June 2014 
 
Yekokeb Berhan Program for Highly Vulnerable 
Children In Ethiopia
Mid-Term Evaluation Report
1 
ACKNOWLEDGEMENTS 
This midterm evaluation exercise was made possible by the generous support of the American 
people through the United States Agency for International Development (USAID), Cooperative 
Agreement Number AID-663-A-11-00005. The contents are the responsibility of ABH Services,
PLC and do not necessarily reflect the views of USAID or the United States Government.
ABH Services was commissioned by Pact to conduct this midterm evaluation of Yekokeb Berhan 
program for highly vulnerable children (HVC) in Ethiopia. ABH would like to express its gratitude 
to Pact and USAID Ethiopia for the opportunity to serve on this important assignment. The 
evaluation team is grateful to the HIV/OVC team at USAID Ethiopia for their support, guidance 
and feedback. ABH would like to extend its appreciation and thanks to Dr. Samson Radeny (Chief 
of Party), Dr. Lucy Steinitz, Dereje Getahun, Abdu Ebrahim, Gobena Seboka and Massamo Ayele 
from Yekokeb Berhan HVC program of Pact and to Professor Getinet Mitike, Research Assistant to 
Pact for their immensely valuable inputs, sharing of all the necessary documents and facilitation of 
the evaluation process. 
ABH thanks all study participants, Yekokeb Berhan implementing partners, governmental offices 
and agencies who contributed their valuable time and energy providing the data requested for the 
study. ABH is also grateful to members of the data management team, field supervisors and data 
collectors. 
Last but not least, special thanks go to the study team members, Dr. Fekadu Adugna, Dr. Mirgissa 
Kaba, Dr. Mengistu Tafesse, Mr. Eyob Kifle for effectively shouldering this responsibility and for 
their commitment and hard work. 
Markos Feleke (MD, MPH) 
Chief Executive Officer 
ABH Services PLC 
June 25, 2014 
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TABLE OF CONTENTS 
ACKNOWLEDGEMENTS ...................................................................................................................................... 1
List of Tables ...................................................................................................................................................... 4
List of Figures ..................................................................................................................................................... 4
ACRONYMS..................................................................................................................................................... 5
DEFINITIONS OF TERMINOLOGIES ........................................................................................................... 7
EXECUTIVE SUMMARY ............................................................................................................................... 8
1. BACKGROUND ..................................................................................................................................... 15
1.1 BACKGROUND OF PACT’S YEKOKEB BERHAN PROGRAM .............................................. 15
1.2 LITERATURE REVIEW ................................................................................................................ 16
1.2.1 Global HVC Situation.............................................................................................................. 16
1.2.2 HVC/OVC Situation in Ethiopia.............................................................................................. 17
2. OBJECTIVES AND SCOPE OF THE EVALUATION ......................................................................... 19
2.1 OBJECTIVES OF THE EVALUATION ........................................................................................ 19
2.2 SCOPE OF THE MIDTERM EVALUATION................................................................................ 19
3. METHODS .............................................................................................................................................. 19
3.1 STUDY DESIGN............................................................................................................................. 19
3.2 SAMPLE SIZE AND SAMPLING PROCEDURES ...................................................................... 20
3.3 VARIABLES ................................................................................................................................... 22
3.4 DATA COLLECTION .................................................................................................................... 22
3.5 DATA ANALYSIS.......................................................................................................................... 23
3.6 DATA QUALITY ASSURANCE................................................................................................... 23
3.7 ETHICAL CONSIDERATIONS..................................................................................................... 23
4. RESULTS ................................................................................................................................................ 24
4.1 DEMOGRAPHIC CHARACTERSTICS OF CAREGIVERS ........................................................ 24
4.2 DEMOGRAPHIC CHARACTERSTICS OF HVC......................................................................... 25
4.3 IDENTIFICATION AND ENROLLEMENT OF HVC.................................................................. 27
4.4 FINDINGS BY PROJECT OBJECTIVES ...................................................................................... 28
4.4.1 Objective 1: Build the capacity of stakeholders to effectively use an improved data 
management system and employ a national HVC supervision system.................................................... 28
4.4.2 Objective 2: Employ effective and efficient family centered, age -based and inclusive HVC 
care management system ......................................................................................................................... 32
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HEALTH CARE...................................................................................................................................... 32
PSYCHOSOCIAL SUPPORT................................................................................................................. 40
EDUCATION .......................................................................................................................................... 41
FOOD AND NUTRITION ...................................................................................................................... 45
SHELTER AND CARE........................................................................................................................... 48
ECONOMIC STRENGTHENING.......................................................................................................... 48
LEGAL PROTECTION........................................................................................................................... 52
4.4.3 Objective 3: Enhance the capability of communities for coordinated and improved 
responsiveness towards HVC care ........................................................................................................... 54
4.4.4 Objective 4: Establish effective and efficient monitoring, evaluation, reporting and learning 
system ensuring evidence based programming and policy formulation .................................................. 59
4.4.5 Perceived changes at community level in consequence to Yekokeb Berhan project.............. 62
5. DISCUSSION.......................................................................................................................................... 64
a. Program Objective 1 ............................................................................................................................ 64
b. Program Objective 2 ............................................................................................................................ 65
c. Program Objective 3 ............................................................................................................................ 74
d. Program Objective 4 ............................................................................................................................ 75
6. LIMITATIONS OF THE EVALUATION .............................................................................................. 76
7. CONCLUSIONS AND RECOMMENDATIONS .................................................................................. 76
a. CONCLUSIONS.................................................................................................................................. 76
Program Objective 1 ................................................................................................................................ 76
Program Objective 2 ................................................................................................................................ 77
Program Objective 3 ................................................................................................................................ 77
Program Objective 4 ................................................................................................................................ 77
b. RECOMMENDATIONS..................................................................................................................... 78
REFERENCES ............................................................................................................................................ 81
ANNEX I: Sources of qualitative data......................................................................................................... 83
ANNEX II: Table showing details of evaluation sites................................................................................. 84
ANNEX III: Comparison of indicators at baseline and midterm................................................................. 85
ANNEX IV: Data collection tools............................................................................................................... 87
4 
List of Tables 
Table 1: Socio-demographic characteristics of caregivers ............................................................................... 24
Table 2: Demographic characteristics of HVC .................................................................................................. 26
Table 3: HVC health outcomes by age and sex ................................................................................................ 34
Table 4: HVC education outcomes ................................................................................................................... 42
Table 5: Food and nutrition indicators ............................................................................................................ 47
Table 6: Economic strengthening outcomes.................................................................................................... 50
Table 7: Summary of legal protection variables .............................................................................................. 53
Table 8: Summary of roles of community structures in connection to the Yekokeb Berhan Program ........... 58
List of Figures 
Figure 1: Distribution of survey woredas ......................................................................................................... 21
Figure 2: Relationship between HVC and Caregiver ........................................................................................ 27
Figure 3: Sources of RH information for adolescent HVC (proportion) ........................................................... 35
Figure 4: Number of HVC tested for HIV, received test result, on ART and with regular follow up ................ 36
Figure 5: Proportion of HVC tested and positive for HIV by region ................................................................. 37
Figure 6: Caregivers’ health status and care seeking behavior ....................................................................... 38
Figure 7: Proportion of caregivers received different HIV services ................................................................. 39
Figure 8: Comparison of school enrollment of HVC at baseline and MTE ....................................................... 43
Figure 9: Comparison of school enrollment of HVC at baseline and MTE by sex ............................................ 44
Figure 10: Proportion of households by major economic strengthening indicators ....................................... 51
Figure 11: Data generation and reporting procedure for Yekokeb Berhan project, April 2014 ...................... 60
 
5 
ACRONYMS 
ABH Alliance for Better Health 
AIDS Acquired Immunodeficiency Syndrome 
ART Antiretroviral Therapy 
BD Business Development 
BoLSA Bureau of Labor and Social Affairs 
BoWCYA Bureau of Women, Children & Youth Affairs 
CBO Community Based Organization 
CC Community Committee 
CCC Community Care Coalition 
CG Caregivers 
CSG Community Support Group 
CSI Child Support Index 
CSO Civil Society Organization 
CSSG Community Saving and Self-help Group 
CV Community Volunteers 
DHS Demographic and Health Survey 
ECD Early Childhood Development 
ES Economic Strengthening 
FGD Focus Group Discussion 
FHI360 Family Health International 360 
GPS Global Positioning System
HAPCO HIV/AIDS Prevention and Control Office 
HEW Health Extension Worker 
HES Household Economic Strengthening 
HIV Human Immunodeficiency Virus 
HVC Highly Vulnerable Children 
INGO International Non-Governmental Organization 
IR Intermediate Result 
IP Implementing Partner 
KII Key Informant Interview 
ME Microenterprise 
ME/MERL Monitoring and Evaluation/Monitoring, Evaluation, Reporting & Learning 
MoU Memorandum of Understanding 
MoWCYA Ministry of Women, Children & Youth Affairs 
MUAC Mid-Upper Arm Circumference 
NGO Non-Governmental Organization 
OCA Organization Capacity Assessment 
OVC Orphans and Vulnerable Children 
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PC3 Positive Change: Children, Communities, and Care Program 
PEPFAR President's Emergency Plan for AIDS Relief 
PSNP Productive Safety Net Program 
PTA Parent/Teacher Associations 
RH Reproductive Health 
SCI Saving, Credit and Investment 
SNNPR Southern Nations, Nationalities and People’s Region 
SPM Selection, Planning and Management 
SPSS Statistical Package for the Social Sciences 
SSDG Standard Service Delivery Guidelines 
TOCA Technical and Organizational Capacity Assessment 
TVET Technical and Vocational Education Training 
UNAIDS Joint United Nations Program on HIV/AIDS 
USAID United States Agency for International Development 
WFP World Food Program 
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DEFINITIONS OF TERMINOLOGIES 
Birth certificate An official record of the name, date and place of birth of a child issued 
by authorized government offices in Ethiopia. For the purpose of this 
evaluation, birth certificates issued by churches, mosques and other 
religious institutions were not considered.
Fully vaccinated Children were categorized as fully vaccinated if the caregiver reported 
that the child had received all of the age-appropriate vaccinations 
through the routine vaccination schedule in Ethiopia. For the purpose of 
this evaluation, this was confirmed by data collectors’ observation of the 
child’s vaccination card.
HVC A highly vulnerable child (HVC) is a child who is less than 18 years of 
age and whose survival, care, protection and/or development might have 
been jeopardized due to a particular condition. The child is currently in a 
situation that precludes the fulfillment of his or her rights and is enrolled 
in to Yekokeb Berhan program for support. The definition adheres to the 
guideline of Pact/Yekokeb Berhan and the Ethiopia’s Standard Service 
Delivery Guidelines for Orphans and Vulnerable Children Care and 
Support Programs.
HVC household An HVC household is a household with at least one HVC and at least 
one of these children enrolled in to Yekokeb Berhan program for 
support.
Moderate acute 
malnutrition
Children under five years of age were categorized as having moderate 
acute malnutrition when their mid upper arm circumference 
measurement was between 11 to 12 cm.
Severe acute 
malnutrition
Children under five years of age were categorized as having severe acute 
malnutrition when their mid upper arm circumference measurement was 
less than 11cm.
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EXECUTIVE SUMMARY 
BACKGROUND 
Since mid-2011, Pact has been implementing a USAID-funded program for Highly Vulnerable 
Children (HVC) called Yekokeb Berhan. This five-year program is designed to reduce vulnerability 
among HVC and their families by strengthening supportive systems and structures to deliver quality 
essential services and increase resiliency. 
The program has four primary objectives: 1) build the capacity of stakeholders to effectively use 
improved data management systems and employ a national HVC supervision system; 2) employ 
effective and efficient family-centered, age-appropriate and inclusive HVC care management 
system; 3) enhance the capability of communities for coordinated and improved responsiveness 
towards HVC care; and 4) establish effective and efficient monitoring, evaluation, reporting and 
learning systems ensuring evidence- based programming and policy formulation. 
In order to achieve these objectives, Pact has been working in partnership with Family Health 
International 360 (FHI360), Child Fund, 39 local civil society organizations (CSOs) and public 
sector organizations at the federal level: Ministry of Women, Children and Youth Affairs 
(MoWCYA), HIV prevention and Control Office (HAPCO) in nine regional states and two City 
Administrations of Addis Ababa and Dire Dawa where the program has been implemented. The 
program has been implemented in Tigray, Afar, Amhara, Oromia, Somali, Benishangul Gumuz, 
Southern Nations Nationalities and Peoples’ Region (SNNPR), Gambella and Harari regions and 
Addis Ababa and Dire Dawa cities. Yekokeb Berhan Program is targeted to reach 500,000 HVC 
and their caregivers annually in urban and peri-urban areas with relatively high HIV prevalence. 
Yekokeb Berhan Program has five regional cluster offices in Addis Ababa, Bahir Dar, Jimma, 
Hawassa and Adama towns and is currently working with 39 Implementing Partners (IPs), with ten 
operating in more than one region. 
In 2013, Alliance for Better Health (ABH) Services was commissioned by Pact to undertake the 
midterm evaluation of Yekokeb Berhan Program to document progress against various outcome 
level indicators as well as changes in the lives of beneficiaries. 
METHODS
A combination of quantitative and qualitative methods was employed to collect data to determine 
the program’s achievements and to identify benchmarks that were not addressed in the baseline 
survey. Quantitative data were collected through a cross sectional survey of HVC households. In the 
qualitative assessment, focus group discussions and key informant interviews were conducted with 
beneficiaries, community volunteers, implementing partners (IPs), community committees and 
government office staff. Secondary data including the baseline survey, routine reports, supervision 
reports and other relevant program documents were also reviewed to complement the primary data 
in order to address the four midterm evaluation objectives. 
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The evaluation was conducted in four major target regions where the majority of beneficiaries of 
Yekokeb Berhan Program are found: Amhara, Oromia, SNNPR, Tigray and the Addis Ababa City 
Administration. Using Epi Info (Center for Disease Control, Atlanta, USA) statistical software and 
multi-stage sampling, sample size was determined to be 2,142 households for the household survey. 
This was allocated to the five regions proportional to the number of beneficiary children. Zones, 
woredas, kebeles and households were selected randomly. One HVC enrolled in Yekokeb Berhan 
Program or their primary caregiver was interviewed from each of the selected households using 
survey questionnaires. When there were more than one children in the household, one was 
randomly selected. If the child was younger than 14 years of age, the caregiver was interviewed on 
behalf of the child. Children 14 years or older responded to the questions by themselves. 
Focus group discussions (FGDs) were conducted with caregivers, community committees (CCs), 
community volunteers (CVs) and saving groups in selected program sites, and a total of twenty 
sessions of FGDs were completed. Key informant interviews (KIIs) were conducted with thirty-four 
individuals representing: implementing partners; MoWCYA officers at federal, regional and woreda 
levels; international non-governmental organization (INGO) partners (Pact, FHI 360 and Child 
Fund); and Yekokeb Berhan Program regional cluster managers. 
Quantitative data were entered into SPSS (IBM Corp, New York, USA) computer software, cleaned 
and analyzed – frequencies were run, and cross tabulations, graphs and charts were produced. Chi￾square tests were done on certain variables to test differences as appropriate. Qualitative data were 
transcribed and compiled under pre-defined thematic areas. Data from all sources were 
synchronized before producing the final report.
KEY RESULTS 
Program Objective 1: build the capacity of stakeholders to effectively use improved data 
management systems and employ a national HVC supervision system
Building capacity of the different stakeholders involved in the implementation of the program was a 
primary expectation of Yekokeb Berhan Program. With this regard, it was found that the program 
conducted capacity assessment of implementing partners (IPs), government offices and the 
community using different approaches. Gaps and needs were identified for all levels. Different 
capacity building training materials were developed for each stakeholder and a series of trainings 
provided to IPs, government partners and community structures were hold using the corresponding 
training materials. In developing capacity of the different stakeholders, Pact, Child Fund and FHI 
360 worked in close partnership but with distinct responsibilities. 
Evidence from different sources at all levels revealed that implementing CSOs received different 
types of capacity building through training, supportive supervision, coaching and mentoring. Such 
capacity building endeavors were found to enable IPs and community structures to identify HVC 
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using standard formats, to mobilize support from stakeholders at different levels and to 
continuously monitor and record accomplishments. 
Despite actions being taken to build the capacity of stakeholders, data from the field identified 
specific capacity gaps at different levels. The major capacity gaps identified at government level 
consist of: continuing staff turnover and consequent limitation of awareness about the project; poor 
partnership with CSOs; a lack of standard alternative care; and poor logistics to undertake 
monitoring and supportive supervision. 
Program Objective 2: employ effective and efficient family-centered, age-appropriate and 
inclusive HVC care management system 
Most of the indicators related to health and healthcare services clearly indicate a positive effect of 
Yekokeb Berhan package of interventions in improving the health status of the HVC as well as their 
families. Reported episodes of HVC illness in the previous two weeks decreased from 30% in 
baseline to 16.8% and the change was significant (p<0.05). Similarly, HVC who reported having 
diarrhea in the two weeks preceding the evaluation fell to 6.1% at the midterm evaluation from 
10.8% at baseline (p<0.05). Health-seeking behavior of HVC has improved since the initiation of 
the program with 63.9% of those who had fever seeking treatment at the midterm compared to 
48.4% at the baseline (p<0.01). Similarly, those who sought treatment for diarrhea also increased 
from 49.7% to 86.2% (p<0.01).
Coverage of age-appropriate vaccination for under-five HVC, as confirmed from immunization 
card, was 57.6% at the midterm compared to 33.9% at the baseline (p<0.05). HVC vaccination 
coverage found in midterm was also higher than the national urban coverage of 48.1%. In the 
midterm, 272 (60.3%) adolescent HVC aged 14-17 reported having access to reproductive health 
(RH) information. Based on self-report, 988 (46.6%) HVC were tested for HIV over the twelve 
months preceding the evaluation, and there was no difference between boys and girls. In the 
baseline survey, however, it was found that only 38.7% of the HVC were ever tested for HIV. 
When school enrollment was assessed for HVC aged 3 years and above, 21,754 (85.7%) were 
reported to be attending school or pre-school during the evaluation compared to 71.1% of HVC at 
the baseline (p<0.05). The finding that 92% of HVC aged 14 years and above were in school was 
especially promising. Of those HVC who were in school during the evaluation, 264 (15.1%) 
benefited from formal tutorial activities organized by Yekokeb Berhan Program. Significantly more 
girls (16.9%) than boys (13.1%) received tutorial services from the program (p<0.05). Overall, 
94.7% of in-school HVC reported regular attendance compared to 89.3% in the baseline (p<0.05). 
There was no difference between boys and girls in regular school attendance. When school 
performance of HVC was assessed, 1049 (85.8%) were promoted to the next grade in the previous 
academic year, and there was no difference between boys and girls. 
In 771 (36.1%) households, at least one adult family member has received nutrition related training, 
counseling or advice in the past year through the support of the program. A child was prescribed 
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food by health/nutrition workers over the past one year in 166 (7.8%) households, and 129 (77.7%) 
of them received the prescribed food while the rest did not get it. Nutritional assessment of 695 
children aged less than five years using mid-upper arm circumference (MUAC) testing found that 
21 (3.0%) of them had moderate acute malnutrition while 8 (1.2%) had severe acute malnutrition. 
No significant differences were found between boys (4.3%) and girls (3.7%) in the rate of acute 
malnutrition in the midterm evaluation. 
When the housing conditions of the HVC households were assessed, it was reported that in 910 
(42.6%) houses, water leaked into the part of the house where the children slept when it rained, but 
this was significantly lower than found in the baseline (52.5%: p<0.05). Similarly, the proportion of 
houses where wind blew into the part of the house where children slept decreased from 50% at the 
baseline to 879 (41.1%) at the midterm (p<0.05). 
Focusing on economic strengthening (ES) activities of Yekokeb Berhan Program, 819 (38.3%) 
households were engaged in ES activities including involvement in: trainings, provision of market 
information; technical support through ES animators/facilitators; and/or provision of matching 
funds. Of ES targeted households, 493 (60%) received training in community saving and self-help 
groups (CSSGs) through Yekokeb Berhan Program. CSSG training is an entry point for Yekokeb 
Berhan ES activities and all those enrolled to ES received this training. The discrepancy between 
number enrolled and trained is perhaps due to similar activities like organizing microenterprises 
(MEs) and saving groups being undertaken in other programs and study participants may not have 
differentiated between these and Yekokeb Berhan Program’s ES supports. 
One-quarter of those households engaged in ES were involved in small scale business or MEs. Of 
these, 49% reported that they were able to expand or diversify their business over the past one year. 
Out of ES households engaged in small scale business or MEs, 58% were able to save some money 
from their business. It was found that 106 (12.9%) of the ES households acquired additional 
productive assets over the past two years including working capital, cattle, sheep, goat and farm 
land. 
Caregivers involved in saving groups reiterated that ES support has positively changed their lives as 
well as that of their children. However, there was some dissatisfaction from volunteers, saving 
groups and CCs in all study settings such as suggestions that the matching funds were often too 
small and was not available in time. 
Legal protection is an integral component of the TB Program. Of all the caregivers involved in the 
evaluation, 147 (6.9%) reported that their household had experienced some form of violence in the 
past one year. Out of the households that experienced violence, 92 (62.6%) went to police to get 
legal services while 45 (30.6%) did nothing. The majority (53%) of households who were referred 
or linked to legal services for various reasons over the past year were by Yekokeb Berhan Program 
through IP staff, CCs or CVs. More than half (51.7%) of the households said that they feel more 
secure in terms of legal protection this time than before they were involved in Yekokeb Berhan 
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Program. Assisting HVC to get birth registration is one of the key components of legal protection 
services the program has been providing to the beneficiaries. However, only 185 (8.7%) of the HVC 
were found to have birth certificate from an authorized government office as confirmed by the 
surveyors, though it was significantly better than the baseline when only 5.5% of HVC had birth 
certificate (p<0.05). 
Program Objective 3: enhance the capability of communities for coordinated and improved 
responsiveness towards HVC care 
The program has been able to effectively identify and work with community structures and local 
resources. Capacity of the community to care for HVC was developed through various trainings and 
material supports including stationaries and office furniture. Strong links between community 
structures and different government offices, specifically with the Bureau of Women, Children and 
Youth Affairs (BoWCYA), were established. This linkage seems to help the program to ensure that 
its interventions are supported by government structures. Yekokeb Berhan Program has 
strengthened the BoWCYA offices at all levels to enable these offices to coordinate care for HVC 
and their families 
Coordination of care has improved over time through established mechanisms and standards to 
engage government bodies, CSOs, communities and the private sector. In order to coordinate and 
harmonize care and support to HVC and their families, implementing NGOs were encouraged to 
sign memoranda of understanding (MoU) with different stakeholders, particularly with health 
facilities, microfinance actors and education institutions. This situation has improved service 
provision to HVC through referral linkages. In support of this argument, it was found that some 
CCs have mobilized support from local government and private institutions and community 
members including iddirs (culturally-based burial associations), religious organizations and 
individual community members to improve care and support for HVC and their families. 
In as much as coordination of care is critical component of the program, there were gaps that were 
identified by the different categories of participants. At the community level, there were some 
challenges coordinating the different structures (CVs, CCs and community care coalitions (CCCs)) 
as designed in the program. 
Program Objective 4: establish effective and efficient monitoring, evaluation, reporting and 
learning systems ensuring evidence- based programming and policy formulation 
It was found that Yekokeb Berhan Program has established a well-defined method of collecting, 
managing and reporting about HVC situations and services. Standard tools were developed to 
collect, compile, analyze, report and use routinely collected data. Mechanisms were developed to 
collect data on HVC and their families at the household level. CVs make door-to-door visits to 
HVC and their families to record the state of service provision on a weekly basis using formats 
developed for this purpose. CVs submit a report to the CC every month who, in turn, verifies and 
13
share it with a community facilitator. Data generated by CVs at the household level pass through 
successive verification and approval steps. 
Another important activity that the program has undertaken in order to achieve objective 4 was 
strengthening regular meetings to review program activities at all levels. It was found that IPs 
conducted monthly and quarterly meetings with government partners including: health offices, the 
MoWCYA, education sector actors and HAPCO offices. Review meetings were also held at 
community level with CC/CCC members and volunteers to discuss achievements, identify gaps and 
work on improvement. A key informant described this as: ‘we conduct regular meetings with 
CC/CCC and CVs in all kebeles and discuss progress and challenges. This has helped us a lot to 
solve problems that may affect our program at the implementation level.’ (KII, IP staff, Hawassa). 
Secondary data review also revealed that the IPs carry out periodic review meeting with partners 
and discuss issues that affect implementation of the program like high turnover of CVs. From 
review of program reports it was found that Yekokeb Berhan Program also conducted regional 
quarterly review meetings in all the five clusters where Yekokeb Berhan and IP staffs and regional 
government representatives (BoWCYA, Bureau of Labor and Social Affairs (BoLSA) and HAPCO) 
were involved. The meetings were intended to review the program progress, facilitate experience 
sharing focusing on coordination of care and ES among the IPs, review strengthening and ways to 
address improvement areas and discuss program priorities for subsequent time. 
RECOMMENDATIONS
 The proportion of HVC who had a Human Immunodeficiency Virus (HIV) test over the 
previous year has shown improvement over the baseline data. However, less than half of the 
HVC were tested and knew their HIV status. HIV testing and counseling is an entry point to the 
continuum of care and is an important component of HIV services. It is even more important for 
HVC as this group has elevated HIV risk because of their vulnerability. Considering this fact, 
more focus on increasing HIV counseling and testing coverage for HVC in the program support 
areas is needed. 
 More tutorial services are called for to improve school performance of HVC. Despite such needs 
and the evident contribution to improved school performance, only a small proportion of HVC 
got tutorial support. This service may be more sustainable if bureaus of education are engaged 
to sustain and scale up tutorial support to HVC at national level. Negotiations with local 
universities and colleges to engage college students for community services would help to scale 
up the service. 
 Parenting skills are essential for caregivers to enable them to provide quality care for their 
children. There were efforts by the program to provide caregivers with this skill through 
parenting trainings. However, only 52% of the caregivers reported attending better parenting 
skills trainings provided by the program. In order to achieve sustainable impact of the program 
14
by improving care for HVC, coverage of better parenting training for caregivers should be 
increased. 
 Birth registration and acquisition of a birth certificate is one of the important components of 
legal service to HVC, and Yekokeb Berhan Program has been supporting this service. However, 
only 8.7% of the HVC had a birth certificate issued from authorized government office. This 
proportion is very small and more efforts should be exerted to increase the coverage of birth 
certificate for HVC in the program areas. 
 Members of CVs and CCs desire capacity building trainings and/or refresher trainings that 
would sustain their engagement. It is recommended to either develop mechanisms to motivate 
them and keep their active support or develop a strategy where members of such structures 
graduate within one year to reduce turnover and recruit other members, train and engage them to 
sustain necessary numbers. Similarly, continuous auditing of capacity gaps by CSOs and 
government partners and designing cost effective on going capacity building intervention are 
important considerations. 
 Coordination of care in Yekokeb Berhan Program is an important component that helps to 
address more HVC in need and help stakeholders to work together for common goal. Yet, there 
is lack of clarity on how to ensure accountability of the parties involved. This calls for 
development of strategy to ensure accountability and determine who follows up such 
partnerships. 
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1. BACKGROUND 
1.1 BACKGROUND OF PACT’S YEKOKEB BERHAN PROGRAM 
Pact has been implementing Yekokeb Berhan Program for Highly Vulnerable Children (HVC) since 
April 2011. Yekokeb Berhan, meaning ‘illuminating light from a star,’ is representative of the 
resiliency and potential of each and every child. 
The five-year program, funded by the United States Agency for International Development 
(USAID) and the President's Emergency Plan for AIDS Relief (PEPFAR), is designed to reduce 
vulnerability among HVC and their families by strengthening systems and structures to deliver 
quality essential services and to increase resiliency. In order to meet such a broad goal, Pact works 
in partnership with Family Health International 360 (FHI360) and Child Fund; 39 local civil society 
organizations (CSOs); and public sector institutions at the federal level including: the Ethiopian 
Ministry of Women, Children and Youth Affairs (MoWCYA) and HIV prevention and Control 
Office (HAPCO) in nine regional states (Tigray, Afar, Amhara, Oromia, Somali, Benishangul 
Gumuz, Southern Nations, Nationalities and People’s Region (SNNPR), Gambella and Harari) and the 
two City Administrations of Addis Ababa and Dire Dawa. The program targets 500,000 HVC in 
urban and peri-urban areas with relatively high human immunodeficiency virus (HIV) prevalence.
The long-term vision of Yekokeb Berhan Program is to have a child-focused social welfare 
framework developed in Ethiopia that allows all children, including HVC to thrive. 
The primary objectives are to: 1) build the capacity of stakeholders to effectively use improved data 
management systems and employ a national HVC supervision system; 2) employ effective and 
efficient family-centered, age-appropriate and inclusive HVC care management system; 3) enhance 
the capability of communities for coordinated and improved responsiveness towards HVC care; and 
4) establish effective and efficient monitoring, evaluation, reporting and learning systems ensuring 
evidence-based programming and policy formulation. 
In order to facilitate smooth implementation of the program, Yekokeb Berhan initiative has five 
regional cluster offices, including Addis Ababa (located at the head office in Addis Ababa), Amhara 
(Bahir Dar), West Oromia (Jimma), SNNPR (Hawassa) and East Oromia (Adama). The program 
has established and organized the cluster offices to facilitate close monitoring of activities done by 
its implementing partners (IPs) and provide them with hands-on technical support. 
Currently, the program has 39 IPs, with 10 operating in more than one region. FHI360 and Child 
Fund are international partners that are working with Pact and offer technical assistance on key 
technical programming issues, including design of guidelines and training materials and provision 
of follow-up technical support to other teams and IPs. At the grass-roots level, Yekokeb Berhan 
staff assist IPs and local governments in supervision, training and support for over 20,000 local 
community volunteers (CVs) who go home-to-home to share their skills and knowledge with 
16
beneficiary families, promote referrals, provide follow-up and develop one-on-one relationships 
with targeted children for supplementary care, encouragement and emotional support.
Alliance for Better Health (ABH) Services was commissioned by Pact to undertake the midterm 
evaluation of Yekokeb Berhan Program to document progress for various outcome level indicators 
as well as changes in the lives of beneficiaries. This report presents findings from the midterm 
evaluation and provides conclusions and recommendations based on the findings. 
1.2 LITERATURE REVIEW 
1.2.1 Global HVC Situation 
PEPFAR defines a vulnerable child as one who is living in circumstances with high risks and whose 
prospects for continued growth and development are seriously threatened.1 Similarly, the Joint 
United Nations Program on HIV/AIDS (UNAIDS) defines vulnerable children as children whose 
survival, well-being or development is threatened by HIV/ Acquired Immunodeficiency Syndrome 
(AIDS).2
 However, other factors, apart from HIV/AIDS may influence vulnerability. These factors 
need to be considered to better define the context related to children and vulnerability. These factors 
include: poverty, access to shelter, education, health facilities or other basic services, stigma due to 
HIV/AIDS and political and socio-economic crisis. Skinner et al.3
 have identified a list of variables 
to measure vulnerability in children including: death or desertion of parents; severe chronic illness 
of parents: HIV/AIDS or others; illness of a child; physical or mental disability of a child; poverty; 
access to basic needs such as education, health, social services, etc.; inadequate clothing; emotional 
problems; abuse of the child; and drug abuse by caregivers or the child. 
HVC constitute the most vulnerable members of any society since they lack basic needs such as 
food, health care, shelter and education and are stigmatized, exposing them to further abuse and 
exploitation. In as much as vulnerable children suffer consequences, community and family 
members are also stressed as they try to care for these children. As most vulnerable children and 
their families struggle to meet their basic needs in developing countries, they must also deal with 
the effects of isolation, marginalization, trauma and grief. In child-headed households, lacking 
adults to talk to them, teach them important life skills and offer a source of protection, many 
orphans and vulnerable children report feelings of loneliness and isolation.4
 There is also long-term 
economic stagnation or decline as children grow into unskilled workers, become vulnerable to HIV 
infection through increased morbidity and malnutrition and face greater risk of exploitation and 
abuse. 
 
1Orphans and Other Vulnerable Children Programming Guidance for United States Government In-Country Staff and 
Implementing Partners, The President’s Emergency Plan for AIDS Relief Office of the U.S. Global AIDS Coordinator, 
July 2006. 
2Children on the Brink 2004, A Joint Report of New Orphan Estimates and a Framework for Action, UNAIDS,UNICEF 
and USAID, July 2004.
3
Skinner, D. et.al, Social Aspects of HIV / AIDS and Health Research Program, Cape Town, 2004.
4CARE. A Model for Community-Based Care for Orphans and Vulnerable Children: Lessons learnt, 2005.
17
Globally, an estimated 153 million children worldwide have lost either one parent (single orphan) or 
both parents (double orphan). Of these, 56.1 million (37%) live in sub-Saharan Africa and 16.6 
million (11%) have lost their parent(s) due to AIDS.5 Despite the rapidly growing burden of orphans 
and vulnerable children (OVC) in sub-Saharan Africa due to the spread of the HIV/AIDS epidemic, 
many countries in the region do not have effective programs to support OVC and caregivers.6
 This 
problem is partly attributable to a lack of data on the prevalence and the situation of OVC in most 
countries in the region. 
1.2.2 HVC/OVC Situation in Ethiopia 
In Ethiopia, there were an estimated 4.2 million orphans in 2013, accounting for approximately 12% 
of the total child population.7
 Of these, 792,840 (19%) were orphaned due to HIV/AIDS. The 2011 
Ethiopian Demographic and Health Survey (DHS) estimates that 25.6% of all households are caring 
for a foster8
 and/or an orphan child under 18 years of age.9
 All OVC are at increased risk for 
neglect, abuse, malnutrition, poverty, illness and discrimination and as they get older, are at 
increased risk for HIV infection. Overall, girls suffer more than boys by not being able to attend 
school, having to care for others and being forced into early marriage. 
Meeting HVC’s immediate needs is vital not only to their current well-being but also to their future. 
Basic needs include food/nutrition, shelter and care, legal protection, health care, psychosocial 
support and education. Illness in the family or the loss of a parent or parents is extremely disruptive 
for children, and often seriously disadvantages their chances for obtaining basic living needs as well 
as for securing a place in school or future employment. Financial and material resources are often 
required to meet many of these needs and this makes economic strengthening of vulnerable children 
an essential component of targeting services to this group. PEPFAR has identified priority 
interventions that address the needs of children through OVC programs. These interventions consist 
of components including education, psychosocial care and support, household economic 
strengthening (HES), social protection, health and nutrition, child protection, legal protection and 
capacity building.10 Similarly, the Ethiopia OVC Standard Service Delivery Guidelines (SSDG) 
recommends seven core service areas which are considered critical components of a set of services 
for programming targeting vulnerable children. These are: Shelter and Care, Economic 
Strengthening, Legal Protection, Health care, Psychosocial Support, Education, Food and Nutrition 
and Coordination of Care.11
 
5UNICEF, UNAIDS, and WHO. Children and AIDS: Fifth Stocktaking Report.
6Mishra, Vinod, and SimonaBignami-Van Assche. 2008. Orphans and Vulnerable Children in High HIV-Prevalence 
Countries in Sub-Saharan Africa.DHS Analytical Studies No. 15.Calverton, Maryland, USA: Macro International Inc. 
7HIV Related Estimates and Projections for Ethiopia – 2012, Ethiopian Health and Nutrition Research Institute Federal 
Ministry of Health, August, 2012. 
8
Foster children are those under age 18 living in households with neither their mother nor their father present. 
9Ethiopia Demographic and Health Survey 2011, Central Statistics Agency, Addis Ababa, Ethiopia.
10Guidance for Orphans and Vulnerable Children Programming, PEPFAR, July 2012. 
11Standard Service Delivery Guidelines for Orphans and Vulnerable Children’s Care and Support Programs, Federal 
Democratic Republic of Ethiopia, February 2010.
18
Over the past decade, the Government of Ethiopia, with the support of international non￾governmental organizations (INGOs) and through bilateral collaborations, has undertaken a range 
of activities that support HVC and OVC with the aim of mitigating the impacts of poverty and 
HIV/AIDS on this segment of the population. Of these, the most notable are the Productive Safety 
Net Program (PSNP), Multisectoral Plan of Action for HIV (2007-2010) and Positive Change: 
Children, Communities, and Care Program (PC3). 
Ethiopia has successfully implemented the first Multisectoral Plan of Action for Universal Access 
to HIV Prevention, Treatment, Care and Support in Ethiopia during 2007–2010. One of the 
objectives of the plan was to improve the quality of life of OVC by providing support to OVC 
guardians and taking actions to increase the current school attendance ratio of orphans to non￾orphans (age 10-14) from 60% to 80%.12 Implementation of the plan has seen major achievements 
in HIV/AIDS services expansion, including provision of antiretroviral therapy (ART) and reduction 
in the rate of new HIV infections.13
The PC3 Program was designed to provide OVC and their families with comprehensive and 
coordinated services in health services, education, economic strengthening, psychosocial support, 
food and nutrition and legal protection. The program ran over five years (2004-2008) and targeted 
500,000 OVC in seven regions with a total budget of about US $20 million.14 The goal of PC3 was 
to improve the well-being of 500,000 OVC and families affected by HIV/AIDS. The program was 
able to build on existing community network created by burial societies (Iddirs) and created a 
holistic, child-friendly environment for community-based activities. PC3 did this through 
developing the capacity of local non-governmental organizations (NGOs) who, in turn, partnered 
with a variety of community-based organizations (CBOs). Pact has sought to apply the lessons 
learned from PC3 to Yekokeb Berhan Program. Hence, many of the lessons learned from previous 
initiatives were built into the design of Yekokeb Berhan Program.15 Pact has established effective 
working relationships with key government partners and has developed and utilized manuals, 
guidelines and checklists for training and tracking Yekokeb Berhan implementation.16
 
 
12Multisectoral Plan of Action for Universal Access to HIV Prevention, Treatment, Care and Support in Ethiopia 2007 –
2010, HIV/AIDS Prevention and Control Office (HAPCO). 
13Multi-sectoral HIV/AIDS Response Monitoring & Evaluation Report for 2004 EFY, July 2011 - June 2012, Federal 
HIV/AIDS Prevention and Control Office. 
14Ethiopia Positive Change: Children, Care and Communities (PC3) End-of-Project Evaluation, July 2008. 
15 Evaluation of USAID/Pact Program for Highly Vulnerable Children: Yekokeb Berhan, Baseline Findings, September 
2012.
16 USAID/Pact: PEPFAR In country Reporting System: Pact Yekokeb Berhan for Highly Vulnerable Children, Annual 
Progress Report FY2012.
19
2. OBJECTIVES AND SCOPE OF THE EVALUATION 
2.1 OBJECTIVES OF THE EVALUATION
The midterm evaluation has the following objectives: 
1. To identify baseline values for outcome indicators that were not addressed in the program’s 
baseline survey; 
2. To objectively measure outcome level results and changes registered by the program against 
baseline measures; 
3. To provide practical programmatic recommendations to improve the impact of the program; 
4. To identify and document critical lessons learned and knowledge generated in the course of 
implementation of the program. 
2.2 SCOPE OF THE MIDTERM EVALUATION
The scope of this midterm evaluation was to measure progresses made in program implementation 
since the beginning of the program in order to recommend actions or interventions for 
improvements. The midterm evaluation addressed all the four objectives of the program related to: 
1) systems, structures and policy framework; 2) quality of services; 3) community capacity 
development; and 4) evidence-based programming. To this effect, the baseline survey report and 
available program related documents were reviewed, appropriate data collection tools developed 
and quantitative and qualitative data collection was undertaken. 
Primary data obtained from the quantitative and qualitative methods and data from secondary 
sources were analyzed, compiled and presented based on objectives of the program. Conclusions 
and recommendations were made based on the findings. 
3. METHODS 
3.1 STUDY DESIGN 
In the midterm evaluation, a combination of quantitative and qualitative methods was employed to 
collect data required to determine program achievements and to identify benchmarks that were not 
addressed in the baseline survey. For the quantitative component, a cross-sectional survey that 
involved households with HVC was employed. In the qualitative assessment, focus group 
discussions (FGDs) and key informant interviews (KIIs) were conducted with beneficiaries, 
community volunteers (CVs), partners, community committees (CCs) and others. Comparison of 
key outcomes was made between the midterm evaluation and baseline findings wherever applicable. 
Full comparison was not possible due to differences in the methods and target groups of the two 
surveys (the baseline survey included non-HVC households). Besides the midterm survey, 
secondary data including the baseline survey, routine reports, supervision reports and other relevant 
sources were thoroughly reviewed to complement the primary data in order to address the four 
20
midterm evaluation objectives. The different data sources of the midterm evaluation allowed 
triangulation of data yielding more valid results. Utilization of the different data sources allowed the 
evaluation team to make valid conclusions and recommendations in order to improve program 
performance leading to positive outcomes and impacts on children and families. 
3.2 SAMPLE SIZE AND SAMPLING PROCEDURES
This midterm evaluation was conducted in four major target regions: Amhara, Oromia, SNNPR, 
Tigray and the Addis Ababa City Administration. Sample size for the survey was determined based 
on a 50% planned proportion estimate, 3% margin of error and 95% confidence level. This 
computation was carried out using the StatCalc function for sample size estimation of Epi Info 
version 7, (Center for Disease Control, Atlanta, USA) statistical software package. The sampling 
procedure was multi-staged and there was a need to adjust for a design effect. In this survey a 
design effect of two was considered, which is used in most practical situations. Based on these 
requirements, the sample size for questionnaire survey was estimated to be 2,130. A final sample 
size of 2,142 was determined based on distributions at the woreda level. This total sample size was 
allocated to each of the four survey regions and Addis Ababa City Administration proportional to 
number of beneficiary HVC in each region.
The primary sampling unit was region followed by zone, woreda and kebele. Accordingly, four 
regions, Amhara, Oromia, SNNPR, Tigray and Addis Ababa city Administration were purposely 
selected. From each region, two or three zones were selected based on the size of the HVC 
beneficiary population. Three zones (including the capital city of the region) were randomly 
selected from each of the Amhara, Oromia and SNNPR regions while two zones were selected from 
each of Addis Ababa and Tigray regions. Among the two zones considered from Tigray region, the 
city of Mekelle was included in order to be consistent regarding inclusion of the regional capitals. 
Hence, a total of 13 zones were included in the evaluation. Taking into account the total number of 
program woredas and the mathematical relevance of the given data points, it was assumed that a 
total of 21 woredas (about 10% of the total program woredas) would be representative. Amhara, the 
region with the largest number of beneficiary HVC, was used as a reference point and sample sizes 
other regions were allocated based on proportion of HVC in this region to achieve the largest 
number of survey households. Woredas were randomly selected from each region to meet random 
allocations. The distribution of survey woredas is presented in Figure 1. 
21
Figure 1: Distribution of survey woredas
To enhance geographic variability within woredas, it was agreed to take three kebeles per woreda
so that 34 households would be surveyed in each kebele. Accordingly, three kebeles were randomly 
selected in each of the selected woreda. At a household level, a caregiver and an HVC (either under 
14 or 14-17 years old) were interviewed for every selected household. When there was more than 
one HVC, one child was randomly selected using lottery method (every child enrolled in the 
program was listed separately on a piece of paper and the paper folded and one drawn randomly). 
When the selected child was less than 14 years, the caregiver was interviewed about the child using 
part two of the survey questionnaire. When the selected child’s age was 14-17 years the child 
him/herself was interviewed using part three of the survey questionnaire. From the program’s 
document, it appears that the proportion of young HVC (<14 years) to adolescent HVC (14-17 
years) is 2:3. Based on this proportion, we expected to get 1,400 young HVC and 730 adolescent 
HVC upon random selection of the children. The caregiver was interviewed in every survey 
household.
Seventeen sites were selected for the qualitative study and allocated for each region based on 
population size. Accordingly, two each from Addis Ababa and Tigray; four sites each from Amhara 
22
and SNNPR and five sites from Oromia were involved in the study. Community structures and 
organizations including IPs, women, children and youth affairs sectors (labor and social affairs in 
the case of Tigray) were purposefully selected and involved in the study. Additional stakeholders 
including coordinators at regional levels as well as federal-level partners participated in the study. 
Data on awareness about Yekokeb Berhan Project, implementation capacity, coordination of care, 
service provision, recruitment and enrollment of HVC and their families and data management and 
reporting were collected. 
3.3 VARIABLES 
The survey collected information on socio-demographic, health and health care, education, food and 
nutrition, psychosocial support, shelter and care, legal protection, economic strengthening and 
coordination of care variables. 
3.4 DATA COLLECTION 
Quantitative data was collected using questionnaires that were translated into three major 
languages—Amharic, Oromifa and Tigrigna—that were used in areas where the respective 
language is spoken. The questionnaire consisted of three parts (Annex IV). The first part consisted 
of a module for caregivers of HVC; the second part comprised of a module pertaining to HVC 
under 14 years of age with the respondents being caregivers; and the third part consisted of a 
module for older HVC aged 14-17 years with the children themselves responding. Mid-upper arm 
circumference (MUAC) measurements were taken for all under-five children in a household. 
Similarly, coordinates of each surveyed household were recorded using a global positioning system 
(GPS) apparatus by data collectors for further analysis. 
Qualitative data was collected using FGDs and KIIs in order to explore shared perceptions and lived 
experiences. Perceptions and experiences primarily related to capacity building at community and 
implementing partner levels, coordination of care, data collection and reporting mechanisms and 
perceived changes in connection to Yekokeb Berhan Program. Qualitative data provided context for 
deeper probing deeper into types of services provided by the program and supplemented
quantitative data findings. 
Twenty FGDs were completed with five target groups, namely community committees, savings 
groups, caregivers and four among community volunteers with a total of 33, 36, 52 and 37 
participants respectively. Key informant interviews were conducted with a total of 34 individuals 
representing Ministry of Women, Children & Youth Affairs (MoWCYA) at federal, regional and 
woreda levels; Pact at Addis Ababa and regional levels; FHI360 and ChildFund (Annex II).
Participants for the qualitative study were purposely identified and selected from program sites 
representing the different program stakeholders. Data were collected with an application of tools 
developed in reference to the objectives of the midterm evaluation, baseline tools and the Yekokeb 
Berhan Program documents. 
23
3.5 DATA ANALYSIS 
Quantitative Data: Quantitative data were entered into a data template created for this analysis 
using SPSS computer software (IBM Corp, New York, USA). The template was created using the 
final version of data collection tools by an experienced statistician. Data entry, cleaning and 
analysis was carried out by the data management team. Relevant cross tabulations, graphs and 
charts were produced as appropriate. Chi-square tests were done on certain variables to test 
differences between populations as appropriate. The statistical tests were applied to see differences 
among males and females, age categories and differences between the midterm survey and baseline 
findings. 
Qualitative Data: Qualitative data were transcribed and checked for consistency by an assistant 
who was not involved in the data collection. Transcribed data were read and re-read to define 
themes and sub-themes and organized according to objectives of the study. Two individuals were 
engaged to summarize data under themes and sub themes. Differences were checked and verified. 
Key quotes were used verbatim with efforts to retain original meaning where necessary to 
substantiate arguments. 
3.6 DATA QUALITY ASSURANCE
The tools for the data collection were developed from instruments used for the baseline survey in 
Ethiopia and questionnaires used elsewhere. Ethiopian SSDGs and other international guidelines 
such as the PEPFAR OVC guidelines and Measure Evaluation Core OVC program impact 
indicators were referenced. All data collectors and supervisors had previous experience of data 
collection in similar settings. The data collectors and supervisors had a minimum of first degree in 
health or social sciences. A three-day intensive training that included presentations, role plays and 
field testing of the instruments was conducted. Pre-testing for the quantitative and qualitative 
methods was conducted in Addis Ababa sites that were not included in the survey. One supervisor 
was assigned for four to six data collectors and filled questionnaires were checked and corrected on 
the spot. The supervisory team included supervisors, investigators and also teams from Pact/ 
Yekokeb Berhan program. Feedback sessions were conducted among supervisory teams at different 
levels, and immediate corrections were made when problems observed. For qualitative data, double 
entry was done and frequencies were run to check consistency and to ensure data quality. Data entry 
and analysis were conducted by experienced data clerks and by statisticians with experience in 
handling large surveys.
3.7 ETHICAL CONSIDERATIONS 
An introduction letter was written by Pact or relevant IP offices to the respective regional 
MoWCYAs and approval was obtained from these entities. Qualitative participants were informed 
about the study, objectives and ethical procedures prior to being engaged. Data collection began 
once verbal consent was obtained from a participant after reading out a consent section for each 
data collection method. It was made clear to every participant that they had the right to refuse to 
24
respond to any of the questions. Names of caregivers were not written on the questionnaire and 
HVC names were delinked during analysis as well as in the report. In data dissemination, only the 
type of data collection and geographical setting was reported for a participant’s responses. 
4. RESULTS 
Data were collected in March 2014 from all evaluation sites. A total of 2,138 (99.8% of the planned 
2,142) households with a HVC were involved in the quantitative survey. The survey was 
administered to 2,138 caregivers and 2,121 HVC. Twenty FGDs and 34 KIIs (involving a total of 
192 people) were conducted with the target groups in the qualitative methods.
4.1 DEMOGRAPHIC CHARACTERSTICS OF CAREGIVERS
As detailed in Table 1 below, of the total respondent caregivers, 2022 (95%) were female and 116 
(5%) were male. Nine (0.4%) of the caregivers were found to be less than 18 years old while 124 
(5.8%) were elderly people aged 65 years and above. Approximately half of the caregivers (45.5%) 
were married while 29% and 20% were widowed and divorced, respectively. Approximately half 
(46.7%) of the caregivers had formal education – 36.3% achieving primary and 10% secondary and 
above level of education. When occupation of the caregivers was assessed, it was found that 35.6% 
were wage laborers while 22% were engaged in small-scale businesses. In the surveyed HVC 
households, mean number of family size and children under 18 years of age was 4.7 and 2.4,
respectively. 
Table 1: Socio-demographic characteristics of caregivers
Male
No. (%)
Female
No. (%)
Total
No. (%)
 Age Group
Total 116 2022 2138
<18 2 (1.7) 7 (0.3) 9 (0.4)
18-24 7 (6.0) 116 (5.7) 123 (5.8)
25-45 63 (54.3) 1424 (70.4) 1487 (69.6)
46-64 25 (21.6) 370 (18.3) 395 (18.5)
65+ 19 (16.4) 105 (5.2) 124 (5.8)
Mean age 45.0 38.8 39.2
 Marital status
Total 116 2022 2138
Single
12 (10.3) 78 (3.9) 90 (4.2)
Married 79 (68.1) 894 (44.2) 973 (45.5)
Divorced 11 (9.5) 426 (21.1) 437 (20.4)
Widowed 14 (12.1) 608 (30.1) 622 (29.1)
Live with partner/cohabit 0 16 (0.8) 16 (0.8)
No Response 0 0 0
25
 Highest level of school completed
Total 116 2022 2138
No formal education 39 (33.6) 1100 (54.4) 1139 (53.3)
Primary (grade 1-8) 45 (38.8) 731 (36.2) 776 (36.3)
Secondary (grade 9-12) 15 (12.9) 133 (6.6) 148 (6.9)
Preparatory (11-12) 11 (9.5) 32 (1.6) 43 (2.0)
10+TVET 6 (5.2) 16 (0.8) 22 (1.0)
College/university 0 2 (0.1) 2 (0.1)
No Response 0 8 (0.4) 8 (0.4)
 Occupation of the caregiver
Total 116 2022 2138
Farming 15 (12.9) 64 (3.2) 79 (3.7)
Wage Laborer 47 (40.5) 714 (35.3) 761 (35.6)
Government employee 7 (6.0) 23 (1.1) 30 (1.4)
NGO 3 (2.6) 25 (1.2) 28 (1.3)
Business 7 (6.0) 463 (22.9) 470 (22.0)
Student 3 (2.6) 10 (0.5) 13 (0.6)
Housewife 3 (2.6) 477 (23.6) 480 (22.4)
Other 19 (16.4) 150 (7.4) 169 (7.9)
No occupation 11 (9.5) 92 (4.5) 103 (4.8)
No Response 1 (0.9) 4 (0.2) 5 (0.2)
Engagement in paid work in the last 3 months
Total 116 2022 2138
Yes 49 (42.2) 828 (40.9) 877 (41.0)
No 67 (57.8) 1176 (58.2) 1243 (58.1)
No Response 0 18 (0.9) 18 (0.8)
4.2 DEMOGRAPHIC CHARACTERSTICS OF HVC 
A total of 2,121 HVC were interviewed in the evaluation out of which 1024 (48.3%) were male and 
1097 (51.7%) female. Of these, 1670 (78.7%) were young children aged less than 14 while 452 
(21.5%) were adolescents aged 14-17 years and the mean age was 9.9 years. Of the total surveyed 
HVC, 1738 (81.9%) have ever attended formal school with 81.2% of males and 82.7% of females 
HVC reported ever attending school (Table 2). 
When vulnerability factors were assessed, 599 (28.2%) of HVC had lost both parents, 683 (32.2%) 
had lost a father and 227 (10.7%) had lost a mother. Other vulnerability factors such as living in a 
household headed by a chronically ill person, an elderly individual or a child were also found in 
smaller proportions of households. 
26
Table 2: Demographic characteristics of HVC
Male Female Total
No (%) No (%)
Age group (n=2121)
 0-4
118 (11.5) 120(10.9) 238 (11.2)
 5-9
316 (30.9) 336(30.6) 652 (30.7)
 10-13 394 (38.5) 386(35.2) 780 (36.8)
 14-17 196 (19.1) 255(23.2) 451 (21.3)
TOTAL 1024 (48.3) 1097 (51.7) 2121
Mean age (year) 9.8 10.0 9.9
Ever attended school (n=2121)
Yes 831 (81.2) 907 (82.7) 1738 (81.9%)
No 151 (14.7) 149 (13.6) 300 (14.1%)
Not applicable (child < 5yrs) 42 (4.1) 41 (3.7) 83 (4.0)
Highest level of education completed (n=1738)
KG 29 (3.5) 2 (0.2) 31 (1.8)
Grade 1-8 723 (87) 762 (84) 1485 (85.4)
Grad e 9-10 70 (8.4) 97 (10.7) 167 (9.6)
Grad e 11-12 3 (0.4) 14 (1.5) 17 (1.0)
10+ TVET 6 (0.7) 2 (0.2) 8 (0.5)
University/College 0 (0) 1 (0.1) 1 (0.1)
No response 0 (0) 29 (3.2) 29 (1.7)
Child vulnerability factor (n=2121)17
Both mother and father are dead 599 (28.2)
Mother is dead 227 (10.7)
Father is dead 683 (32.2)
Chronically ill 55 (2.6)
HIV positive 66 (3.1)
Has some kind of disability 27 (1.3)
Household is headed by a child (<18) 16 (0.8)
Household is headed by elderly 198 (9.3)
Household is headed by ill person 291 (13.7)
Household is headed by disabled 41 (1.9)
Others18 757 (35.7)
No response 20 (0.9)
 
17 More than one factor applies to some HVC, hence the total is more than n. 
18 Children from households with severe economic problem, street children and children in conflict with the law, who 
according to the national OVC Standard Service Delivery Guidelines fulfill the criteria, may have been enrolled and 
categorized in this category. 
27
The majority of the children (76.8%) lived with at least one parent while 13.2% lived with their 
grandparents. Proportion of double orphan HVC seems high compared to those reported living with 
at least one parent. This is perhaps in many parts of the country culturally non-biological parents are 
considered as parents and this may have increased number of those reported living with at least one 
parent. A small proportion of HVC lived with other relatives and 1.4% with people without blood 
relation (Figure 2). Seventy (3.4%) of the HVC reported having some form of disability. Out of 
HVC with disability, 46 (65.7%) said that their daily activity was limited by their disability. 
Physical disability was the most common form of disability accounting to 37.1% of the disabilities 
followed by deafness or partial deafness (24.3%) and blind or partially blind (11.4%). 
Figure 2: Relationship between HVC and Caregiver 
4.3 IDENTIFICATION AND ENROLLEMENT OF HVC
When knowledge of the caregivers about the program was assessed, 95.6% said they knew about 
Yekokeb Berhan Program. Qualitative data from participants in CCs and CSSGs reveal the common 
assertion that ‘the program was meant to support poor children.’ Although some CSSG participants 
mentioned the program’s role in ‘building the culture of saving’ to benefit vulnerable children, 
participants often could not identify many components of the program. 
About two-thirds (64.4%) of the beneficiary HVC were initially identified by kebele administration 
staff for support by Yekokeb Berhan Program while 17% said they were identified by IP staff. CC 
and CV also identified 13.3% of the HVC for enrollment into the program. Basically, IP staffs were 
not involved in identification and selection of HVC and this perhaps emanated from lack of 
differentiation by the respondents between these entities. According to the respondents, final 
decision of enrollment of HVC was made mostly by CCs and kebele administration. 
28
Qualitative data has revealed that recruitment of vulnerable children was guided by specific 
procedures and tools. Participants from different regions unanimously stated that: 
‘[A]t the beginning of the program HVC selection was not free from bias because we did not have 
clear guide to recruit HVC. Now, Yekokeb Berhan Program provides us with a format [the Child 
Support Index (CSI)] and trains us on how to use the format to recruit. The volunteers do the 
assessment and community committee review, verify and approve.’(IP staff, Dugda, Oromia)
 
4.4 FINDINGS BY PROJECT OBJECTIVES 
4.4.1 Objective 1: Build the capacity of stakeholders to effectively use an improved data 
management system and employ a national HVC supervision system
Yekokeb Berhan Program has ventured to build the capacity of different stakeholders involved in 
the implementation of the project. This intervention is one of the most important components of the 
project in view of the fact that implementation of the project and sustaining the initiative depends 
on whether IPs at different levels have the relevant capacities. 
An interview with Pact Yekokeb Berhan Program focal person suggests that at the program’s 
inception, 49 CSOs were identified and brought on board as potential IPs to this initiative. Capacity 
of these institutions was assessed with an application of Technical and Organizational Capacity 
Assessment (TOCA) tool. Assessment focused on their technical, programmatic, management 
(human technical, financial) and partnership capacities. 
From the assessment, capacity gaps of the IPs varied. However, the common capacity gaps were 
seen in: project leadership, management practices, human resources, capacity to support partners, 
infrastructure and logistic, communication and external relations, how to ensure sustainability of 
interventions, monitoring and documentation, volunteers’ management and coordination of care, 
local resource mobilization and ability to overcome challenges.19
The project has further assessed the capacity of government institutions as a key partner to Yekokeb 
Berhan Program. Capacity assessment for this partner focusing on the women, children and youth 
affairs and labor and social affairs for the Tigray region reveals that government partners for this 
project have strong capacities in: 1) establishing partnership with other sectors and mainstreaming 
child care to these sectors; 2) establishing close working relations with the community at 
operational level and recognition of community as key stakeholders; 3) identifying service 
providers at woreda and city administration level; and 4) disseminating national OVC service 
guideline to operational levels.20
 
19 PACT. TOCA preliminary report per implementing organization, ND. 
20 Consolidated Report of Organizational Capacity Assessment conducted for Government Partners for all Regions of 
Ethiopia (All Bureaus and selected Zone and woreda offices), September, 2012.
29
Despite these strengths, there were a number of capacity gaps identified including: 1) weak 
attention by leaders to child affairs especially in allocation of resources; 2) limitation of financial 
and material resources to implement child-focused programs and undertake monitoring activities; 3) 
failure to consider gender and disability in identification of vulnerable children; 4) limitation of 
operational guideline for child focused program; 5) weak clarity between sectors on responsibility 
between BoWCYA, the Bureau of Labor and Social Affairs (BoLSA) and HAPCO; 6) limitations 
in providing capacity development supports to lower level structures; 7) weak database 
management and supportive supervision; 8) poor infrastructure and logistics to facilitate works of 
HVC; 9) limited work relationship with NGOs that work; and 10) weak resource mobilization 
skills.21
At the community level, implementing CSOs employed the Community Capacity Barometer to 
identify capacity gaps of community level structures. Accordingly, leadership skills, active 
participation, resource mobilization, coordination of care, operational plan development, 
communication and facilitation as well as data management and reporting were major gaps 
identified.22
Capacity building of the different stakeholders was taken as an entry to roll out of project 
implementation at various levels. Capacity of implementing CSOs, government partners and 
community structures was built by providing a series of training, supportive supervision, coaching 
and mentoring. Capacity building interventions of the program were designed to offer technical 
assistance on key technical programming areas by the different partners. Information from the field 
recognized capacity building interventions.
Training appears to be the main capacity building intervention involved in Yekokeb Berhan 
Program. However, the project has introduced different capacity building interventions other than 
training. These include hands-on technical guidance on implementation of project components 
provided to IPs by Yekokeb Berhan regional cluster managers and standardized supportive 
supervision provided to IPs and community structures by technical staff of headquarters of Pact, 
FHI360 and Child Fund. Child Fund focuses more on capacity building related to economic 
strengthening, FHI360 on better parenting, life skill and food related training such as urban 
gardening and PermaGardening and Pact has put greater focus on coordination of care. 
Some of the common training activities identified by implementing partners, CSOs and other 
community structures include: MERL (monitoring, evaluating, reporting and learning) module I and 
II, economic strengthening (e.g. market study and analysis, business development, saving and loan 
group establishment and strengthening, microenterprise selection, planning and management and 
business development services), early childhood development, life-skill trainings, CSI-I and CSI-II, 
 
21 Consolidated Report of Organizational Capacity Assessment conducted for Government Partners for all Regions of 
Ethiopia (All Bureaus and selected Zone & woreda offices), September, 2012.
22 Consolidated community capacity Barometer report, ND.
30
parent-teacher association (PTA) trainings, better parenting, coordination of care, psychosocial 
support, emotional wellbeing, personal hygiene and sanitation and standard service delivery. 
Regarding the types of trainings received, IPs involved in the study uniformly reported that different 
of trainings were received by the project. Evidence from different sources at community level 
reveals that implementing partners involved in the study uniformly reported to have received 
different types of training. 
‘There are 18 training packages in the program. I personally took basic volunteer, economic 
support, coordination of care, journey of life/better parenting, gardening and all of these were 
cascaded to operational level. Such capacity building interventions enabled us not only internalize 
the problems of HVC but also made us committed to do as much as we can to reach out to more 
HVC by mobilizing support from the community.’ (Staff member, EKHC, Arbaminch)
‘Generally, Pact has given us more than 20 trainings on different aspects that could help us 
implement Yekokeb Berhan program and several operational guidelines which we applied to 
improve the capacity of our stakeholders at community level.’ (Staff member, EDA-Debreberahn) 
The evaluation also revealed that trainings provided by the program have positively impacted 
services to HVC. This was highlighted by the study participants as follows: 
‘I strongly feel capacity building by Yekokeb Berhan program has brought tangible changes to our 
service provision and to reach the right target beneficiaries with the right services.’ (Staff member 
Dugda IP, East Shoa) 
‘My organization has obtained opportunities for capacity building that helps us to employ standard 
approach in addressing the needs of HVC. This was not usually the case. Now, my organization 
knows what to do to address problems of HVC and how to address it.’ (Member, Progynist, 
Wolkite) 
Government partners reflected on the impact of capacity building efforts of Yekokeb Berhan 
Program: 
‘Yekokeb Berhan project has contributed to bridge capacity gaps by providing office furniture, 
provision of training to staff members of BoWCYA, different forms of training to community 
structures and beneficiaries.’ (Staff members, BoWCYA, Amhara) 
The CSI tool and coordination of care in particular were repeatedly mentioned to have far reaching 
implications for sustainable HVC care and support planning, implementation and policy decisions. 
‘The CSI HVC data base is a whole new way of data generation and management. It consists of 
every aspect of service provisions and the data generated from the data base is unbiased.’ (Staff 
member, Progyist Butajira) 
31
‘The system is advance where it prohibits redundancy where one HVC may not get support from 
two sources. The data are useful for any organization that would be interested in helping HVC.’
(Staff member, Mary Joy, Hawassa) 
In Yekokeb Berhan Program, training of IPs is not considered as an end in itself. IPs were expected 
to roll out training received by Yekokeb Berhan Program to community-level structures such as 
caregivers, volunteers, CCs and CCSGs who were found at the frontline of Yekokeb Berhan 
Program intervention. According to a staff member from the MoWCYA: 
‘There has never been an organization engaged in building community system and capacity in 
response to children’s problems. Yekobeb Berhan program however introduced a new initiative to 
build capacities and systems at community levels to sustain care and support to HVC and their 
families.’ (Children affairs mainstreaming and partnership team leader, MoWCYA, Federal) 
Community structures were provided with training that contributes to improved implementation of 
Yekokeb Berhan Program. Based on information gathered from the community structures 
themselves, different sets of training were provided. 
Community committee were generally found to have been trained on ‘child care, parenting skill, 
child-family relationship, how to select HVC using available format, collection and reporting of 
data on HVC on a regular basis and coordination of care’ (Member of CC, Adama). Members of 
CCs were generally regarded as having the capacity to link HVC with services. This was 
highlighted by one of the participants: ‘We have the capacity to link HVC with health bureau, 
justice office and private schools at all levels and to mobilize local resources to help HVC’ 
(Member of CCC, Adwa). 
Community level structures (CCs, CVs and CSSGs) were provided with different types of trainings. 
CVs were trained on: ‘… CSI including how to fill CSI and reporting system, parenting skill, 
psychosocial and life skills, better parenting, coordination of care’ (CV, Mekele). On the other 
hand, it was stated that: ‘Caregivers were trained on ‘psychosocial support, emotional wellbeing, 
parenting and life skill, gardening and on hygiene and sanitation.’ (Staff member, Padet, Gondar).
Besides, CSSGs were reported as trained on: ‘market analysis, prima garden, rules and regulations 
for savings’ (Member of CSSG, Mekele).
Despite such capacity building actions for different stakeholders, the study identified prevailing 
capacity gaps at different levels. One of the major capacity gaps identified at government level was
staff turnover which led to gaps in institutional memory and consequently, limited awareness about 
the project, poor partnership with CSOs, lack of standard alternative care and poor logistics to 
undertake monitoring and supportive supervision. 
‘We have not received any capacity building from PACT although our regional bureaus are 
benefitting from the different training activities.’ (Staff member, MoWCYA, Federal) 
32
‘Limited awareness about HVC and procedures of service provision is not very clear to community 
level partners.’ (Staff member, BoWCYA, Jimma) 
‘Lack of experience in community facilitation by CC and CVs; weak monitoring and supervision 
capacity at government partner’s level was reported.’ (Staff member, Rest, Mekele)
‘Every quarter we receive supportive supervision by a team that comes from regional office of 
Yekokeb Berhan. They work closely with us and provide feedback to every challenge we 
encountered. This was quite empowering for us.’ (Staff member, ANNPCAN, Gondar) 
Supportive supervision was found to be an important approach to build the capacity of the 
implementing partners. This was underscored by a key informant as: 
‘One implementing partner (NGO) obtains at least one supportive supervision once every quarter of 
the year. At the end of each supportive supervision meeting, partners are provided with both oral 
and written feedback. Actions based on previous feedback are tracked during the next supervision.’ 
(Regional manager, Yekokeb Berhan, Amhara) 
‘Over the last year we have provided supervision to implementing partner (NGO), caregivers and 
HVC at household level monitoring if training worked well and consequent accomplishments 
service standards.’ (Staff member, FHI360) 
4.4.2 Objective 2: Employ effective and efficient family centered, age -based and 
inclusive HVC care management system 
HEALTH CARE
The primary health outcomes assessed in this study for HVC are given in Table 3 by age and sex. 
Assessment of HVC’s perception of their own health status over the last 12 months showed that 
1,585 (74.7%) stated their health status was either good or very good. In the baseline survey, only 
61.6% of the HVC perceived their health status as either good or very good and the difference is 
statistically significant (p<0.05). On the other hand, 194 (9.1%) of the HVC reported their health 
status to be either poor or very poor and this was significantly better than the baseline where 14.7% 
assessed their own health as either poor or very poor (p<0.05). There was no statistically significant 
difference between boys and girls in perception of their own health status in the midterm evaluation. 
Overall, 356 (16.8%) HVC were reported to have an episode of illness over the past two weeks as a 
result of which they could not participate in daily activities. In the baseline 30% of the HVC 
reported having illness in the two weeks preceding the survey. Disaggregation of data by sex 
showed no significant difference between boys (17.6%) and girls (16.1%) in the baseline. Fever in 
the two weeks preceding the midterm evaluation was reported by 399 (18.8%) of the HVC 
compared to findings from the baseline (15.7%). There were no differences by sex for having fever. 
For diarrhea in the preceding two weeks, at baseline, 10.8% of the HVC reported diarrhea in the 
two weeks before the survey. In the midterm evaluation, 130 (6.1%) HVC had diarrhea in the last 
33
two weeks preceding the survey. There were slightly higher rates for boys, 60 (6.8%), compared to 
girls, 70 (5.5%). Health-seeking behavior of HVC was also assessed by asking whether they sought 
treatment for their fever and diarrheal episodes. Of those who reported having fever in the midterm, 
63.9% sought treatment while 86.2% of those who had diarrhea did the same. In the baseline 48.4% 
and 49.7% who had fever and diarrhea, respectively reported seeking treatment for these illnesses. 
The changes in proportion of HVC who sought treatment for fever and diarrhea from the baseline to 
the midterm were both highly significant (p<0.01). Overall, health seeking behavior was found to be 
similar for boys and girls in the midterm as 65.1% of boys and 61.2% of girls sought treatment for 
their fever and 88.6% boys and 83.3% girls received treatment for diarrhea. There was no difference 
in prevalence of fever and diarrhea and also health seeking behavior across the age for both boys 
and girls. 
34
Table 3: HVC health outcomes by age and sex
0-4 5-9 10-13 14-17 Total
M F M F M F M F M F Total
No (%) No (%) No (%) No (%) No (%) No (%) No (%) No (%) No (%) No (%) No (%)
Total (n) 118 120 316 336 394 386 197 254 1025 1096 2121
Too sick to participate in daily activities in the last 2 weeks (n=2121)
Yes 26 (22.0) 22 (18.3) 54 (17.1) 45 (13.4) 69 (17.5) 63 (16.3) 31 (15.7) 46 (18.1) 180 (17.6) 176 (16.1) 356 (16.8)
No 92 (78.0) 98 (81.7) 262 (82.9) 291 (86.6) 325 (82.5) 323 (83.7) 166 (84.3) 208 (81.9) 845 (82.4) 920 (83.9) 1765 (83.2)
Had fever in the last two weeks (n=2121)
Yes 32 (27.1) 29 (24.2) 61 (19.3) 63 (18.8) 72 (18.3) 75 (19.4) 24 (12.2) 43 (16.9) 189 (18.4) 210 (20.5) 399 (18.8)
No 86 (72.9) 91 (75.8) 255 (80.7) 273 (81.3) 322 (81.7) 311 (80.6) 173 (87.8) 211 (83.1) 836 (72.6) 886 (80.5) 1722 (81.2)
Had diarrhea in the last two weeks (n=2121)
Yes 18 (15.3) 14 (11.7) 25 (7.9) 19 (5.7) 19 (4.8) 19 (4.9) 8 (4.1) 8 (3.1) 70 (6.8) 60 (5.5) 130 (6.1)
No 100 (84.7) 106 (88.3) 291 (92.1) 317 (94.3) 375 (95.2) 367 (95.1) 189 (95.9) 246 (96.9) 955 (93.2) 1036 (94.5) 1991 (93.9)
Had fever and sought treatment (n=299)
Yes 23 (71.9) 16 (55.2) 42 (68.9) 43 (68.3) 47 (65.3) 51 (68.0) 12 (50.0) 21 (48.8) 123 (65.1) 131 (62.4) 255 (63.9)
No 9 (28.1) 13 (44.8) 19 (31.1) 20 (31.7) 25 (34.7) 24 (32.0) 12 (50.0) 22 (51.2) 66 (34.9) 79 (37.6) 144 (36.1)
Had diarrhea and sought treatment (n=130)
Yes 17 (94.4) 9 (64.3) 24 (96.0) 19 (100) 17 (89.5) 18 (94.7) 4 (50.0) 4 (50.0) 62 (88.6) 50 (83.3) 112 (86.2)
No 1 (5.6) 5 (35.7) 1 (4.0) 0 2 (10.5) 1 (5.3) 4 (50.0) 4 (50.0) 8 (11.4) 10 (16.7) 18 (13.8)
Child fully vaccinated for age (n=238)
Yes 72 (61.0) 65 (54.2) 72 (61.0) 65 (54.2) 137 (57.6)
HVC tested for HIV (n=2121)
Yes 54 (45.8) 45 (37.5) 149 (47.2) 149 (44.3) 188 (47.7) 171 (44.3) 90 (45.7) 142 (55.9) 481 (46.9) 507 (46.3) 988 (46.6)
No 64 (54.2) 75 (62.5) 167 (52.8) 187 (55.7) 206 (52.3) 215 (55.7) 107 (54.3) 112 (44.1) 544 (53.1) 589 (53.7) 1133 (53.4)
Adolescent HVC got health information/counseling about reproductive health (n=451)
Yes 113 (57.4) 159 (62.4) 113 (57.4) 159 (62.4) 272 (58.3)
No 31 (15.7) 48 (18.9) 31 (15.7) 48 (18.9) 79 (17.5)
No response 53 (26.9) 47 (18.5) 53 (26.9) 47 (18.5) 100 (24.2)
35
In the midterm survey, 137 (57.6%) of the under-five HVC were fully vaccinated for their age as 
confirmed from their vaccination card. Baseline data however shows that only 33.9% of the HVC 
had age-appropriate vaccination confirmed by card and the change is statistically significant 
(p<0.05) between the baseline and midterm. HVC vaccination coverage found in this midterm is 
also higher than the national urban coverage of 48.1%.23 It was also gathered that 61% of boys and 
54.2% of girls less than five years of age received age appropriate vaccine and there was no 
significant difference for boys and girls in the midterm. 
In the midterm, adolescent HVC aged 14-17 were asked whether they had access to information 
about reproductive health (RH) and 272 (60.3%) reported having access to RH information. There 
was no difference between girls (62.6%) and boys (57.4%) in accessing reproductive health 
information. The primary source of RH information for 76.8% of HVC who had access was
schools. Yekokeb Berhan Program was the source of RH information for 12.5% of HVC having 
access to such information. Other sources of RH information that served small proportion of HVC 
included government health facilities, health extension workers and private health facilities (see 
Figure 3). 
Figure 3: Sources of RH information for adolescent HVC (proportion)
When asked if they have received information on counseling about HIV (including transmission 
routes, methods of prevention, care and treatment) by health workers over the past 12 months, 389 
(86.4%) of adolescent HVC responded favorably. Information related to HIV education and 
counseling services to HVC was not collected in the baseline. Overall, 988 (46.6%) HVC were 
tested for HIV over the last twelve months preceding the evaluation and there was no difference 
 
23 Ethiopia Demographic and Health Survey 2011, Central Statistical Agency, Addis Ababa, Ethiopia and ICF 
International, Calverton, Maryland, USA, March 2012.
36
between boys and girls having accessed testing (Figure 4). In the baseline survey, however, only 
38.7% of HVC were ever tested for HIV. 
Of 963 HVC (481 boys and 507 girls) who received HIV test results in the midterm, 56 (5.8%) were 
positive for HIV. When disaggregated by sex, 24 (5.1%) boys and 32 (6.5%) girls reported being 
HIV positive and the difference was not statistically significant. Baseline data shows that 14.2% of 
HVC who were tested and received their results were positive for HIV. Altogether, 48 or 85.7% of 
HIV positive HVC reported being on ART during the midterm and of these, 48 (85.7%) reported 
having regular follow up in a health facility (Figure 4). In the baseline only 61% of those HIV 
positive HVC were receiving ART treatment.
Figure 4: Number of HVC tested for HIV, received test result, on ART and with regular follow up
Regional disaggregation of HIV testing of HVC showed that Oromia has the highest testing rate 
with 56% of the interviewed HVC reporting testing in 12 months preceding the midterm (Figure 5.). 
Addis Ababa had the lowest HIV testing rate with only one-third of the HVC tested. Positivity rate 
among the tested HVC was found to be the highest for Addis Ababa (10%) followed by Amhara 
and Oromia each with a 7% rate. For all regions, these positivity rates were much higher than the 
national HIV counseling and testing data where they range from 3.4% for Addis Ababa to 0.6% for 
SNNPR.24 This is perhaps because of naturally high prevalence rate among HVC compared to the 
general population. 
 
24 Federal HIV/AIDS Prevention and Control Office 2005 EFY Multisectoral HIV/AIDS Response, Annual Report, July 
2012 to June 2013. 
37
Figure 5: Proportion of HVC tested and positive for HIV by region
Health status and health-seeking behavior of caregivers were assessed as the poor health condition 
of caregivers potentially has an impact on their children. The majority of the caregivers (60%) 
stated that their health status was good or very good in the 12 month preceding the midterm 
compared to only 50% at the baseline and the difference was significant (p<0.01). Similarly, the 
proportion of caregivers who said their health status was either poor or very poor decreased from 
28.1% at the baseline to 20% in the midterm (p<0.01) (Figure 6). 
38
Figure 6: Caregivers’ health status and care seeking behavior
Less than one-quarter (23.8%) of the caregivers reported being too ill to participate in routine daily 
activities in the two weeks preceding the midterm. Out of the caregivers who had some illness in the 
last two weeks, more than two-thirds (67.0%) received treatment from health providers for their 
illness in the midterm. This was slightly higher compared to 64.6% of caregivers who sought 
treatment for an illness preceding this episode. In the midterm, three-quarters of the caregivers 
sought heath care for their last illness went to government health facilities to seek health care while 
17.6% sought treatment in private hospitals or clinics. For the midterm participants, reasons for not 
seeking treatment for the last illness vary. However, for the majority (68.6%) it was lack of money 
to cover treatment related expenses while 12% and 9.7% said illness was not serious enough to seek 
treatment and health facility was far, respectively. 
In this midterm, it was found that 84.4% of the caregivers received HIV counseling or education by 
health workers and 76% were tested and of these, 98.6% received test results (Figure 7). Out of 
those caregivers who were tested and received test result, 231 (14%) were positive for HIV. At the 
baseline 12% of caregivers tested were positive for HIV. There was no statistically significant 
difference between HIV rates comparing the baseline to midterm surveys. Out of the HIV positive 
caregivers at the midterm, 89% were on ART and out of these 98 % reported to have regular follow￾up with health care providers. 
39
Figure 7: Proportion of caregivers received different HIV services
Data from the qualitative assessment suggested that procedurally, HVC with health problems were 
reported to CVs who coordinate transfer of such children to health facilities. Health service 
provision was generally the responsibility of local health facilities and specialized facilities through 
referral. In principle, HVC obtain health services free of charge through referral arrangements 
mainly from public health facilities. However, for emergency health problems, cost recovery for 
service delivery was organized either with direct payment by caregivers through reimbursement or 
on a credit arrangement with health facilities by Yekokeb Berhan IPs. 
In some settings, for instance in Hawassa and Gondar, a credit system was instituted with an 
agreement between health facilities and the implementing partner so that the former provides health 
care services for HVC on credit basis when a child encounters emergency medical problems. In 
other settings, HVC obtain health services through a reimbursement process where caregivers are 
expected to pay for the service and the cost would be reimbursed by the IP (or CSO) on presentation 
of receipt. Despite such variation in cost recovery, emergency health services were generally found 
to be provided to HVC free of charge. Yet, it was clear that services that deemed expensive were 
supposed to be addressed through coordination of care depending on prior arrangement with 
potential stakeholder in the community. 
‘The cost of health services covered is limited often only meant to cover cost of laboratory 
investigation or small expenses for medicine such as for syrups. You can’t cover cost of big health 
expenses with this program.’ (Senior Project Coordinator, Mary Joy, Hawassa) 
There were also situations where even emergency health service provision has stopped. In 
Arbaminch, the IP EKHC reported that health service provision to HVC has been stopped due to 
shortage of budgetary resources. 
40
Within the health service components, raising awareness on healthy living with a focus on 
immunization, HIV/AIDS and hygiene and sanitation was carried out by CVs and health extension 
workers (HEWs). Many of the CVs, IPs and government partners involved in this evaluation 
believed that such awareness creation activities have not only contributed to the prevention of 
diseases but also developed a positive health seeking behavior among caregivers. One of the 
Community volunteers captures the common arguments related to awareness creation endeavors: 
‘Previously some community members didn’t know that there are people who are living in 
desperate living condition in their neighbor. They even ask why we visit some families every week. 
Such personal discussions in each area increased the communities’ awareness about HVC, their 
problems and what to do about it at our level.’ (CVs Hawassa)
PSYCHOSOCIAL SUPPORT 
Evidence on whether an adult member of a household received information or skills on better 
parenting (how to better care for children) shows that 1117 (52.2%) of the caregivers reported that 
there was someone in the household who had received better parenting training. Similarly, about 
two-thirds of the households (64.1%) reported that someone from the household has received 
counseling, some form of advice and/or emotional support from Yekokeb Berhan program as part of 
psychosocial support. Most HVC suggested emotional stability as only 5.8% of those less than 14 
years of age had sudden changes in mood or behavior in the past month. Furthermore, 1,125 
(52.6%) caregivers reported having someone to turn to in order to share concerns and get support in 
case of a problem with a slightly higher proportion of respondents in the baseline reporting having 
someone to turn to (55.3%). In the midterm survey, sources of such support were found to be family 
members for 647 (57.5%) of the respondents while for 245 (21.8%) of the respondents either friends 
or neighbors are sources of such support. Yekokeb Berhan IP staff, CC members and CVs were also 
mentioned by 207 (18.4%) of caregivers as source of support when problem is encountered. Out of 
the total 451 HVC aged 14 and above, 125 (27.7%) have received life skill training through 
Yekokeb Berhan Program in the past two years while 38 (8.4%) said someone in the household has 
received it. Most of the psychosocial indicators presented above were not collected in the baseline 
and hence comparison was not possible. 
Data from qualitative methods shows that psychosocial support to HVC was found to be expanding 
during the last few years. Following parenting and life skills training provided to volunteers and 
caregivers, it was gathered that HVC benefitted from psychosocial support at household level. 
Furthermore, coaching on life-skills was provided by community caregivers and volunteers to HVC
to promote their self-confidence and enable them to plan their future life. CVs described that they 
were involved in arbitration of conflicts between HVC and their caregivers to foster smooth 
relationships and avoid potential stress. In the same vein, it was gathered that children with special 
needs such as physical disability were provided with special supports such as provision of 
wheelchairs, although this is not found in all the study communities. 
41
EDUCATION 
Educational support to HVC involved in Yekokeb Berhan program was found to include 
distribution of school uniform and supplies, tutorial support and assistance with school fees. 
Volunteers routinely tracked HVC school attendance and performance. CCs and CCCs in different 
locations reported to have signed memoranda of understandings (MoU) with education bureaus, 
government and private education institutions, business men, teachers and the community at large in 
their respective areas to better serve the educational needs of HVC. 
School enrollment was assessed for HVC aged three years and above. Out of a total of 2,046 HVC 
three years of age or above, 1,754 (85.7%) were reported to be attending school or pre-school 
during the midterm survey (see Table 4). Data from the baseline survey shows that only 71.1% of 
the HVC were enrolled in school during the survey and the difference between the baseline and 
midterm was statistically significant (p<0.05). 
42
Table 4: HVC education outcomes
3-4 5-9 10-13 14-17 Total
M F M F M F M F M F Total
No (%) No (%) No (%) No (%) No (%) No (%) No (%) No (%) No (%) No (%) No (%)
Total (n) 81 82 316 336 394 386 197 254 988 1058 2046
Children currently attending school or pre-school (n=2121)
Yes
21 (25.9) 19 (23.2)
258 
(81.6)
280 
(83.3) 383 (97.2) 377 (97.7)
180 
(91.4)
236 
(92.9)
842 
(85.2)
912 
(86.2)
1754 
(85.7)
No
60 (74.1) 63 (76.8) 58 (18.4) 56 (16.7) 11 (2.8) 9 (2.3) 17 (8.6) 18 (7.1)
146 
(14.2)
146 
(13.8) 292 (14.3)
Children who have someone who could help with school work when needed (n=1754)
Yes, often 6 (28.6) 5 (26.3) 75 (29.1) 76 (27.1) 69 (18.0) 82 (21.8) 27 (15.0) 34 (14.4)
177 
(21.0)
197 
(21.6) 374 (21.3)
Yes, sometimes 6 (28.6) 2 (10.5) 58 (22.5) 64 (22.9) 78 (20.4) 70 (18.6) 39 (21.7) 59 (25.0)
181 
(21.5)
195 
(21.4) 376 (21.4)
Never 9 (42.9) 12 (63.2)
125 
(48.4)
140 
(50.0) 236 (61.6) 225 (59.7)
114 
(63.3)
143 
(60.6)
484 
(57.5)
520 
(57.0)
1004 
(57.2)
Children ever participated in a tutorial activity organized by Yekokeb Berhan program or in the community (n=1754)
Yes
0 (0.0) 1 (5.3) 21 (8.1) 20 (7.1) 45 (11.7) 74 (19.6) 44 (24.4) 59 (25.0)
110 
(13.1)
154 
(16.9) 264 (15.1)
No 21 
(100.0) 18 (94.7)
237 
(91.9)
260 
(92.9) 338 (88.3) 303 (80.4)
136 
(75.6)
177 
(75.0)
732 
(86.9)
758 
(83.1)
1490 
(84.9)
Children promoted to next grade/ level in the previous academic year (n=1222)
Yes 2 (25.0) 3 (50.0)
120 
(71.9)
154 
(80.6) 263 (89.8) 262 (92.9)
104 
(88.9)
141 
(89.2)
489 
(83.6)
560 
(87.9)
1049 
(85.8)
No, he/she 
repeated 1 (12.5) 0 (0.0) 7 (4.1) 10 (5.2) 22 (7.5) 13 (4.6) 10 (8.5) 15 (9.5) 40 (6.8) 38 (6.0) 78 (6.4)
No response 5 (62,5) 3 (50.0) 40 (24.0) 27 (14.1) 8 (2.5) 7 (2.5) 3 (2.6) 2 (1.3) 56 (9.8) 39 (6.1) 95 (7.8)
43
When school enrollment was analyzed by age category, 91% of children in the age group 5-13 and 
92% of those aged 14 years or above were enrolled at the midterm (see Figure 8). At the baseline, 
school enrollment of 5-13 years and 14 years and above age groups was 77%. Similarly, 75% of 
aged 3-4 years were enrolled to pre-school education at the midterm while only 4% of children of 
this age group were in pre-school at the baseline. All changes of school enrollment across the age 
groupings between the midterm and the baseline were statistically significant (p<0.05). 
Figure 8: Comparison of school enrollment of HVC at baseline and MTE
When school enrollment was disaggregated by sex, 842 (85.2%) boys were enrolled at the midterm 
versus 70.3% at the baseline and the change was significant (p<0.05). Similarly, 912 (86.2%) girls 
were in school during the midterm compared to 72% at the baseline and the difference was 
significant (p<0.05). 
44
Figure 9: Comparison of school enrollment of HVC at baseline and MTE by sex
Out of in-school HVC, 1,222 (69.7%) reported that their school expenses including books, uniform, 
stationaries, transport, school fees, etc., were covered by Yekokeb Berhan Program. Further 
analysis by sex shows that 582 (69.4%) boys and 640 (69.9%) girls reported having their school 
expenses covered by the program. Of HVC who are currently in school, 264 (15.1%) benefited from 
tutorial activities organized by Yekokeb Berhan Program. Significantly more girls (16.9%) than 
boys (13.1%) received tutorial services from the program (p<0.05). On the other hand, only 750 
(42.8%) in-school HVC reported to have someone to help with their school work. When major 
reasons for not enrolling to school for the 290 out of school HVC during the midterm were 
analyzed, two-thirds of respondents suggested that it was because of illness of the child, the child 
had to work to support family (9%) and lack of money to cover school expenses (7.2%). In the 
baseline survey, 42.1% of those who were not enrolled in school stated it was because they were 
needed in the household to help family members in household while child illness was a reason 
given for 41.1% of these respondents. 
Regular school attendance of HVC enrolled in Yekokeb Berhan education support activities was 
also assessed based on the number of school days missed in the month preceding the survey. The 
majority of these children (70.7%) did not miss school while 24% missed ≤ 25% of school days. 
Overall, regular school attendance rate for Yekokeb Berhan -supported HVC was 94.7% with 
males’ and girls’ regular attendance rate being 94.8% and 94.5%, respectively. At baseline, 89.3% 
of those in school reported regular attendance with sex breakdown of 90% boys and 88.5% girls. 
Overall school attendance of HVC was significantly better at the midterm than the baseline 
45
(p<0.05). There was no statistically significant difference between boys and girls in regular school 
attendance during the midterm. 
Of HVC provided education support, 1049 (85.8%) were promoted to the next grade in the previous 
academic year while 6.4% were held back while information was not available for the rest of them.
More girls (87.9%) were able to progress to the next grade compared to boys (83.6%) in the 
midterm and this was statistically significant (p<0.05). However, promotion to next grade was not 
different between young and adolescent HVC. In the baseline, this was assessed differently – HVC 
were asked if they have ever repeated a grade and 24% of them reported repeating a grade in the 
past. 
As revealed from the qualitative results, follow up on the performance of HVC was conducted by 
volunteers both at home and at school level. Most caregivers and volunteers who participated in the 
study confirmed that students were provided with guidance and tutorial support to ensure their 
school attendance and successful accomplishment. Caregivers argued that parenting training helped 
them develop a new habit of making follow up in the academic performance of HVC in most of the 
situations. 
Most IPs involved in the study indicated that tutorial support to HVC was useful to help the needy 
HVC to catch up with their academic performance. Besides, there were coaching and help with 
homework, or when the child did not understand something, that were provided by volunteers and 
these supports were also found to be useful for HVC. However, there were reservations about the 
sustainability of such support since volunteers are stretched visiting 25 HVC per week. Most of the 
IPs and participants in FGDs agreed that the delivery of school uniforms and education materials 
has helped HVC to stay in school and increased educational performance. Information from some 
caregivers and volunteers, however, revealed that educational support, specifically school uniforms 
and stationary materials, were not available to them in time. Some CC participants (e.g. Hawassa, 
Fogera, NSL, Mekele and Adama) shared this idea and echoed their concern over the delayed 
provision of educational materials which may affect HVC’s school attendance. 
FOOD AND NUTRITION 
Table 5 presents details related to provision of food and nutrition services. Over one-third (36.1%) 
of households had at least one adult family member who has received nutrition related training, 
counseling or advice in the past one year. Over half (58%) of the households involved in the 
midterm reported that they have experienced a shortage of food in the past twelve months. When 
the food shortage was assessed by days, 30% of the households did not have enough food to eat for 
1-2 days, 35% for 3-6 days and 24.3% for seven days or more in the one month period prior to the 
evaluation. For extreme cases, 109 (8.8%) households reported that they did not have enough food 
throughout the month. Significantly higher numbers of respondents (66%) reported having food 
shortage in the month preceding the survey. 
46
Respondents were asked they had some food reserve or store to cope up with an unexpected 
situation of loss of income or resources for food purchase. Slightly more than half (58%) said they 
had food reserve of various levels during the evaluation. However, only 37.1% of the households 
had food reserve that was enough for one or more weeks. At the baseline, availability of food 
reserve was reported for only 20% of the households and the difference compared to the midterm 
was significant (p<0.05). 
Availability of supplementary and therapeutic foods for children who need them was assessed as 
one of the dimensions for food and nutrition services to the HVC. A child was prescribed food by 
health/nutrition workers over the past one year in 166 (7.8%) households and 129 (77.7%) of them 
received the prescribed food while the rest did not get it (see Table 5). 
Nutritional assessment using MUAC of 695 children aged less than five years of age in the 
households involved in the study revealed that 21 (3.0%) of these children had moderate acute 
malnutrition while 8 (1.2%) had severe acute malnutrition. No significant differences were found 
between boys (4.3%) and girls (3.7%) in the rate of acute malnutrition in the midterm.
47
Table 5: Food and nutrition indicators
No (%)
A family member received nutrition related training, counseling or advice in the last one 
year (n=2138)
Yes 771 (36.1)
No 1344 (62.9)
Don't know 5 (0.2)
No Response 18 (0.8)
Household experienced shortage of food in the past 12 months
Yes 1239 (58)
No 897 (42)
No response 2 (0.1)
Number of days a household did not have enough food to eat in the past month?(n=1238)
No enough food all days 109 (8.8)
1-2 days 375 (30.3)
3-4 days 261 (21.1)
5-6 days 177 (14.3)
7 days or more 313 (24.3)
How long food would reserves/stores of the household last? (n=2138)
No food store at all 886 (41.4)
Less than 1 week 446 (20.9)
1-4 weeks 611 (28.6)
1-2 months 125 (5.8)
3-6 months 31 (1.4)
More than 6 months 30 (1.4)
No response 9 (0.4)
A child was prescribed food by health workers/ nutrition workers over the past one year 
(n=2138)
Yes 166 (7.8)
No 1965 (91.9)
No Response 7 (0.3)
Child received the prescribed food (n=166)
Yes 129 (77.7)
No 33 (19.9)
No Response 4 (2.4)
Nutritional status of children 0-4 years (MUAC) (n=695) 
No malnutrition 666 (95.8)
Moderate malnutrition 21 (3.0)
Severe malnutrition 8 (1.2)
Qualitative data suggest that food and nutrition support was provided mainly through the 
collaboration between the Yekokeb Berhan Program and the World Food Program (WFP). 
Caregivers and HVC who needed food support were referred to WFP and provided with flour, oil 
and lentils on a monthly basis. In some areas, the program also mobilized local private institutions 
48
(like bars and restaurants), universities and community members to assist in meeting the food needs 
of HVC. Informants suggested that IPs create more linkages with hotels and universities to fill the 
gap in availability of food for the needy HVC since food provision by WFP was not sufficient. 
Insufficiency of food support was described by a study participant as: 
‘The support is insufficient especially the food distribution is not adequate – it is just like sprinkling 
holy water.’ (Staff member, ANNPCA, Gondar) 
Through the Yekokeb Berhan Program, an initiative called ParmaGarden was reported to have been 
introduced in Mekele, Arbaminch, Debreberhan, Hawassa, to help caregivers to produce food for 
the family and surplus for market. Although findings varied by site, information from one site 
shows: 
‘PermaGardening on small space helped to cultivate vegetables (cabbage; carrot etc) which helped 
families to feed their children and now several families become independent in food.’ (Staff 
member, EDA, Debrebirahn) 
SHELTER AND CARE 
Of the surveyed HVC households, in 1,262 (59%) households, the family lived in a one-room house 
while 651 (30.4%) living in a two-room and 9% in a three or more rooms household. Twenty two 
(1.0%) households lived in a temporary shelter. 
When housing condition of the HVC households was assessed, it was reported that in 910 (42.6%) 
houses, water leaked into the part of the house where the children slept when it rained. This was 
significantly lower than the 52.5% of HVC who had the same problem at the baseline (p<0.05). 
Similarly, the proportion of houses where wind blew into the part of the house where children slept 
when it is windy outside went down to 41.1% at the midterm from 50% at the baseline (p<0.05). 
The proportion of HVC who lived in an adequate shelter during midterm evaluation was found to be 
about one-third. Comparison with the baselines was not however possible as data was not complete 
for this indicator. 
One component of care and support service to HVC families by Yekokeb Berhan Program was the 
renovation of existing depleted houses of destitute households to protect them from exposure to 
various problems. This was undertaken by mobilizing local resources from the community by the 
community. Evidence from KIIs revealed that there were several families in most of the survey sites 
that have benefitted from construction or renovation of houses. 
ECONOMIC STRENGTHENING 
The economic strengthening packages involved in Yekokeb Berhan Program mainly focus on 
helping caregivers to generate financial resources and become economically self-reliant in the long 
run which allows for sustainable support to an HVC and their entire family. One approach designed 
by Yekokeb Berhan in this regard is to encourage caregivers to be involved in saving groups. To 
49
this effect, caregivers were provided with economic strengthening training (e.g. basic saving and 
loan training, microenterprise selection planning and management and business development 
services) and matching funds to expand small scale business. 
Qualitative data shows that caregivers and CSSGs were identified and empowered by CVs and CCs 
to be able to be able to take care of HVC and generate their own livelihood. While caregivers were 
head of the household that hosted HVC, CSSGs were established with an objective to enable group 
of caregivers to improve their livelihood through saving and credit schemes. With this initiative, a 
number of family members were able to generate income that could be used to feed and send their 
children to schools. Furthermore, the Yekokeb Berhan Program has advocated and promoted a 
saving culture to sustain HVC care and support initiatives. To this effect, CSSGs and caregivers 
were trained on starting and operating a small scale business and were assisted to initiate their own 
savings. These community level groups were provided with trainings. 
‘The major capacity we have received through economic strengthening training is how to start 
small business and thrive. They Yekokeb Berhan project provided us with relevant knowledge that 
has long standing implication on our economic activities throughout our life. We started from 
nothing and now we are all leading a successful life.’ (Member of CSSG, Hawassa)
Table 6 below summarizes findings from economic strengthening variables. It was found that 819 
(38.3%) households were engaged in economic strengthening activities with the support of the 
Yekokeb Berhan Program including training, market information, technical support through ES 
animators/facilitators or provision of matching funds. Of those households engaged in ES, 493 
(60%) have received training in CSSGs through the Yekokeb Berhan Program. Participants of 
CSSG trainings described a wide range of benefits of the training in strengthening their household’s 
financial condition. The majority of (76.3%) said it enabled them develop saving habits. Other 
benefits mentioned were increased savings which was not possible in the past (23%), increased 
formation of social bonds (22%), increased vision with set objectives and goals (12%) and access to 
loan funds for MEs. Microenterprise selection, planning and management (ME-SPM) training was 
received by 267 (32.6%) of those households engaged in ES activities. According to the 
respondents, the ME-SPM training enabled more than 50% of the participants to understand the 
local market opportunities for their products/services while in about one-third they understood 
about the need for ME operation skills. One-quarter of the households engaged in ES said they have 
received assistance from the program to access financial or technical services from community or 
government microfinance institutions. 
Twenty five percent of those households engaged in ES activities were involved in small-scale 
businesses or MEs and out of these, 49% stated that they were able to expand or diversify their 
business over the past one year. When asked if they were able to save some money that they 
generated from the small-scale business or micro-enterprise that they were engaged in, 119 (58%) 
responded affirmatively while 72 (35%) said no. 
50
In support of this, participants of CSSG pointed out that they have developed saving habits which in 
turn have implication on improving the lives of their children. 
‘The training we received is very important. This is the basis for our saving knowledge. Currently, 
saving of 17 women has reached 11,000 with only 10 birr saving a week’ (Member of saving group, 
Hawassa). A group in Adama explained the ‘Our income improved that we are able to feed our 
children and some of us start to buy school materials for children. We are really happy for getting 
involved in the saving group.’ (Member of saving group, Adama)
Table 6: Economic strengthening outcomes
Household engaged in economic strengthening (ES) program (n=2138) No (%)
Yes 819 (38.3)
No 1315 (61.5)
No Response 4 (0.2)
ES household had training in Community Saving and Self-help Groups (CSSG) (n=819)
Yes 493 (60.2)
No 316 (38.6)
No Response 10 (1.2)
ES households other training on how to set up a business and run it (ME-SPM) (n=819)
Yes 267 (32.6)
No 533 (65.1)
No response 19 (2.3)
ES households that had regular income in the past 12 months (daily, weekly, monthly, 
quarterly, biannually) (n=819)
Yes 593 (72.4)
No regular income 221 (27.0)
No response 5 (0.6)
ES households involved in a small scale business or micro-enterprise (n=819)
Yes 204 (24.9)
No 608 (74.2)
No response 7 (0.9)
ES households expanded or diversified small scale business over the past one year (n=204)
Yes 100 (49.0)
No 91 (44.6)
No Response 13 (6.4)
Productive assets of the household engaged in ES compared to a year ago (n=819)
Acquired additional productive assets than a year ago 106 (12.9)
Same as a year ago 142 (17.3)
Less than a year ago 570 (69.6)
No response 1 (0.1)
Compared to last year, how do households feel about their financial security (n=2138)
More secure 586 (27.4)
Less secure 587 (27.5)
No change from last year 965 (45.1)
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Out of the targeted households, 593 (72.4%) reported having a regular income on daily, weekly, 
monthly, quarterly or a biannual basis. Out of the total surveyed HVC households, 27% stated that 
they were financially more secure, 45% said they were at the same level and 28% less secure than a 
year before. Information on regular income of households was not collected at the baseline. 
Figure 10: Proportion of households by major economic strengthening indicators
It was found that 106 (12.9%) of the ES households acquired additional productive assets over the 
past two years while 142 (17.3%) had the same productive assets and 570 (69.6%) had less than 
what they had a year ago. Acquired productive assets included working capital, cattle, sheep, goats 
and farm land. 
Caregivers involved in saving groups reiterated that ES support has changed the life of participants 
as well as that of their children. Several accounts from participants revealed that economic 
strengthening through saving has recovered people in the community from poverty. 
‘Initially I was nothing. I did not have anything and was waiting for peaceful death. Through this 
program however I was given the opportunity to get loan through revolving fund and am now in 
good shape supporting my children with basic needs.’ (Participant from the FGD of CG, Gondar) 
‘One of the useful lessons from saving is that I was able to stop waiting for my husband whom I 
used to sit around and wait for to give me money for household use. Now, I am capable of making 
money and meeting household needs and am planning to reach better level.’ (CSSG participant, 
Hawassa) 
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‘Saving helped to generate income on which women have full authority to decide on. I am not 
worried about expenses for my children’s education or what to feed them since I have money no 
matter how small it is.’ (CSSG member, Nifas, Silk Lafto) 
In addition to saving and credit schemes, ES initiatives have also enabled caregivers to do 
gardening. Extensive training has been provided to caregivers and saving groups on perma 
gardening that helped families to produce food for them, and some have started marketing such 
product. While all participants were highly fond of the gardening initiative there appears to be a 
sense of remorse for failing to recognize this as pointed out by one of the participants: ‘we were 
fully asleep, we just woke up (Caregiver, Butajira).
Despite such widely recognized successes in connection to saving, which some refer to as a ‘change 
in their culture where saving and gardening is recognized as an easy doable strategy,’ there were 
some complaints. Volunteers, saving groups and CCs in all study settings complained about 
matching funds that were often too small and not available in time. 
LEGAL PROTECTION 
Provision of legal protection is an integral component of Yekokeb Berhan Program. Implementation 
of the program follows specific procedures whereby the justice system and police are represented in 
different forums (woreda coordination forum and kebele CC) and a child abuse protocol is adopted. 
It was gathered that Yekokeb Berhan Program has put in place a reporting system with appropriate 
legal office bodies on abuse of HVC. The legal protection and support include: protection of the 
rights of HVC, protection of HVC from different kinds of abuses and delivery of birth certificates. 
To this effect, caregivers, community volunteers, CC members and saving groups were trained on 
protection and safeguarding the right of HVC and protecting them from abuses. In addition, HVC 
were provided with information on their rights, especially the right to services, and on how to 
exercise it. 
Table 7 below summarizes findings related to legal protection variables. Of all the caregivers 
involved in the study, 147 (6.9%) reported that their household has experienced some form of 
violence in the past one year. Of these, 68 (46.3%) encountered verbal abuse while 60 (40.8%) 
encountered physical abuse. Sexual violence was also reported by 4.1% of the households. 
According to the respondents, most of the violence was perpetrated by neighbors or unknown 
people while household violence by a spouse accounted only for 12% of the cases. Out of the 
households that experienced violence, 92 (62.6%) went to police to get legal services while 45 
(30.6%) did nothing. On the other hand, 8.2% of the households were referred to legal services for 
various reasons over the past year, and the majority (53%) of this referral was done by Yekokeb 
Berhan Program through IP staff, CCs or CVs. More than half (51.7%) of the households said that 
they feel more secure in terms of legal protection this time than before they were involved in 
Yekokeb Berhan Program.
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Only 185 (8.7%) of the HVC had a birth certificate from an authorized government office as 
confirmed by the surveyors. This was low but significantly higher compared to the baseline where 
only 5.5% of the HVC had birth certificate during the survey (p<0.05). In the midterm there was no 
difference between boys (8.4%) and girls (9.0%) in terms of possession of birth certificate. 
Table 7: Summary of legal protection variables
Total %
HVC has birth certificate issued from authorized government office (seen 
and confirmed) (n=2121) 185 8.7
Over the past 12 months, any member of your household experienced any 
violence (n=2138) 147 6.9
Type of violence experienced (n=147)
Physical violence 60 40.8
Verbal abuses 68 46.3
Sexual violence 6 4.1
Other 13 8.8
Action taken after the violence occurred (n=147)
Went to police/sought legal services 92 62.6
Went to health center/clinic 21 14.3
Went to Kebele/ women & children affairs 25 17.0
Told a relative or neighbor 14 9.5
Did nothing 45 30.6
Other 1 0.7
No response 7 4.8
Who mostly perpetrated the violence? (n=147)
Spouse 18 12.2
Neighbor 70 47.6
Older child 11 7.5
Unknown people 26 17.7
Other 13 8.8
No response 9 6.1
Households referred or linked to any legal services over the past 1 year 
)n=2138) 176 8.2
Who referred or linked you to legal services he/she needed? (n=176)
Total
Yekokeb Berhan IP 46 26.1
Community committee 26 14.8
Community Volunteers 22 12.5
Kebele administration 47 26.7
Other 24 13.6
No response 11 6.3
Household that feel more secure in terms of legal protection this time than 
before you were involved in Yekokeb Berhan program (n=2138) 1105 51.7
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4.4.3 Objective 3: Enhance the capability of communities for coordinated and 
improved responsiveness towards HVC care
Community structures and coordination of care 
At the community level, there were three important structures that were found functional in 
connection to Yekokeb Berhan Project. These are: CCs/CCCs,25 CVs and CSSGs. Each of these 
structures was either established in connection to this project or was already functioning and was 
therefore strengthened. Nonetheless, it was clear that these structures were empowered to play their 
specific roles which were found to cover those exhibited in the table below.
1. Community structures 
a) Community committee/community care coalitions 
Community committee was found to be a structure with a responsibility to coordinate support for 
HVC at community level. This structure is found to be chaired by the chairman of the kebele
administration with kebele chief executive officer as a secretary. The members are from 
representatives of MoWCYA, HAPCO, health, education, NGOs, faith based organizations, and 
community based organization and community representatives. Participants’ representing CC 
explained their specific roles as follows: 
‘The role of CC in relation to Yekokeb Berhan program is to identify poor households with 
vulnerable children based on specific criterion and determine level of poverty, prioritize children 
that should get support, initiate working relationship with government sectors to support HVC and 
link them with different NGOs to get relevant support.’ (Member of CCC, Mekele) 
According to this group, care and support for HVC requires coordinated multi-sectoral response to 
avoid duplication of support. Members of the CC in all study areas believe they will be responsible 
to sustain the project after it phases out.
‘We are here to assure sustainability of care and support to HVC initiated by Yekokeb Berhan 
project through mobilization of resources from the community. We are engaged in building 
community awareness to ensure community’s ownership of HVC. Furthermore, they pointed out 
that CC collects worn out cloth, money and other materials to support HVC and their family for 
immediate solution but our main target being to sustain the initiative after the project is phased 
out.’ (CC member, Gondar) 
Similar opinions were reflected on the role of CC which coordinates HVC’s care and support at 
community level by mobilizing community resources and sustaining initiative activities. 
 
25 In Tigray and since recently in Amhara region such groups are referred to as community care coalition (CCC) 
55
The CC monitors and supervises distribution and utilization of support provided to HVC and their 
families, supervise community volunteers and strengthen community-based child care and support 
initiatives.’ (Member of CC, Adama) 
The CC is composed of different stakeholders involved in care and support for orphans and 
vulnerable children or are believed to have a stake in this. 
‘We meet with different structures: iddir, teachers, youth and women associations, government and 
nongovernmental institutions as members of CCC. This is a forum we discuss and work and 
evaluate our work with Yekokeb Berhan program every 3 months.’ (Member of CCC, Mekele) 
At the community level, scheduled monthly meeting is held among CC and CVs to discuss on 
accomplishments and challenges encountered. 
‘The different groups [CC and CVs] meet every month to discuss about their progress, problems 
encountered, and solutions attempted.’ (Member of CSSG, Nifas Silk Lafto)
Resources mobilized from within the community have helped CCs to provide educational materials, 
free training opportunities for HVC over 18 years of age and construction and renovation of houses. 
This is mentioned to be the case by CC participants from all settings. It was found that: ‘often 
resources mobilized from community level fill urgent gaps in addressing the needs of HVC’ 
(Member of CCC, Mekele). 
b) Community volunteers 
CVs are members of the community who are identified by CCs. They are provided with relevant 
trainings as pointed out above and are responsible for 25 HVC and their families. According to 
information from Pact team, currently there are over 20,000 CVs supervised by community 
facilitators. Every CV meets with group of HVC and their families as well as community volunteers 
each week. CVs are the front line in implementation of Yekokeb Berhan Program, identifying 
challenges and reporting about Yekokeb Berhan Program operation.
The below statement from one of the volunteers captures their role:
‘We work closely with HVC and their families. We raise their awareness about Yekokeb Berhan 
program and how they could sustain their life in its absence by initiating their own through 
involvement in saving groups and using loan. We follow and help HVC to attend their school, guide 
them on use of their time to study and equip them with moral and discipline. We also help 
caregivers to keep their environment clean, on housekeeping and environmental sanitation. We visit 
every care giver as well as HVC every week to keep records and help them solve problems in 
addition.’ (CVs, Nifas Silk Lafto) 
Furthermore, CVs are provided with various trainings that they, in turn, share with beneficiary 
families. 
56
‘We train caregivers on parenting, sanitation, fill CSI to track problems HVC encountered in 
relation to their education, food and health. We bring this to the attention of CC to solve their 
problems. Our role is to bring change on the outlook of the community towards vulnerable children. 
We checked out the child’s development and problems.’ (CV, Mekele) 
CVs are responsible for generating data and reporting to the CC on progress and challenges in 
response to HVC at the community level. 
‘We were trained on child care/parenting skill, child-family relationship, how to select HVC using 
the available format, collection and reporting of data on HVC on a regular basis.’ (Member of 
CCC, Mekele) 
Yet, government partner at regional level do not feel capacity building at community structure’s 
level is yet sufficient. 
2. Coordination of care 
Coordination of care is one of the core components of Yekokeb Berhan Program. The objective of 
this component of the project is to establish strong partnerships between different stakeholders to 
improve level of care and support to HVC. At federal level, Pact, FHI360 and Child Fund have 
created partnerships to guide the project following government’s strategy.26 Such partnerships have 
translated to community level where community members, government sectors such as education 
and health, CSOs operating in the community, private (for profit) institutions and individual 
members of the community work together to improve the life of HVC and their families. 
Coordination of care works in such a way that once HVC are identified, they are provided services 
within the reach of Yekokeb Berhan Program and referred to other stakeholders for more support 
that could not be accommodated within Yekokeb Berhan Program. Data generated from Pact as 
well as community structures revealed that for food support HVC are referred to WFP, while for 
chronic health problems the health sector would take responsibility. At the community level, 
community facilitators27 are responsible: 
‘To bring CC and volunteers together and guide them to track source of support at community level 
and link HVC with such support.’ (Yekokeb Berhan regional manager, SNNPR) 
Evidence from the field shows that: 
‘Service mapping is carried out to determine available sources of support and develop directory of 
services so as track types of resources at community level.’ (Members of CC, Robe and Hawassa) 
 
26 Although level of partnership between HAPCO and MoWCYA was not clear, resistance from HAPCO to participate 
in this study appears to shade light on the fact that HAPCO is not quite happy for not being a direct partner to Yekokeb 
Berhan for this program. 
27 Paid field level worker responsible to supervise 600-700 CVs, responsible to provide technical support and guidance 
to community structures, liaise community structures with Implementing CSOs.
57
‘Such service mapping and directory is a reference for community structures to mobilize support for 
HVC and their families based on needs identifed through CSI.’ (Amahara regional coordinator) 
At the woreda level, a coordination forum is established where membership include representatives 
of the WCYAs office, women associations, schools, community leaders, police, education and 
health sectors and CSOs chaired by the WCYAs office. 
‘The objective of such forums is to share experiences and solicit solutions for problems’ (Gondar, 
PADET). Furthermore, it was argued that ‘such forums will also be considered to identify potential 
support stakeholders could provide.’ (ODA staff, Robe) 
IPs and regional cluster managers underscored that the project encourages maximum utilization of 
locally-available resources (human, material and financial) by mobilizing such resources from 
different stakeholders through the CCs at the community level. To this effect, Yekokeb Berhan 
Program built capacity of implementing partners and CCs were trained to enhance their capacity to 
mobilize resources and coordinate with stakeholders operating within their setting to improve care 
and support to HVC and their families. 
Interview with Pact staff members reveals that as part of the effort to coordinate and harmonize care 
and support to HVC and their families, implementing NGOs were encouraged to sign MoUs with 
different stakeholders (government and non-governmental) to improve service provision to HVC at 
community level on referral basis. Often such MoUs were reported to be with health facilities, 
microfinance institutions and education institutions.
CCs at operational levels reported to have mobilized support from local government and private 
institutions and community members including iddirs, religious organizations and individual 
community members so as to improve care and support for HVC and their families. In fact, the 
composition of CC itself is considered as a step towards coordination of care. 
In addition to the above components of the coordination of care and support, many participants of 
this study suggest that coordination of care and support initiatives laid the basis for sustainability of 
the program. Most of them also suggest the need to intensify coordination of care by building the 
capacity of CCs. Besides, it is important to note the value of such a strategy by ensuring ownership 
and close follow up of government partners. 
58
Table 8: Summary of roles of community structures in connection to the Yekokeb Berhan Program
Partner Roles 
CCs  Recruitment of HVC and their families to be enrolled into the Yekoekb 
Berhan program
 Determine which vulnerable children should receive what support 
 Establish relationship with likeminded institutions (civil society 
organizations (CSOs), private organizations and government structures) to 
mobilize support for children and their families 
 Ensure there is no double use of available resources – avoid duplications 
 Support and supervise volunteers
 Visit beneficiaries at home with volunteers
Caregivers  Take full responsibility for a smooth growth of children
 Care for our children
 Send children to school 
 Provide psychosocial support to children
 When the child gets sick take them to health center for medical support
 Provide food and ensure personal hygiene of children 
CSSGs  Save every week (the amount of money that they save would be decided 
by the members of the group)
 Develop their internal rules and regulations 
 Report their progress through the chair 
 Proper management of their business
 Active and sustained engagement in production of livelihood 
CVs  Responsible for 25 HVC whom they visit at HHs to 
 Identification and registration of potential beneficiaries
 Carry out vulnerability assessment using CSI
 Share assessment result with CC for approval
 Advice family members on how to care for their children.
 Follow and guide children on their education 
 Advice caregivers on self-reliance and how to start income generating 
activities 
 Train caregivers on parenting and truck on they apply the skill for 
improved child care
 Advice HVC and their families on personal hygiene 
 Record accomplishments and report to Community Committee
 Facilitate linkage between caregivers with sick child with health facilities 
for medical support 
 Raise community awareness on HVC and sustainable HVC care and 
support
 Maintain strong and close working relations with caregivers and HVC 
 Preparing and submitting the monthly activity report 
Source: Data generated from different participants of the midterm evaluation, March 2014 
59
4.4.4 Objective 4: Establish effective and efficient monitoring, evaluation, reporting and 
learning system ensuring evidence based programming and policy formulation 
Evidence-based programming 
Yekokeb Berhan Program has a well-defined method of collecting, managing and reporting about 
HVC. Standard tools were developed to collect, manage, report, analyze and use data for planning 
purposes. Mechanisms were developed to collect data on HVC and their families at the household 
level. Volunteers make door-to-door visits to HVC and their families to record state of service 
provision on a weekly basis using formats developed for this purpose. They submit the report to CC 
every month who, in turn, verifies and share it with community facilitator. Data generated by 
volunteers at household level passes through successive verification and approval steps as shown in 
figure below.
60
 
Figure 11: Data generation and reporting procedure for Yekokeb Berhan project, April 2014
Source: Data generated from different participants in assessment, March 2014
MERL Officer/ 
Coordinator
MERL Director/ Sr. Manager
Data Entry Clerk – Woreda 
level
(IP and BoWCYAs)
Community Facilitator 
Community Committee
Volunteers
Verify/correct and 
share to COP
Verify/correct and submit 
to Executive Director
Encode data, share 
data with MERL, 
and file hard copies 
Check, verify, approve 
and submit to partner 
office
Verify, approve 
and submit to CF
Generate data from 
HH and subm to 
CC
Verify/correct, 
Consolidate and share 
with MERL Team
Feedback at all 
levelson
PACT Chief of Party (COP)
USAID
Households 
(HVC & Caregivers)
Partner’s Executive Director
Regional Cluster Office
MERL Team
Verify/correct and 
submit to Pact 
regional office
Verify/correct 
and share with 
MERL 
Director/Sr. 
ManagerCOP
DCOP
Consolidate and share to 
MERL Director
Verify/correct and 
share to USAID
61
Participants from government offices at regional and woreda levels were found to have limited or 
no information on changes regarding routine data generation, management and reporting although 
they are aware of national level endeavors to establish a child related database. Even if data is 
shared with BoWCYA regional offices, there appears to be lack of appreciation as revealed by a 
representative of one of the regional office staff: ‘Yekokeb Berhan Program sends quarterly plan 
and reports to our office, but we do not pay attention to the plan or report.’ 
At the woreda level, however, IPs recognized that data is routinely generated and compiled at the 
implementing NGO level, providing an opportunity to track the state of HVC in the woreda. As 
pointed out in one of the data source: 
‘In previous years we did not have data on the number of HVC supported in our woreda and who 
provides such support. As a result, some children get support from three or four NGOs while others 
barely get one.’ (Hawasa, BoWCYA) 
Yet, it was gathered that still there are gaps as reflected by most government partners at operational 
levels. Despite some evidence of improved capacity (through training) on data management and 
reporting to the government partners, the importance of data appears to be undervalued where data 
is not shared with the woredas. This, however, was not seen at all sites since some woredas are 
proactive and benefitted from Yekokeb Berhan Program.
‘Yekokeb Berhan Program has helped us to enrich our previous data collection form and now we 
have detail data due to HH level data collected by volunteers.’ (BoWCYA Butajira) 
Similar insights were reflected where: 
‘Previously, we were documenting HVC information but after the beginning, Yekokeb Berhan
program we were able to manage and use data properly but still there is gap on timely 
documentation.’ (BoLSA Adaw) 
Furthermore, routine data collection and management by Yekokeb Berhan program has facilitated 
easy recruitment of HVC for support. 
‘In earlier days when service providers request us for needy children, we used to send them to 
kebele who will readily identify children for the intended purpose without strong evidence. Now, 
thanks to Yekokeb Berhan program, now data on how many children deserve support and where 
they are found are all available.’ (BoWCYA, Hawassa) 
In addition to the use of such data for identification beneficiaries, respondents suggested that it is 
used for planning of child related activities. 
‘When we plan child focused activities in a particular kebele or when we are asked about children 
current in support, we resort to data generated through Yekokeb Berhan program.’ (BoWCAYA, 
Kombelcha) 
62
Another important activity that the program undertaken in order to achieve its objective 4 was 
strengthening regular meetings to review programs at all levels. It was found that IPs conducted 
monthly and quarterly meetings with government partners including health offices, MoWCYA, 
education sector and HAPCO offices. Review meetings were also held at community level with 
CC/CCC members and volunteers to discuss achievements, identify gaps and work on 
improvement. A key informant described this as: 
‘[W]e conduct regular meetings with CC/CCC and CVs in all kebeles and discuss progress and 
challenges. This has helped us a lot solve problems that may affect our program at the 
implementation level.’ (IP staff, Hawassa) 
Secondary data review also revealed that the IPs carry out periodic review meeting with partners 
and discuss issues that affect implementation of the program like high turnover of community 
volunteers.28,29 From review of program reports it was found that Yekokeb Berhan also conducted 
regional quarterly review meetings in all the five clusters where Yekokeb Berhan and IP staffs, and 
regional government representatives (BoWCYA, BoLSA and HAPCO) were involved. The 
meetings were intended to review the program progress, facilitate experience sharing focusing on 
Coordination of care and economic strengthening among the implementing partners, discuss on 
strengthens and ways to address improvement areas and discuss program priorities for subsequent 
time.
30,31
4.4.5 Perceived changes at community level in consequence to Yekokeb Berhan 
project 
In all settings study participants explained changes brought about due to Yekokeb Berhan Program 
and resulting community structures. Some of such changes were highlighted as follows: 
‘In former times, community members insult orphan children with offensive terms words saying 
komat (poor), abou zidefe (who kills his/her father). This is history and no one would say this. 
Children consider these structures and refer to them as ‘kokeb berhan’ where as some caregivers 
refer to us as ‘embur berhan’ (colored light).’ (CV, Mekele)
Findings show that the Yekokeb Berhan Program was mobilizing support and ensuring that HVC 
attend schools. 
‘A lot of children have been exempted from school fees and have all materials necessary for them to 
attend their education. In one wereda alone we can find 500 or 600 children exempted from school 
fee due to the intervention of the CC.’ (Yekokeb Berhan regional manager, Eastern cluster) 
 
28 Pact, Minutes on Partners’ Quarterly Performance Review Meeting, Nekemte, June 04, 2012. 
29 Pact, Minutes on Partners’ Quarterly Performance Review Meeting, Jimma, November 22-23, 2012. 
30 Pact Yekokeb Berhan Program for Highly Vulnerable Children, Annual Progress Report, Oct 2012 to Sept 2013.
31 Pact Yekokeb Berhan Program for Highly Vulnerable Children, Semi-annual Progress Report, Oct 2013 to Mar 2014.
63
More specifically a CG in Hawassa explained that: 
‘I have three children. I wouldn’t have sent them all to school if it was not for this project to support 
two of my children. I am not worried for exercise book, pen and pencil.’ (Members of CGs, 
Hawassa) 
Now more families are economically empowered to the point that they can sustain their own 
livelihoods. 
‘Many individuals who were jobless are engaged in self-income generating activities and changed 
their life.’ (Padet, Fogera)
–‘The life of most HVC has improved in terms of school attendance, development of self-confidence, 
better (renovated) house. Besides, now community is taking more responsibility to support HVC.’ 
(Staff member of EKHC, Arbaminch) 
Similarly, it was argued that community’s capacity was built to provide support to HVC with local 
resources. 
‘Because of coordination of care the community was able to support HVC. They were able to 
realize capacity within the community and they were able to mobilize that to care for and support 
HVC.’ (Staff member of ODA, Robe) 
At the IP level it was gathered that capacity of CSOs as implementing partners was improved. 
Specific mention was made of the experience in harnessing local resources to support HVC. 
‘I think this is the first project that works on using the local resource. We were able to have the 
experience of mobilizing local resource. This project has formalized local resource mobilization.’
(Staff member of Mary Joy, Hawassa) 
Besides, the data base system introduced was widely recognized as important contribution from 
Yekokeb Berhan project. It was argued that: 
‘Previously service delivery was informed by information that was not based on accurate database. 
The current database contains its own care plan and now that can verify and used for decision 
making on who get the service and what type of service.’ (Staff member of Padet, Fogera)
64
5. DISCUSSION 
In this section, findings presented in the previous sections are discussed in comparison with the 
baseline findings, wherever information is available from the baseline. The challenge here,
however, is that many of the variables were not documented in the baseline. Efforts have been made 
to get as much information as possible by reanalyzing the baseline data. However, most of the 
relevant variables to the program were missing. Health, education and shelter variables were better 
collected in the baseline and hence comparisons with the midterm findings have been better in these 
areas. Variables related to psychosocial and legal protection, apart from birth certificate, were not 
collected in the baseline. Some economic strengthening and food and nutrition variables were 
collected differently than the programs activities and direct comparison of these variables with the 
midterm findings was not possible. For variables that were not documented in the baseline and for 
those documented in a different manner, comparison is made with national data and other sources, 
including secondary data as appropriate. 
a. Program Objective 1
Yekokeb Berhan Project introduced a system to identify and enroll HVC to benefit from 
standardized care and support. In order to enable stakeholders at different levels, different systems 
and structures were put in place or strengthened. Dissemination of the National OVC Standard 
Service Delivery Guidelines (SSDG) was perhaps the foremost step of the program in strengthening 
the capacity of key government partners. This finding was consistent with the project reports which 
state that large number of copies of SSDG were distributed to IP staffs, CC/CCC members, 
volunteers, and government officers were oriented to enhance their understanding of the 
guidelines.32,33 Similarly, the various trainings provided to IPs and government, as described by the 
study participants, were found to be congruent with what the program reported in its annual and 
semi-annual reports. 
The innovative method of assessing capacity of the community known as Community Capacity 
Barometer enabled the program to identify capacity strengths and gaps at the community level. 
Based on the findings, the program designed various capacity building activities for CCs/CCCs 
including training, supply of stationery and office furniture and supportive supervision by IPs. 
Community capacity building endeavors of the program were acknowledged by government 
partners as stated by a staff of MoWCYA: ‘There has never been an organization engaged in 
building community system and capacity in response to children’s problems…’ and this may be 
what the makes Yekokeb Berhan Program unique. 
Capacity building of IPs, government partners and community structures as well as improving 
guidance and skills for coordination of care were important initiatives for system building. Such 
system improvement for delivery of services to HVC may help to sustain the program’s initiatives 
 
32 Pact Yekokeb Berhan Program for Highly Vulnerable Children, Annual Progress Report, Oct 2012 to Sept 2013. 
33 Pact Yekokeb Berhan Program for Highly Vulnerable Children, Semi-annual Progress Report, Oct 2013 to Mar 2014.
65
beyond it life. Nevertheless, challenges that undermine the capacity building efforts of the program 
exist. This is mainly related to high staff turnover in the government offices which usually leads to 
gaps in institutional memory and consequently limited awareness about the project which in turn 
leads to poor partnership with CSOs. 
b. Program Objective 2
HEALTH AND HEALTH CARE
Health services are an essential component of a comprehensive HVC program. Yekokeb Berhan 
Program has created access to health care for both preventive and curative services for HVC and 
their families by working closely with the government health care system and the private sector to 
expand children’s access to health services. The impact of this support seems visible as HVC’s
assessment of own health status over the twelve month period prior to the midterm evaluation 
indicated improvements from the baseline. The proportion of HVC who perceived their own health 
to be either very good or good has significantly increased from the baseline. Similarly, those who 
felt that their health was either poor or very poor have significantly decreased over the course of the 
project implementation. This was also supported by the finding that children who reportedly fell 
sick in the two weeks preceding the survey decreased by more than 40% from the baseline. This 
finding was in line with the finding of comparative analysis of CSI-I and CSI-II where in the 
indicator ‘child free from signs of disease’ number of children with score 1s has decreased and 
those with score 2s, 3s and 4s have increased.34
Assessment of rate of diarrhea among HVC as one of the key indicators for their health status was 
also in favor of improvement of HVC’s health situation. Episodes of diarrhea among HVC in the 
two weeks preceding the survey has significantly decreased at the midterm compared to the 
baseline. However, rates of fever among HVC during the two weeks preceding the survey increased 
from the baseline, and this is perhaps attributed to slight geographic variations between the baseline 
and midterm evaluation areas and the difference in the seasons of the surveys (baseline survey was 
conducted during the rainy season while the midterm evaluation was in dry season), both of which 
have role in occurrence of malaria and other febrile illnesses. 
Positive changes in health seeking behavior of HVC, as assessed by whether treatment was sought 
for recent fever and diarrhea, were one of the most noticeable changes in the health outcomes. The 
changes in proportions of HVC who sought treatment for fever and diarrhea gave evidence for 
positive change of health-seeking behavior of HVC. 
The immunization status of children against vaccine-preventable disease was another important 
indicator of health for HVC. Coverage of age-appropriate vaccination for under-five children as 
confirmed by vaccination has shown significant improvement from the baseline and was even 
higher than the national coverage for urban settings. This finding was compatible with the 
 
34 Yekokeb Berhan CSI Report from FY13 Annual Report.
66
comparative analysis of CSI-I and CSI-II of the program also shows that children with scores of 1s 
and 2s have reduced significantly while those with 3s and 4s have increased showing positive trend 
in coverage of immunization.
35 Similarly, comparison of the child health access indicator in the two 
CSIs shows significant reduction of score 1s and at the same time increase in 2s, 3s and 4s. 
Yekokeb Berhan Program prioritizes access to health care for both preventive and curative services 
to HVC and their families and, to this effect, works closely with the government health care system, 
especially with the health extension program, and the private sector to expand children’s access to 
health services.36 Volunteers coordinate with HEWs to identify and refer children needing health 
care, promote child and maternal health through health education (HIV/AIDS, hygiene and 
sanitation and breast feeding), and facilitate and follow up on immunization of children. These 
interventions of the program may have contributed to improvements in health and health-seeking 
behavior of HVC between the baseline and midterm.
HIV and AIDS related services were also among the health services that were provided to HVC and 
their caregivers through the support of Yekokeb Berhan Program. The program supports IPs to 
strengthen health referrals for HVC including for HIV prevention (e.g. prevention of mother-to￾child transmission of HIV) and to HIV testing, care and treatment.37 Though this information was 
not collected at the baseline, the finding in the midterm that large proportion of caregivers and 
adolescent HVC reported having access to HIV information and counseling service over the past 12 
months was generally high. However, this finding was not congruent with the program progress 
report which states that significantly lower proportion of beneficiaries (26%) were supported to 
access HIV services.38 This is perhaps because HVC and their caregivers may have obtained HIV 
information and counseling services through other sources including public health facilities, 
schools, youth clubs and from mass media where these services are often available. 
With 12% of teenage women in Ethiopia starting childbearing,39 high rates of sexually transmitted 
infections including HIV and a high maternal death rate, improving access of youths to reproductive 
health continues to be urgent need in Ethiopia.40 This is even more important when it comes to HVC 
who are usually underserved and vulnerable. The finding in this midterm evaluation that less than 
two-thirds of adolescent HVC had access to RH information was still much lower compared to a 
study conducted in Jimma town in 200941 where 95% of the adolescents had easy access to 
information, education and communication about RH, though the settings are different and Yekokeb 
 
35 Yekokeb Berhan CSI Report from FY13 Annual Report.
36
 Pact Yekokeb Berhan Program for Highly Vulnerable Children, Semi-annual Progress Report, Oct 2013 to Mar 
2014.
37 Pact Yekokeb Berhan Program for Highly Vulnerable Children, Semi-annual Progress Report, Oct 2013 to Mar 2014.
38 Pact Yekokeb Berhan Program for Highly Vulnerable Children, Semi-annual Progress Report, Oct 2013 to Mar 2014.
39 Ethiopia Demographic and Health Survey 2011, Central Statistical Agency, Addis Ababa, Ethiopia and ICF 
International, Calverton, Maryland, USA, March 2012. 
40 UNFPA Ethiopia: http://countryoffice.unfpa.org/ethiopia/2008/12/30/266/reproductive_health_and_hivaids/
(accessed on 11/5/2014).
41 T. Ayalew, G. Yeshigeta. Adolescent Reproductive Health Services in Jimma City: Accessibility and Utilization. 
Ethiop J Health Sci. July 2009; 19 (2): 91-102. 
67
Berhans Program’s target group are selectively defined. Schools appeared to be the most important 
source of RH information for adolescent HVC as they account for three-quarters of the sources. 
This indicates the need to support schools to strengthen their capacity to continue providing the 
right information. On the other hand, the role of Yekokeb Berhan CVs, who also have opportunities 
to interact with HVC, could be expanded as sources of RH information for adolescent HVC. 
With regard to HIV testing of HVC, having ever been tested was assessed at the baseline and direct 
comparison with the midterm finding where testing was assessed for the 12 month period prior to 
the evaluation may have limited value. Nonetheless, HIV testing rate found in this midterm was 
higher than the baseline and routine data of the program. Similarly, the finding that three-quarters of 
the caregivers reported having HIV test in one year prior to the evaluation was much higher than the 
national adult HIV testing coverage of 20%.
42 This may reflect the program’s impact on accessing 
HIV/AIDS services by HVC and their families as it has been providing HIV and AIDS-related 
education and referrals for counseling and testing over the past two years.43,44 The fact that many 
HVC and their caregivers are affected by HIV and as a result belong to high-risk group may drive 
them to seek HIV testing more readily than the general population hence showing higher testing rate 
than the national coverage. The finding that proportion of HIV-positive HVC that was on ART 
significantly increased from baseline was perhaps attributed to the program’s support to HVC to 
access HIV and AIDS information, education and services hence improving their health-seeking 
behavior. However, as described above, there may be public and CSO actors providing HIV 
information and education hence augmenting Yekokeb Berhan Program’s efforts in this regard. HIV 
positivity rate both among HVC and caretakers were much higher than the national prevalence of 
1.2%45 for obvious reason that many of these households may have been affected by HIV as a result 
of which vertical and horizontal transmissions could be possible. 
PSYCHOSOCIAL SUPPORT 
Psychosocial support services aim to provide HVC with psychosocial support that helps them build 
confidence to interact with friends and the family and can plan their future responsibly. Such 
support is believed to break potential stigma and discrimination against HVC. In addition, the 
service seeks to promote and support the acquirement of life skills that allow adolescents in 
particular to participate in school and recreation activities without any restraints.46 The importance 
of parenting skills for caregivers to care for vulnerable children who are often subjected to 
psychological and social problems cannot be overemphasized. Better training and refreshers could 
improve not only breaking stigma and discrimination but also the smooth and responsible 
 
42 Ethiopia Demographic and Health Survey 2011, Central Statistical Agency, Addis Ababa, Ethiopia and ICF 
International, Calverton, Maryland, USA, March 2012. 
43 Pact Yekokeb Berhan Program for Highly Vulnerable Children, Annual Progress Report, Oct 2012 to Sept 2013. 
44 Pact Yekokeb Berhan Program for Highly Vulnerable Children, Semi-annual Progress Report, Oct 2013 to Mar 2014.
45 HIV Related Estimates and Projections for Ethiopia, Ethiopian Health and Nutrition Research Institute, Federal 
Ministry of Health, Addis Ababa, August 2012. 
46 Standard Service Delivery Guidelines for Orphans and Vulnerable Children’s Care and Support Programs, February 
2010, Addis Ababa.
68
development of HVC. As one of the package of services provided to HVC, this support is also 
believed to reinforce the impact of other services among which are education and health. HVC who 
are not stigmatized and discriminated in school and at community level are believed to be self￾confident and can contribute to their own development.47,48
The large majority of HVC appeared to be emotionally stable as proportion of those who had 
sudden change of mood found to be very small and this seems encouraging. Though there was no 
data on psychosocial needs of HVC at the baseline, the fact that improvements were observed for 
children who scored the lowest (‘in greatest need’) in psychosocial assessments when comparing 
two years of CSI scores on some psycho-social indicators49 indicate that there was improvement in 
psychosocial wellbeing of HVC. This may be attributed to the program’s counseling and guidance 
services provided to a large number of HVC through home visits by volunteers and in collaboration 
with religious institutions and professional counselors.50,51 Better parenting training that was 
provided by the program to more than half of the households may have also helped caregivers 
provide better care for the HVC hence helping the latter to be emotionally stable. 
EDUCATION 
Different studies have shown that orphans and vulnerable children are less likely to be enrolled in 
schools than non-orphans.52,53 Consequently, Yekokeb Berhan Program has been working closely 
with local education bureaus and kebele authorities to support HVC households to enroll and keep 
their children in school. The program has supported and mobilized local resources to provide 
scholastic materials and school uniforms to HVC and has facilitated tutorial services and 
exemptions from school fees. Such support coordinated by CCs has involved the community as well 
as school authorities to improve education service to HVC. From this particular study as well as 
previous reports, such support is documented to have improved student’s school performance and 
reduced school dropout rates.
54
Overall school enrollment of HVC in the project area has significantly increased in the midterm 
from the baseline. The change was across all age groups and for both boys and girls alike. The 
biggest change was however observed for youngest children aged 3-4 years where enrollment 
increased from just 4% at baseline to 75% in the midterm. Not only enrollment but also regular 
 
47 Grace Zhou. Understanding psychosocial wellbeing of Orphans and vulnerable children: The intersection of research 
and policy, May 2012.
48 FHI360. Guidelines and programming options for protecting vulnerable children in community based care and 
support programs, 2012.
49 Yekokeb Berhan CSI Report from FY13 Annual Report.
50 Pact Yekokeb Berhan Program for Highly Vulnerable Children, Semi-annual Progress Report, Oct 2013 to Mar 2014.
51 Pact Yekokeb Berhan Program for Highly Vulnerable Children, Annual Progress Report, Oct 2012 to Sept 2013.
52 Mishra, Vinod, and Simona Bignami-Van Assche. 2008. Orphans and Vulnerable Children in High HIV-Prevalence 
Countries in Sub-Saharan Africa. DHS Analytical Studies No. 15. Calverton, Maryland, USA: Macro International Inc. 
53 David K. Evans and Edward Miguel, Orphans and Schooling in Africa: A Longitudinal Analysis. Demography Feb 
2007, 44(1) 35-57.
54 Pact Yekokeb Berhan Program for Highly Vulnerable Children, Semi-annual Progress Report, Oct 2013 to Mar 2014.
69
school attendance is vital for children to perform well in school. Regular school attendance (class 
attendance of a minimum of 75% of school days as defined by the program)55 in the midterm was 
significantly better than that was documented in the baseline survey (p<0.01) and this is 
encouraging. Successful completion of the academic year and transfer to next grade/level at the end 
of the year was measured to assess how an HVC is performing with his/her education. Based on 
data from this evaluation, and program report,56 school performance of HVC was found to have 
improved at the program sites. The overall grade promotion rate of 85.8% found in this evaluation 
showed that Yekokeb Berhan -supported HVC were performing well in school. Though direct 
comparison is not possible, this finding showed improvement over the baseline where a quarter of 
HVC reported they have repeated grade and by implications three-quarters were promoted. 
Although this may be partly attributed to the aggressive implementation of the government’s 
Education Policy, the fact that the improvements are marked indicates that contributions of 
Yekokeb Berhan program with its partners including communities and households are significant. 
In particular, the approach by Yekokeb Berhan Program of strengthening early childhood 
development (ECD) program both in the family context and at established ECD centers may have 
contributed to the big change observed in school enrollment among HVC aged 3-4 years. It was 
found out that the program currently supports 42 ECD centers through provision of outdoor playing 
materials, renovation/expansion of center facilities and training of facilitators.57 The finding that 
school expenses were covered by the program for more than two-thirds of the in-school HVC also 
supports the argument that changes in school enrollment rate could be attributed to the impact of the 
program. 
Tutoring services for HVC was one of the supports found to be provided by the program in 
collaboration with government schools and volunteers. In principle, this support bridges the gap of 
HVC who need help with their school work but do not have anyone to help with this regard. 
However, the finding that only small proportion (15%) of those in school received tutorial service 
while more than half of them did not have anyone to help them with their school work seems a gap. 
This indicates that there has been unmet need of HVC for tutorial support. Moreover, sustainability 
of the tutorial service seems of concern for the community as the service has been provided by 
volunteers who had many other tasks and were not in a binding commitment for this service. One of 
the key lessons from the end-of-project evaluation of PC3 was overburdening community 
volunteers particularly in partners with limited resources.58 Furthermore, high turnover of 
community volunteers has been discussed in Yekokeb Berhan partners’ quarterly review meetings. 
 
55 Yekokeb Berhan /Pact Program for Highly Vulnerable Children Performance Monitoring and Evaluation Plan, 
04/20/2011 - 04/19/2016, Updated in February 2013.
56 Yekokeb Berhan CSI Report from FY13 Annual Report.
57 Pact Yekokeb Berhan Program for Highly Vulnerable Children, Semi-annual Progress Report, Oct 2013 to Mar 2014.
58Ethiopia Positive Change: Children, Care and Communities (PC3) End-of-Project Evaluation, July 2008. 
70
These indicate possible implications on performance of volunteers in regards to extending help in 
school work or provision of tutoring services to HVC.59,60
FOOD AND NUTRITION 
According to the national SSDGs, food and nutrition support is one of the core service areas which 
are considered critical components of a set of services for a program targeting vulnerable children. 
These services aim to ensure that vulnerable children have access to similar nutritional resources as 
other children in their communities.61 Support from Yekokeb Berhan program targets households 
faced with serious food shortage and children who are malnourished and focuses on strengthening 
families through education on nutrition and creating linkages with organizations that provide food 
and nutritional supports such as the WFP. 
The finding in the midterm that slightly more than one-third of the households reported having an 
adult received nutrition-related trainings, counseling or advice was similar to what the program 
gathered through its periodic report.62 However, this does not seem enough, though there is no 
baseline data on this, as strengthening families through education on nutrition is one of the critical 
components of food and nutrition support of the program. 
The impact of food and nutrition supports at household level, however, was remarkable as
proportion of households who reported food shortage significantly reduced from the baseline. The 
finding that 58% of the household did not have enough food for various numbers of days in the 
month preceding the evaluation indicated that the gap with this regard is big though this was lower 
than the baseline of 66%. Similarly, the finding that only slightly more than one-third of the 
households had some kind of food reserve/store to cope up with unexpected situation was 
unchanged from the baseline figure. These indicate that a lot needs to be done in achieving food 
security for targeted HVC and their households through strengthening the collaboration with 
partners. 
Yekokeb Berhan Program actively identifies HVC in need and refers those with moderate and 
severe acute malnutrition to food and nutrition providers, particularly to the WFP, and also to 
government health facilities for nutritional supports. However, the finding that services were not 
available to about a quarter of children who were prescribed food by health/nutrition workers over 
the past one year indicate that there were unmet needs with this regard. Furthermore, the amount of 
food rations provided was generally argued to be far less than demands. This clearly shows the 
shortage of food support and irregular initiatives by community committees to mobilize food 
support from private institutions such as restaurants. This may not meet demands, on the one hand, 
and sustain food support to HVC on the other. 
 
59 Pact, Minutes on Partners’ Quarterly Performance Review Meeting, Nekemte, June 04, 2012. 
60 Pact, Minutes on Partners’ Quarterly Performance Review Meeting, Jimma, November 22-23, 2012. 
61 Standard Service Delivery Guidelines for Orphans and Vulnerable Children’s Care and Support Programs, February 
2010, Addis Ababa.
62 Pact Yekokeb Berhan Program for Highly Vulnerable Children, Annual Progress Report, Oct 2012 to Sept 2013.
71
Malnutrition data was not collected at baseline and it was not possible to examine the changes since 
the commencement of the program. However, the Ethiopian DHS 2011 shows that 10% of 
Ethiopian children are wasted, and 3% are severely wasted based on weight-for-height
measurement. Though the MUAC and weight-for-height measurements are not directly comparable, 
both moderate and severe malnutrition rates found in this midterm evaluation are lower than the 
DHS wasting (10%) and severe wasting (3%) rates, respectively.63 Similarly, in the comparison of 
two CSI results of Yekokeb Berhan Program, a sharp incease in the number of children with 3 and 
4 scores was observed in the indicator on child malnutrition, indicating that a significant proportion 
of children had been cured of malnutrition.64 This is perhaps attributed to the program’s food and 
nutrition support to large number of HVC through the linkages established with WFP, NGOs, and 
private organizations as well as local communities to address the food and nutritional needs of HVC 
and their families. The program’s efforts to mobilize private institution and community memebers 
to meet food and nutrition needs of HVC as described by the respondents of in the qualitative data 
may have also helped to reduce rate of malnutrition among the targeted HVC. Howerver, as was 
explained by some IPs, the support was found be inadequate compard to the large number of needy 
HVC and this was identified as agap. 
SHELTER AND CARE 
The number of rooms used for sleeping in relation to the number of household members is an 
indicator of the extent of crowding, which in turn increases the risk of contracting communicable 
diseases. The finding that about 60% of the HVC households lived in one-room house, hence all 
family members in those households sleep in the same room is significantly better than the national 
situation where 70 percent of Ethiopian households use one room for sleeping (p<0.01).65 Similarly, 
the proportion of HVC households with two and three or more rooms was much higher than what 
was found in Ethiopia DHS 2011. Shelter is considered reasonably comfortable for living when it is 
warm, safe and dry.66 The proportion of houses with water leaking and wind blowing into the part of 
the house where the children sleep has significantly improved from the baseline. Improvement in 
the housing conditions of HVC and their households was supported by the results from Yekokeb 
Berhan CSI report. Comparing CSI I and CSI II scores, it was noted that the magnitude of score of 
1s was shrinking while the scores 2 and 3 & 4 were significantly increasing in the CSII compared to 
CSI I.67 In the first year of the program implementation only, 2,084 HVC were linked with kebele
administration offices and obtained housing/shelter68 this could contribute to improvement. 
 
63
 Ethiopia Demographic and Health Survey 2011, Central Statistical Agency, Addis Ababa, Ethiopia and ICF 
International, Calverton, Maryland, USA, March 2012.
64 Pact, Child Support Index Report from FY2013 Annual Report.
65 Ethiopia Demographic and Health Survey 2011, Central Statistical Agency, Addis Ababa, Ethiopia and ICF 
International, Calverton, Maryland, USA, March 2012.
66 Yekokeb Berhan /Pact Program for Highly Vulnerable Children Performance Monitoring and Evaluation Plan, 
04/20/2011 - 04/19/2016, Updated in February 2013.
67 Pact, Child Support Index Report from FY2013 Annual Report. 
68 Pact Yekokeb Berhan Program for Highly Vulnerable Children, Annual Progress Report, Oct 2012 to Sept 2013.
72
Though there are noticeable changes in the housing condition of HVC in Yekokeb Berhan Program 
areas, the finding that only one-third of the households live in an adequate shelter may indicate that 
more efforts are required to improve the situation. 
ECONOMIC STRENGTHENING 
Economic strengthening support was one of the critical components of HVC care. The ability of 
caregivers’ to meet basic needs of HVC largely depends on the income and other asset bases of the 
household and these are usually meager because of their vulnerability itself. ES services hence seek 
to enable families to meet their own needs from an economic perspective regardless of changes in 
the family situation.69 Significant investments have been made by Yekokeb Berhan Program with 
this regard to ensure that households targeted for economic strengthening have access to the 
resources, skills and knowledge they require to improve their own livelihood.
Enrollment of households in ES support was based on an initial needs assessment for all households 
eligible for microenterprise interventions to select households that have the capacity to commit to 
launching a ME and this objective selection method has enhanced credibility of the program. 
Proportion of households enrolled in economic strengthening was higher than what was gathered 
through the program’s routine system. This was perhaps there may be similar activities like 
organizing MEs and saving groups, as elsewhere in the country, which the study participants may 
not differentiate from Yekokeb Berhan Program’s ES support. The finding that only 60% of the ES 
targeted households received CSSG training was also not in line with the program’s routine activity 
where all households enrolled to ES first receive this training. This again can be attributed to higher 
number of households reported engaging in ES than the program’s actual support with this regard. 
Another possible factor for the low coverage of ES training is perhaps participants may not clearly 
differentiate between CSSG and other additional economic strengthening training like ME-SPM,70
BD and financial management which the program has also provided. Otherwise, it was gathered 
from the program review of secondary data that all ES households were given training on CSSG 
and majority of them also received additional training including ME-SPM, BD and financial 
management.71
It clearly came out from this evaluation that large proportion of the ES targeted households 
benefited from different training and other ES supports they received including the matching fund 
opportunities. Some of these benefits were developing saving habits, setting up or diversifying 
business, understanding local market opportunities, accessing loan fund for ME and being visionary 
in term of setting objectives and goals for their business. These benefits were further supported by 
the finding that a quarter of ES targeted households were able to establish small scale businesses 
including retailing of consumer goods, sale of local drinks and beverages, poultry farming, rearing 
 
69 Standard Service Delivery Guidelines for Orphans and Vulnerable Children’s Care and Support Programs, February 
2010, Addis Ababa.
70 Microenterprise Selection, Planning and Management
71 Pact Yekokeb Berhan Program for Highly Vulnerable Children, Semi-annual Progress Report, Oct 2013 to Mar 2014.
73
and fattening of cattle, and vegetable gardening. The finding that half of the households engaged in 
ES could expand their business and, more importantly, majority of them were able to save money 
form their business hence changing their lives could be attributed to the program’s impact. 
The finding that close to three-quarters of the ES households reported having regular income looks 
good though this was not documented at baseline and as a result it was not possible to see changes 
over time. Similarly, acquisition of additional productive assets by about 13% of ES households 
over the past two years may also indicate significance of the program’s ES support in improving the 
livelihood of some HVC and their households. 
However, the finding that large proportion of the households believed that they were financially less 
secure than or at the same level as before the program may indicate that a lot needs to be done in 
strengthening economic situation of HVC. Although a considerable proportion of households were 
covered with ES interventions, the fact that number of struggler households is growing exemplifies 
the option to be dragged into the destitute group is open until the program intensified its targets for 
economic strengthening in the coming years. It was also evident from the findings that the need for 
matching funds and business opportunities by caregivers was high and these needs were not met 
well. The fact that matching fund was limited to 1500 Birr would limit business to petty activities 
which may eventually adversely affect successes. This may also affect the efforts of the program to 
move struggler families to the next higher level. 
LEGAL PROTECTION 
It has been observed that almost all sectoral policies, including the Health, Education, Women, 
HIV/AIDS, Youth, etc. either don’t address issues of OVC or touches upon it only in general 
terms.72
Although Ethiopia had developed and/or adapted legal provisions to ensure protection of children in 
general and vulnerable children in particular,73 protection of vulnerable children remains 
challenging and often neglected in Ethiopia. The fact that such concerns are not often brought to the 
attention of law enforcement authorities complicate the problem and hamper responses. 
Nonetheless, the initiative by Yekokeb Berhan Project has drawn important lessons. Engagement of 
all stakeholders at community level has eased timely recognition of vulnerable children’s enabled 
timely responses to problems. Policy and law enforcement bodies at kebele level were found to be 
members of the community committee which facilitates protection of the right of HVC and from 
different kinds of abuses. Besides at household level, caregivers and saving groups were trained on 
to ensure protection of HVC at household level. Furthermore, support to HVC to get birth certificate 
was another important initiative within legal protection. 
 
72 Zewdineh B.Haile. 2008. Review of the legal and policy frameworks Protecting the rights of vulnerable Children in 
the Federal Democratic Republic of Ethiopia. 
73 Oak and ODI. 2012. Linkages Study Linking social and legal protection to child protection mechanisms: The 
Ethiopian example. 
74
Though there are no comparisons from the baseline, incidents of violence, including sexual, were 
reported by the caregivers. Most importantly, it was worrisome to find that many HVC households 
do not seek legal assistance for violence that occurs to them. Less than two-thirds of those victims 
went to the police to seek legal services and one-third did nothing, and perhaps this implies that 
more empowerment of HVC households is required. 
The national standard guidelines stipulate that vulnerable children receive legal information and 
access to legal services including birth registration74
. As part of its legal and protection services to 
targeted HVC, Yekokeb Berhan Program has supported beneficiaries to get birth registration. 
However, proportion of HVC who had birth certificate issued from authorized government office 
found in the midterm was very small though there was improvement from the baseline. This is 
perhaps because the evaluation considered only official birth certificates issued by designated 
government offices and did not take into account church baptismal certificates, mosque papers and 
local Kebele documents that can serve as a birth certificate for most purposes in the country. These 
alternate registrations are also promoted by Yekokeb Berhan Program, especially where the official 
birth certificate is relatively costly. Small fees required to get official birth certificate from 
government offices may also prohibit HVC from acquiring it. However, more could have been
achieved with this regard by raising awareness of HVC and their families about the importance of 
birth certificate and by strengthening linkage with government offices where birth certificate is 
issued.
c. Program Objective 3
COORDINATION OF CARE
Coordination of care was found to be core component of Yekokeb Berhan Program. It is considered 
as a strategy to provide holistic support to HVC with mobilization of support and referral networks 
with likeminded institutions. This component of the project among others intends to sustain care 
and support to HVC. As it is documented in this assessment, government sectors such as schools 
and health, CSOs operating at community level, private sectors engaged in for-profit business and 
individual members of the community were found to be key stakeholders engaged in provision of 
support to HVC. 
The coordination of care has enabled the program to benefit from resources available at different 
levels. While coordination at woreda level helped to avoid duplication of efforts and to leverage on 
local opportunities, coordination at kebele level helped to mobilize resources from community 
members, private organizations and CSOs operating in the kebele to better serve HVC and sustain 
interventions. The coordination of care and collaborative efforts with key stakeholders was 
 
74 Standard Service Delivery Guidelines for Orphans and Vulnerable Children’s care and support program, Federal 
Democratic Republic of Ethiopia, February 2010, Addis Ababa.
75
demonstrated by the increasing number of HVC and adults receiving various services through 
referrals.75
Despite the contribution of coordination of care to the quality of support and sustainability, there 
were evident challenges. Firstly, there is no clear strategy which is endorsed and reinforced by 
government to ensure coordination of care works. It was learnt that to date there are limited 
formalization of such coordination of care that sustainability of support may not be ensured. 
Similarly, some of the stakeholders may be interested to provide support only once and there is no 
way such stakeholders could take responsibility for what would happen to HVC in consequence. 
STRENGTHENING COMMUNITY SYSTEMS 
Among others, capacity building interventions were integral component of Yekokeb Berhan 
Program. In view of this, the project is said to have taken series of steps to build the capacity of 
stakeholders at different levels. Capacity-building interventions were informed by evidence where 
capacity gaps were assessed for implementing partners, government stakeholder and community 
structures using tools that were either developed or adapted for this purpose. 
The capacity-building initiative in the form of diverse trainings, supportive supervision, coaching 
and mentoring and meetings was found incredible. Implementing partners (CSOs), government 
stakeholder, community structures as well as HVC have benefited from such support. It is evident 
that with such capacities currently data management from community level to project management 
at federal level has become smoother, skills to provide services at household level has improved and 
materials are believed to have been developed for future such training actives. Besides, it is evident 
from the finding that through saving schemes, caregivers are able to generate income that enables 
them to send HVC to school and feed them. These are all positive developments in connection to 
capacity building endeavors. 
Nonetheless, in view of the dynamism within each of such targets and increasing demands, the 
capacity building demand remains to be insatiable and challenging. Particular capacity concerns 
were flagged at CSOs and government level where continued staff turnover remains to take away 
those with required capacity for Yekokeb Berhan Project. At community level however, limited 
awareness about the packages of services, data management and coordination of care remains to be 
important challenges. 
d. Program Objective 4
Data management and learning is recognized as an important contribution of Yekokeb Berhan 
Project to record HVC and make data available for decision making. Previously, there was no data 
on how many HVC are in a community and there was no tool to record them. Yet, information 
could be obtained with the introduction of CSI by Yekokeb Berhan Project including how many 
 
75 Pact Yekokeb Berahan Program for Highly Vulnerable Children , Annual Progress Report, FY2013.
76
HVC are found in the community and who are enrolled in what support and where. This is believed 
to improve planning interventions as well as policy decisions as well as avoid duplication of efforts. 
Government partners however were concerned over accessing such data. Although Yekokeb Berhan 
Project has established interim data base for the project which defines how data is generated from 
operation level, compiled and shared with Pact for synthesis, analysis and use for programming 
purpose, centralized data management appears to deny partners at different levels the opportunity to 
make use of the data for planning purposes. 
6. LIMITATIONS OF THE EVALUATION 
The evaluation was based on representative samples from Yekokeb Berhan’s implementation 
woredas and kebeles. Like any sample survey, generalizations of the findings to the entire project 
area may be made with caution. 
However, the major limitation of this study was the difference in design, targets and some parts of 
the tools between the baseline and the midterm survey which seriously affected direct comparison 
of outcomes as the goal of the evaluation is to critically examine whether the progress of Yekokeb 
Berhan Program is on track to meet the four expected objectives/results. For instance the baseline 
survey has included non-HVC households; classified households by poverty level; included all 
HVC in a household and used expenditure as main proxy for classifying households as poor and 
non-poor HVC. On the other hand, the midterm included only program-targeted households HVC 
involved in Yekokeb Berhan Program irrespective of their poverty status; randomly selected one 
HVC from a household. The baseline data was reanalyzed by the investigation team and minor 
changes to some denominators from the initial report was encountered. Though no major 
implication is anticipated because of these minor changes, comparisons were made only when the 
variables matched. Since respondents were asked mainly events that happened some time ago, recall 
bias may also be possible in responding to the evaluation questions. 
7. CONCLUSIONS AND RECOMMENDATIONS
a. CONCLUSIONS 
Program Objective 1 
Finding from this assessment witnessed the level of efforts made to build capacity of actors in 
Yekokeb Berhan Project at different levels. It appears that the level and uniformity of effort to build 
capacity of stakeholders at different level is not straight forward. This is further jeopardized by the 
unlimited needs for capacity at different levels and variation of capacity limitations. Yekokeb 
Berhan’s project capacity building strategy follows roll out model where capacity building 
intervention at implementing partner (CSOs) roll to community structures at community level. It is 
evident that further rollout of capacity building to community level structures by implementing 
partner (CSOs) may not necessarily be uniform and keep envisioned standards. In view of this, 
capacity building will remain challenging in the future and may not have easy solution. 
77
Nonetheless, lessons drawn from Yekokeb Berhan initiative may help to reinvigorate capacity 
building endeavors not only in response to HVC and their families but also generic capacity 
building interventions in other development interventions.
Program Objective 2
The program has registered commendable results with regards to major indicators related to HVC 
services. Improvement in health-seeking behavior; reduction of childhood illnesses; increased 
immunization coverage; increased uptake of HIV services; improved school enrollment, attendance 
and performance; improved nutritional status of under-five children; improved shelter condition and 
improved economic situation of households imply that access to health and social services has been 
increased to HVC and their families over the past two years in Yekokeb Berhan Program areas. 
On the other hand, although there were some progress in improving access to adolescent 
reproductive health services, provision of tutorial services for needy school children and enhancing 
birth registration for HVC, significant gaps were observed at the level of implementation in relation 
to the aforementioned services. Nutrition training for caretakers, inadequate food supply to HVC 
who are engaged in food and nutrition support, mismatch between the need and actual support of 
economic strengthening, and availability of therapeutic and supplemental food items at the referral 
points were also inadequate. 
Program Objective 3
As was emphasized in this document, community structure and coordination of care is a major 
contribution of Yekokeb Berhan Project in response to HVC and their families. Findings from this 
assessment revealed that the problem of HVC and their families is getting owned by community 
members and development actors at community level. Community committee and volunteers are 
spearheading HVC focused interventions. They are taking responsibility to coordinate responses, 
mobilize resources and document accomplishments and challenges at their level. This is a big 
success in response to HIV in general and HVC in particular. One major concern here is on 
sustaining the effort at this level and ensuring accountability for coordination of care. Community 
structures appear to feel fatigue from their continued engagement with limited or no compensation. 
This may affect continuity of such structures and efforts. Secondly coordination at community level 
is at times a onetime contribution or does not have reinforcement mechanism even if agreement is 
reached to contribute to such contribution. This may pose challenges to sustainability of care and 
support to HVC and their families. 
Program Objective 4
Evidence generated from this study reveals that now more than ever HVC and their problems are 
documented and data base is now available at different levels. Associated capacities are developed 
at different levels as well. Availability of such data is believed to improve HVC programming as 
well as contribute to policy dialogue as concerns HVC and their family. It however appears that 
78
compilation of such data takes place at higher level that availability of data for programming and 
lower level policy dialogue remains far from expectation. In connection to this, capacity limitation 
to process and use data at kebele, zonal and regional government sector may affect timely use of 
data for decision making. 
b. RECOMMENDATIONS 
 The proportion of HVC who had HIV test over the previous year has shown improvement 
over the baseline data. However, only less than half of the HVC were still tested and knew 
their HIV status. HIV testing and counseling is an entry point to the continuum of care and 
is an important component of HIV services. It is even more important for HVC as this group 
has elevated HIV risk because of their vulnerability. Considering this fact, more focus on 
increasing HIV counseling and testing coverage for HVC in the program support areas is 
required. 
 More tutorial services are called for to improve school performance of HVC. Currently 
despite such needs and evident contribution to improved school performance only small 
proportion of the needy HVC got tutorial support. This service may be more sustainable if 
bureaus of education are engaged to sustain and scale up tutorial support to HVC at national 
level. Negotiations with local universities and colleges to engage college students for 
community services would help to scale up the service. 
 Programs providing parenting skills are essential for caregivers to enable them to provide 
quality care for their children. There were efforts by the program to provide caregivers with 
this skill through providing training. However only 52% of the caregivers reported having 
better parenting skills training provided by the program. In order to achieve sustainable 
impact of the program by improving care for HVC, coverage of better parenting training for 
caregivers should be increased. 
 Expanding economic strengthening seems essential as the need for this service was found to 
be high while a relatively small proportion of households were engaged in the service. Also, 
in order to enhance and sustain benefits of economic strengthening of targeted households it 
is recommended that CSSGs are strongly linked with government-led microenterprise 
programs where they would get continuous support and guidance on business making 
 Birth registration and acquisition of birth certificate is one of the most important 
components of legal service to HVC and Yekokeb Berhan Program has been supporting this 
service. However, only 8.7% of the HVC had birth certificate issued from authorized 
government office. This proportion is very small by any standard and more efforts should be 
exerted to increase the coverage of birth certificate for HVC in the program areas. 
 It is well understood that there were differences in methods and targets between the baseline 
survey and the midterm which made comparisons limited and in most instances complex. 
79
Some of the data required for evaluation were either not covered or differently addressed in 
the baseline survey, for instance malnutrition and economic strengthening variables. Hence 
findings on nutritional assessment, data management and utilization and coordination could 
be bench marked for the end line survey comparison. It is also recommended the instruments 
used in the midterm be maintained at least as a minimum for better subsequent comparisons 
between the evaluation surveys.
 Community committee (CC/CCC) and community volunteers are core stakeholders to 
Yekokeb Berhan Program at community level. They are frontline facilitators of HVC 
intervention. Both structures were providing their services voluntarily and play 
indispensable role in identifying and enrolling HVC. Furthermore, CC/CCC ensures proper 
provision of services and map providers to facilitate partnership among other stakeholders. 
Yet, members of community volunteers and community committee expressed concern over 
the limited capacity development support they obtain from the project. This may affect 
sustainability of their engagement. Thus, it is recommended to either develop continuous 
motivation mechanisms to keep them active in their activities or develop a strategy where 
members of such structures graduate after voluntary service for a given period of time 
before fatigue sets in and to recruit other members, train them and engage them. 
 Capacity building is another core component of Yekokeb Berhan Program. As it was noted 
in the findings, such an endeavor followed systematic approaches where gaps of the 
different stakeholders to the project (implementing partners (CSOs), government partner and 
community structure were assessed with an application of defined tools. Based on findings, 
capacity building plans were drawn and implemented by Pact and rolled out to community 
structures and the community at large by implementing partners (CSOs). However, capacity 
limitation is still the case than an exception at all levels. In as much as capacity building can 
never be considered as done and complete given the dynamics within the targets, the 
Yekokeb Berhan Program should establish an internal mechanism at implementing partners 
and community structure’s level to reinforce capacities. Perhaps the coaching 
mentoring/initiative should be strengthened so that there is a workforce within the 
government structure as well as other structures at implementers and community levels. 
Furthermore, standardizing the training guides/manuals and translating them in to major 
languages and establishing core trainers and guides within the government structure may 
help sustain capacity building endeavors. 
 Coordination of care is an important component of Yekokeb Berhan Program. As such, at 
community and implementing partners’ level, efforts were underway to engage other 
partners for an improved service provision to HVC and sustain such support. Nonetheless, 
available data show that success in engaging partners depends on the strength of CC. Even 
initiated coordination of care is often short lived and is not legally binding. Thus, it is 
80
recommended that, coordination of care should be guided by clearly defined modalities and 
reinforcement mechanisms where government could also overlook such initiatives. 
 Yekokeb Berhan Project was acknowledged for its initiatives in introducing the CSI and 
formats to collect information about HVC, analyze it and reporting it. Community was 
found to have the knowledge and skills to generate such information and use it for decision 
making at its level. Implementing partners were also found to have used the tools for data 
generation and use. This was reported to be a pioneering contribution by Yekokeb Berhan 
Project and child data is made available at project sites for decision making purpose. With 
this data right targets could be identified and enrolled in to the project, duplication in service 
provision could be avoided, planning is evidence informed and policy could benefit from 
evidences. Yet, as it stands now, there were concerns over availability of data for planning 
purpose at community level where it is originally generated. Thus, it is recommended that 
feedbacks on data generated should be given to community structures. It would in fact be 
desirable to build capacity of the community to collect and collate data at their levels and 
use if for planning and interventions. 
81
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to Mar 2014
21 Pact, Child Support Index Report from FY2013 Annual Report.
82
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26 Standard Service Delivery Guidelines for Orphans and Vulnerable Children’s Care and Support 
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Evaluation Plan, 04/20/2011 - 04/19/2016, Updated in February 2013
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Children in the Federal Democratic Republic of Ethiopia
83
ANNEX I: Sources of qualitative data 
Type of data collection Number of 
Sessions 
Total number of 
participants
KII – Pact, FHI360 and ChildFund 3 5
KII – Pact cluster coordinators 4 4
KII-Ministry of Womens, Children 
and Youth Affairs (MoWCYA) at 
federal, regional and wereda levels
26
FGDs-CC 5 33
FGD-CSSG 5 36
FGD-CGs 6 52
FGD-CVs 4 37
84
ANNEX II: Table showing details of evaluation sites
Region Zone/Subcity Woreda Beneficiary 
HVC
Addis Ababa
Arada Arada 6,243
Nifas Silke Lafto Nifas Silke Lafto 11,838
Amhara
South Wollo Ambassel 4,357
South Wollo Kombolcha 2,000
North Gonder Gonder Town 7,449
North Shoa Debrebirhan 7,416
North Shoa Shewarobit 5,000
South Gondar Fogera 2,635
Oromia
East Shoa Adama 5,834
Jimma Jimma 2,204
East Shoa Zeway 4,882
Bale Robe 6,202
SNNP
Gamogofa Arbaminch 2,413
Hawassa Hawassa Town 4,754
Gurage
Butajira 2,278
Wolkite 1,862
Tigray
Central Adwa 3,649
Mekelle Mekelle 9,119
85
ANNEX III: Comparison of indicators at baseline and midterm
No. Indicator Baseline(n=2606)
MTE 
(n=2121) Remarks
1
HVC perception of own health status 
over the past 12 months
Very good 17.5 32.3
Good 44.1 42.4
Fair/satisfactory 23.8 15.7
Poor/very poor 14.7 9.1
No response 0.0 0.5
2
Children too sick to participate in daily 
activities in the weeks preceding the 
syrvey 30.0 16.8
3 Child had fever in the last two weeks 15.7 18.8
4
Child had diarrhea in the last two 
weeks 10.8 6.1
5 Child had fever and sought treatment 48.4 63.9
6
Child had diarrhea and sought 
treatment 49.7 86.2
7
Children fully vaccinated for age 
(confirmed from vaccination card) 33.9 57.6
8
Children tested for HIV in the past 2 
weeks
37.8 46.6
Ever-test was 
assessed at 
baseline
9
HIV Positive (out of tested and 
received results) 14.2 5.8
10 Proportion of children on ART (out of 
positive) 61.0 85.7
11 Caretakers tested for HIV
12
Family/HVC had someone to turn to in 
order to share concerns and get 
support in case of a problem 55.3 52.6
13 School enrollment aged 3 years and 
above (overall) 71.1 85.7
3-4 year 4.0 75.0
5-13 year 77.0 90.6
14 year and above 77.4 92.4
Boys 70.3 85.2
Girls 72.0 86.2
14 Regular school attendance (overall) 89.3 94.7
Boys 90.0 94.8
Girls 88.5 94.5
86
15 Household experienced shortage of 
food in the past 12 months 66.0 58.0
16 Household reported having food 
reserve/store during the evaluation 20.0 58.4
17 HVC who have birth certificate issued 
from authorized government office 5.5 8.7
18 When it rains, water leak into the 
part of the house where the children 
sleep
52.5 42.6 
19 When it is windy outside, does the 
wind blow into the part of the house 
where the children sleep?
50.0 41.1 
 
87
ANNEX IV: Data collection tools
YEKOKEB BERHAN PROGRAM FOR HIGHLY VULNERABLE CHILDREN 
MIDTERM EVALUATION – FEBRUARY 2014, ETHIOPIA 
 QUANTITATIVE QUESTIONNAIRE 
PART 1: SURVEY QUESTIONS FOR CAREGIVERS OF HVC
SECTION 0: IDENTIFICATION DATA 
Q01 QUESTIONNAIRE IDENTIFICATION NUMBER |_____|______|______| 
Q02 Region____________________ Partner _____________________ 
Q03 Zone _____________________________ 
Q04 Woreda________________________Q05 Town_______________Q06 Subcity_________ 
Q07 House Number _______________________
Q08 GIS Code______________________________ 
Q09 Household size (total no. of people living in the house) _____________________________ 
Q10 Implementing partner _______________________________________________
Q11 Name of interviewer ____________________________________________ 
Q12 Date of interview: _______________________________________ 
Q13 Time interview started_____________________________________ 
Q14 Time interview ended _____________________________________ 
INTRODUCTION 
“My name is…………………I am collecting information that will help to understand how the 
YEKOKEB BERHAN program has been going, since the start of its implementation about two 
years ago. I will want to find out your experiences as a [vulnerable child/guardian]. in this program. 
Other people in your neighborhood are participating in similar interviews. The results, taken 
together will be used to improve services in the future. Your participation in this survey is voluntary 
and there is no remuneration or any other form of benefit for this participation. 
CONFIDENTIALITY AND CONSENT
88
 “I may ask you some very personal questions that some people may find difficult to answer. I am 
not going to talk to anyone about what you tell me. Your name will not be written on this form, and 
will never be used in connection with any of the information you tell me. You do not have to 
answer any questions that you do not feel comfortable with, and you may end this interview at any 
time you want to. However, your honest answers to these questions will help us better understand 
the situation of vulnerable children and their families – social, economic and psychological – and 
whether they are receiving support to alleviate these problems. We would greatly appreciate your 
help in responding to this interview. The interview will take about 60 minutes. Would you be 
willing to participate?” 
1. Yes: Thank him/her and continue with the interview 
2. No: Note his reason briefly, thank him/her and proceed to the next household 
______________________________________________________________
Incomplete Interviews Log 
Visit 1 Visit 2 Visit 3
Date
Interviewer
Comment
Comment codes: Appointment made for later today 1; Appointment made for another day 2; 
Refused to continue and no appointment made 3; Other (Specify) 
CHECKED BY FIELD SUPERVISOR: Signature ____________________ Date ___________
89
No. Questions And Filters Coding Categories Skip To
SECTION 1: BACKGROUND INFORMATION ON CAREGIVER AND HOUSEHOLD 
Q101 Age of the respondent, as 
best she/he knows
 [_________]
Q102 Sex of the respondent Male
Female
1
2
Q103 Marital status of the 
respondent
Single
Married
Divorced 
Widowed
Live with partner/cohabit
No Response
1
2
3
4
5
99
Q104 Have you ever attended 
formal school?
Yes
No
No Response
1 
2
99
Q106
Q105 What is the highest level of 
school you completed? 
(CIRCLE ONE)
Primary (grade 1-8)
Secondary (grade 9-10)
Preparatory (11-12)
10+TVET
College/university
No Response
1
2
3
4
5
99
Q106 What is your occupation Farming
Wage Laborer
Government employee
NGO
Trading/business
Student
Other (Specify)________________
No occupation
No Response
1
2
3
4
5
6
7
8
99
Q107 Have you been engaged in 
paid work (where you 
earned any amount of 
money) in the last 3 
months?
Yes
No
No Response
1
2
99
Q108 Including yourself, how 
many people live in this 
household?
Total_________
Male_________
Female_________
No Response
1
2
3
99
Q109 How many persons under 
the age of 18 live in this 
house?
Total
Number of boys
Number of girls
No response
____
____
____
99
90
Names of all
the children younger than 18
years of age who usually live in
your household
Age Sex
1 = 
Female
2 = Male
Relationship to 
the household 
head
1= Child, 
2=Sister/brother 
3= Sister’s/brother’s 
child 
4=grandchild
5=relative 
6= no blood relation
7 = other (specify) 
99 = No response.
For all 
children 
age 6-
59 
months, 
take 
MUAC 
in MM
Classify the 
nutritional 
status of 
each child
1= no 
malnutrition
2 = 
moderate 
malnutrition
3 = severe 
malnutrition
Q109.1 Q109.2 Q109.3 Q109.4 Q109.5 Q109.6
1
2
3
4
5
6
7
8
9
10
Q110 Do you know about the 
Yekokeb Berhan project that 
is supported by 
USAID/Ethiopia and 
implemented by _____(IP) in 
your area?
Yes
No
No response
1
2
99
91
Q111 How many children under 
18 in this household are 
enrolled in the Yekokeb 
Berhan project that is 
implemented by ____(IP) in 
your area?
None ________
Boys ________
Girls________
Total________
No response
1
2
3
4
99
Q116
Q112 When did the Child/ren 
start participating in the HVC
care and support program of 
Yekokeb Berhan?
Since two years ago
Since one year ago
Other (specify)___________
No Response 
1
2
3
99
Q113 Who first identified the 
Child/ren to possibly 
become involved in the 
Yekokeb Berhan care and 
support program?
A Community Committee 
Community volunteers
Kebele Administration 
____(IP) staff
 Other (specify) ____________
Don’t know who they were 
 No Response 
1
2
3
4
5
88
99
Q114 Who finally selected the 
Child/ren to be involved in 
the Yekokeb Berhan care 
and support program?
A Community Committee 
Community volunteers
Kebele Administration 
____(IP) staff
 Other (specify) ____________
Don’t know who they were 
 No Response 
1
2
3
4
5
88
99
Q115 When the Child/ren were 
selected for HVC care and 
support were you asked 
about the major problems 
and needs of the child/ren?
Yes
No
Don’t know
No response
1
2
88
99
Q116 Do you (the caregiver) have 
any disability?
Yes
No
No response
1
2
99
Q201
Q201
Q117 If yes, does that make it 
difficult for you to participate 
in daily activities?
Yes
No
1
2
Q118 How would you describe
your disability?
(Multiple responses are 
possible)
Blind or partially blind
Deaf or partially deaf
I have difficulties learning
Physical disability
Other (specify)_________________
No response
1
2
3
4
5
99
Q119 Are you receiving any kind 
of assistive device or other 
support for you disability?
Yes
No
I don’t know
No response
1
2
88
99
92
Q120 What kind of assistive 
device or support/services 
are you receiving?
Prosthesis(artificial leg or arm)
Eye glasses
Hearing aid
Crutches
Wheelchair
Medical care
Home-based care
Financial support
Others (specify)_____________
No response
1
2
3
4
5
6
7
8
9
99
Section 2: Health and Health Care
Q201 In general, how do you rate 
your own health over the 
past 12 months?
Excellent
Good
Fair
Poor
Very poor
 No response 
1
2
3
4
5
99
Q202 In the last 2 weeks, have 
you been too ill to participate 
in daily activities?
Yes
No
No response
1
2
99
Q206
Q206
Q203 Did you get treatment from a 
health provider for this 
illness?
Yes
No
No response
1
2
99
Q206
Q206
Q204 Where did you seek health 
care for your illnesses?
(if there is more than one 
response, write only one 
response they consider most 
common)
Government health facility
Private hospital/clinic
Pharmacy
Traditional healer
Other (specify) ---------------------
No response
1
2
3
4
5
99
Q205 For your last illness if you
did not seek care, what was 
the reason?
(Multiple responses are 
possibility, take only the 
main reason)
No money
Hospital/health center too far
Illness not serious
Did not want treatment
Clinic is too crowded
Too ill to go
Other (specify)_______________
No response
1
2
3
4
5
6
7
99
Q206 Over the past year, has your 
household experienced not 
getting adequate 
healthcare?
Yes
No
No response
1
2
99
93
Q207 Did you receive any 
education or counseling 
about HIV by
a health worker or someone 
else (ways of transmission, 
methods of prevention, care 
and treatment) in the past 12 
months?
Yes
No
No response
1
2
99
Q208 Have you been tested for 
HIV in the past 12 months?
Yes
No
No response
1
2
99
Q210
Q217
Q209 If not tested, why not? I didn’t want it
I already know my status
I didn’t think it is important for me
Didn’t know where to go
Fear of positive result
Others (specify) _____________
No response
1
2
3
4
5
6
99
Q210 Did you receive your HIV 
test results?
Yes
No
NA (not tested)
No response
1
2
3
99
Q212
Q217
Q217
Q211 If you did not receive HIV 
test results, why not?
Did not want results
Results took too long
Still waiting for results
Other (specify) ______________
No response
1
2
3
4
99
Q212 What were your HIV test 
results?
Negative
Positive
No response
1
2
99
Q217
Q217
Q213 If HIV positive, are you 
currently taking ART? 
Yes
No
Not eligible for ART
No response
1
2
3
99
Q217
Q215
Q217
Q214 If taking ART, do you always 
go to health facility for follow 
up as scheduled by the 
health workers?
Yes, always
Yes, but sometimes misses schedule
Often misses schedule
No response
1
2
3
99
Q215 If not eligible for ART, do 
you have follow up at a 
health facility for HIV care?
Yes
No
No response
1
2
99
Q216 If no to Q215, what is the 
reason?
Did not want because of fear of 
stigma
Did not know that I have to
Did not want because I feel healthy
Too busy to go for follow up
Lack of money for transport
Other (specify)_______________
No response
1
2
3
4
5
6
7
99
94
Q217 (If caregiver is female, HIV 
positive and age 18-49, 
ask this question)
Now I would like to ask you 
a very personal question: 
Are you currently pregnant? 
Yes
No
Not applicable (HIV –ve or >49 yr)
No response
1
2
3
99
Q401
Q401
Q401
Q218 If so, are you currently 
attending antenatal care?
Yes
No
No response
1
2
99
Q219 Has anyone talked to you 
about ways to prevent 
infecting your unborn child 
with HIV?
Yes
No
No response
1
2
99
Q401
Q401
Q220 If so, who talked to you 
about how to prevent 
infecting your unborn child?
Health workers
Community volunteers
Health extension workers
A friend
A family member
Other (specify)_________
1
2
3
4
5
6
Q221 Did you take PMTCT in 
order to prevent infection of 
your newborn?
Yes
No
No response
1
2
99
Q401
Q401
Q222 If not, why? Fear of stigma
Husband did not agree
Did not want to take
Other (specify)_______________
No response
1
2
3
4
99
Section 4: Food and Nutrition 
Q401 Over the past year, has your 
household experienced any 
shortage of food?
Yes
No
No response
1
2
99
Q403
Q403
Q402 In the past month, how 
many days did your 
household not have enough 
food to eat?
None (we had enough food all days)
1-2 days
3-4 days
5-6 days
7 days or more
No response
1
2
3
4
5
99
Q403 How many meals did this 
household take yesterday?
No meals
One meal
Two meals
Three meals
Four meals
No response
1
2
3
4
5
99
95
Q404 How long would food 
reserves/stores of the 
household last?
No food store at all
Less than 1 week
1-4 weeks
1-2 months
3-6 months
More than 6 months
No response
1
2
3
4
5
6
99
Q405 How do you assess 
adequacy of food supply in 
your house over the past 
year?
Not enough
Barely enough
Just enough
Excess
No response
1
2
3
4
99
Q406 In your family, is there a 
child who was prescribed 
food by health workers/ 
nutrition workers over the 
past one year?
Yes
No
No response
1
2 
99
Q408
Q408
Q407 Did the child receive the 
prescribed food?
Yes
No
No response
1
 2 
99
Q408 Did any family member 
receive nutrition related 
training, counseling or 
advice in the last one year?
Yes
No
No response
1
2
99
Section 5: Psychosocial Support
Q501 Has any adult member of 
this household received 
information or skills to help 
with Better Parenting (how 
to better care for children)?
Yes
No
No response
1
2
99
Q502 Is there someone that you 
can go to, to help solve a 
problem?
Yes
No
No response
1
2
99
Q504
Q504
Q503 If yes, whom do you consult 
or ask for help?
Family members
Friends
Neighbors
Staffs of IP
Community volunteers
Community committee
Other (specify)_____________
No response
1
2
3
4
5
6
7
99
96
Q504 In the last 12 months, did 
you or someone in the 
household receive any 
counseling, advice-giving or 
emotional support from 
someone who comes from 
__IP or from the Yekokeb 
Berhan Program
Yes, I received
Yes, somebody else received
No, no body in the household 
received
No service was not required 
No response
1
2
3
4
99
Section 6: Shelter and Care
Q601 What type of dwelling does 
the family live in?
Observe and confirm
single house
several structures
flat
room in larger dwelling
improvised housing
Shared room
Temporary shelter
other (specify)_______________
No response
1
2
3
4
5
6
7
8
99
Q602 When it rains, does water 
leak into the part of the 
house where the children 
sleep?
Yes
No
No response
1
2
99
Q603 When it is windy outside, 
does the wind blow into the 
part of the house where the 
children sleep?
Yes
No
No response
1
2
99
Q604 Is your house fairly safe 
from thieves?
Yes
No
No response
1
2
99
Q605 What is the main water 
source of the household?
Pipe
Protected well
Unprotected well
Spring
Other (specify)_______________
No response
1
2
3
4
5
99
Q606 What is the main type of 
toilet facility used by 
household members?
Flush
Pit latrine
No toilet
Other (specify)______________
No response
1
2
3
4
99
Section 7: Legal Protection
Q701 Over the past 12 months, 
has any member of your 
household experienced any 
violence?
Yes
No
No response
1
2
99
Q705
Q705
97
Q702 If yes to Q701, what type of 
violence?
Physical violence 
Verbal abuses
Sexual violence
Other (specify)_______________
No response
1
2
3
4
99
Q703 What did you do after the 
violence occurred?
went to police/ legal services
went to health center/clinic
went to Kebele/ women & children 
affairs
told a relative or neighbor
did nothing
other (specify)_______________
No response
1
2
3
4
5
6
99
Q704 Who mostly perpetrated the 
violence? 
My spouse
Neighbor
Older child
Unknown people
Other (specify)______________
No response
1
2
3
4
5
99
Q705 Have you ever been referred 
or linked to any legal 
services over the past 1 
year?
Yes
No
No response
1
2 
99
Q707
Q707
Q706 Who referred or linked you 
to legal services he/she 
needed? 
Yekokeb Berhan IP staff
Community committee
Community Volunteers
Kebele administration
Other (specify)__________________
No response
1
2
3
4
5
99
Q707 Do you feel more secure in 
terms of legal protection this 
time than before you were 
involved in Yekokeb Berhan
program?
Yes
No
Not sure
No response
1
2
3
99
Section 8: Economic Strengthening
Q801 Is your household 
engaged in economic 
strengthening program of 
Yekokeb Berhan program 
(training, market 
information, technical 
support through ES 
animators/facilitators, 
matching fund provision, 
etc)
Yes
No
No response
1
2
99
Q806
Q806
Q802 Did you have training in 
Community Saving and 
Self-help Groups (CSSG)? 
Yes
No
No response
1
2
99
Q804
Q804
98
Q803 In what way this training 
has helped you to advance 
on self-help 
endeavor(multiple answers 
possible)
Developed saving habits
Increased own saving funds which was 
not possible in the past
Became visionary with set objectives 
and goals
Increased social bonds
Abled to access loan fund for ME
Other (specify)_______________
No response
1
2
3
4
5
6
99
Q804 Did you receive any 
additional training on how 
to set up a business and 
run it—for example, SPM 
training? 
Yes
No
No response
1
2
99
Q806
Q806
Q805 How has this training 
helped you to engage in a 
new/expand existing ME?
Understood the local market 
opportunities for my product/service
Understood the need for ME operation 
skills
understood source and allocation of 
initial capital
able to analyze profit loss calculations
others (specify)________________
No response
1
2
3
4
5
6
99
Q806 Do you have assistance to 
access financial or 
technical services from 
community or government 
microfinance institutions
Yes
No
No response
1
2
99
Q807 Do you usually work 
throughout the year, or do 
you work seasonally, or 
only once in a while?
Throughout the year
Seasonally/part of the year
Once in a while
No Response
1
2
3
99
Q808 What is the main source 
of income for the 
household
Employed (salary)
Self-employ (Own business)
Spouse’s income
Pension
Daily work
Working children
Charity ( from NGOs)
Charity (from community)
Donations from relatives
Other (specify) ____________
No response
1
2
3
4
5
6
7
8
9
10
99
Q809 On average, how much
does the household earn 
every month (from all 
sources)?
If not exact, take the best 
estimate
Below 200
200-300 Br
300-500 Br
500-1000 Br
1000-2000 Br
More than 2000 Br
No response
1
2
3
4
5
6
99
99
Q810 How regular was your 
income in the past 12 
months? 
Daily
Weekly 
Monthly
Quarterly
Biannually
Not regular
No response
1
2
3
4
5
6
99
Q811 Are you or any member of 
your family currently 
involved in a small scale 
business or micro￾enterprise?
Yes
No
No response
1
2 
99
Q816
Q816
Q812 When was the small scale 
or micro-enterprise 
business started?
Less than 6 month
6-12 month
12-18 month
18-24 month
More than 24 month
No response
1
2
3
4
5
99
Q813 If engaged in a business, 
have you been able to 
expand or diversify your 
small scale business over 
the past one year?
Yes
No
Not applicable (not engaged in 
business)
No response
1
2
3
99
Q814 On average, how much 
money do you make from 
this business per month? 
Below 200
200-300 Br
300-500 Br
500-1000 Br
1000-2000 Br
More than 2000 Br
No response
1
2
3
4
5
6
99
Q815 Have you been able to 
save some money that you
generated from the small 
scale business or micro￾enterprise that you engage
in?
Yes
No
No response
1
2
99
Q816 Thinking about the last 
time you bought any food 
for eating or cooking, how 
did you pay? 
Do not read responses. 
Record one primary 
response only. 
Prompt if necessary:
maize meal, sugar, 
cooking oil
Current income (cash)
Savings
Loan from family or friend
Loan from money lender
Sold livestock
Sold poultry
I have not bought any food recently
Other (specify)_______________
No response
1
2
3
4
5
6
7
8
99
100 
Q817 Thinking about the last 
time you had to pay for 
any school- related 
expenses, how did you 
pay? 
Do not read responses. 
Record up to two 
primary responses only.
Prompt if necessary:
PTA fees, uniforms, 
books, other materials
Current income (cash)
Yekokeb Berhan or the IP
Loan from family or friend
Loan from savings group 
Savings group social fund grant
Loan from microfinance
Loan from money lender
Sold food surplus
Sold food meant for consumption
Sold livestock 
Sold poultry 
Sold other asset (specify):______
Could not pay 
I don’t recall school related expenses
Other (specify)_______________
No Response
1
2
3
4
5
6
7
8
8
9
10
11
12
13
14
99
Q818 Thinking about the last 
time you had to pay for an 
unexpected household 
expense, such as a house 
repair, or urgent medical 
treatment, how did you 
pay? 
Do not read responses. 
Record up to two 
primary responses only.
Current income (cash)
Savings
Loan from family or friend
Loan from savings group 
Savings group social fund grant
Loan from microfinance
Loan from money lender
Sold food surplus
Sold food meant for consumption
Sold livestock 
Sold poultry 
Sold other asset (specify): ________
Could not pay 
I don’t recall school related expenses
Other (specify)________________
No Response
1
2
3
4
5
6
7
8
8
9
10
11
12
13
14
99
Q819 Compared to last year, do 
you feel that your 
household is more or less 
financially secure?
More secure
Less secure
No change from last year
No response
1
2
3
99
Q820 Compared to other 
households in your 
community, how well do 
you feel you can meet the 
needs of the children in 
your care? Would you say 
…?
Read out responses.
Much better than other households
A bit better than other households
About the same as other households
A bit worse than other households
Much worse than other households
No response
1
2
3
4
5
99
101 
Q821 Thinking of what the 
household had two years 
ago, how do you describe 
the current productive 
assets of your household?
(Productive assets are 
assets that help the 
household generate 
income) 
We have less than a year ago
We have same as a year ago
We have acquired additional productive 
assets than a year ago
No response
1
2
3
99
Q823
Q823
Q823
Q822 If the household acquired 
additional productive 
assets over the past two 
years, what is/are 
this/these?
(Multiple responses are 
possible)
Farm land
Cattle
Sheep/goats
Plot of land
House
Poultry
Working capital
Other (specify)______________
No response
1
2
3
4
5
6
7
8
99
Q823 Over the past year, has 
your household 
experienced any loss of
Income or assets?
Yes
No
No response
1
2
99
Q824 Over the past year, has 
your household 
experienced any children 
leaving school due to 
financial problem?
Yes
No
No response
1
2
99
Q825 Over the past one year, 
has your household 
experienced any children 
having to do work outside 
the home during school 
days/time due to financial 
problem?
Yes
No
No response
1
2
99
Section 9. Coordination of care
Q901 In the past one year, have 
you or your family member 
been referred to another 
organization, office or 
individual to obtain any 
services that you needed?
Yes
No
Don’t Know
No Response
1
2
88
99
C101
C101
C101
102 
Q902 If so, for what services have 
you or your family member 
been referred to?
(Multiple responses are 
possible)
Food and nutrition
Shelter 
Education
Healthcare
Psychosocial support
Economic strengthening 
Legal services
Other:_____________________
No response
1
2
3
5
6
7
8
99
Q903 If referred for any of these 
services, were the services
obtained? 
Yes, fully
Yes, partially
No, not at all
No response
1
2
3
99
Q905
Q905
Q904 If obtained, were you 
satisfied with the quality of 
the services you received?
Yes, I was fully satisfied
Not well-satisfied but it was okay
Not satisfied at all
No response
1
2
3
99
Q905 When was the last time you 
or your family member was
referred for a service or 
support?
_______ days ago
_______weeks ago
_______months ago
No response
1
2
3
99
Q906 Who provided the referral? Community Committee
Kebele administration
Yekokeb Berhan IP staff
Community volunteers 
Another NGO
Government office 
Other(specify)_______________
No response
1
2
3
4
5
6
7
99
Q907 Was there any follow up to 
know if you or your family 
member received the 
services (feedback)
Yes
No
No response
1
2
99
103 
PART 2: SURVEY QUESTIONS FOR YOUNG HVC (< 14 YEARS)
Interviewer: Please select a child age less than 14 years in the house hold from the list in 
Q109.1 above using a simple random sampling method.
Now, I want to ask you questions about child (name) who is enrolled in Yekokeb Berhan Program. 
No. Questions And Filters Coding Categories Code Skip To
SECTION 1: BACKGROUND INFORMATION OF THE CHILD
C101 Which is true about (name)?
(Multiple responses are 
possible)
Mother is dead
Father is dead
Both mother and father are dead
Chronically ill
HIV positive
Has some kind of disability
Household is headed by a child (<18)
Household is headed by elderly
Household is headed by ill person
Household is headed by disabled
No response
1
2
3
4
5
6
7
8
9
10
99
C102 Has (name) ever attended 
formal school?
Yes
No
Not applicable (child < 5 years)
No Response
1 
2
3
99
C104
C104
C104
C103 What is the highest level of 
school (name) completed? 
(CIRCLE ONE)
Primary (grade 1-8)
Secondary (grade 9-12)
10+TVET
College/university
No Response
1
2
3
4
99
C104 Does (name) have a 
disability?
Yes
No
No response
1
2
99
C201
C201
C105 If yes, does that make it 
difficult for (name) to 
participate in daily activities?
Yes
No
1
2
C106 How would you describe 
(name’s) disability?
(Multiple responses are 
possible)
Blind or partially blind
Deaf or partially deaf
I have difficulties learning
Physical disability
Other (specify)_________________
No response
1
2
3
4
5
99
C107 Is (name) receiving any kind 
of assistive devise or support 
for his/her disability?
Yes
No
I don’t know
No response
1
2
88
99
C201
C201
C201
104 
C108 What kind of assistive device 
or support/services (name) is 
receiving?
Prosthesis(artificial leg or arm)
Eye glasses
Hearing aid
Crutches
Wheelchair
Medical care
Home-based care
Financial support
Others (specify)______________
No response
1
2
3
4
5
6
7
8
9
99
Section 2: Health and Health Care
C201 In general, how would you rate 
(name’s) health over the past 
12 months?
Excellent
Good
Fair
Poor
Very poor
 No Response 
1
2
3
4
5
99
C202 In the last 2 weeks, has (name) 
been too sick to participate in 
daily activities? 
Yes
No
 No Response
1
2
99
C211
C211
C203 Has (name) had fever in the 
two weeks preceding the 
survey? 
Yes
No
No response
1
2
99
C205
C205
C204 Did (name) receive treatment -
from a health provider for this 
illness?
Yes
No
No response
1
2
99
C205 Has (name) had diarrhea in the 
last two weeks? 
Yes
No
No response
1
2
99
C206 Did (name) receive treatment 
from a health provider for this 
illness?
Yes
No
No response
1
2
99
C208
C208
C207 Where did you seek health 
care for the illnesses of 
(name)?
(if there is more than one 
response, write only one response 
they consider most common)
Government health facility
Private hospital/clinic
Pharmacy
Traditional healer
Other (specify) ---------------------
No response
1
2
3
4
5
99
105 
C208 For (name’s) last illness if he or 
she did not seek care, why 
not?
(Multiple responses are 
possibility, take only the 
main reason)
No time to escort him/her
No money
No transport
Hospital, health center too far away
Illness not serious
Patient did not want treatment
Clinic is too crowded
Illness was too serious
Other (specify)_________________
No response
1
2
3
4
5
6
7
8
9
99
C209 About how much did the 
household spend on (name’s) 
healthcare during the last
illness (including at clinics, 
pharmacy, traditional healer, 
transport costs etc.)?
<100 Birr
101 – 200 Birr
201-300 Birr
301 -400 Birr
401-500 Birr
501+
No response
1
2
3
4
5
6
99
C210 Who covers (name’s) above 
costs of treatment?
The household itself
Relatives
Neighbors/acquaintances
CBOs (Idir, etc)
Yekokeb Berhan program
Volunteer people (their own 
donations) 
Other___________________
No response
1
2
3
4
5
6
7
99
C211 If (name) is under 5, has 
he/she received age
appropriate vaccinations?
(Refer to the provided note 
for the definition of age￾appropriate vaccination)
Yes
No
Not applicable (> 5 years)
No response
1
2
3
99
C213
C213
C213
C212 Does (name’s) have 
vaccination card?
(Ask the caregiver to show 
vaccination card)
Yes (card shown) 
No
Said had card, but was not shown
No response
1
2
3
99
C214
C214
C214
C213 Is (name) fully vaccinated for 
his/her age?
(Don’t ask, see the vaccination card 
and choose appropriate answer as 
described during the training)
Yes, full vaccinated
Only partially vaccinated
1
2
C214 If (name) was sick and needed 
to see a doctor, is there 
someone who could help get 
child to doctor or another 
health care provider?
Yes
No
No response
1
2
99
C215 Has (name) been tested for 
HIV in the past 12 months?
Yes
No
No response
1
2
99
C219
C219
106 
C216 Did (name) or you receive 
his/her HIV test results?
Yes
No
No response
1
2
99
C218 
C217 If (name) or you did not receive 
HIV test results, why not?
Did not want results
Results took too long
Still waiting for results
Other (specify) ________________
Do not know
No response
1
2
3
4
88
99
C218 What were (name’s) test 
results?
Negative
Positive
Don’t know
No response
1
2
88
99
C219 Does (name) know his/her
HIV status?
Yes
No
Too young to understand
Don’t know
No response
1
2
3
88
99
C221
C220 If (name) does not know his/her 
HIV status, why not?
Never tested
Too young to understand
Decided child should not know
No health problems/no concerns
Other (specify) _________________
No response
1
2
3
4
5
99
C221 If (name) is HIV positive, is he 
currently taking ART (on 
treatment for AIDS)? 
Yes
No
Not eligible for ART
Not Applicable (HIV negative)
Do not know 
No response
1
2
3
8
99
C223
C222 If taking ART, does (name) 
always go to health facility for 
follow up as scheduled by the 
health workers
Yes, always
Yes, but sometimes misses schedule
Often misses schedule
Don’t know
No response
1
2
3
88
99
C223 If not eligible for ART, does 
(name) have follow up at a 
health facility for HIV care?
Yes
No
No response
1
2
99
C224 If no to C224, what is the 
reason?
Did not want because of fear of 
stigma
Did not know that I have to
Did not want because I am healthy
Too busy to go
Lack of money for transport
Other 
(specify)__________________
No response
1
2
3
4
5
6
99
Section 3: Education (Only for children ≥ 3 years of age)
107 
C301 Does (name) currently 
attend school or pre￾school?
Yes
No
No response
1
2
99
C312
C312
C302 If yes, what grade is 
(name) in right now?
_____________________
Do not know
No response
1
88
99
C303 If (name) needed help with 
school work, is there 
someone who could help 
him/her?
Yes, often
Sometimes
Never
No response
1
2
3
99
C305
C305
C304 Who often helps (name) 
with this regard?
A family member/relative
Peer group
Classmates
Yekokeb Berhan volunteers
Teacher or tutors via the school
Other (specify) ________________
No response
1
2
3
4
5
6
99
C305 Has (name) ever 
participated in a tutorial 
activity organized by 
Yekokeb Berhan program 
or in the community? 
Yes
No
Do not know
1
2
88
C306 How many days was
(name) absent from school 
during the past month? 
(Please estimate if not 
sure)
None
1-3 days
4-6 days
7-9 days
10 days or more
No response
1
2
3
4
5
99
C308
C308
C307 What was the main reason 
for (name’s) being absent 
from school?
No money for fees, materials, transport
Child is too sick to attend school 
School is too far away 
Child has to work to help family 
Child had to care for sick family members
Not interested in school
Poor treatment by teachers at school
Poor treatment by peers at school
Stigma at school
Other (specify)_______________
No response
1
2
3
4
5
6
7
8
9
10
99
C308 During the previous 
academic year, has 
(name) been promoted to 
next grade/ level?
Yes
No, he repeated
No response
1
2
99
C310
C310
C309 If no, what was the 
reason?
Failed end of year exam/poor grades
Disciplinary dismissal
Dropped/stopped attending
Other (specify) _________________
No response
1
2
3
4
99
108 
C310 How would you rate
(name’s) school 
performance in the past 12 
months compared to the 
previous year?
Better
No change
Worse
No response
1
2
3
99
C311 Who usually covers 
(name’s) school expenses 
(books, uniform, 
stationaries, transport, 
school fee, etc) since the 
past 12 months?
(In the case of multiple 
responses, take the most 
common one)
Household (from income)
Household (sold assets)
Relatives
Neighbors/acquaintances
CBOs (Idir, etc)
Yekokeb Berhan program IP
Volunteer people (their own donations) 
Other___________________
Not applicable (child is not in school)
No response
1
2
3
4
5
6
7
8
9
99
C312 If (name) is not currently 
enrolled in school, what 
was the reason? 
Do not read responses. 
Circle up to two primary 
responses.
No money for fees, materials, transport
Child is too sick to attend school
School is too far away / no school
Child has to work to help family
Child needs to care for sick household 
members
Child does not like school
Child is too young to attend school
Other(specify)__________________
No response
1
2
3
4
5
6
7
8
99
C313 If (name) has 
stopped/dropped attending 
school, what was the main 
reason that (name) 
stopped attending school?
Could not pay fees, materials, transport
Cared for sick family member
Poor school performance
Caring for siblings
Graduated from school
Pregnant or parenting
Got married
Illness
Child not interested
Got a job
Expelled
Work at home
Disability
Other (specify)_______________
No response
1
2
3
4
5
6
7
8
9
10
11
12
13
14
99
C314 If (name) is out of school, 
would (name) like to return 
to school?
Yes
No
Do not know
No response
1
2
88
99
Section 4: Food and Nutrition 
109 
C401 What is true about 
(name’s) food 
consumption over the past 
month? 
It has been…
Less than enough
Just enough
More than enough
No response
1
2
3
99
C402 In the past four weeks, did 
[name] have to eat a 
smaller meal than you felt 
was needed because 
there was not enough 
food?
Yes
No
No response
1
2
99
C404
C404
C403 If yes –
How many times did this 
happen?
Read out responses.
Rarely (1-2 times in past 4 weeks)
Sometimes (3-10 times in past 4 weeks)
Often (> 10 times in past 4 weeks)
No response
1
2
3
99
C404 In the past four weeks, did 
[name] have to skip a 
meal because there was 
not enough food?
Yes
No
No response
1
2
99
C409
C409
C405 If yes –
How many times did this 
happen?
Read out responses. 
Rarely (1-2 times in past 4 weeks)
Sometimes (3-10 times in past 4 weeks)
Often (> 10 times in past 4 weeks)
No response
1
2
3
99
C406 In the past four weeks did 
[name] go to sleep at night 
hungry because there was 
not enough food to eat?
Yes
No
No response
1
2
99
C407 If yes –
How many times did this 
happen?
Read out responses.
Rarely (1-2 times in past 4 weeks)
Sometimes (3-10 times in past 4 weeks)
Often (> 10 times in past 4 weeks)
No response
1
2
3
99
C408 How often did (name) go a 
whole day or night without 
eating in the last 4 weeks?
Rarely (1-2 times in past 4 weeks)
Sometimes (3-10 times in past 4 weeks)
Often (> 10 times in past 4 weeks)
No response
1
2
3
99
C409 In the past week, how 
many meals (name) 
consumed a day on 
average?
One
Two
Three
Four
More than four
No response
1
2
3
4
5
99
110 
C410 In the past week, how 
many times did (name) 
have protein meals (meat, 
fish, egg, milk, pulses)?
Number of meat or fish 
meals
(If fasting season, please 
note this)
___________________
C411 In the past week, how 
many times did (name) 
have vegetable meals 
(cabbage, lettuce, 
beetroot, carrot, etc)?
Number of vegetable
meals
_________________
C412 In the past week, how 
many times did (name) 
have fruit (banana, 
orange, mango, avocado
etc) 
Number of times fruit
taken
__________________
C413 If (name) was classified as 
moderate or severe 
malnutrition, was he/she 
prescribed or referred to 
some place to get 
supplemental or 
therapeutic food?
Yes 
No
No response
1
2
99
C501
C414 Did he/she get it? Yes 
No
No response
1
2
99
C501
C415 If no, why not Didn’t have time to go
Shortage of prescribed food
Didn’t know where to get it
Other (specify)__________________
No response
1
2
3
4
99
Section 5: Psychosocial Support
C501 How do you describe 
(name’s) general 
emotional status?
(Ask for his/her usual 
observation about the 
child)
Usually happy, joyful, interactive
Quiet, not interactive but happy
Not interactive, angry and sad
Rebellious/disobedient
No response 
1
2
3
4
99
111 
C502 In the past month, have 
you noticed any sudden 
changes in (name’s) mood 
or behavior?
Yes
No
No response
1
2
99
C601
C601
C503 If so, how often did this 
happen to (name) in the 
past month?
Once
Twice
Three times or more
No response
1
2
3
99
C504 Do you know what was the 
cause of this sudden 
change in mood or 
behavior of (name)?
Yes, I know the cause
No, I didn’t know the cause
No response
1
2
99
C505 Did you try to get any help 
for (name) when you 
discovered the change in 
mood?
Yes, I tried
No, I didn’t try
No response
1
2
99
C506 If so, where did you go 
help from?
Health center/clinic
Community committee (CC)
Yekokeb Berhan IP staff
Yekokeb Berhan volunteers
Other (specify)_________________
Did nothing
No response
1
2
3
4
5
6
99
Section 6: Shelter and Care
C601 Does (name) have a 
blanket or night clothes for 
sleeping at night?
Yes
Yes, but not enough
No
No response
1
2
3
99
C602 If age of (name) is 3-5 
years old, did (name) 
receive home, community, 
or center-based early 
childhood support/services 
from Yekokeb Berhan in 
the past 12 months?
Yes
No
No response
1
2
99
Section 7: Legal Protection
C701 Does (name) have birth 
certificate issued from 
authorized government 
office?
Yes
No
No response
1
2
99
C703
C703
C702 Could you please show 
me [name’s] birth 
certificate?
Seen / confirmed
Not seen / not confirmed
No response
1
2
99
112 
C703 Does (name) experience
discrimination by peers or 
any other persons in the 
community? 
(discrimination includes 
Stigma, bias, attitudes, 
treatment or behavior) 
Yes
No
No response
1
2
99
C706
C706
C704 If yes to C703, how often 
the discrimination 
happen?
Often
Sometimes
rarely 
No response 
1
2
3
99
C705 What is the primary 
reason for discrimination?
Because of AIDS
Because of being poor 
Because he/he is orphan
Because of his/her disability 
Other (Specify)________________
No response
1
2
3
4
5
99
C706 Has (name) encountered 
any legal problem over the 
past 1 year?
Yes
No
No response
1
2 
99
C709
C709
C707 If yes to Q706, what type 
of legal problem was 
encountered? 
(Multiple response are 
possible)
Related to child abuse and neglect
Related to children in conflict with the law
Related to inheritance 
Related to land ownership
Related to divorce 
Related to sexual violence 
Related to domestic violence
Other (specify)______
No response
1
2
3
4
5
6
7
8
99
C708 What measures did the 
family take?
Asked support from IP staff
Asked support from community 
committee (CC)
Asked support from police 
Asked support from Yekokeb Berhan 
volunteers
Did nothing
No response
1
2
3
4
5
99
C709 Has (name) been referred 
or linked to any legal 
services over the past 1 
year?
Yes
No
No response
1
2 
99
C711
C711
C710 Who referred or linked 
(name) to legal services 
he/she needed? 
CSO staff
HVC committee
Volunteers
Kebele administration
Other________________________
No response
1
2
3
4
5
99
113 
C711 Over the last one year, did 
(name) experience 
physical, emotional or 
sexual abuse? 
Yes
No
Do not know
No response
1
2
88
99
A101
A101
A101
C712 What type of violence did 
(name) experience 
(physical, emotional or 
sexual abuse, etc)?
Physical abuse 
Psychological (emotional) abuse
Sexual abuse
Being left alone or unsupervised for long 
period of time (for her/his age)
No response 
1
2
3
4
99
C713 If so, what did the family 
do?
Solved in house
Reported to kebele
Reported to police
Reported to community committee
Went to health center or clinic
Did nothing
Other (specify): ______________
No response
1
2
3
4
5
6
88
C714 Does (name) sometimes 
do care for a family 
member of your 
household?
Yes 
No
No response
1
2
88
C715 What kinds of other work 
does (name) sometimes 
do? 
Multiple responses are 
possible mentioned
Hawk goods
Sell food at market
Household / farm chores for others
Work in a restaurant or bar 
Help out in shop
Construction
Sewing
Mechanic
Clerk, Delivery, Administrative 
Other (specify) ____________
No response
1
2
3
4
5
6
7
8
9
10
99
C716 How often does (name) do 
other work? 
Would you say….?
Read response 
categories
Every day / most days
Several times a week
Once a week
Once in a while
No response
1
2
3
4
88
C717 Has (name) ever been 
neglected (being left alone 
or unsupervised for long 
period of time (for her/his 
age)
Yes
No
No response
1
2
99
114 
PART 3: SURVEY QUESTIONS FOR ADOLECSENT HVC (14-17 YEARS)
No. Questions And Filters Coding Categories Skip To
SECTION 1: BACKGROUND INFORMATION OF THE RESPONDENT 
A101 Age of the respondent [_________]
A102 Sex of the respondent Male
Female
1
2
A103 Marital status of the 
respondent
Single
Married
Divorced 
Widowed
Live with partner/cohabit
No Response
1
2
3
4
5
99
A104 Which is true about you? Mother is dead
Father is dead
Both mother and father are dead
Chronically ill
HIV positive
Has some kind of disability
Household is headed by a child (<18)
Household is headed by elderly
Household is headed by ill person
Household I headed by disabled
No response
1
2
3
4
5
6
7
8
9
10
99
A105 Who is taking care of you
currently? 
Do not read responses. 
Circle up to two primary 
responses.
Mother and/or father
Sister and/or brother
Aunt and/or uncle
Grandmother and/or Grandfather
Other relative
Neighbor
Friend
No one/self
Other (specify)_______________
No response
1
2
3
4
5
6
7
8
9
99
A106 Have you ever attended 
formal school?
Yes
No
No Response
1 
2
99
A108
A108
A107 What is the highest level of 
school you completed? 
(CIRCLE ONE)
Primary (grade 1-8)
Secondary (grade 9-10)
Preparatory (11-12)
10+TVET
College/university
No Response
1
2
3
4
5
99
A108 Do you have a disability? Yes
No
No response
1
2
99
A113
A113
115 
A109 If yes, does that make it 
difficult for you to participate in 
daily activities?
Yes
No
1
2
A110 How would you describe your
disability?
(Multiple responses are 
possible)
Blind or partially blind
Deaf or partially deaf
I have difficulties learning
Physical disability
Other (specify)_________________
No response
1
2
3
4
5
99
A111 Are you receiving any kind of 
assistive devices or supports 
for his/her disability?
Yes
No
I don’t know
No response
1
2
88
99
A113
A113
A113
A112 What kind of assistive devices 
or supports/services are you 
receiving?
Prosthesis(artificial leg or arm)
Eye glasses
Hearing aid
Crutches
Wheelchair
Medical care
Home-based care
Financial support
Others (specify)______________
No response
1
2
3
4
5
6
7
8
9
99
A113 Do you know about the 
Yekokeb Berhan project that is 
supported by USAID/Ethiopia 
and implemented by 
_____(IP) in your area?
Yes
No
No response
1
2
99
Section 2: Health and Health Care
A201 In general, how would you rate 
your health over the past 12 
months?
Excellent
Good
Fair
Poor
Very poor
 No Response 
1
2
3
4
5
99
A202 In the last 2 weeks, have you 
been too sick to participate in 
daily activities? 
Yes
No
 No Response
1
2
99
A210
A210
A203 Have you had fever in the two 
weeks preceding the survey? 
Yes
No
No response
1
2
99
A205
A205
A204 Did you receive treatment -
from a health provider for this 
illness?
Yes
No
No response
1
2
99
A205 Have you had diarrhea in the 
last two weeks? 
Yes
No
No response
1
2
99
A207
A207
116 
A206 Did you get treatment from a 
health provider for this illness?
Yes
No
No response
1
2
99
A208
A208
A207 Where did you seek health 
care for your illnesses?
(if there is more than one 
response, write only one 
response they consider most 
common)
Government health facility
Private hospital/clinic
Pharmacy
Traditional healer
Other (specify) -------------------
No response
1
2
3
4
5
99
A208 For your last illness if you did 
not seek care, what was the 
reason?
(Multiple responses are 
possibility, take only the 
main reason)
No money
No transport
Hospital, health center too far away
Illness not serious
Did not want treatment
Clinic is too crowded
Illness was too serious
Other (specify)_________________
No response
1
2
3
4
5
6
7
9
99
A209 Who covers your above costs 
of treatment?
It was free (in public health facilities)
The household itself
Relatives
Neighbors/acquaintances
CBOs (Idir, etc)
Yekokeb Berhan program
Volunteer people (their own donation) 
Other___________________
No response
1
2
3
4
5
6
7
8
99
A210 How do you rate your health 
care since the past 12 months 
compared to a year before?
Better
Similar
Worse
No response
1
2
3
99
A211 If you were sick and needed to 
see a doctor, is there 
someone who could help you 
get to a doctor or a health 
worker?
Yes
No
No response
1
2
99
A212 What is true about your
healthcare services you 
currently get whenever 
needed?
It is…
Less than enough
Just enough
More than enough
No response
1
2
3
99
A213 Did you receive information or 
counseling about HIV by 
health workers or anybody 
else (ways of transmission, 
methods of prevention, care 
and treatment) in the past 12 
months?
Yes
No
Don’t know
No response
1
2
88
99
117 
A214 Now I would like to ask you 
some sensitive questions
about your health:
Have you ever been tested for 
HIV?
Yes
No
No response
1
2
99
A215 If so, did you receive your HIV 
test results?
Yes
No
Don’t know
No response
1
2
88
99
A217
A216 If you did not receive HIV test 
results, why not?
Did not want results
Results took too long
Still waiting for results
Other (specify) _____________
No response
1
2
3
4
99
A217 If you received, what were 
your test results?
Negative
Positive
Don’t know
No response
1
2
88
99
A220
A220
A220
A218 If you are HIV positive, are 
you currently taking ART?
Yes
No
Not Applicable (HIV negative)
Do not know 
No response
1
2
3
8
99
A219 If taking ART, do you always 
got to health facility for follow 
up as scheduled by the health 
workers?
Yes, always
Yes, but sometimes misses schedule
Often misses schedule
Don’t know
No response
1
2
3
88
99
A220 Did you ever get health 
information or counseling 
about reproductive health?
Yes
No
No response
1
2
99
A221 Where from do you get 
information or counseling 
about reproductive health?
Government health facilities
Health extension workers
Yekokeb Berhan volunteers
School
Other (specify)______________
No response
1
2
3
4
5
99
Section 3: Education 
A301 Do you currently attend 
school?
Yes
No
No response
1
2
99
A314
A314
A302 If yes, what grade are you
in right now?
_____________________
Do not know
No response
88
99
A303 If you needed help with 
school work, is there 
someone who could help 
you?
Yes, often
Sometimes
Never
Do not know
No response
1
2
3
88
99
A305
A305
A305
118 
A304 Who often helps you with 
this regard?
A family member/relative
Peer group
Classmates
Yekokeb Berhan volunteers
Teachers (after school classes)
Other (specify) ___________
No response
1
2
3
4
5
6
99
A305 Have you ever participated 
in a tutorial activity 
organized by Yekokeb 
Berhan program or a 
school or another 
organization in your 
community? 
Yes
No
No response
1
2
99
A306 In past 12 months, did you 
get encouragement about 
your school works from 
Yekokeb Berhan or its IP 
volunteers
Yes
No
No response
1
2
99
A307 (For girls 12 years and 
above only)
In the last two months, did 
you miss school for at 
least one whole day 
because you were 
menstruating?
Yes
No
No response
1
2
99
A308 How many days did you
miss school during the 
past month? 
(Please estimate if not 
sure)
None
1-3 days
4-6 days
7-9 days
10 days or more
Not applicable (not in school)
Do not know
No response
1
2
3
4
5
6
88
99
A310
A310
A310
A310
A309 What was your main 
reason for missing school?
No money for fees, materials, transport
Child is too sick to attend school
Due to menstruation (for girls only)
School is too far away 
Had to work to help family 
Had to care for a sick family member
Not interested in school
Poor treatment by teachers at school
Poor treatment by peers at school
Stigma at school
Other (specify)________________
No response
1
2
3
4
5
6
7
8
9
10
11
99
119 
A310 During the previous 
academic year, have you
been promoted to next 
grade/ level?
Yes
No, he repeated
No response
1
2
99
A312
A312
A311 If no, what was the 
reason?
Failed end of year exam/poor grades
Disciplinary dismissal
Dropped/stopped attending
Other (specify) _____________
No response
1
2
3
4
99
A312 How would you rate your
school performance in the 
past 12 months compared 
to the previous year?
Better
No change
Worse
Not applicable (not in school)
No response
1
2
3
4
99
A313 Who usually covers your
school expenses (books, 
uniform, stationaries, 
transport, school fee, etc)
since the past 12 months?
(In the case of multiple 
responses, take the most 
common one)
Household (from income)
Household (sold assets)
Relatives
Neighbors/acquaintances
CBOs (Idir, etc)
Yekokeb Berhan program
Volunteer people (personal donation) 
Other (specify)_____________
No response
1
2
3
4
5
6
7
8
99
A314 If you are not currently 
enrolled in school, what is 
the reason? 
Do not read responses. 
Circle up to two primary 
responses.
No money for fees, materials, transport
Child is too sick to attend school
School is too far away / no school
Child has to work to help family
Child needs to care for sick household 
members
Child does not like school
Child is too young to attend school
Other(specify)_______________
No response
1
2
3
4
5
6
7
8
99
A315 If you have
stopped/dropped attending 
school, what was the main 
reason that (name) 
stopped attending school?
Could not pay fees
Cared for sick family member
Poor school performance
Caring for siblings
Graduated from school
Completed grade 10 and did not pass 
exam
Pregnant or parenting
Got married
Illness
Stigmatized by peers
Got a job
Expelled
Work at home
Disability
Other (specify)______________
No response
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
99
120 
A316 If you are out of school, 
would you like to return to 
school?
Yes
No
Do not know
No response
1
2
88
99
A317 If you are out of school, 
did you receive (receiving) 
any type of vocational 
training?
Yes
No
No response
1
2
99
A401
A401
A318 If yes, who provides the 
vocational training?
Yekokeb Berhan program
Kebele/woreda office
Community based organization
An NGO
Government (TVET college)
Other (specify)_______________
No response
1
2
3
4
5
6
99
Section 4: Food and Nutrition 
A401 What is true about your food 
consumption over the past 
month? It has been…
Less than enough
Just enough
More than enough
No response
1
2
3
99
A402 In the past four weeks, did you
have to eat a smaller meal
than you felt was needed 
because there was not 
enough food?
Yes
No
No response
1
2
99
A410
A410
A403 If yes –
How many times did this 
happen? Read out 
responses.
Rarely (1-2 times in past 4 weeks)
Sometimes (3-10 times in past 4
weeks)
Often (> 10 times in past 4 weeks)
No response
1
2
3
99
A404 In the past four weeks, did you
have to skip a meal because 
there was not enough food?
Yes
No
No response
1
2
99
A405 If yes – How many times did 
this happen?
Read out responses. 
Rarely (1-2 times in past 4 weeks)
Sometimes (3-10 times in past 4
weeks)
Often (> 10 times in past 4 weeks)
No response
1
2
3
99
A406 In the past four weeks did you
go to sleep at night hungry
because there was not 
enough food to eat?
Yes
No
No response
1
2
99
A407 If yes – How many times did 
this happen?
Read out responses.
Rarely (1-2 times in past 4 weeks)
Sometimes (3-10 times in past 4
weeks)
Often (> 10 times in past 4 weeks)
No response
1
2
3
99
121 
A408 How often did you go a whole 
day or night without eating in 
the last 4 weeks?
(If fasting season, please 
note that)
Yes
No
No response
1
2
99
A409 In the past week, how many 
meals did you consume a day 
on average?
One
Two
Three
Four
More than four
No response
1
2
3
4
5
99
A410 In the past week, how many
times did you have protein 
meals (meat, fish, egg, milk, 
pulses)?
(If fasting season, please 
note that)
Number of meat or fish 
meals
___________________
A411 In the past week, how many 
times did you have vegetable
meals (cabbage, lettuce, 
beetroot, carrot, etc)?
Number of vegetable meals
_________________
A412 In the past week, how many 
times did you have fruit
(banana, orange, mango, 
avocado etc) 
Number of fruit meals
__________________
Section 5: Psychosocial Support
A501 Do you have someone in your 
life that you can confide in or 
talk to about yourself or your 
problems? 
Yes
No
No Response
1
2
99
A502 Do you have someone in your 
life that can take you to the 
health worker or a counselor if 
you needed it? 
Yes
No
No Response
1
2
99
A503 Do you have someone in your 
life that shows you love and 
affection? 
Yes
No
No Response
1
2
99
A504 Did you receive any life skill 
training over the two years?
Yes, I received
Yes, somebody received
No
No response
1
2
3
88
122 
Section 7: Legal Protection
A701 Do you have birth certificate 
issued from authorized 
government?
Yes
No
No response
1
2
99
A703
A703
A702 Could you please show me 
your birth certificate?
Seen / confirmed
Not seen / not confirmed
No response
1
2
99
A703 Do you experience
discrimination by peers or any 
other persons in the 
community? 
(discrimination includes 
stigma, bias, attitudes, 
treatment or behavior) 
Yes
No
No response
1
2
99
A706
A706
A704 If yes, how often the 
discrimination happens?
Often
Sometimes
rarely 
No response 
1
2
3
99
A705 What is the primary reason for 
discrimination?
Because of AIDS
Because of being poor 
Because I am of orphan 
Because of my disability
Other (Specify)________________
No response
1
2
3
4
5
99
A706 Have you encountered any
legal problem over the past 1 
year?
Yes
No
No response
1
2 
99
A709
A709
A707 If yes, what type of legal 
problem was encountered?
(Multiple response are 
possible)
Related to child abuse and neglect
Related to children in conflict with the 
law
Related to inheritance 
Related to land ownership
Related to divorce 
Related to sexual violence 
Related to domestic violence
Other (specify)________________
No response 
1
2
3
4
5
6
7
8
99
A708 What measures did you or the 
family take for this legal 
problem?
Asked support from a Yekokeb 
Berhan IP
Asked support from community 
committee (CC) 
Asked support from police 
Asked support from Yekokeb Berhan 
volunteers
Other (specify)__________________
Did nothing
No response
1
2
3
4
5
6
99
123 
A709 Over the last one year, did you 
experience any type of abuse 
(physical, emotional or sexual, 
etc)? 
Yes
No
Do not know
No response
1
2
88
99
A712
A712
A710 What type of violence did you 
experience?
Physical abuse 
Psychological (emotional) abuse
Sexual abuse
Other (specify)____________
No response 
1
2
3
4
99
A711 What did you do for the 
violence?
Solved the problem in house/ family
Reported to kebele
Reported to police
Reported to Community committee
Reported to IP volunteers
Did nothing
Other (specify): _____________
No response
1
2
3
4
5
6
7
99
A712 Have you been referred or 
linked to any legal services 
over the past 2 years?
Yes
No
Not applicable (service not required)
No response
1
2
3
99
A714
A714
A713 If yes, who referred or linked 
you to legal services you
needed? 
IP staff
Community committee
Yekokeb Berhan Volunteers
Kebele administration
Other (specify)_______________
No response
1
2
3
4
5
99
A714 Do you feel more secure in 
terms of legal protection this 
time than before you were 
involved in HVC program?
Yes
No
Not sure
No response
1
2
3
99
A715 In the past 6 months, have 
you worked for a wage, salary, 
commission or any payment 
‘in kind’?
Yes
No
No response
1
2
99
A716 About how much time do you 
spend per day doing this 
work?
Less than 1 hour
1-2 hours
3-4 hours
More than 4 hours
It depends / it is different everyday
No response
1
2
3
4
5
99
A717 Did these works interfere with 
your schooling (working during 
school days/time)?
Yes, always
Yes, sometimes
No
No response
1
2
3
99
A718 Do you do household chores? Yes 
No
No response
1
2
99
End
End
124 
A719 What household chores do 
you usually do? 
Multiple responses are 
possible; circle all 
mentioned. 
Prepare food
Fetch water 
Clean toilets
Take care of younger children
Plant/tend to/harvest crops
Feed, care for animals
Wash clothes, blankets
Care for sick family member
Other (specify)_______________
No response
1
2
3
4
5
6
7
8
9
99
A720 About how much time do you 
spend per day doing these 
household chores?
Less than 1 hour
1-2 hours
3-4 hours
More than 4 hours
It depends / it is different everyday
No response
1
2
3
4
5
88
A721 Do these household chores 
interfere with your schooling 
(doing household chores 
during school days/time)?
Yes, they interfere
No they don’t interfere
No response
1
2
99
125 
YEKOKEB BERHAN PROGRAM FOR HIGHLY VULNERABLE CHILDREN AND 
THEIR FAMILIES: MIDE TERM EVALUTAION, FEBRUARY 2014 
Key Informant Interview Questions (1) 
Stakeholders to Yekokeb Berhan program at Federal/Regional level (HAPCO, 
MoWCY, PACT, Child Fund and FHI)
Confidentiality and consent 
[Moderator: Please read the following paragraph to the participants and continue the discussion 
only if they consented to participate in discussion] 
Good morning/ good afternoon! My name is ____________________________I and my colleagues 
(depending on if you are two) are collecting information on behalf of Yekokeb Berhan related to 
implementation of highly vulnerable children (HVCs) and their families in high HIV prevalent urban 
area. 
We are asking you for your time to participate in this study. We are looking for information on changes 
to the life of highly vulnerable children and their families. The information you provide us will help 
Yekokeb Berhan to understand whether the project implementation has brought changes and what 
needs to change in the future. 
We would greatly appreciate your participation. Please note that the information collected in this study 
will remain confidential. Your identity as a participant will never be used in connection with any of the 
information you tell us will not be revealed to people other than the facilitators. Any references to 
information that would reveal your identity will be removed or disguised in the preparation of the 
research reports and publications. Would you be willing to participate? 
Agree_____ Disagree _______
Region___________________ Zone ________________Woreda ________________ 
Town_______________________ Subcity________________________Tape code_________________ 
Name of the organization _____________________________________________ 
Position of the informant in the organization_________________________________ 
Year of service in the present position____________ 
Sex of respondent: Male [ ] Female [ ] 
Age: [ ] 
Date of the interview________________________ 
Time started____________________________ Time finished ___________________________ 
Name and signature of interviewer ________________________________
126 
Instruction to facilitator: 
Note that under this section, we are interested to get information related to changes in system to 
improve provision of care and services to HVC and their families at community level. Specifically, 
we wanted to know if changes were introduced in systems, procedures and tools that contributed to 
impacts on improved wellbeing of HVC and their families. 
Participants: 
Participants under this section are stakeholders at federal level including government partners 
(HAPCO and MoWCYAs and International CSOs such as PACT, FHI and Child Fund. Specific 
targets here are OVC focal persons at Federal, Regional and Wereda level representing these 
institutions.
Theme S.No Questions /probing
General understanding of 
the project
1 Can you tell me what changes were noted at policy and programming 
level as a result of Yekokeb Berhan’s project? Please provide 
examples.
Capacity 2 What system was developed to build the capacity of implementing 
partner? Probe –
- How were capacity gaps of implementing partners identified?
- What systems and tools are in place to address the different 
gaps (please specify capacity building interventions and 
corresponding approaches?)
Types of 
capacity gaps
Capacity building 
approaches
What 
tools/systems 
is/are in place
- - -
- - -
- - -
- Which implementing partners benefitted from such capacity 
building interventions?
- What is the role of your organization in this?
- What change has been noticed in consequence at level of 
HVC and their families? Probe – how such change is 
tracked? Please provide examples?
Data management and use 3 What system is put in place to routinely generate data on 
accomplishments of care and service for HVCs and their families 
- How is data generated from operational level and reported to 
the next level (check on what format and channel of reporting 
used, what data management system is in place at 
implementing partners level)
- Who developed this system? What was your organization’s 
127 
role?
- How regularly was the system used by implementing partners 
and community level structure? If not regular probe on why 
not – check friendliness of formats and reporting channels.
- How has such data used for programming and policy? Please 
provide examples and levels
- What changes were introduced in data generation and 
management since the inception of the project?
- What consequences were noticed as a result of instituting 
data generation and management at operational level?
Support to implementing 
partners and community 
structures at operational 
level
4 What change has been introduced in support for implementing 
partners at community level (CSOs, CBOs, volunteers) to improve 
intervention? Probe –
- If there was/were tools to identify support needs of 
implementing partners? eg technical and organizational 
capacity of partners
- If support provision is planned and regular? 
- If such support was recorded and feedbacks are provided to 
implementing partners?
- Whether service standards were developed/adapted?? And 
shared with implementers to guide service provision to a) 
HVCs and b) their families? 
- If service standards were shared and enforced to guide 
interventions at operational level and how?
- What was the role of your organization in this?
- What support was provided to the different implementing 
partners during the last one year (probe in terms of supportive 
supervision…)
Coordination among 
implementing partners
5 Assuming there are different implementing partners at operational 
level to provide care and services to HVC and their families;
- What measure was taken to improve coordination among the 
different implementers? 
- More specifically check if there were procedures put in place 
and if that was implemented? 
- What consequent change in the life of HVCs and their 
families was noted? 
- How was that change known? 
- Under circumstances where services are not available for 
HVCs in the community (eg for health care) what happens? 
Probe if there is procedures for referral and feedback is 
drawn (check for which services)
- What was the role of your organization in this? 
- How do you explain the role of Yekokeb Berhan in 
improving coordination of the different implementing 
partners? Please provide examples.
Targeting 6 What changes were introduced to ensure HVC and their families are 
reached with care and services? Probe –
128 
- If gender
- Age
- Disability etc were given due attention in selecting the right 
beneficiaries 
- What was the role of your organization in this?
129 
YEKOKEB BERHAN PROGRAM FOR HIGHLY VULNERABLE 
CHILDREN AND THEIR FAMILIES: MIDE TERM EVALUTAION, 
FEBRUARY 2014 
Key Informant Interview Questions (2)
Implementing partners at community level (CSOs, CBOs) and microfinance 
associations 
Confidentiality and consent 
[Moderator: Please read the following paragraph to the participants and continue the only if they 
consented to participate in discussion] 
Good morning/ good afternoon! My name is ____________________________I and my colleagues 
(depending on if you are two) are collecting information on behalf of Yekokeb Berhan related to 
implementation of highly vulnerable children (HVCs) and their families in high HIV prevalent urban 
area. 
We are asking you for your time to participate in this study. We are looking for information on changes 
to the life of highly vulnerable children and their families. The information you provide us will help 
Yekokeb Berhan to understand whether the project implementation has brought changes and what 
needs to change in the future. 
We would greatly appreciate your participation. Please note that the information collected in this study 
will remain confidential. Your identity as a participant will never be used in connection with any of the 
information you tell us will not be revealed to people other than the facilitators. Any references to 
information that would reveal your identity will be removed or disguised in the preparation of the 
research reports and publications. Would you be willing to participate? 
Agree_____ Disagree _______
Region___________________ Zone ________________Woreda ________________ 
Town_______________________ Subcity________________________Tape code_________________ 
Name of the organization _____________________________________________ 
Position of the informant in the organization_________________________________ 
Year of service in the present position____________ 
Sex of respondent: Male [ ] Female [ ] 
Age: [ ] 
Date of the interview________________________ 
Time started____________________________ Time finished ___________________________ 
130 
Name and signature of interviewer ________________________________ 
Instruction to facilitator: 
Note that under this section, we are interested to get information related to changes in the provision 
of care and services to HVC and their families at community level. Specifically, we wanted to know 
if there were changes at implementing partners’ level in terms of provision of ‘package of services’ 
to HVCs and their families. We would ultimately intend to know how this has improved wellbeing 
of HVC and their families. 
Participants: 
Participants under this section are implementing partners at community or wereda level level 
including CSO, CBOs and microfinance institutions.
Change in role of 
implementing partners 
1 What is the role of your organization in the effort to improve the 
life of HVC and their families? Probe –
- What are the specific roles of your organization in 
meeting the needs of HVCs and their families?
- What change has been made to the organization’s role 
in implementing the goal of the project?
- Why has such change introduced? 
- What consequences were noted in connection to such 
change in terms of meeting the needs of HVCs and their 
families (note this could be positive or negative change) 
Capacity building support 
received at HH level
2 What capacity change was noted at your level to contribute to 
an improved wellbeing of HVCs over the last one year? Probe 
what support and with what implication? 
Type of 
capacity built
(probe for all 
support 
received)
Who provided 
such support
Implication of such 
support for improved 
wellbeing of HVCs
Training on ..
Financial for
- How do you explain if such capacity building has 
enabled the HH to play its role; please provide 
examples
131 
- What needs to improve in terms of capacity, please 
provide evidences of why this is desired?
Role/function of 
community structures 
(CBOs and volunteers)
3 Which community structures are operating in this 
community/wereda in connection to care and services for HVC 
and their families? Probe – on all CBOs (iddir, saving groups, 
women groups, youth groups… and volunteers?
Community 
structure
Roles in care and 
services to a) 
HVC b) their 
families 
Changes over the 
last one year
What service standards guide service provision to a) HVCs and 
b) their families (probe if there are standard service package as a 
guide, who developed it and where the partner got it from?
What is still considered as gaps in service provision at 
community structure level? Probe in terms of capacity (provide 
specific example) 
Coordination among 
partners
4 What measure(s) was/were taken to improve coordination 
among the different implementers in the community (wereda)? 
Probe –
- What system was put in place to improve coordination 
between CSOs, CBOS and volunteers? Has this 
changed after the inception of the project? Why was it 
changes? 
- Please provide evidences of consequent implication on 
the wellbeing of HVCs and their families over the last 
one year? Probe changes in terms of quality of specific 
services, coverage of services.
- Under circumstances where services are not available 
for HVCs in the community (eg for health care) what 
happens? Probe if there is procedures for referral and 
feedback is drawn (check for which services)
- What was the role of your organization in this? 
132 
- How do you explain the role of Yekokeb Berhan in 
improving coordination of the different implementing 
partners? Please provide examples.
Data management and use 5 How has implementing partners been continuously generating 
data on accomplishments of care and service for HVCs and their 
families 
- What tool(s) is there to generate data on 
accomplishment and how is it reported to the next level 
(system in place?) 
- Who developed this system? When was this developed? 
What was your organization’s role? 
- How regularly is your organization generating data on 
interventions using the tool developed for this purpose? 
Where do you send the report?
- How has such data used for programming at your level; 
please provide examples.
- What change has been observed in consequence over 
the last one year?
Changes in care and 
services
6 How do you explain changes in meeting the needs of highly 
vulnerable children and families in [the community? Wereda]
Probe – for HVC
- What specific changes were there?
Services Changes Probe 
(quality, coverage, 
appropriateness)
How did you 
know of the 
changes?
Health
Health 
care
Nutrition
Education
Economic 
position
Emotional 
wellbeing
Other 
areas
- What is the reason for such changes – probe if such 
133 
change is associated to change at the level of 
implementing partners? Please provide evidences of 
change at the level of implementing partners in terms of 
eg. technical and organizational capacity (specify what 
this is)
- What is the role of your organizations in such changes? 
Please provide examples
- What is still considered as gaps in service provision? 
Probe in terms of whether all targets are reached? 
Quality and appropriateness of service needs further 
change; provide detailed information to each point. 
134 
YEKOKEB BERHAN PROGRAM FOR HIGHLY VULNERABLE 
CHILDREN AND THEIR FAMILIES: MID TERM EVALUATION, 
FEBRUARY 2014 
FGD Guide (1) 
Caregivers 
Confidentiality and consent 
[Moderator: Please read the following paragraph to the participants and continue the only if they 
consented to participate in discussion] 
Good morning/ good afternoon! My name is ____________________________I and my colleagues 
(depending on if you are two) are collecting information on behalf of Yekokeb Berhan related to 
implementation of highly vulnerable children (HVCs) and their families in high HIV prevalent urban 
area. 
We are asking you for your time to participate in this study. We are looking for information on changes 
to the life of highly vulnerable children and their families. The information you provide us will help 
Yekokeb Berhan to understand whether the project implementation has brought changes and what 
needs to change in the future. 
We would greatly appreciate your active participation. Please note that information you provide are 
equally important and there is no right or wrong answer. Note also your response remains anonymous 
and reference is made to your collective point instead of who said that. If reference is made to personal 
identity, personal identifiers will be removed or disguised in the preparation of the research reports and 
publications. Would you be willing to participate? 
Region___________________ Zone ________________Woreda ________________ 
Town_______________________ Subcity________________________Tape code_________________ 
Date of the FGD________________________ 
Time started____________________________ Time finished ___________________________ 
Name and signature of facilitator ________________________________ 
135 
Instruction to facilitator: 
Note that under this section, we are interested to get specific information on changes in the 
wellbeing of HVCs as well as the HHs. More particularly, we are interested to find out if 
intervention has changed the way HVCs live and how empowered HHs are in meeting the needs of 
HVCs. 
Participants: 
Participants under this section are care givers to be identified from within the community 
Participant’s 
code
Age Sex Education
(highest grade 
completed)
For how long have you been 
involved in the Yekokeb 
Berhan program? 
P1
P2
P3
P4
P5
P6
P7
P8
P9
P10
P11
P12
Current situation 1 What is the current reality in the provision of care and services 
for HVC? (you may probe in terms of changes in the number of 
HVCs with problems, what has changed or not)
Care and services for 
HVCs
2 What care and services are available for HVCs at:
- HH level –
o Please list all care and services provided to 
HVC at HH level including psychosocial 
support 
Services List all services 
provided
Health
Health 
care
136 
Nutrition
Education
Economic 
position
Emotional 
wellbeing
Other 
areas
o What service standards guide service provision 
to a) HVCs at family level (probe where the 
standards has come from, who developed it and 
where the partner got it from? If the standard 
was useful and why?
o Explain appropriateness of such care and 
service
o Explain quality of such care and service
o What is still considered as gaps in service 
provision at this level?
- Community level￾o Please list all care and services provided to 
HVC at community level
o Explain appropriateness of such care and 
service
o What service standards guide service provision 
to a) HVCs at community level (probe where 
the standards has come from, who developed it 
and where the partner got it from? If the 
standard was useful and why?
o Explain quality of such care and service
o What is still considered as gaps in service 
provision at this level
- How do you explain if support to HVCs addresses all 
targets in terms of: 
o Gender
o Age
o Disability
Capacity building support 
received at HH level
3 What capacity change was noted at HH level to improve the 
wellbeing of HVCs over the last one year? Probe what support 
and with what implication? 
Type of
capacity built
Who provided 
such support
Implication of such 
support for improved 
137 
(probe for all 
support 
received)
wellbeing of HVCs
Training on ..
Financial for
- How do you explain if such capacity building has 
enabled the HH to play its role; please provide 
examples
- What needs to improve in terms of capacity, please 
provide evidences of why this is desired?
Consequent changes 4 How do you explain changes at the level of HVC 
- What specific changes were there? Please provide 
evidences:
o Health
o Nutrition 
o Educational achievement
o Emotional wellbeing 
- What is still considered as gaps in service provision? 
Probe in terms of whether all targets are reached? 
Quality and appropriateness of service needs further 
change; provide detailed information to each point. 
Changes at HH level
- What changes were noted at HH level over the last one 
year? Probe on specific changes and examples?
Services Changes - Probe 
(quality, coverage, 
appropriateness)
How did you 
know of the 
changes?
Health
Health 
care
Nutrition
Education
Economic 
138 
support 
Emotional 
wellbeing
Other 
areas
Changes at community level
- What changes were noticed in connection to improved 
wellbeing of HVC and capacity of HH? Probe on 
specific changes and implications
- Under circumstances where services are not available 
for HVCs at HH and within the community (eg for 
health care) what would you do? Probe if there is 
opportunities for referrals 
- Has there been such referral during the last one year and 
what happened? Probe reason for referral and 
satisfaction with referral services and why?
- How do you explain the role of Yekokeb Berhan in 
such changes different levels? Please provide examples.
Data management and use 5 How do you report service provision to HVCs at your level to 
the next level (probe –
- Where would accomplishments at HH level reported to? 
What reporting tool is applied? 
- How such data was used at HH level; please provide 
examples.
- What change has been observed in consequence over 
the last one year?
139 
YEKOKEB BERHAN PROGRAM FOR HIGHLY VULNERABLE 
CHILDREN AND THEIR FAMILIES: MID TERM EVALUATION 
FEBRUARY 2014 
FGDs (2) 
Community committee, community volunteers and saving groups 
Confidentiality and consent 
[Moderator: Please read the following paragraph to the participants and continue the only if they 
consented to participate in discussion] 
Good morning/ good afternoon! My name is ____________________________I and my colleagues 
(depending on if you are two) are collecting information on behalf of Yekokeb Berhan related to 
implementation of highly vulnerable children (HVCs) and their families in high HIV prevalent urban 
area. 
We are asking you for your time to participate in this study. We are looking for information on changes 
to the life of highly vulnerable children and their families. The information you provide us will help 
Yekokeb Berhan to understand whether the project implementation has brought changes and what 
needs to change in the future. 
We would greatly appreciate your active participation. Please note that information you provide are 
equally important and there is no right or wrong answer. Note also your response remains anonymous 
and reference is made to your collective point instead of who said that. If reference is made to personal 
identity, personal identifiers will be removed or disguised in the preparation of the research reports and 
publications. Would you be willing to participate? 
Agree_____ Disagree _______
Region___________________ Zone ________________Woreda ________________ 
Town _________________________ Subcity_____________________________ 
Date of FGD ________________________ 
Time started_____________________________ 
Time finished ___________________________ 
Name and signature of facilitator ________________________________ 
140
Instruction to facilitator: 
Note that under this section, we are interested to get specific information on changes in the 
wellbeing of HVCs as well as the HHs and the contribution of community committees, saving 
groups and volunteers. More particularly, we are interested to find out if there are changes in this 
group that sustains improved the wellbeing of HVCs and their families. 
Participants: 
Participants under this section are members of community committee, saving groups and volunteers 
that would be identified from within the community 
Participant’s 
code
Age Sex Education
(highest grade 
completed)
For how long have you been 
involved in the Yekokeb 
Berhan program? 
P1
P2
P3
P4
P5
P6
P7
P8
P9
P10
P11
P12
General information 1 Can you please tell us:
- Who in community are highly vulnerable (children 
and their families)
- Why are these vulnerable? 
Sources of information 2 Where do people in this community get information on care 
and services for HVCs and their families? Probe –
- What do people in the community know about service 
packages to HVC? (probe on what specific services?)
- Who are the providers of such information
- What is the channel of information provision (probe if 
community discussion, coffee ceremony, media,…
- Who organize such information provision in the 
community? 
- What change is there in community’s awareness about 
HVC and their families
141 
Community’s role 3 What was the community’s role in the identification of HVCs 
and their families? Were those on supports the right groups? 
What should change in future in choosing targets for care and 
services?
What other roles do community members play to ensure the 
wellbeing of HVC and their family? Please specify 
community members role including volunteers?
Community capacity 4 What community capacity improvement was there over the last one 
year? Who provided such capacity improvement? On what specific 
area? What was the added value of capacity improvement?
Care and service providers 5 What support is/are available for HVC and their families at 
community level? Probe on what support, for whom, by whom and 
implications of such support
Type of 
support 
(probe on 
available 
support at 
community 
level for 
HVCs and 
their families)
For whom 
(HVC/HH) 
Who provide 
support
Implication 
of such 
support 
Credit?? 
Training?
- How do you explain if such support is satisfactory in 
enabling the HH to play its role; please provide examples
- What needs to improve, please provide evidences of why 
this is desired?
Care and services for 
HVCs
6 What care and services are available for HVCs at:
- HH level –
What care and services are available for HVCs at:
- HH level –
o Please list all care and services provided to HVC at 
HH level including psychosocial support 
142 
Services List all services 
provided
Health
Health 
care
Nutrition
Education
Economic 
position
Emotional 
wellbeing
Other 
areas
o What service standards guide service provision to 
a) HVCs at family level (probe where the standards 
has come from, who developed it and where the 
partner got it from? If the standard was useful and 
why?
o Explain appropriateness of such care and service
o Explain quality of such care and service
o What is still considered as gaps in service 
provision at this level?
- Community level￾o Please list all care and services provided to HVC at 
community level
o Explain appropriateness of such care and service
o Explain quality of such care and service
o What is still considered as gaps in service 
provision at this level
- How do you explain if support to HVCs addresses all 
targets in terms of: 
o Gender
o Age
o Disability
Consequent changes in 
care and services
7 How do you explain changes at the level of HVC 
- What specific changes were there? Please provide 
evidences:
o Health
o Nutrition 
143 
o Educational achievement
o Emotional wellbeing 
- What is still considered as gaps in service provision? Probe 
in terms of whether all targets are reached? Quality and 
appropriateness of service needs further change; provide 
detailed information to each point. 
Changes at HH level
- What changes were noted at HH level over the last one 
year? Probe on specific changes and examples?
o Improved productive assets (probe implication on 
paying for health and educational services, 
buying/producing food… 
o Improved capacity to provide psychosocial support 
Changes at community level
- What changes were noticed in connection to improved 
wellbeing of HVC and capacity of HH? Probe on specific 
changes and implications
- Under circumstances where services are not available for 
HVCs at HH and within the community (eg for health care) 
what would you do? Probe if there is opportunities for 
referrals (has there been such an incident over the last one 
year and what happened? 
- How do you explain the role of Yekokeb Berhan in such 
changes at different levels? Please provide examples.