:

To reach caregivers, the Foundation will strengthen civil society organizations – including community-based organizations, faith-based entities and capacities of service providers; government authorities at all levels (local, district and national); and networks, who are ultimately responsible for establishing standards for quality and monitoring of ECD services in community and facility settings. We hypothesize that by strengthening these systems, we will be able to reach caregivers and children affected by HIV and AIDS in a sustainable manner.

3) Build and Disseminate Evidence to Improve Practice and Policy:

To influence practice, policy and investments at the national and global levels, the Foundation will build and widely share the evidence base and address key knowledge gaps. Our hypothesis is that if we generate credible evidence concerning what approaches work best, that this will facilitate the replication and scale up of proven ECD interventions.

The next five years provide the opportunity to lay the groundwork for achieving the SDGs. The Foundation is eager to contribute to this endeavor, while ensuring that the most vulnerable children affected by HIV and AIDS are not left behind. Building on a successful initial Phase One, the Phase Two Young Children Affected by HIV and AIDS Strategy will aim to support a more focused, evidence-based approach to high-quality interventions targeting pregnant women and caregivers of the youngest children over the first 1,000 days, working through civil society and government systems and networks.

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