Evaluating replacement childcare arrangements: methods for combining economic and child development outcome analyses

HIV/AIDS has many impacts, among which is the effect of the epidemic on children. Children may themselves be infected, they may be living with, and possibly caring for, ill parents or other family members, and many will lose one or both parents. There are numerous aspects that will be required in a comprehensive response to these impacts, one of which is the provision of care for those who have lost parents or whose parents are too ill to care for them. While only one aspect of the required response, this replacement1 care, involves difficult decisions. Governments, non-governmental organisations (NGOs) and individuals are already struggling with alternative approaches, or models, of providing support to children who need new care arrangements as a result of the loss or incapacitation of their caregiver. As the scale of the problem increases so efforts to respond to it will have to be expanded, including those aimed at providing replacement care. There are many different ways of providing care to children, so a number of alternative models of care are appearing. Some children remain in their original homes and another family member takes on the role of primary caregiver. At the other extreme, some children are removed from their homes and communities and live in formal institutions. In between these two extremes are a host of alternative models, from foster care to children¿s villages and so on. While a range of options is required, as no one model will be appropriate in all situations and settings, decisions will have to be made as to which models should form the core of the response. Again it will not be a single set of models that should form the core in every setting, as circumstances may alter requirements. What is needed are ways to identify appropriate models and to supply decision makers with relevant information on the alternatives in order to support the policy making process. A variety of different types of information are required to inform decision makers in this area. This paper seeks to develop methods of providing some of that necessary information. Its emphasis is on linking the costs of models to their outcomes. As outlined in the following diagram, this is one part of what is required to support effective, equitable and efficient decision making.