Realistic expectations: exploring the sustainability of graduation outcomes in a program for children affected by HIV in Kenya’s Northern Arid Lands

ABSTRACT

Orphans and vulnerable children (OVC) programs in high HIV prevalence contexts are shifting toward ‘graduation’ approaches to facilitate outcome-focused programming, but little is known about the sustainability of participant outcomes post-graduation. We conducted a qualitative follow-up study to 4Children’s quantitative tracer study of the APHIAplus IMARISHA program in Kenya examining the sustainability of graduation benchmarks nine months after graduation. Our analysis examined effective intervention sequencing, graduation benchmarks, and characteristics linked to household-level backsliding, with a focus on the role of economic capacity-building interventions. We conducted 59 in-depth interviews with IMARISHA participants and four key informant interviews with program implementers. High levels of backsliding among tracer study participants demonstrate a misalignment between interventions received and expected outcomes as measured by benchmarks. Our analysis identified several barriers to sustaining program gains, including constraints on the availability or intensity of interventions, ongoing dependency on program resources, and weak execution of the graduation process. No pattern emerged to explain the most effective sequence of interventions, and no intervention could be described as most important to sustainability, but greater participation across interventions was linked to improved outcomes. We recommend longer-term economic capacity-building paired with ‘family strengthening’ interventions addressing internal household social issues to improve sustainability.

KEYWORDS:

• OVC
• HIV
• PEPFAR
• graduation
• economic strengthening

Acknowledgments

The authors thank Dr. Andres Martinez and Dr. Joyce Olenja for their contributions to this study.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This study was produced under United States Agency for International Development (USAID) Cooperative Agreement No. AID-OAALA-13-00001 and was made possible by the generous support of the American people through USAID and the United States President’s Emergency Plan for AIDS Relief. The contents are the responsibility of FHI 360 and do not necessarily reflect the views of USAID or the United States Government.